very symbolic. it was very mythologized in this outlook. it will be logical to stop their -- there and see what comes out of this move. i think, and i'm coming back to where you started, we should think about russia and its future. restoration is anyially important for prospects of food and -- qiagen -- putin's regime. it might be that by mere putin's russia will follow the same path. there will be some economic catastrophe. because the question is, what happens next.

what happens after the current regime? the soviet people with their anti-western mindset still admire the west as consumers. the same phenomenon is observed in today's russia. they brandished their patriotic as rely on imports in almost every aspect of their daily area. -- experience. anyone who can afford to go abroad for shopping or were some -- tourism will do it. the population might welcome more engagement with the west. they have the hope of achieving a higher living standard. but it becomes too risky. historical parallels become too risky. painful memories of the interior crisise -- the ukrainian

has reopened the old sores. it did not heal any wounds. the contrary was the case. russia remains extremely fragile. this is not good news for anyone who wants to be democratic or peaceful. [applause] >> thank you very much. that was a professor from the university of tartu in estonia. is annal speaker associate at harvard university. >> thank you. expertise is in military. i will start by talking about the russian military operations. i will expand a little bit on a couple of the things that were

touched on. the "why now" aspect. i will talk about the u.s. policy and response and some of the implications of where this might be going. as far as the military operation, we have to remember one key fact that makes crimea very different from the rest of ukraine. there is a relatively large contingent of russian troops that are based there by treaty and by agreement long before any of these events happened. contingent that was there is about 14,000. primarily navy personnel. it also includes some naval infantry anthony the infant naval airand some

forces. easy toelatively augment those forces with special forces troops. russia did bring them into the existing base without it being as noticeable as it might have been in other parts of ukraine or elsewhere. we -- you remember from tv, they could take off their idiotic error -- insignia appearance as little green men. in russian social media, they were the whole light evil. -- polite people. they occupy key locations around ukrainian military bases. areas that connect crimea to the rest of ukraine will stop --

ukraine. this could be done very quickly. it was done very quickly. it was done before people knew what was going on. for the success of the operation. by the time the ukrainian government, which was not the most organized, had taken over, and they saw what was going on, they already control most of the key facilities. what this tells us about the russian military is that special forces are very well-trained and equipped. they can carry out covert operations effectively. we should be careful because this does not necessarily the to the quality of the entire military force. we should not make assumptions brigadeot of the other

and other forces in russia have a much lower state of readiness. broughtes that were into crimea came from the southern military district. it is one of russia's or military district of that is where they have expected combat or the past 10 years. georgia,ya, the world -- the war with georgia, various counterterrorism unit. there are relatively few conscripts. it has the most modern equipment. interesting and there was a kind of divergent very tactic used where there were these highly publicized exercises that were conducted by the western military district around eastern

ukraine. troopsere lots of supposedly being used. everyone pay attention over here, at the same time, troops from the southern military district -- if you follow the open press, it is like there was nothing going on there. they were the ones who were brought in together with some airborne forces. and they brought in people who are generally kept a higher age of readiness. that is how it was done. that is a fairly small number of truth -- troops at that level. if you look at other russian forces, a of the brigade commanding levels of worry 40%-60%.r 60% -- what i am trying to say is just because russia has highly effective troops, we should not assume that it has 750,000

highly effective. that is something to keep in mind. there are also some serious limitations on logistics. that would make sustained operations much more difficult to carry out then a quick strike like this. this did not involve any work fighting. war-fighting. in terms of the implications for what we know about russian military capabilities, they can plan a good operation and do it well. but we have not learned that much about how the russian military would function in an actual serious conflicts, especially over a period of time. that. leave it at i will leave the military aside for now.

-- it to -- i am mostly had a few points on why putin did this and i cross them off as we went through them. this is good. it is nice to be thinking along the same lines. i think there is an obvious now?" n of "why there is an important corrective that needs to be made. this is not a victory for putin. this is a loss for putin. when we look at everything if we look at putin's position at various points in time when yanukovych

golden --go with putin and not sign the agreement, he thought he had ukraine. in february, when the protesters -- when he thought he had a deal , there wasvych instability. it looked like he had all of ukraine. suddenly, ukraine is lost. what happens is, and this goes to the why now question, and we mentioned briefly, "why now? " is that you will not suddenly make the best of a bad situation. that is where this tactical ukraine is tosing take what you can get.

crimea is relatively easy to get. that reduce the below in a way, it also destabilizes ukraine in the short term. benefits for putin there. it is a miscalculation. lotss ukraine has changed a , it seems to me that the government was right for a situation that was similar to what had happened after the word resolution -- orange revolution. there were disparate elements in the coalition. they would fall relatively quickly. the russian government could choose one or more of them to make an alliance with or buy off. then they could restore their

position to some kind of equilibrium. by intervening, as we heard, they unite the rest of ukraine against the attacker. -- they provide more assistance from the west. that was the miscalculation. that is where we get into some of these ideological and his store coal factors -- his store factorss -- historical that lead to some of these issues. i do not have a lot of time, but i want to get to some of the u.s.-based policies.

i think that the obama administration has handled this pretty well. clear --t initially now, sitting back after crimea has been annexed, we can say, of course. he was going to take over crimea. that was not clear initially. by warning of serious forequences well allowing was the de-escalate right course of action. clearer and clearer that the equation was not on the table, we are seeing the ramping up of sanctions. thatecond part of that is some people say that sanctions are not hurting enough.

the administration looks weak. i am not seeing what the alternatives are from those critics. militarythink that intervention is on the table. nor should it be. aren't -- i do not see what the alternatives are. at the sanctions are the meditations are the ones that do not hit the average russian. it is not their goal. that fault. -- full. ault. hitting the regime the right target. it would make it easier for putin to rally the population

ound the flag. what i see going forward now is that sanctions will hurt the elite. conception time, our in the u.s. and europe of what russia is about and what russian foreign policy is about has fundamentally changed. that will affect how -- the willingness of the west to invest in russia. that will cause economic pain to russia. it will not be directly blamed on the west. .here will be less investment the russian stock market is down. it may rise in the future, but he will be at a lower level now. europe is going -- there will be

steps to reorient away from russia. that will take time. again, it is going to cause economic pain to those russian elites. think this is the right direction. select -- ast a slap on the wrist. let me conclude by talking about some of the risk factors for the future. i see short-term risks, medium risk, and long-term risks. short-term risks, and the obvious one is instability. thatems pretty clear russian intelligence in eastern locals is working with to create instability.

it will be very difficult, but very important the ukrainian government to stabilize that situation. the second risk is in crimea. that has been alluded to. the crimean tartar population. population of about 300,000 people. not happy with the way things are. it is possible that they could be bought off. i do not know. i have not talked to them. there's going to be the source of instability for wresting control crimea. number oflso some ukrainian patriots stilling crimea. some have fled, but somewhere

there. those are the short-term risks. the medium risks are the key. one of the big things for me that is coming out of his speech 's speech was the statement about defending ethnic russians outside russian borders. threat to a whole bunch of countries. , classics onaine zakstan.xpand -- kha we mentioned the baltic states. this creates a security threat to the region. out, it has broader implications for the international borders. there are lots of countries that

have ethnic minorities that live in other countries. china. hungary. that if russiang does not back away from it, -- putin talked about domestic issues. this is essentially operationalizing regular people living their regular lives as a potential fifth column. they will now be treated with suspicion. that is the jurists. it is a huge risk. that, there are potential efforts to piggyback on annexing other countries. also could create more instability. in the long term, and i will not speak too much about this, but

the economic situation in ukraine. it is something that has to be dealt with. ukrainethe way that wins in the long run is to become more attractive as a place to be than crimea is in russia. where ukrainians go. i'm not economist. i do not know how to do that. me to be ato long-term challenge. not just the economy, but also the governance as well. [applause] >> thank you. we have some time for discussion. i invite questions. please keep them brief. please identify yourself.

>> hi i am from georgetown university. think these actions will have any impact in future years? what about fiscal year 2016? for the u.s.. i'm sure it will. i do not know how. i am not a u.s. defense expert. i know that there are people in the pentagon and various regional commands that are thinking about russia that have not been thinking about russia for a while. translatethat will into structure and planning and so forth. it is hard to tell.

there are no numbers yet. >> i am vice president of george washington university. i am a ukrainian-american. this is an impressive and informative panel. dubovyk.y professor you should run for political office given how passionately you spoke. what is your educated guess about russia going into eastern ukraine in the procedural feature -- foreseeable future? will it happen? >> i hope it will not happen. i do not think it will happen. >> my opinion is the probability

is about 7%. [laughter] 7% probability of invasion into eastern ukraine. possible, butis not very probable. i am with them. possible, but there have to be missteps by the ukrainian government along the way. if the opportunity presents itself, it is certainly possible. i do not think it is in the plan. >> i have discussed this topic with my friends and my colleagues yesterday. it is only about 5% or 7%. maybe 15%.

now it has gone down. [laughter] >> i am from georgia. of russianh memories activities in the same manner and same style. one thing i would like to commend about the measuring of access is that putin has different measuring system of his own success. he does not measure how we view success as we do. a successful economy, people's , these are not measurements for him. of projecting,s he cannot stop. if he stops, it means defeat to him. he needs to continue.

he needs more victories. judge.ard to ukraine, i think he making things happen there without military intervention. the issue is the interim government before the elections concentrate ond helping ukraine. i have a question also in this regard. putin'slearly seen in recent interview when he had his appearance justifying his behavior that russia would not stand with nato on its own borders. this is something he fears. this will undermine russia. he will view it a hidden defeat.

what is the ratio of public support of ukraine nato made .orship -- membership >> let's collect a few questions. >> hello. for the twois professors. you mentioned the percentage of people in different ukrainian cities would want unification of russia. i want to know when those old were conducted and also if there were any indicators about the current feeling in the cities are. i know you are from those cities, see probably have some perspective on that. weeks, there 2-3 have been a lot of propaganda. that can change the opinions of april -- people.

[inaudible] i have a phd in crimea. i've been going to crimea for the left will years. -- last 12 years. i am a crimean scholar at george mason. address some issues. leader of thehe crimea movement. he spoke with president putin this month. putin wanted to talk to him and he invited him to meet in moscow. they spoke on the phone. putin asked him his support on annexation.

he told them that they always supported ukrainian territory. annexation was against the budapest agreement of 1994 stop when he came back, he said everything was planned. this is just my opinion. you guys are talking about soldiers. or were 25,000 soldiers together in sevastopol. those green men are not my warriors -- worries. my worries are that i have been in crimea for the last will be and i have years seen those people who are called russian unity and other groups. they have been training against the enemy for the last when the years. -- 20 years.

people.ys are local those are the scariest ones. they killed one crimean tartare. they killed -- kidnap someone else. a member of the opposition party. they are walking out in crimean tartare neighborhood. there are other things. burnede mosque was the mosque was burned in december of 2012. youtubed and went viral on the internet. nobody was punished. these people have entitlement. that is the most scary part for me.

i don't have a question. i am sorry. thank you. >> let's take one more question before we turn back to the panel. drews, retiredan world bank staff. wasn't he clever to move his byital to an area also ceded the soviet union where there were a lot of russians? my question is about unintended consequences for putin. could this lead to further caucasus, inthe particular because of what has happened to the tatars in crimea and what the russians have done? i have a feeling there can be many unintended consequences to what has just happened. the first thing is on the

missteps of ukrainian government which could lead to further invasion of russian troops into ukraine. i don't think that is the case. evidently, we are seeing putin operating based on a special picture of imagined reality he has constructed about what is going on in ukraine. it does not matter for that matter what the ukrainian government does or does not do. he would still be talking about riots,s -- pogroms, missing journalists, and torture. ane of it is true but still picture projected to russian consumers and the picture rush is trying to project to people in the west through their media channels and so on. if we know we should be careful not to do any of those missteps, that would be one thing.

but if we know regardless of kievwe do or don't do in or elsewhere in ukraine, russia make their mind corresponding to their idea of vit needs to be done visa ukraine, that is scary because it leaves us without leverage. polls have been showing about 77%. that is unheard of for ukraine. it has never been that far, that high. people in thet of east and south, by the way. the government in kiev is not talking about membership. the current prime minister went to brussels and talk to people -- talked to people. he said that is not an agenda

for ukraine. to me is a tactical position for our government. we need to look for alternative ways. all the ways we used to have to do not work. they proved to be inefficient. bilateral, the guarantees of assurances did not work. what else is left for ukraine to do other than look for more systemnt and functional of providing security? polls were taken right before russia moved into crimea. crimea is not a good territory for conducting polls and surveys. verge. is too on the from what i am seeing and hearing from them, they need to

avoid doing this because of provocations, hostilities, and negativities towards people. people will be trying to see some double agenda in why you're asking me this question and so on. we should wait until things calm down, hopefully, before new polls are conducted. the possibility of confrontation in crimea troubles me a lot. i would agree that is not regular russian troops we should be afraid of or scared of, but the irregulars, paramilitaries that have been brought. moved in vast numbers. those are some really crazy people. they might go and do stupid things. crimea tatars have their own emotions running high. that is clear potential unfortunately for clashes. >> the question is about polls.

>> [indiscernible] poll i mentioned was conducted in the middle of february of this year by the international institute. i don't know about after the crimean crisis. for example, my students aboutted a survey andzens on integration intervention. for the european customgreement and a

union agreement. [indiscernible] there are two different situations before and after the crimea crisis. a number of supporters of nato membership dramatically increases. that is throughout the ukrainian region. game witheat power relations between the u.s., russia, and ukraine. is there a lot of space for aboutations and agreement

the military state of ukraine and the architecture of international security after the crimea crisis? unintended consequences. yes, it is probably too early to say anything concrete. i am not sure the situation in the caucasus might tear a thank you deteriorate -- might deteriorate as a consequence of the crimean crisis. what is more probable is the growth of xenophobia which will accompany this frenzy we are observing now. tocould potentially lead deterioration of internal ethnic relations in russia. this is a potential. another unintended consequence , let's waitoccur is

and see what happens with the eurasian union, the agreements on the eurasian economic union. it was planned for signature in may. it is not guaranteed this will happen. the will be the content of agreement is not clear, how successful it will be. one more thing which i would probably point out in the context of what he said were the sanctions. right now, you see signs in "obama is not welcome here" as a response to the sanctions imposed on russian leaders. i think this is temporary. it cannot last long. the polarization with the bureaucracy, and not just putin

himself, but the top leaders who are usually considered corrupt and inefficient and selfish, that can turnhing against putin politically and domestically. there is a division between the public and bureaucracy rather than consolidation around the flags. concur, we might remember after the georgia war, there was a similar first -- first of support. the protested not come that long afterward. that kind of thing can happen again. i want to say one more thing on the crimean tatars. i think you are right on being concerned about the local groups.

the one thing we have to keep in mind is the interests of these local elites may diverge from the interests of putin and company or the elites in moscow. has been making noises about how we will respect tatars writes -- crimea -- rights and include crimean tatars in the line which of the in the constitution of the republic, he was saying evict tatarse to from some of the land they are on. this is the start of the thing.

the locals have been having hostile relations with the crimean tatars for a long time. to -- is trying >> [indiscernible] crimean tatars. to focus on this side of the room for a moment. i have a question and comment. this is more a question of a citizen of ukraine then of an this is a question to our experts. moves further to eastern ukraine, what sanctions or other steps will come from

the west? this is a question that bothers a lot of citizens of ukraine today. comment, this may not be a primary issue, but the is that the regime was shaken by the situation. the state has denied nuclear weapons in exchange for any kind of guarantees for security for defense and security. means nothing can defend you. maybe except nuclear weapons. this is a clear message to iran prt in case crimea would be

taken by russia that the united states should apologize to iran for taking their time when trying to enhance their security with the only real means of enhancement of security. for lars onreat till -- the horizontal nonproliferation movement. as for vertical proliferation, i think it will be a big goal of mobile nuclear zero. russia will not continue nuclear reductions just to create new strategic nuclear forces. they are understood

pushing and creating scenarios in ukraine and other places. there is no idea it can be created in kiev like this revolution. only washington. some of my colleagues support this idea. coming and west is will create consolidation in ideas and the means to enhance russia's security. it means russia will not pursue reduction. this is for the vertical proliferation and nonproliferation. thank you. >> i have questions for the distinguish panel. i am retired foreign service. to what extent the russian

winter olympics provided cover for putin to plan his crimea operation the same way the invasion of georgia took place during the summer games. what are the prospects for invading moldova? agents are agitating the situation now. could you please comment to what extent the european union is unified in their resolve to come to the russian aggression, especially the german attitude toward the crisis? thank you. i am from american university. thank you to the panel for interesting comments. i'm curious about whether there is any difference in what happened in ukraine. these are the same accommodations that might take race after an election at the --

might take place after an election at the regional level to accommodate a new power in kiev. does it matter that this new power did not come to power through an election, that they came to power through other means? does that affect the willingness of the population in the east and south to support them rather than simply accommodate? i wanted to point out the logic behind russia not moving into -- further into the east would also be applicable to never having entered crimea. given that we do know they entered crimea, i wondered if you could update the underlying logic in the fact that they invaded --and will go further in that they invaded crimea and will go further. >> my question is about the economy. i know none of the panelists are economists. he touched upon this question

and someone else said something about the long-term dangers of the economic situation of ukraine. the economy triggered the protests last year. and united states be able to absorb the turbulences caused by necessary austerity measures and association from russia? now ukraine and russia live in a quasi-symbiotic economic unity. there will have to be dissociation. us will cause social unrest -- this will cause social unrest, as we have seen in greece, a more stable country than ukraine. what kind of government in ukraine will be able to regulate these kind of unrests that are for siebel and will determine the future of ukraine? >> thank you. y and gotart with dmitr this way. >> a lot of things.

intervene, but what further steps if they do intervene? obviously, there is no certainty. it seems to be the main , there areis crimea three i guess. one is the basis of intervention. two is crimea a self-contained. there is an obvious stopping place. into one, you go into another. if you go into another, go to odessa. then while you're at it, take kiev. that does not mean they won't do it. , ukraine will have

no choice but to defend using arms. that is a big difference. it is not that russia cannot defeat the ukrainian military. but as we have seen in the u.s. interventions in various places in the world over the last decade or two, it is easy to invade. it is harder to hold. pain tould be a lot of so iying troops, i think, think that is the reason why. the population, even in the even ifost regions, there were sizable percentages of some cities, as we heard from the polling data, rural areas

are predominately ukrainian speaking. you know more about this than i could hope to. it seems it is much more complicated. we haves further steps, the plan, level three sanctions. assuming we don't want to go to war, the final step is cutting russia off from the international financial system. that is the extreme sanction iran is under. that obviously causes a lot of pain to europe. there are further steps that can be taken. why is another reason

kind of like the obama response. if you have a limited amount of ammunition, you don't want to use all of it that once. you want tot worse, within thedo more upper limit of what you're willing to do. so that is another benefit. there was a question about using the winter olympics as a cover. i don't see it. toin spent a lot of money use the winter olympics is a big p.r. show for the regime. no beam -- nobody remembers that anymore. it still works on the domestic scene, but as far as internationally, it was wasted.

to me, that is another indicator this was not something planned much in advance. can you address the germany question? i can do it. go ahead. i will pick up where you stopped with the olympics. it refers back to the question about different measurements. these are two consecutive victories. in international politics, the situation seems to have mold whatever was gained by the winter olympics -- annulled whatever was gained by the winter olympics. it was a limited exercise to take romeo to protect russia's influence and show to the

domestic about russia is still strong. -- that russia is still strong. in terms of potential further let me risk, producing one more nightmare scenario. why don't you demand the corridor? that could be a clever move from a certain point of view. possible. at the same time, we must be aware of the fact that people in the kremlin, the ministry of defense, the ministry of finance, there are some sensible people. they must be able to at least make the case. the risks grow exponentially as you continue down that path. partly answers the

question about moldova. moldova will get close attention from the european union. the association agreement is already in the pipeline. the free trade area is probably going to be in place soon. yes, of course, it is quite possible there is some education in moldova proper by russia -- ova properin motld by russia. it is already very much agitated by itself. the thing is excluded. -- nothing is excluded. there is a possibility for overstretch. the reaction of the e.u. and

germany, there is a strong presence of this position in germany. let's do business with russia. let's forget about the politics russia is trying to play, this kind of appeasement attitude. it is very strong in the business circle and intellectual circles. it had been there before the ukrainian crisis. it is still there. is still very tangible. e.u. is notin the exactly on the russian side, but on the more moderate side, let's put it this way. again, there are limitations to what can be done.

they will come under pressure domestically from civil society. a crucial indication of what the e.u. is going to do would be the helicopter carriers which france is scheduled to deliver to russia. that will be a litmus test for the determination of the e.u. to do something about ukraine and russia. the question about what would happen after the russian invasion in eastern ukraine and sanctions. they would probably need military protection from international forces. ukrainian territorial integrity. aggression is important in the crisis in crimea. indicates inkraine

current political international in 1945hich was created . inbolically, this order 2015. the resolution of the way of development. it is one point of view. accommodationbout of eastern ukraine -- occupation of eastern ukraine. the central government does not have capacity to keep power in eastern ukraine without

settlement of part of eastern ukrainian elite. situation, in the ukrainian regions, the pattern is integration. the new government [indiscernible] the second pattern is transition . the settlement with the formal elite [indiscernible] between the governor and the cabinet. failed state and failed region.nt -- failed [indiscernible] no settlement, no negotiation between kiev and crimea.

it is the way to civil war. it is the topic of my future on a solution for ukraine. establishing a new ukrainian constitution and resolution between east and west ukraine. , 50% oft of ukraine elections include government. the democratic but formal part of the region. you need government in ukraine if you want to keep the eastern region in ukraine. >> we have about one more

minute. >> my colleagues have done a good job answering questions, so i will give it to you cory. >> let me say thank you very much to our panelists for a stimulating discussion. we are hopeful and optimistic thet ukraine's future, relationship of ukraine with its neighbors. please join me in thanking the panel. [applause] [captions copyright national cable satellite corp. 2014] [captioning performed by national captioning institute]

>> the map of the world changed since congress went on the weeklong recess. the new bipartisan ukraine sanctions bill attempts to get house and senate on the same page. he is joining us at c-span. what is ahead when congress returns on monday in terms of the ukraine legislation? >> i think the house and senate will try to get on the same page. since they left, russia formally annexed crimea. the two chambers have different approaches to bills that would levy sanctions on russian officials they feel are responsible for the violence and would assure ukraine gets loan guarantees and direct economic assistance.

host: how is the build the house will take up any different from what they passed? guest: i think it tries to move things closer between the chambers. it talks about different types andid through agencies european bank reconstruction. the senate bill which the chamber will take a vote to proceed on also has restructuring of aid to the international monetary fund that could help ukraine. republicans in that chamber and house republicans disagree, they think that is an extra in use provision that can be done another time. they are battling -- backing a not what theion, house passed before recess.

the chair and ranking member rolled out this bill today that could provide a point for compromise. it will be marked up on tuesday. host: how do the sanctions fit in with what the house has done? guest: i think they anticipate adding names. the thinking is to go after the people financing putin and who are the moneybags in the eyes of the congress. it would add on to what the administration has done. there were a couple of rounds of sanctions this past week. the russians retaliated slapping sanctions on members of congress and white house officials. congress is getting in the game along with the white house. host: we heard from the majority leader before they left. this will be the first thing they take up when they come back monday. we have heard word of the deal done on the extension of unemployment insurance benefits. what is ahead with that?

guest: there have been multiple attempts to renew the jobless aid that expired in december. the latest deal has the support of five senate republicans. if you get 55 members of the democratic caucus, you might be able to a transit. -- advance it. it would renew the unemployment insurance and require long-term recipients to get job training and other steps. the problem is the house republicans are hostile to this approach. john boehner says after a three-month interruption of aid, it would be an administrative nightmare getting this restarted and getting the eligibility figured out. they would rather focus on measures that create jobs rather what was temporary assistance. the: your colleague wrote effort on unemployment is just part of the democrat's effort to

revive their economic agenda. what did he mean by that? guest: there are a variety of steps democrats were hoping to showcase this month to highlight income inequality such as increasing the minimum wage. it seemed they stumbled out of the gate and are pushing these things back further. international events may be over taking that as well. their staunch republican opposition to a lot of the measures because of the issue of pay for. everything has to be paid for. their have to be offsetting cuts elsewhere in the budget. it is hard to get them to agree on all of that. facing a deadline on medicare payments to doctors. is there another short-term measure ahead? is there any possibility they will get a long-term measure passed? it is looking like another short-term patch to head off a

scheduled 24% cut in medicare reimbursements to physicians. it is almost an annual exercise in washington. long-term, they would like to replace the formula that dictates the cuts. what they would like to do is maybe do a nine-month patch that takes us off the table for the election. you have to find a way to pay for that. it is easier to pay for a one-month measure. that is increasingly looking like what they may do. host: the senior editor with "roll call." you can follow him on twitter. thanks for joining us. c-span, sit in on the house when they returned. lots of hearing coverage when they return next week. before they left, we covered the house of the subcommittee on

sports safety and brain injuries. they looked into concussions and heard from a number of athletes who have suffered from them, including the u.s. women's soccer going. we will show you that tonight at 8:00. from this morning's conversation, a discussion on community health care centers. "washington journal" continues. communitythe unity health center is located in washington, d.c., just a few miles from the capital building. vincent keane is the president and ceo of unity health care. mr. keane, first of all, what is unity? guest: good morning, peter. unity community health center is ain washington, d.c.

network of community health centers that provide health care, social services, a whole people whorvices to has shortly do not access health care on the mainstream. basically our commitment is to the underserved, to those who are marginalized, including the medicaid population, including the immigrant population, including those who may just identifyt be able to with mainstream health care. federally qualified health center, and it enables people to get health care in their site come in their local community, and also addresses whatever their specific needs are. we serve about 100,000 patients a year. we have 1000 employees, and we provide health care to the homeless population, to residents of the jail,

communities within all wards of the city, as well as how centers. we are a large network. there are over 1000 similar type programs in the united states under the community health center banner. host: mr. keane, what is the definition, the official definition of a community health center? au spoke of unity being federally qualified health center. what does that mean? well, the term federally qualified health center comes from the legislation, which really -- to fully understand, you have to go 1955 when the concept of a community health center was first established. that was established by president johnson in his war on poverty. there were two health centers set up an very impoverished neighborhoods. one in mississippi and one in

boston. 1000 of them basically have been replicated over the last 50 years. what defines a federally qualified health center is several things. one, we must provide hombre heads of health care services, so in other words, it is a whole ability to serve, and ability to serve the whole patient. we must provide services regard as of the ability of the patient to pay. we must be open to all comers. and if you do pay, you pay on a sliding fee scale. and i guess a third and very important parts of what constitutes a federally qualified health center is that you must actually have a governing board that is at least 51% of the consumers who use those services. .his allows for community input it is locally owned, locally

governed by the community that we serve. host: mr. keane, where does your funding come from? today our finding, and this is true of community health centers national wide, we started out in the earlier days receiving federal funds, and we still receive direct grants to provide care to the uninsured, to those who were at a certain level of poverty, but most health centers now also use medicaid, they use medicare. a lot of health centers actually because of the need to -- some people will pay based on their ability to pay. in the case of unity, we receive revenues from medicaid. the district has been very generous in medicaid coverage, unlike other states.

we sit receive money -- we receive money from medicaid, it is attached to the individual, we receive money for medicare, we receive money from the satient's themselves -- patient themselves. we also receive grants. in the case of unity, we also receive private money from foundations and individuals. in that sense, we have a very broad-based funding and support system. i would say at this point, with the expansion of medicaid through the affordable care act, medicaid is one of the largest sources of our revenue just now. host: does the community care center operate like a hospital? can it be used as a clinic? an an emergency room, a doctor's office? guest: i would think the latter, peter.

it is probably more akin to a doctor's office where in fact it is not a hospital, and those of us with experience in hospitals, that implies a long-term -- a longer stay. it is not an emergency room, although unity health care and several health under throughout the united states offer urgent urgent carey offer from the perception of longer hours of service so that people can gain access, but it is not a hospital. it is not a minute clinic. it is akin to a doctor's office aere you weror i might go for range of services. it is not just a one-on-one doctors visit. the patient is the focus of the service, and that patient may caree with their primary provider, which could be a nurse practitioner, a doctor, or a

physician's assistant. they also engage with a nurse. they also engage -- many of them because of the complexity of their illnesses will need what we call case management and care management, and the focus under the affordable care act today is what we call patient-centered medical home where the patients literally is that the center of his and her care. that patient is also educated to take responsibility for their health care. that is more than just a doctor's visit. the doctor is critical to that, but he or she has a team that surrounds them in providing that care, which does not -- it actually starts before the patient comes in, and it continues after the patient leaves the office. there is follow-up, there might be referrals. and in some cases to doctors, hospitals. it is primary care focus. in other words, preventing illnesses, or venting folks from

going into the hospital, but being able to recognize when that we haveh care access to get them in there, peter. host: we will put the numbers on the screen. for the rest of this morning's "washington journal," we will be live from unity community health center in washington, d.c. we will begin by talking to vincent keane, president and ceo, who we are talking to now, and then we will talk to a couple of doctors from the health center as well. if you live in the east and central time zones, (202) 585-3881 for those of you in the mountain and pacific time zones, and medical professionals, particularly if you worked in a community health center, we would like to hear from you as well. (202) 585-3883. you can also send in a tweet as twitterspanwj is our handle. mr. keane, how has the affordable care act affected unity health car community heal?

guest: well, the affordable care act is one of the most significant events probably in the last 100 years in terms of providing coverage for folks who lack access to health care. for the most part, the aca, the providese care act, opportunity for people who were previously not covered by insurance to get covered. ways.as in two by the expansion of medicaid and by the exchanges. that helped health centers nationwide to serve those who were not previously served. in other words, yes, the answer is the aca has been a very significant -- has had a very significant impact in increasing access to care for those who had liked it. how does that impact health

centers? it increases your patient load. and also we have to be prepared for that influx of new patients. committee health centers nationwide serve over 20 million people, 22 million people. i the time the affordable care act is fully implemented, we serving nationwide up to 35 million people. here in d.c., we expect our population to come to our community health centers to grow. however, the district, as i have said before, has been very generous in terms of its coverage. as you realize, in many states, they are not covering medicaid, which was the original intention of the affordable care act, and that is going to limit some of those who could have coverage if they were open to that, but you will hear later on from one of our physicians that's one of the challenges that health centers how are weface is -- going to have the manpower to

take care of that influx of new patients? dr. robinson later on we'll talk about that in terms of some of the creative ways that unity and other health centers nationwide are affecting that. so definitely the aca is focusing on the right things. number one, it is focusing on prevention. onit makes us focus more prevention, getting people into care earlier, and also if they focus on primary health care to prevent the issues you addressed earlier about admitting people into emergency rooms and hospitals. of course, in addition to that, there is great advantage is in untilof covering kids they are 26 years old on their parents -- so a lot of opportunities in the affordable will benefit health centers, but more port it will benefit the people we serve. host: mr. keane, any downside for chc's and the affordable

care act? guest: the potential downsides, again, are probably -- you know, we have historically relied on federal funds direct from the federal government. those funds are still necessary, and i think it is greatly important that our congress realizes that even with the affordable care act, and it is wonderful, it is still not going to cover all of the expenses associated with running a health center, taking care of a population who have chronic rate thanat a greater the general population. as i indicated earlier, peter, a patient comes to our health center with chronic illness -- they need more than a doctor. they often might need language translations. they will often need mental-health services. these are services that are not always directly reimbursable, so we are pleading to the congress to recognize the ongoing funding

through these trust funds for health centers, which was established under the aca, but needs to continue, needs to be refunded so that as well as drawing on the affordable care act reimbursement system, that we can always -- also get federal response to continue to fill the gaps that are there. so i would say it is not a downside, but it is a worry that the federal government continue its direct funding to community health centers as the needs expand. fundingextend that to for teaching health centers, where we can teach the workforce of the future, and i would extend that to something like the national health service corps, which is a key workforce pipeline for young men and women in the country to work in underserved and rural areas, and they get grants from the government to do so. so increase funding, sustained funding as well as all the other advantages of the aca will

ensure access for 35 million medically underserved people throughout the country. can anybodyt keane, go to a community health center? to anyone.re open our primary focus is of course the medically underserved. those who historically have been cut out of the mainstream system. those who are perhaps economically disadvantaged, linguistically, other challenges. so our primary focus would be on that level of population, the underserved in whatever category, whether it is financially or not. however, with the affordable care act, we are recognizing that there is a new covered population, and that would be the folks above 200% of poverty. i hear them being referred, some of them to the invisibles, -- invincibles, the young, 26, whatever the invincible age is,

i don't know. that is the new population. it is good to get them into care both from a risk reduction for the system as well as for improved outcomes because that is a general demographic that young people do not seek health care during that time, yet that is often a time when chronic illnesses, other social issues impact theirreally long-term health. so we are saying yes, we are open to take care of those that historically been part of our mission, however that mission starts to creep a little but as we can see people a little but above the poverty line. with medicaid expansion, people are actually going to be flipping back and forth between medicaid and between the insurance exchanges, so at unity and community health centers will be there for them

regardless of their covered status. is ourincent keane guest, president and ceo of unity health care. (202) 585-3880 if you want to preserve a, east and central time zones, (202) 585-3881 out in the pacific, and medical professionals, we would like to hear from you as well, (202) 585-3883. david in glen cove, new york, good morning. you are on the "washington journal." caller: yes, good morning. i have a couple of questions. i have a feeling -- what if somebody comes to the health center and gets diagnosed with, let's say cancer, and they are told what at that point? are they told to go seek a hospital? and how to they pay for this? host: if you can hold on for just a minute, mr. keane, we will get the second question as well.

david? we are listening. go ahead with the second question. caller: the second question is is the health center really targeting people below the poverty line? care, how do they pay for that the health center cannot provide and are told well, you have cancer or you have a terminal disease that you have to go to hospital? host: all right, david, i think we got the point. vincent keane. guest: david, very good question, and is a challenge that many health centers it turns on a day-to-day basis. the answer to your question, david, will depend a lot of times on the state in which that person resides, but in terms of unity in the community health 's responsibility obviously is for the whole person and for their long-term continuity of care.

so a patient comes in to our health center, is diagnosed with cancer, here in d.c., thankfully, we have a system. medicaid is generous. we also have a city run program called the alliance. generally speaking we can get that person into a hospital for diagnosis, procedure, and treatment. i am not saying that is true in every state. each state, each health center has to come up with with the continuity of care land. a lot of times these are based on the generosity of hospitals who are willing to kind of make their resources available, but here in d.c., if you came in and would becovered, it our responsibility at least to try to connect you to the care. 90% of the time, and i am sure one of my physicians can be more clear on this, 90% of the time that person would be able to be connected to specialty care and hospital care.

david, that is not true in every state, and i think you said you are from new york will stop in new york, medicaid may be more generous, but i certainly can assure you that it is a challenge. at the same time, a health center needs to be connected to other medical institutions to , thatthose relationships actually address serious problem for the help center is not capable of addressing. i hope that answers your question. host: john is calling from houston, texas, a physician. hi, john. caller: hi. guest: hi, john. caller: hi. i served in the early to mid-1980's in a community center migrate clinic in south texas on the border. my experience with that it was like we were a full-service health facility, and basically a

one-stop full-service place for -- and iation, however have not been involved with the community health centers in a long time, but i do recall at that time it was up the thatning of my career there were, how shall i say it, local medical political influences, at least in the way we practiced in our community, and i was just wondering if that has changed over the years werese even though we colleagues with our practitioners in the private sector, there was always a little bit of tension about and we always had

to kind of be kind of careful issued referrals because we relied on our doctors and the private sector to provide specialty services to our patients. i would say the people that needed services that we could not provide, we had a very strong social services department that were able to individually evaluate each person to see what sorts of services that were available locally or reasonably that would solve whatever problem it was that we were trying to address. host: all right, john, thank you very much. mr. keane. andt: thank you, john, thank you for your service in texas. i have a lot of friends in that area, and brownsville and others

that have served in a community health center, and the national health service corps through which you came is still a critical element of our workforce resource. the answer is exactly as you said, john. buildhealth center has to relationships with its local services, other private practitioners, whether it is hospitals, and particularly specialists. you are absolutely right. sometimes we have to rely very much on generosity. is there competition? well, yes. generally speaking there are not competition for those who are not covered and are uninsured and do not carry a payment mechanism. i would say the answers your question right now, john, is there is more competition today because with the affordable care act, all of a sudden, many entities are coming into this market that historically have not played in this before.

historically did not want to see our patients because they do not carry a payment mechanism. so health centers are going to experience composition, but i am confident that the quality of care that you get at a health center is second to none, and we kind of welcome back competition. thank you. lancaster, is in ohio. jenny, go ahead with your question or comment. caller: my comment is i think it is ridiculous that every time you turn the tv on, you have all these commercials for , and people do not know with those medications are. only a doctor or pharmacist would know. and the health care gets attacked up skyhigh. up skyhigh.ed i think that is what make a lot of the medicine go up in price. host: mr. keane, as a medical

professional, what is your opinion of that? i would probably venture to leave that to one of my other guests. let me just say, there is no doubt about it. there are many factors that are contributing to rising prices and rising costs in health care delivery. no question about it. our caller reflects the certainly, youd know, there are people alive today who would not be alive without medication, and sometimes those medications are expensive. health centers deal with very hard allele patients, so that education plays an -- health centers deal with very chronically ill patients, so medication place an important use. that is where our care management comes in. there is real i love about that. the other issue she brings up his medical malpractice

coverage. generally speaking, in some cases, medical malpractice coverage increases the overall large as quite as , iple tend to think, however do think that there has been a tendency in the past to practice expensive medicine, but generally speaking i think our doctors are there to take care of patients. they are committed to that, and yes, you want to be sure that your patients always have right of redress, but i think the two issues she mentioned do have an impact on health costs, medications are important, of course being able also to educate the patient because a lot times a patient may be on multiple medications and is not really know enough about them to address that issue. host: mr. keane, how many

physicians do you have a unity? are they full-time? are they volunteers? actually, when i say physicians, we include in the physicians all providers, that is psychiatrists, nurse practitioners, medical physician assistants, dentists and podiatrists. we have 180 in our network of serving 100,000 people a year. and these are various levels of discipline. we focus a lot on primary health care, we focus on pediatrics, so we have a very diverse array of physicians and providers. see a very diverse population ranging from babies preterm all the way up to senior citizens,

so our services are geared toward that, as are most community health centers. we have grown significantly in the last several years and taken on additional health responsibility, particularly in the jail, that requires us to increase our workforce, which we are always excited, and we invite any young or middle-aged or older practitioners who might be out there, wanted to come to d.c. -- unity would be a great place to come to. rich, brodheadsville, pennsylvania, you are on "washington journal." caller: since the aca came about, i am now covered under my wife's insurance. she works at a state university. under the aca, we still have our same doctor, same coverage. we have not lost in the coverage. we get an x or $30 on the paycheck every paycheck, so

there is a plus. thee the other thing -- other thing i'm noticing since the aca came about, it looks like a lot of committees, right down the road from me, there is a satellite medical center. that is good, that is providing jobs and helping the economy, but the entire thing of this is, you know, with the whole aca, 69% of people who haven't now are satisfied. they are content. yes, there are problems with it, but how can people be against something that is giving people health care who never had a before? and the right wing, the republicans want to take what is helping people's children and cut it and leave those people who do not have insurance before -- now they don't have any health insurance, and they are back to where we are before. why would republicans want to do them? i find a heartless, senseless, and downright -- well, we know why they want to get rid of the aca. you do not have to be a brain

surgeon to do that. your point.k we got did you want to ask another question very quickly? caller: dave medical centers we , if a patient goes in there that is not have insurance, is there funding, is there aca laws that help fund these patients, you know, that he not have insurance? host: we got your point. thank you, rich. mr. keane? guest: thank you, rich. i think your remarks from the aca from somebody who serves previously unserved community, absolutely, everything you say is correct. i am not quite sure, and i think i mentioned one of the callers earlier, there is a competition coming up. some local pharmacies are setting up many clinics. some local institutions are setting up more like urgent care

centers, where people can get access to the health center, to patients who were not previously served. if you are setting up a community health center, if you a federallyup qualified health center, nothing changes for that person who does not have insurance. the same for primary care based on their ability to pay and that is our mission, that is our charge. that goes back to our founding in 1965. you talk about something that i think is very important. we employ over 1000 people in the district of columbia. that is a significant business initiative. some of our health centers throughout the united states and are economic engines within the community, and that is critical, as well as delivering health care because as we know, unemployment,

poverty are contributing factors to poor health outcomes. host: smiley tweets into you, mr. keane -- how do you reach the poor, rural people? they have the highest interest rate and no health insurance. thank you. this is the challenge of every health center. how do the community health centers reach them? has anommunity center outreach program where they have folks, i mean, the best way of reaching folks is by word of mouth, getting the word out. some health centers are very creative about how they use, how they educate and market themselves. some have established mobile outreach vans to go out into the communities. some health centers actually have home visitation programs where in fact they go out with resources.

for instance, here in unity, we would have home visitation programs where those folks who find it difficult to come in. rural health centers have come up with very creative ways. i have not had that experience myself, but mobile outreach, , gettingtation transportation is often a barrier to getting people in for health care. these are initiatives that every health center takes upon itself to make sure they are serving the population that has been designated to them. now, i would have to say that part of our mandate really is not to build a health center and hope they will come, but rather to actually build a health center and actually make sure that the community is being brought into that network of care. are their strength on how

you can spend your feder funds? guest: yes, there is significant oversight responsibilities attached to receiving federal funds. to beare audits i need done on medicaid and medicare annding, and yes, our funds c only be spent directly on primary care is an all of those ancillary services associated with primary care such as social services, dental, all of that. for instance, going back to one talked aboutrs, we we cannot pay for hospitalization for people. we cannot pay for things that as it were happen outside the walls of the clinic. we can set that up, arrange for , developnship agreements between hospitals and ourselves, however, we cannot pay -- in other words, there are

our designated services that are allowable under our grant that we must be responsive to and consistent with. oversight.lot of i mean, this is not money that is wasted. this is not taxpayers money. we are very conscious of our responsibly to become good stewards of taxpayers' money entrusted to us on behalf of the indigent and those who are underserved. host: john in evansville, arizona, thank you for holding. you were on with vincent keane, president of unity health care community health center. caller: my grandson is a resident physician in annapolis, and he serves clinics for the poor. being that loan is so, he is being helped out on that by the service. he recently said that that was going to be reduced or cap.

-- capped. do you know who is responsible or what can be done about this? thank you. guest: ok, peter, there was part of the question i did not get. the: he was talking about education loans that his grandson received for his medical education. and whether or not those are forgiven. or reduce. guest: yeah, i got that, and actually, that is a very significant concern we have. when i spoke earlier about the federal funding, he may have been served through the long repayment row graham, the national health service corps. it is quite possible that that is reduced, and there is an issue that several of us throughout the united states are coming to try to address this week. there is a national meeting here in d.c. where we are trying to cross the fact

that another 15 million people, you cannot put them into coverage without providing them access through your doctors, physicians, nurse practitioners, so a significant component of that is loan repayment and scholarship. we just have to really advocate strongly for that not to be capped, not to be reduced. that is a challenge, and i agree ath the caller that it is worry, and it is a worry for those young men and women coming into the medical health system, and teaching that their support may not be there be on the next couple of years, and it a criticals recruitment issue for health centers and indeed for the medical system throughout the united states. host: vice president joe biden will be speaking to the community health centers organization association today. that will be live on c-span at

10:15 a.m. eastern time. kathy in santa fe, new mexico. caller: good morning. i called to see if i can find carehy dental and vision is it better paid for by our older people. we need our teeth to chew to get good nutrition, and we need our vision to read the labels on whatever we are buying. host: thank you, ma'am. mr. keane, are those services that you provide? guest: thank you very much, and i certainly identify with her as i am getting older myself, and with teeth and vision problems. in early speaking, she is correct. dental and vision are very difficult and expensive to cover under private insurance, however, here is where the community health centers come in again. community health centers offer dental and vision services.

in addition to that, they often will build -- like in our case, i can only speak to what unity does. we actually do have ophthalmology, we do have vision screening. it is very cripple for people who are diabetic -- it is very critical for people who are diabetic. much of our population is diabetic. so having that service available and then having the proper reserve system. not every health center will be able to do that because it is an expensive resource, however, it is critical, and we are very aware of that. dental is similar. most health centers will provide dental services. there is funding to do that, but it is always, we need to embellish that funding, additional funding, and build relationships with dental schools and with other vision entities to ensure that number one, if somebody is diagnosed with even glasses, they can actually get them. if someone is diagnosed with needing dentures that they can get them. so these relationships have to be built because health centers can provide the service, but not

necessary the ancillary areas. host: mr. keane, do you need to have an id to go into your health clinic? if so, do you have non-english-speaking people to help as well? guest: yes. one thing about community health centers is that they are very culturally diverse, and they actually are very aware of the needs. many of the folks that we see, and this is throughout the d.c., states -- here in one of our sites in the northwest section has 100 lane which is spoken. languages spoken. we emphasize linguistic and cultural sensitivity to that. so the answer is yes. most health centers will look at what is their predominant, what is the population other than english that is predominant. in our case, it would be

spanish, and we would have folks and staff members who can do the translation and can't medicate with them -- can community with them. the answer to the question about an id is not as such. generally when someone comes into to the health center, they are enrolled in the health center. that becomes their idea. do they need a drivers license? they may need some modification if they want to get on public benefits, but in terms of -- let's say if we are asking the question about who can be served, the answer is in community health centers, all can be served, regards us of their legal or immigrant status. pick live on c-span3. >> "washington journal" continues. host: unity health care community health center is located a few miles from the capital and washington, d.c., and we are live there this morning on the "washington journal," and we are joined by

dr. andrea anderson with the medical director there. dr. anderson, what is your job? guest: hi, thank you for having us. i am the medical director of the health center. as our ceo explained, the network is a large network, and i am the medical director of one of the largest community health centers located in the northwest quadrant of washington, d.c. we are the center where vincent was referring to that over 100 lane which is are spoken. i am the medical director of that fight. we serve about 21,000 patients, and we have over 100,000 patients each year. i also service the discipline director of family members for all of unity health care. i direct curriculum and policy affecting family physicians. host: what are the negatives --

navigators used throughout the community health center? guest: good question. we have a wide variety of comprehensive health services within our centers. one is that we utilize the patient centered medical home model. sed approaches to health care. it is more than dr. and patient in an exam room taking care of the problems you need. it is true that we need a village to take care of the patients, so we employ a variety of staff and practitioners in the health care, one of which are navigators. to help the patients navigate their way through the complex health care system. as we know, it can be confusing for many patients, especially underserved patients who may face language barriers, educational barriers, time barriers, so many things can person's ability to effectively navigate the health care system, so navigators are very important aspects of the care that we

provide. the: what are some of services, dr. anderson, that are provided at unity? ofst: we have a wide variety services. primarily we focus on primary care. that is what i do. i am a family physician, and that means i see patients from the whole range of their life, from birth to death. just last weekend, considering my day, i saw newborn patients, i see nursing mothers, elderly patients, teenagers, the whole gamut of patients we can provide will stop in addition, we provide specialty care. site, we have infectious disease services. we have podiatrist services, dental services, mental health. a wide variety of services in that way. vince also made reference to us providing care in the d.c. department of corrections. we also provide school-based

health centers. we have four school-based health centers in which we have fully functional health centers located within d.c. public schools where the majority of children are, and we know children are spending most of their days at school and most of their time is spent in school and around the school community, so we bring the health care to them. in addition, we have a mobile functionalis fully -- which is a fully functional health care center that is mobile. that is actually how our organization was originally founded, as health care care for the homeless, before we expanded to become a federally qualified health care center. that is just a part of the wide range of services that we provide, and there are several innovations within the, within those services that i am very proud of and excited about. one of which would be a group visit, and i can talk more about that if you're interested. host: what is that? guest: group visits -- think of

physicianis, i as a might have 100 patients on my panel with high blood pressure. obviously i have a lot more, but to make the numbers a little simpler. instead of me having 100 different visions with those -- visits with those patients and telling them the same thing about how to take their medications, but exercise and modifications, i might want to meet with 10 or 20 of my patients at the same time in one room with patients' consent so we can all have a visit and discuss that issue. the beauty of this vision is visit is that employees the knowledge of the practitioner, which would be myself at the medical register there, but also capitalizes on the collective wisdom of the group, so for example, i might say it is important to eat vegetables if you have diabetes, for example, and i can say that, but someone in the group might fail, yes, and they are on sale

this week on our local supermarket. and someone else might say oh, yes, and if you cook it this way, it tastes better, how it tastes in our country, and you can use this bison that spice postop and another person gets a yes come i did that, now my blood pressure has been lowered or my diabetes is better. so the group receives an enhanced experience of health care and they can really benefit from one another's experience. so we provide group visit that cardozor, the upper health center, for a variety of concerns. prenatal care, chronic pain, atef, and we're looking providing group visits coming up in the future for pediatric health care. host: dr. anderson, how many physicians on your staff are full-time? how many are volunteers, etc.? the majority of physicians are full-time. i would say over 90% or full-time. we do not have any volunteer physicians, and that is part of

the legislation of the federally qualified health centers, that all of the physicians, and this includes again nurse practitioners, physician assistants -- they are all salaried employees of our center. or our partnership of whatever center we are partnering with. so we all our employees and have our primary focus here at the center. we have a large variety of centers, so some of our physicians, particularly our specialists, may work at different sites throughout our network, so they may spend one day a week at one site, today's a week at another site, so on and so forth like that. host: what percentage of your patients that walk in our crisis patients? guest: crisis patients? that can be a very broad definition, and i would almost argue that by definition, based

on the population that we serve and the challenges that they face, they could all be considered crisis patients at some point or another. i think all of us experience difficult times in our lives, especially the patient that we see. they may be dealing with multiple medications. they may be dealing with low health literacy. low english proficiency. they may be homeless. they may be experiencing violence in their lives. they may be recently unemployed. there are so many things that can contribute to someone being termed a crisis patients or a high risk patient, as the termite be used. --we again employee a large as the term might be useful to so we again employ a large righty. i've been with you need for several years now, they did comfortable opening up to me about certain things, but they

also build go opening up to the mao are the chief manager or the social worker about other things. that is why we work as a team, so that we can all benefit the patient in the most opportune way. andrea anderson has her m.d. from brown university. how did you get interested in this aspect of health care? guest: when i was a young girl, i had a primary care physician who to this day i credit him with really inspired me to be a medical professional. we also visited a community health center in art the permit in new york -- in our neighborhood in new york. as they went on with my training and education i came to be impassioned to speak those who have no voice. fact very inspired by the

that it is my responsibility, that if i've been given something i need to reach back and give it to others. that is what inspired me to get involved in medicine. i was fortunate to be a member of the national self hers was -- health service corps, at which time i received caller ship funding and later on loan repayment for my medical education. many physicians, as you may know, come out of medical school owing more than $200,000. that is starting out already in debt. the national health service corps is a wonderful way for these clinicians to receive subsidies to pay back those medical loans and still work in the communities that they care for and are passionate about. i am also a by we the is the addition -- i legal position, i speak spanish, so i was motivated to work the latino population is welcome and that is what i'm able to do at our site. host: andrea anderson is the

medical director at unity health center. here are the numbers by times of -- time zone. we are going to begin with a call for message driven -- from massachusetts. impartingank you for the information that you have given us this morning. several,, one having to do with the systems. sommunity health service sites, is afferent reflection of a significant need of the population during the

last two years of the united states. is a i apologize, it really bad connection we are getting with you. i do not know if you could clearly, but i said that he said that community health services are a reflection of the unmet medical needs in this country today. that is true. i would happily agree with that. there's so much more to a person's medical needs then their insurance coverage. that is actually very important about their health care needs, that is why we are very excited about the affordable care act. need access to physician with a needed place where they can feel comfortable, they need a place where people are not afraid to talk about some personal things, whether they be a little of substance abuse, whether they be dealing with violence in their homes, whether they be illiterate and not able to read. there are so many aspects that

are unaddressed in the traditional health care paradigm that community health centers are definitely stepping in and filling that gap. as i mentioned with the group visits that we have, ongoing counseling, partnership with community resources, really caring for the whole patient, not just the medical needs. to be awhy very proud community health center position of and we deathly encourage others toencourage think about the medical profession and get involved in centermunity health movement. host: a tweet -- caller: [inaudible] guest: great question. notre realizing it is enough to treat patients, we have much preven