screening a higher level of screening stuff that fits the profile, that are potentially problematic. it.m pretty impressed by there is a law on the books that everyes 100% scanning of aece of cargo that leaves foreign port by the united states government, which is a very large unfunded mandate that was put on the books in 2007. the statute creates the option every two years, and i waved it because we do not have the money to put in place at every single foreign port, which we do not control, and logistically it is

not there. i we are developing -- and promised the principal sponsors of this law that we are going to develop a plan to get to 100% not have the we do resources. congress has not given us the resources. we are developing that. i would like to see us get to a higher percentage of what is dean's scanned -- what is being scanned right now. i look at what comes into the country and the method we have for screening it all, and it is pretty sophisticated. so i take away from that a pretty good story. ok, yes, sir. >> last question. on ebola. we are now screening at five airports. do we have the capability to deal with this, and do we have

contingencies if things get worse? >> we very definitely in this country have the ability to deal with the ebola virus. every time there has been an outbreak of ebola in the world, it has been defeated. here in the united states, we have the best health care, doctors, infrastructure, hospitals. it is a treatable disease if it is caught in time and you receive the right medical care and the right medical treatment in time. diagnosed case of ebola in the united states. from the are that three affected countries, there is no direct flight to the united states. you have to transit through various different points, mostly in europe, and on average is about 150 people a day that come from one of the three countries

to any place in the united states, and 94% of them come ark, jfk,er new chicago., or thee determine to enhance screening we have in place. what is already in place is the screen by local authorities in the three countries outbound when you get on the plane to leave africa, where there is a temperature check and other things. the airlines have been given a lot of information about it. we give passengers information about us, what to do if you're feeling symptomatic, and so forth, and we have been doing i pv and you put people to the normal customs process, and

what we decided to announce we were going to be doing is more active, aggressive screening at inbound, at the point when you arrive, where we are going to have travelers from the three countries fill out a declaration with all your contact information, where you are going to be for the next 21 days, e-mail, cell phone, asked for numbers, all the normal stuff, and in addition, systematic -- are you feeling ill, you have a high fever, and had he been around anybody who has had ebola that you know, and where are you coming from. additionally, we are going to have temperature checks. every passenger who comes in from the three countries, a thermometer, we will have these in place as early this weekend at the five airports.

create is we internationally as many different checkpoints as possible for travels who go through the system. thank you all very much. iq. -- thank you. [applause] [captions copyright national cable satellite corp. 2014] [captioning performed by national captioning institute] >> at the end, secretary jeh

johnson talking about creating five screening at international airports, including jfk in new york. the house armed services committee reports they are $750 million to support the ebola response. oklahoma, aom ranking member on the committee, has withheld approval of the funds in his chamber, saying it would add demands on a defense budget already stretched thin. we will hear more about the u.s. in a moment.bola first, a look at the campaign 2014 coverage coming up tonight. our campaign 2014 coverage

continues. tonight at 7:30, live coverage of the illinois house debate for district.uri later at 9:00, live coverage of the illinois governors debate. friday night, 8:00 eastern, the wisconsin governors debate between scott walker and burke.at mary w more than 100 debates for the control of congress. here are a few of the comments we received from our viewers. >> not one democrat that icf the hearing on that freeing the

sergeant from the mexican prison. i have called the president many aboutin the last months the release of this man, and it seems like the president could have picked up the phone and made thatall have release. >> i just got done watching your c-span regarding the gentleman in mexico. i need to complement you and pliment and tell you this is the best evidence i have ever seen or heard from any station on the television about the corruption that we have to deal with in the politics, particularly, the president and all the things that he is doing wrong, and particularly, what he is allowing to happen on the

border between mexico and the united states. town halluestion, the arizona,arlier, from the veterans administration, the hospital out there. all the was just broke, veterans and what they have been going to there. someone has to do something out there. it is just a mess. and it was really interesting to see just each and every one of ache thathe heart their families have been going through. and i pray that something will be done to help these people. they deserve it. they fought for our country and our freedom. thank you. >> continue to let us know what you think about the programs you watch. e-mail us, or you can

send us a tweet. conversation.n like us on facebook. follow us on twitter. sylvia burwell answering questions about the 's ebola or spots. she also talks about the implementation of the health care law and the updated website. moderate this session. >> good morning. welcome to the latest in our series of joint kaiser health

news, health policy newsmaker breakfasts. my name is alan weil. i'm editor in chief of "health affairs," a leading journal at the intersection of health care and policy. running the show today will be julie rovner, distinguished fellow at kaiser health news. you all know her from her 16 years as health policy correspondent for national public radio. the star of our show today, the reason you here is sylvia burwell, who is the nation's 22nd secretary of the department of health and human services. as you know, she came to hhs after serving as director of the office of management and budget with previous stints at quite a few places but mostly so as president of the walmart foundation and present of the global development program and coo of the bill and melinda gates foundation. we are pleased to cosponsor this

event, and i will now hand it over to julie to get the program going. >> good morning. thanks ago for being here. thank you, madame secretary, for being here. i'm going to ask moderators open question and i'll open it up to the audience. we do have tv cameras here, so please wait for a microphone to get to before you speak and please identify yourself and your news outlet when you ask a question. madame secretary, i think pretty much anybody in this room still has ptsd from last year's open enrollment. what could you say to reassure us that we will be having a groundhog day when november 15 rolls around? >> well, in terms of that i will also remind everyone that a year ago on this date i was doing a government shutdown in terms of these questions and ptsd. with regard to open enrollment, i might start with a broader lens and come to that issue specifically are in first of course want to thank kaiser, thank you, julie, for moderating

today. as i also should mention ebola. i think for me to be her i'm sure we will have some questions about that issue. it is one that we are working on deeply at the department, and have been for many months actually in terms of the issue working across the department from the office of global affairs where we of someone actually embedded at w.h.o. from the hhs team. all the work you're also very with the cdc is doing, there preparedness at home and attacking the epidemic at its center in west africa. i am at the end of my first 100 and a. those onegotten to hundred days to recall thousand children in the care of hhs when aarrived, i am reminded of point in time before when i was in the clinton administration, when it was announced i would be

deputy chief of staff to erskine bowles. as many of you probably know, somebody said, don't you think sylvia is somebody who is too young for this job? erskine said a year is a dog year. i am not young anymore in terms of my first 100 days. but with regard to the affordable care act and how we are thinking about that and being ready for that, it's obviously one of the top priorities. when i think about the affordable care act, i think in terms of three measures -- quality, affordability and access. and this particular question about healthcare.gov and the marketplace is deeply focused on access. i think it's important to recognize when we talk about access that the most important measure there is the reduction in the uninsured. with regards to the access question, that's why the legislation was passed. when we think about what is the

measure by which we should judge ourselves, it's the question in the reduction of the uninsured. the marketplace is a very important means by which we get there, so is medicaid, so is employer-based coverage. so with regard to the marketplace as we go into it, i think there was a conversation even here yesterday about these issues. there were a lot of lessons learned. and those lessons were both positive and negative. in terms of some of the positive things, we learned a lot about how the consumer behaves and reacts in terms of the consumer works up against deadline. we learned a lot about the importance of sound technology. and from those lessons have put together a plan that we are working on every single day and have been since the day i arrived and before i arrived. as part of that plan, there have been a number of pieces. one, prioritization in terms of deadlines we're meeting on a day-to-day basis. second, i think i many of you know that we have focused on management as a part of that going forward.

many of you, i think, yesterday had an opportunity to spend time with andy slavitt and loy lotus. those are new additions to an already-strong team, and finally we are, obviously, deeply focused on technology. so continue to make progress every day and are looking forward to continuing to do that day by day. we're deeply focused in quite a bit of detail. >> well, before i get to the audience, i have my own question which was that last month the gao put out a report that suggested that plans were not necessarily doing a good job letting people know when there was elective abortion covered. this was, obviously, one of the last issues settled when the law was enacted. there's supposed to be one plan that doesn't have abortion coverage, one plan that does. apparently, that's not necessarily happening. what is the department doing to make sure that all gets straightened out? >> so, first, i think it's important to reflect that with

regard to the federal law and the issue of federal funds, there are no federal funds being used for abortions except in the cases as the law states, rape, incest and questions of life of the mother. and i think that's an important part in this context. with regard to the issue that's been raised, it's one where we believe we need to be sure the law is being enforced, and right on the ways we're going to communicate with states and insurers. >> will this be straightened out for open enrollment? >> working through the plans are in place, you know, for the most part we're finalizing those plans. so in terms of how the communication is going to work, we'll have to see how quickly we can get the communication out and where we are, because i think the gao report was actually based on a previous year's plans, not this year's plans. >> ok. let's go to the audience. or right here. no, wait for the microphone.

>> maureen with "the indianapolis star." the governor said there are still disagreements after that meeting. what are the disagreements and how confident are you that you're going to be able to reach a deal with indiana to expand medicaid? >> with regard to the issue of medicaid and medicaid expansion more broadly, i think everyone knows there are 27 states plus d.c. that have done the medicaid expansion. we're in conversations with a number of states has has been purr purported, and each of the stated as we think about this issue and are working with each state individually, there are really two things that are the guiding principles of these conversations. the first one is that it is important to listen hear the needs on a state-by-state basis and the needs of indiana and how that governor is approaching it are actually different than tennessee which has also been reported and utah which has also been reported in terms of my conversations with those

governors. that is where we are having the conversation. the governor and his team have over a period of a year in good faith on this effort. i think everyone is coming to the table with a real desire to make progress, and we're going to continue to work on that. >> wait for the microphone. >> thank you. dena jones from cnn. it's a compound question. you touched on ebola, so just is on health care sign-ups, do you have a goal that you can share for this year in terms of number of sign-ups, and i guess i'll turn to the number of reductions in the uninsured, is there a target goal, and on ebola, we all know this temperature screening at some of the major airports in america going to start, but what do you say to people who argue this is in some

cases all sort of for show, to calm the public's fears since many, many people could still make it through given the 21-day incubation period? >> so with regard to the first question about our goal, our goal is for the consumer to have a quality experience in our open enrollment period, and we will continue to try to move those uninsured numbers and to maximize our ability to do that. with regard to the question of a specific goal and the numeric goal, one of the things -- and there is a cbo number that exists, a 13 million number -- that is based on a trajectory that eventually gets to 25 million. and i think one of the things that is different from when that number was originally put out is now we actually have information about what happened in the first open enrollment. so how one thinks about the slope of that line over a period of time is something we are analyzing and working on, and working on from this perspective. a top-down number is how you get to reaching a specific number out there, but now we have data

and information, and we want to try to build that number bottom up, based on what we know both on those that did enroll and information we learn from that. so that's something we're continuing to work on with regard to that specific question. in terms of the issue of ebola and how we are thinking about the issue of homeland preparedness and making sure that we are ready as a nation, as i think has been made clear by director fauci or -- tony fauci or dr. frieden, the important and most important place with regard to taking care of screening is actually at the point of departure. and that's been in place for many months. and as we know, we have a case, you know, and that case, sadly, is deceased. but for many months did not have a case that entered the country. and we know that screening has worked in the sense of 80 people have been pulled from the lines and stopped in the home country. that's the most important place for us to do that.

the next step with regard to preparedness as we've discussed is having a system that can handle any case that we have, and we have had one case. and i think there may be other cases. and i think we have to recognize that as a nation. and that's why the preparedness of our health care system and whether that's the fact that 8,000 health care providers have been on cdc webinars or the fact that literally hundreds of thousands of health care workers have been communicated through our health alert network and the seven separate directional documents. those are the most important steps. at the same time, we continue to evaluate and add steps that we think are helpful both to fight in west africa and to care for our people. the question of the screening we'll be doing at this period in time, there are a couple of things that we know and believe, and that is it's the importance of asking the question, how a person may answer a question at

the point of departure versus the point of entrance may differ. the second thing is the true, it is a period of time of travel. there is, there isn't -- and i don't think we're making a claim that anything is 100% secure, but what's most important is we know, we know how to contain, and that is detect, contact tracing, isolation and treatment. and that was what was implemented, and we've seen implemented in dallas in terms of the tracking of the folks. so we will continue. and, yes, confidence is an important thing, but there is also what will happen in that period in terms of the questioning and what will happen in terms of that period of time when a fever could occur. oh, sorry. >> back over here. >> hi, thank you. chuck ross from "the post-dispatch in st. louis. another open enrollment question. as you know, there are, there

were three facilities around the country that were processing paper applications during open enrollment, and one of them was in suburban st. louis, and there were allegations there that there was little work being done there. i'm wondering if you can talk a little bit about it, have those situations been cleared up, have they been fixed, and have you gotten a better sense of paper versus online applications as you go forward in the new open enrollment period? >> i think what we are hopeful is that we want things to happen and occur online as much as possible. in terms of -- but one of the things we're focused on deeply is the consumer and the consumer experience and want to make sure that we have alternatives and places for the consumer to go. and whether that's consumers' ability to work with navigators, some people want to work with a person to do this in terms of this is new and they need help, other people want to go directly on. for example, yesterday we previewed 2.0 which is, actually, out and in the space right now in terms of the

special enrollment period. and we think that tools like that will help people who want to do it online do that more. so we would like to see more people online. we will continue to work to insure that consumers -- and consumers have different needs. there are consumers, you know, why it's on a mobile app is because we know that many of those young people that are in that gap use mobile applications. that's why we've tried to move that to a mobile device. we also know that in terms of the latino population, that actually there's deep penetration of smartphones, deeper than the penetration for the nation as a whole. so what we're trying to do with regard to the question of open enrollment is make sure that we're serving the consumer the best that we can in two forms. one, operational technology being sound, and that gets to questions that were discussed, i think, yesterday about testing. and the other is as much consumer ease as we can. will there be imperfections? yes. things will not be perfect. but i think what we do know is that we are aiming for a strong consumer experience, and it will be better. >> over here, in the back.

>> nancy metcalf from "consumer reports." we saw in the first open enrollment period a lot of people signing up who really had low health insurance literacy. and a couple of problems i saw crop up, one was people who would have been eligible for reduced cost-sharing silver plans never knew it because they never got past the full screen of bronze plans and ended up with plans with much higher deductibles than they were really entitled to. and the second is the inability of people to really -- and this is not a surprise, i mean, it's been talked about before -- really figure out who's in their networks. and i just wonder if you have made or are contemplating making any improvements to those features of the user experience. >> so with regard to we are working across the board in terms of that user experience and making sure that people are

educated about how to go on and how to shop. i mean, one of the things is this is a complex space to begin with, and you mentioned that many of these people have not been in the market. i think if i went person by person and said what is your premium, what is your deductible, what is your monthly premium, what is your deductible, the people in this room are the single most educated people in the nation with regard to health care, period. you know, you all are the people that write about this every day, you think about this every day. and for me to even, you know, go through and tell me your co-pay, for every single individual, i think we might have some gaps in terms of each of you. and so i think we have to put this knowledge question in the context of where we are as a nation. i think we believe that the marketplace is going to, hopefully, move those individuals you're talking about, but i think this question of us as a nation and how educated we are which takes us to an important issue which is the issue of making sure that we

have high quality care and affordable care. some people call that delivery system reform. so we are working to do that. in terms of the ways that we're working to do that, our stakeholders are an important part of that education process. having met with them myself several times, whether that's enroll america or the groups of stakeholders, that as we talk about and as they are doing outreach with regard to enrollment, there are two additional pieces of outreach they need to do, enrollment and reenrollment, but they need to do use and shopping, education, and the other thing -- and that's on the website for the marketplace. but the other piece that is an important thing that's the next step is making sure people know how to use the care. and i think that's another part of what we're doing. with regard to this question of access to providers, we are working with the insurers to make sure that when you click through in a plan, that there is a place where you can click to get to that provider list, to try and create some ease. i think this is a place where we are all going to make steps,

we're trying to make steps step by step as we go, but i think your point, actually, is about the marketplace, but it is a broader point. >> bloomberg bna. are you tracking the number of policies that are being canceled because they're not compliant with obamacare, and or what are your expectations for getting a more normal risk pool this year? >> with regard to the issue of cancellations, that's an issue i think you probably know that last year we put in place a policy that would leave both states and insurers with the choice of extending till 2016 as a transition period to try and create a place of transition to get through issues that were raised last year. at this point a couple of things. one, we obviously think the number is going to be much smaller number than last year.

i think we need to recognize that the issue of cancellations, again, in the marketplace before the affordable care act there are policies being canceled in employer-based care. insurers do that. and so there's the question of what's happening in the regular marketplace and then those plans that need to come into compliance with quality health plans. we believe, we put in place an alternative for transition. we are working with insurers so where there are those situations, do they have another plan that is an alternative plan, and are they communicating that clearly? so working through the issue, i think that there will be a smaller number this year. >> the issue of -- [inaudible] >> with regard to the question of the risk pool, i think when one sees that we have a large increase, 25% increase in the number of plans and insurers coming in to system this year as we announced recently, i think that is a reflection of the question that the risk pool is

something that, obviously, the insurers believe is a risk pool that works for them economically, or they wouldn't be entering and putting plans in the marketplace. >> in the back. >> i'm jim landers with "dallas morning news." i had a question about the transparency initiatives of the department. you've just put out an open payment system for the links between doctors and pharmaceuticals and medical device companies. you've had on the web for some time now medicare and in-patient and physician charges. there have been problems with the open payment system on the drugs and device links in the last week, but as far as the other ones go, the hospital systems say that charge masters really aren't relevant to anything that's actually paid in the hospital system, so it's not really a good indication of what those prices are.

what are you doing to strengthen the transparency that cms is providing the public about these things? >> so continue to work and respond to comments. as you mentioned, when we put the first set of information out, one of the things we heard was making sure that the information has context. so when we did the most recent release, tried to provide more context both in terms of the release and anything about that. i think the issue of transparency, when we think about where we were four years ago with regard to the question of transparency -- and it goes back to our consumer report question a little bit -- the issue of what kind of transparency people have even about benefits in their plans and the transparency that people have now that they know what a qualified health plan is and what those benefits are and those being clearly stated. across the board in the health care space -- and whether it's around the provider information,

around the consumer information -- we are trying to move on all fronts. it's also related to electronic medical records in terms of the transparency that an individual can actually have about their own health care. and so with regard to what are we doing, we're working, actually, on all fronts in terms of trying to move the information forward so that both consumers and providers have information that they can make decisions about and that we create a transparent marketplace where decisions are made. can we improve it, should we improve it? yes. when we hear the feedback on this most recent elements of open enrollment, we want to do that. one of the decisions that we had to make and i had to make the decision is the information wasn't perfect. in the most recent rollout. there was data that was not as clean, and so we had to present some of the information, couldn't present exactly all. but made a decision that it was better to get out a large portion of the information so that we can continue on this path on transparency. the transparency path, because

it's new to everyone, it's going to take us time to get there. we need to continue to evolve. but i think we think it's an essential part coming back to a point i just raised which is the importance of information to decision making to getting to a place where quality and affordability we drive towards that. and that is about delivery system reform. >> hi. i'm from "the washington examiner." i have a question related to the risk corridors which is that a few months ago you had issued guidance on the risk corridors saying that if the -- in-payments weren't enough to cover the out payments, that the hhs would find other sources of funding subject to appropriation. and as you know, the gao just released a legal opinion recently saying that, basically,

that depending on which language congress adopts that hhs won't be able to make payments unless, essentially, the appropriations language allows for it. and so i just wanted to get your understanding of whether or not hhs will be in a position to make payments in fiscal year 2015 if congress doesn't put in language allowing it. >> i think that there is a distinction between what happens at the end of the program and the current approach we have to the fee-based structure that the gao was talking about. and so with regard to we don't have concerns in the upcoming year, and as we've said and said in what you're reflecting earlier, we will work with the congress if there are needs in terms of this question of appropriation. so don't think it's a question that will need to be faced right here in 2015. if it ever does become a question, i think we've been clear we'll work with the congress on any additional

language that we need. >> back over here. maggie? >> maggie fox with nbc. your style and the style of your predecessor has been very different in terms of handling crises than the previous administration. you've had to deal with the crisis of the rollout of obamacare and now the crisis of ebola. i remember during the bush administration hhs was very much in front. you're taking a backseat this time. are you happy with that strategy, and will it continue? >> i guess i would start by saying i would like to understand definition of a back seat. i have an ebola meeting every single day since july 28. i usually have three a day. >> can you tell us about that? because the face to the public has been tom frieden who people know and trust and tony fauci who people know and trust. we haven't seen secretary burwell. >> so with regard to the issue of ebola, i think everyone knows

the nation is frightened, and people are frightened of this disease. they're frightened because it has a very high mortality rate, they're frightened because they need to learn to understand what the facts are about that disease. and thinking about people and trust and who you want to hear that information from, tony fauci as he said on friday, i think he said 38 years in terms of his work on this space. dr. tom frieden has been, whether it's his work in new york or his work at cdc. and when one has such high quality, experienced physicians and infectious disease experts, you know, dr. frieden also has an mph, a master's in public health as well. for me, that's why i questioned what you meant. i think what you're suggesting is who is on camera often versus the question of deep work on the

issue is something that i consider my responsibility and do. and whether that's on a day-to-day basis making sure that our teams are working on this issue internationally or working on the domestic preparedness, that is something that i consider my responsibility. with regard to the voices and the voices on a day-to-day basis, i think it is important to have the experts that we have and we're lucky to have in our federal government working and speaking about the issues. >> back over here. >> jay hancock, kaiser health news. we've written a couple stories about hhs' minimum value calculator which, as you know, is certifying as minimum value plans for large employers which do not include hospital benefits while at the same time foreclosing the employees who were offered these plans from

getting subsidies in the exchanges. and a lot of people are wondering if this is something that the administration intended. and so far we've had no answer. can you talk about that? >> this is an issue i'm going to be honest and say not familiar with this one in terms of the minimum value calculator and that. i think the one thing i would say is i think you know the issue that the administration is deeply focused on is making sure that people have access and the issue of affordable and quality access. so within that context -- >> well, these folks don't -- they don't have access. these plans don't have hospital coverage. can i get back to you, to somebody in your office -- >> welcome to. we're happy to follow up. >> and who should i be in touch with? >> think right now -- i think right now ben will follow up with you. >> ok, great. thank you. >> uh-huh.

over here. rebecca? >> hi, i'm rebecca adams with cq roll call. i have an ebola question and a medicaid question, actually. i wondered since you are so deeply involved in the ebola issue, can you give us an update on the work that's going on at nih or whether there'll be additional deployment for public health workers overseas, and what do you anticipate in terms of needed funding that you may need to ask congress for after the cr expires? and then my medicaid question is about backlog which we've seen in applications, states such as california still have an enormous backlog, and i wondered if you could address that. >> i'll do reverse order. with regard to the medicaid backlog, that is something that each state and the regions in each state are different, and so that is something that we actually -- it is retail. and so we work state by state by state and are working through that on a state-by-state basis, continuing to work with the states on their plans and how they're going to do that.

i think many people know we sent certain types of letters to different -- if you follow the issue, you probably know we sent those letters. and in terms of sending clear signals about the level of import. and we continue to follow up. as i said, it is retail. because each state actually varies as to why there are issues in the backlog, and we are working on literally a state-by-state basis to clear it. with regard to ebola and where we are, i think i welcome that someone has brought up the fight in west africa, because that is where this has to be taken care of. that is what we need to do, and that is where there isn't the public health system in place to implement the things that we know can contain ebola. with regard to the progress that's being made, i'd also reflect that when you look at nigeria and what nigeria was able to do in terms of their capability to contain, that is a place where we have seen it

work, and we've seen it work in a developing world system. certainly, nigeria had a also the advantage of there was a lot of polio infrastructure that was transferred to be used in terms of the contact tracing and some of those efforts and had experience in terms of emergency operation centers and those kinds of functions, and we see that. with regard to progress on the ground, i think as you know the u.s. military just started with the largest deployment for cdc, we also are the large d.a.r.t. which is the disaster and response teams that we usually use that are led by usaid and now have brought in, you know, the command and control that comes and the logistical capability that comes with the united states military. they are on the ground. progress is being made in terms of the construction of ebola treatment units, in terms of the construction of the 25-bed medical unit which is an important part of attracting health care workers from around the world to be willing to come and serve there, continuing to get the training up and working

which dod is doing, and dod has also already deployed labs. several of the labs for the testing, and that's an important part of the detection. so continuing on that line. at the same time, we are also working with the countries and who on doing community-based care. it's not a full ebola treatment unit, but during this interim period while we are getting those up and running and for people who may not have access, making sure that there is community isolation. and so that is the other piece that's being worked on. there has been progress on burial, and i think as everyone is sadly focusing on here in the united states today, the issue of ebola spreading even through a deceased's body is an important one. that is a place we are making

progress. that has to be a behavioral change because for many, the burial process, which is a cultural issue, generally involves touching, and that is something we have had to work , but there is being progress, progress being made. the numbers are going to increase before we can get to a leveling-off point. but right now what is most important is that every day those on-the-ground efforts that there is urgency. it is about days. every day makes a difference in terms of the number of cases that are contracted. and so there's great urgency on the ground. at the same time, i think we're all very focused on the urgency here at home. and yesterday, i think you all know, president did a call -- i was on the call -- with governors and elected officials across the country. dr. frieden did another one with statehouse officials. the urgency on both fronts, make sure the country is prepared, but we have to work every day to make sure that we are standing up the capability for these three countries to handle this.

>> good morning. bloomberg news. i wanted to ask about the other plague that's in the news right now, and i think the one that's a little scarier to parents in the united states particularly, enterovirus. what does your department know about how this outbreak began, and what is your department doing to develop either treatments or understand any linkages to paralysis or other serious outcomes? >> so cdc is doing its traditional tracking and working with health departments across the country to understand when there are cases and make sure that the appropriate testing to understand, you know, when there are likely cases, whether it is that virus or not. and so that's step one. and we are doing the tracking that we do in terms of the numbers and the numbers by state and the numbers by locality so that we have an understanding of that. the other thing that cdc is doing is communicating clearly

about the things that we believe are most important, and i would just encourage everyone in this room to step up your hand washing, and if you have children, to make sure that you are encouraging that kind of hand washing. that's one of the basic things, but it's something, you know, before the meals, before everything, making sure we're doing that. cdc's communicating that. the last part, and i think it gets to the core of your question, cdc is working with the individual health departments to do the investigatory work to understand in these cases are, you know, whether it's the question of paralysis or the question of death, is it directly related to the virus or something else. and so we are part of that investigate process to term -- process to determine those things. so cdc is doing its traditional work that we do with public health while as you're appropriately reflecting there's much focus on the ebola issue, our teams are deeply engaged in this issue. >> [inaudible] determine the origin of the outbreak at all? >> that's a question i would

defer to dr. frieden. >> over here. >> i'm mary agnes kerry with kaiser health news. just a couple questions about healthcare.gov. you talked about how consumers' public response to deadlines, what are you doing to make sure you don't have problems at the beginning and end of enrollment, and could you talk about the building of the back end? that has been a problem before. >> so with regard to the question of load, that's something that i think was spoken to a little bit yesterday by andy which is we're doing a lot of different kinds of testing, end-to-end testing which is something i think most people focus on. but one of the types of testing we are doing is load testing, and that is about trying to test the system with different amounts of volume to try and address the issue that you are raising and to make sure that we're appropriately prepared for surges that would occur. with regard to the issue of back end, as we work through -- there

were a number of things the back end, you know, parts of the back end worked in terms of -- that were happening last year, and there were other parts of the back end -- i think you're probably referring to maybe payment issues or those kinds of issues, and we are continuing to work on those. some of the back end issues are around the irs issues that we'll be doing, continuing to make progress on each of those issues in a sequenced fashion. as i mentioned before in the beginning, we are prioritizing as we go through, but continuing to make progress on these back-end functions and whether that's the database lining which some folks here have asked me questions about before. we continue to work with with insurers and our own systems.

>> if i could follow up before we go to the next question. can you give can us an update on the people who still need to get in documentation as of the end of last month? how many people have actually been cut off and how many people are going to have their subsidies changed? >> two different categories. one is the documentation related to that, and we are continuing to process that information because i'm sure you can imagine that more paper to the deadline point that was just raised, more paper has come in. same thing with the income. when we send out the letters that say things will change, that's when we start to get the documents. we're in the middle of processing those, want to get all of that processed as much as possible before we get to open enrollment. so we'll have final numbers, but the numbers continue to go down from the numbers we made public. what we tried to do, and this is to the transparency point earlier, is put out the numbers. the numbers, you know, 115,000 letters were sent on the immigration front. that number will come down. similarly, you know, the number of the starting point, it was 1.2 million households that had income issues. well over 800,000 of those were resolved, and then we sent out letters to that block, and we're processing what we've gotten in. >> have you actually cut anybody

off or changed their subsidies? >> with regard to the question of subsidy change in the cutoff, i think in terms of how that will be implemented, it is over a month-to-month period over their cycle, so i think that also has to do with insurers and when they would do that. >> hi, ricardo saldovar with ap. the focus is on people signing up for the first time next year, there's a lot of focus on that. but i wanted to ask you, what are your goals for retention for the people who are already in the system? what are your goals for a satisfying consumer experience for those people, particularly since for many of them automatic enrollment may not be a good option since costs of their plan, the premium and their subsidies are going to change?

so can you lay out for us your objectives for retention both on the consumer experience and the kind of percentage share of retention that you want to see. >> reenrollment, i think it's important to raise because i think as we think about the system and going through the process, i think people think this is year two. it's not year two because of the point you just raised. this is the first year that we will have reenrollment and enrollment. so it is the first year through the cycle. and to be honest, when we get to april, it's the first year of the reconciliation cycle. so this is the first full year. and i think the focus on reenrollment is something that we are really focused on. as i said earlier on the question of the analytics, when i think about the 13 million number or whatever number we think is the right number, we

have to derive this number too. so right now we are working both with the insurers and their analytics on this as well as our own analytics on what percentage retention we think will be there. that's going to be a part of this overall of what we think our final numbers will be. so don't have a specific number on that. continuing to work through to try and get to the right place, and that right place is based on this is a new product, this is a product as some have reflected hasn't been used and trying to get to that right number. with regard to the deep focus on making sure that two things happen, that people who want to do auto-enrollment are able to do that in the easiest way possible and that for those we want to encourage those to go in and shop because that's a part of what the marketplace is. our communications are targeted toward exactly what you just suggested which is making sure that people know the importance of going in and shopping. and i think it was outlined yesterday, and i think we're going to spend time and come back and probably, i think, ann kevin will

both be talking further about the specifics of the reenrollment process, but let me say a few general things which are our communications are going to be targeted on encouraging people to come in, because i think we believe it is best if they can go in and make sure they shop. that is the idea of a marketplace, to make sure you get the best keel. i think kevin mentioned we want to make this as simple as possible, and doing simplified instructions that are easy, usable and very simple are an important part of this process. the other thing that i think is an important part of what we are going to do to make sure that the consumer has an experience and makes it easier for them with the question of reenrollment is making sure that they have alternatives. different people will want to do this different ways. some people are going to want to put in their plan and go shop. some people are going to want to auto-enroll in their own plan. some people are going to want to use help and guidance, so making sure we have different avenues because one of the things that gets reflected as we get into these questions of how people go in and what they do, different people have different needs, and we're trying to meet as many of those consumer needs as we can.

>> are you going to prominently tell people who are being reenrolled that their subsidies might change, they might get a better deal if they shopped? >> yes. yes. that will be a part of the communication pattern that we will do. and the communication will start with marketplace communication and insurer communication as open enrollment starts and then will go through that period in terms of making sure that people know and understand that. and people who are auto-enrolled will also get communication so that they know that they still have an ability to go in and change even after that point while we're still in an open enrollment period. >> diane. >> i wanted to know -- i'm sorry, diane weber, kaiser health news. we saw a big difference in states that had an insurer who sort of actively did a marketing plan like in florida,

healthcare.gov states that had an active insurer on the ground versus states like iowa or south dakota where the biggest insurers sat out of year one. what do you know about insurer'' marketing plans to try to reach these customers, and, you know, what can you tell us about them? are they stepping up and planning to put the information out there, too? >> so with regard to ininsurers, i think it is, you know, the reflection that for those insurers who aggressively pursued market share, one saw the impact and results of what they did. and i think that is something that, you know, it is at least our understanding from our conversations with insurers that they are thinking about. and i think different insurers are thinking about different ways to go about that both in terms of the issue that was mentioned in terms of reenrollment as well as the issue of additional open enrollment. and i think they are, as they

would do, as they each have their own marketing plans in terms of how they're going to go about doing it because it is about competition in term of how they market. so it is our sense in conversations with the insurers that this is something that they are each individually thinking about how they maximize. >> are you pulling some progressive ones in? [inaudible] >> you know, we are encouraging whether it is our stakeholder partners or our insurer partners to be partners with us as we go into open enrollment. and that has to do both with reenrollment and how we communicate. what we're trying to do as much as possible is communicate with the insurers in this case on what we are communicating on. our communication materials in terms of what they will contain so that they know what we're doing, same thing with the shareholders, so that their efforts can be complementary in terms of giving people good information about reenrollment which is a challenge for people who are not part of an insured population as well as those new people to the marketplace.

so thing that we're trying to do most is make sure we have clear communication. >> joyce frieden, med peach today. one of the things that's come up with the plans on healthcare.gov has been the issue of narrow networks, some plans offering only one hospital or very limited choice of doctors. i know some states are developing or the naic is developing a model standard for what constitutes a network, but i wondered if hhs was thinking about putting in any more standards for that. >> i think as you appropriately reflected, the role of the state insurance commissioners in the regulating of the networks is the place where there is the core fulcrum of the point. we want continue to listen and understand how the marketplace

is working. we are hopeful that will increase the diverse at the of the plants in place. it is what we will continue to listen and understand in terms of how people are behaving in the marketplace as well as we continue to look at what is going in the marketplace that we understand how consumers are behaving, but providing support we can't efforts of state insurance commissioners if they have questions or need help as they are thinking on how to work through this issue. >> cnbc. where do things stand on the ,ssue of direct enrollment being able to enroll subsidy qualified individuals directly without having to go to the interface, healthcare.com?

we heard multiple promises that was going to happen. ofin terms of the specifics where they go through, that is a andy to i will defer to make sure what they are able to -- anderms of the whether they can do it them selves. with regard to the welcoming of brokers and intermediaries as a part of it, this is part of the system and we think it is an important part of the system. kevin mentioned yesterday we think it is something that we welcome. with regard to our ability to make armrests on as many fronts as possible in terms of integrating from a systemic -- there is a downs on consumer friendly lists and making sure

the functionality is there with regard to making sure we have the testing space. as we have made decisions about what we can accomplish this year, it is the balance of those two things. >> i wanted to know if you can give us a status update on some of the states that ran their own exchanges, as far as state transitioning to the federal platform, their own technology, where do you things -- where do you see things as far as stabilizing? >> there are a number of states in a number of different of statuses. statef the states on a estate acis come again, this is another one that is retail because of the difference in each of the states. we continue to work on a date racists and whether that is

making sure folks in nevada have an opportunity and how they are going to reenroll as we work as the states like massachusetts and maryland making sure their systems are ready to function. where working on a state by basis tois is right -- provide support. what we do is continue to track it and work with each of them directly. the issue of communication and is aty is one that i think tool that we are trying to use from a management perspective in terms of being clear about what our expectations are and making sure we are communicating with them about what their expectations are of us, where we have, which reflects that point where we have crossover with the states that have those challenges. >> are you confident that the states that had challenges are all going to work starting november 15? >> we are doing everything we can to insure and have asked the questions. we work with them on a day by day basis in terms of the different types of progress. for different states there were

different issues, and we continue to work with them on a day-by-day basis. >> arthur allen for politico. i wanted to ask a slightly more obscure area of policy, but on health i.t., there's been a lot of dissatisfaction expressed by some provider groups, the ama, about the meaningful use program, and there's also on the other side a lot of concern that these health systems and computers and hospitals aren't talking to each other as well as we'd like yet. and i'm just wondering whether things have reached a point that you've considered any sort of -- in talks with the onc or cms changing the focus or altering the meaningful use program, incentive program at all. >> i think that steps have been taken in terms of some of the issues that were raised in terms of the timetable and trajectory and slope of the line with

regard to the issue of meaningful use, because we have heard some of that feedback. so that, i think, is a step that has been taken. i think what's a challenge here, and it gets to the core of the issue, what we need to get to is interoperability in order that we can get to the point of, you know, when i first came to hhs and everyone was meaningful use, you know, those words -- the idea that once we can get these systems interoperable, that's when you get the real value. you get the real value as a practicing physician, you get the real value as a consumer. and that's the next step. at the same time, as we're trying to move forward, we're receiving comments and pressure to slow the implementation. and so this is a push-pull as we're going through change. and so what we're trying hard to do with the office of the national coordinator for technology -- i don't know the onc doesn't seem to be very meaningful, don't follow this as closely as it sounds like you

do -- but what we're trying to do is get that balance of hearing the input that we're hearing about slow a little but at the same time move as quickly as we can to getting over the hump. because that's when -- we're starting to see some of the value of electronic medical records, but the real value comes at that point in time. and that's also the point in time which we're going to see the changes in, that will help with reforming the way we deliver quality in the system. and so this is an important part of it. a couple of weeks ago i spoke and spoke with the brt and did several things around the issue of delivery system reform, and this is one of information and what you have raised has to be one of the fundamental anchors of that change. so right now what we're trying to balance is that pushback on speed, at the same time continue moving forward.

>> thank you. cleveland "plain dealer." on the subject of provider networks, it can be quite a task for the consumer to go on healthcare.gov it becomes quite a process. you look at price, these plans my doctor int is there, is my hospital in their? concern --e any >> we asked the providers to list that on their networks, and updatedthese issues are and it is the providers that

provide this information, what we do is link to that. that's how we are getting that information, trying to get access to that information for the consumer. >> but, again, not all are equally transparent, i'm finding. >> continue to work with the insurers on their levels of transparency. i would say this is an employer-based issue in terms of the entire market and gets to this broader issue of transparency in the entire health care space. and i think as we look because we are driving and the marketplace has so many questions, we are driving and pushing this. but i think the issue you're raising is an issue, that lack of transparency, if there is lack of transparency or varying levels i think as you described it, is something that is an issue across the board. we're trying to encourage, and because we are doing the links, we're hopeful that that is going to encourage the providers to provide the information for the consumers that they need for decision making. >> right here. >> hi, jayne o'donnell with "usa today." doctors and hospitals say that with the increase in high

deductible plans that they're seeing people wait longer and longer to get treatment, and they're seeing an uptick in things like later-stage cancers. do you think the middle class is actually worse off while the poor are better off with their plans, and what do you think that's going to portend for the nation's health? >> with regard to the evidence of that, that's something that, of course, we will want to see if there is evidence of what you just described. i think what we do know with regard to the question of the broad middle class -- and this is an important part of what the affordable care act did -- is in terms of prevention and screenings and the things that actually are very important to preventing some of the conditions you manage, that because of the affordable care act people will have access to those and access to those in a number of cases without payment. without co-pays, without any kind of thing. so when i spoke earlier about the importance of making sure that people understand how to use their health care, that was a comment that was actually not just about those who are newly entered into the marketplace and newly insured, it's about

everyone here. again, the most educated group, i'm in a room with the most educated, and if i asked everyone to write down the top six things that you can get to do because of the change in the affordable care act, i think it's a reflection of we do need the education to make sure people know and are taking advantage of that for their own health care. so with regard to the increased access, the other thing is for many women the issues of plans that could charge more more women because of their different health care, that's no longer there, and i think that's an important middle class issue. for middle class people, if any of you chose to make a decision to change your employer right now and there is anyone in your family that has a pre-existing condition, you can now do that without fear that you won't be covered. and so the questions of the benefits with regard to the middle class and even those who are in employer-based systems are something that i think we need to spend time focusing on both in terms of educating people about a what it is that are the benefits of the

affordable care act. >> i'd also like to ask about the consumer experience. >> introduce yourself. introduce yourself. >> i'm jeff young with the huffington post. a little over a year ago the president, your predecessor, everybody down the line talked about how wonderful the shopping experience was going to be and how great the website was and how the call centers were all staffed up and people were ready, and that turned out, to put it briefly, to not be the case. so, i mean, what can you say to assure the public that this time what we're hearing now about how the website's better and the call centers are ready is going to be true? >> so i want to be clear, i think that what we have said is that the experience will be better. we have said that it will not be perfect. we know that, and we know there will be issues that will be raised as we go along through the process. in terms of the question of the

evidence and where we are, i think what we can say is yesterday you saw an application that is up and running that was tested since july that reduces the number of screens from 76 to 16 in terms of an application that while not everyone can use -- and it is for those who are newly enrolling -- that we see that we have that and have that in place. the second thing with regard to the experience, because i think there are two elements to the experience as i said, one is the actual functionality which you were reflecting was problematic as well as the consumer experience. and that's an example on the consumer experience side. on the question of the functionality, i think we've outlined in detail and spoke to this yesterday, i think andy spoke to it yesterday with regard to the testing that we are doing to insure that the functionality has that capability and whether that's the end-to-end testing, the alpha testing, the functional testing, the load testing. and those are the pieces of

evidence that i think we reflect. i think yesterday what andy said is very true, what we want to work on is not talking about expectations, but about results. and that's what we're focused on as we work through this time in this process. >> so as secretary, you're confident at this point you have a firm grasp of exactly where things stand, because a part of the issue last year is it seemed like the people at the top of the chain didn't know that the website wasn't going to work. >> what i have said and will continue to say is that every day we are working through the deadlines that we have internally to get us to what we have said which is a good consumer experience for open enrollment. and each day we do that, we work through them on the technological side, we work through them on the consumer experience side. >> we have time for one more question here in the back. >> hi. susan jaffe, kaiser health news contributor.

if consumers really do the homework and track down which providers are in which plans, providers can and do drop out during the plan year. other than requiring advance notice -- and i'm talking about marketplace plans as well as medicare advantage plans -- other than requiring some advance warning, what can hhs do to address this problem, especially since so many plans have, you know, very limited provider networks, so if your doctor leaves your plan, you may not have a whole lot of options in the middle of the year. >> this is an issue that works across the entire employer-based system, and so it is an issue for the entire system. it is not simply a marketplace issue. and that is a decision that providers make. and so our ability to control, you know, the insurer and the provider, what we want to do is create a marketplace and that the competition in the marketplace will drive consumers to make choice and decision.

one of the things that we saw last year in terms of what consumers, many consumers make their decisions on -- and you see it in the private employer place -- is actually they do make that decision often based on price. and so as we continue to move forward, we're going to learn, and we want to continue to learn what the consumers are making choices on and have that income how we try and shape and influence. but much of this is -- it is a marketplace. it is an open market, and that is a part of the system that we have and that we support and work within. regulates these plans, so if your dr. leaves the plane, should you be able to leave? a question i have not heard raised before in terms of that specific issue. as we work through this and understand what the consumer actually cares about and wants, those are things we will

incorporate in their, i think -- in there. >> thank you very much. i hope we do this again soon. >> thank you for having me. thank you very much. [captions copyright national cable satellite corp. 2014] [captioning performed by national captioning institute] hill," a from "the story about the ebola outbreak. hold ons been lifted a $750 million. a house committee member is blocking it. they say they are waiting for a plan on how that money would be used. theill keep you posted on c-span networks. today, campaign 2014

coverage continues from illinois and the race for the 17th congressional district. off in a rematch of their 2012 campaign. we will have that debate tonight at 7:30 eastern on c-span. or from illinois with the governors debate between the incumbent and the gop candidate. tonight will be their first debate. we will bring this to you vp in p torilla. we will have that at 9:00 eastern. night, aeekend, friday memorial service for president reagan's press secretary james rady. powell talksin about world affairs, and sunday to talk about how as a marine in vietnam a landmine explosion nearly killed him and changed his life.

c-span2, ralph nader calls for an alliance between parties to take on the issues that plague america. why an author:00, feels medical science should be doing more for the aging and dying. marketday night, free capitalism. theay at 8:00, c-span3, curator of the cia museum explains the museum's mission of presenting the agency's history. , king george's war. 8:00 p.m.,t, president ford's congressional testimony on the nixon pardo

n. let us know what you think about the programs you are watching. call us, e-mail us, or send us a tweet. join the c-span conversation. like us on facebook. follow us on twitter. week in the west virginia senate race, a debate .as held between the candidates they met in charleston. here is part of their debates. aca,uld you vote to repeal 160,000uld mean those west virginians would lose their insurance? >> i would vote to repeal and replace. hasso recognize the aca some very good things about it. making sure people did not get cut off for pre-existing conditions.

i was for that before the president decided take that on on a much larger and detrimental . keeping our students on until they are 26, that is a good thing. we need to keep what is good, replace it with what will work, get rid of the business mandate, making sure is is is are not % increase in their premiums. remember, the president, who i will remind you, said if you like your health care plan, you can keep it. that did not work out so well. a bill of goods, basically. we hear people who are losing their physicians, whose deductibles have gone up in thousands of dollars. it is unaffordable. i wish we had worked together some i wish we had worked in a bipartisan way to find a way to keep folks who are on insurance

medicaid, keep0 them ensure because that is important to us, not just to them, but important to us as a state. >> a response? here she goes again. i wish she says one thing and votes another way. she said she is for all of these but yet shee aca, has voted to repeal it. i won't vote to repeal it because i know what is like to go without health care. my daughter had open-heart surgery when she was a week old. many folks across west virginia prayed for her, and her prayers were answered. she is a happy 12-year-old right now. when my husband started our business, we wanted insurance. he said i talked to the insurance company, tried to get insurance, it the business and the family, and they said they

would not cover the daughter before -- because of her pre-existing condition. i was devastated because what their take something that parents cannot have. i will never go back to the days when insurance companies can deny insurance for someone with a pre-existing condition. for her to sit here and say she is for that, she has voted to take that away. >> recent polls list the race as leaning republican. you can watch the debate anytime online at www.c-span.org. a look at tomorrow's "washington journal." the recent response to the ebola outbreak and how to prevent future global health emergencies. then a discussion on the role of turkey when it comes to the fight against isis. and a look at the problem of domestic violence in america.

your phone calls, facebook comments, and tweets, all starting live tomorrow morning at 7:00 eastern on c-span. calledhristine lagarde on the u.s. to pass the imf reform package after a recent report showed china overtaking america as the world's largest economy. the package is before congress, but not yet ratified. this is 40 minutes. >> good morning, everyone, and thank you for coming today. and welcome to our 2014 annual meeting and we look forward to your questions this morning. i would ask you to be brief and we will try to do as many as possible. let me introduce to you this morning are managing director

christine lagarde. we also have with us to her right the first deputy managing director. without further ado, let me turn to the managing director for opening remarks and we will come to your questions of the room. these identify yourself before asking the question. legard?e >> good morning to all of you. i hope you are well and i would includewelcome not only you in wishing the business institution a happy birthday. and it is ars old, brand-new, relevant, energize machine, i can assure you. i will say a few words about the current economic outlook as we see it. i would like to say a few words about the institution first. , founded inrs old

1944, and i believe that it is not only relevant, but in a position to respond to the challenges that the world is facing. as a sign of that, i would mention a couple of examples. i said this morning in the theident -- with a love of members of the community looking at tried out the three western african countries that are hit by a bullet, i said for once, just for once -- by ebola, it is fine if those countries increase their fiscal deficit. this is not like the imf. david was a bit concerned, and i'm sure we have colleagues that were concerned. but it is an indication that we are capable of mobilizing , and others are going

to have to put grants on the table and significant numbers, but there are also resources where we are capable of revisiting traditional standards . we have done the same this year debtrning sovereign restructuring. this is a matter we have studied, where we have come up with proposals, revisions of certain clauses of sovereign bonds issuance terms, and we will continue to work on this issues. in the same vein, we are also sb following up in helping with profound changes and modified regulations applicable to the financial sector. there are areas where we would -- where we were not expected, and it is not bad to look at the fiscal side of climate change and what can be done about it, and we have made proposals.

subsidies inmoving a socially responsible way. we have made proposals concerning price setting and including externalities in the price of fossil i'll energies. -- fossil energies. it is also responsible in my view to assess the sustainability of growth in the light of strongly increasing inequalities becoming excessive, and therefore likely to hamper growth. it is not irrelevant either for the imf to look into growth and jobs and the inclusion of women in the job market. that some might argue are not absolutely core business, and yet we contend that it is part and parcel of

the mission of the imf to look at issues that are macro critical, but touch on topics that we are facing and that in many ways can be new or more acute. in addition to that, we do all the normal things that we have to do, so surveillance, multilateral, the intersection of the two, of course, lending, of course, and we have done more lending then maybe might have been considered. we extended a significant facility to ukraine earlier this year. we nee are negotiating with a couple of african countries that are looking for support. there are countries in transition that are also major clients of the fund. and the third areas where

business is extending, if i may say, is technical assistance, capacity building, and training. we have opened up our fifth training center this her, and technical assistance is an area where there is massive demand from all corners of the membership. it is with that background that 70thted to wish us a happy anniversary. now, moving to the more traditional comments that you might have expected from me, for those of you who have seen the ook, asconomic outl you know we have trimmed our 3.3%ast for 2014 and 2015, , 3.8% in 2015, and what we have noted clearly is more and more countries' specificity. it is not a group of countries

countries ored emerging markets recovering where others would be lagging behind. within each group, some countries are ahead and others are lagging behind. in the advanced economies, the dusty recovery is driven by the united states and the united kingdom. in the emerging economies, you have reasonably strong, although ,lower growth out of china better than we had thought out of india, and clearly of major -- a major slowdown in countries like brazil and russia. specific, and by the same token the low income in developing countries are thriving from the march smaller base, granted, but that growth rates are very impressive which is why it makes the current

ebola epidemic even more threatening, because it might certainly jeopardize economic recovery that was underway and entail a decline of those be wastinghat would the gains that they have earned as a result of their efforts. so in the face of what we have called the risk of a new andocre where growth is low uneven, we certainly believe there has to be new momentum, and that is what we will be discussing with a membership in the coming days. i believe you have received the global policy agenda, a copy of which i have somewhere here, yeah, so you have received that, right? so this is the document that encapsulates for the membership the strategy direction of the work that we will be discharging over the next 12 months, and

this is the document on which we seek the approval and their support. withthis new momentum hopefully more growth, more jobs, better growth, better jobs is what we would certainly call upon the membership to produce, and what does it mean in practice? and i will very the first is monetary policy where we will see asynchronous movements. where we believe particularly in the euro zone and in japan, more of that monetary policy is going forward. time, the fed is going to normalize its monetary policy and whether we would continue to caution a lot of the emerging market economies and developing economies to prepare themselves for a bit more

volatility than we observed over the past few months. on the fiscal front, we believe that more growth friendly fiscal policies can be put in place and those of you who have followed the press conference of the new head of the fiscal affairs department will understand what i mean by pointing to the potential labor reforms and fiscal policies adjusted to support job market reform which we believe could make a lot of sense. the financial policies must continue to aim at reducing excesses, make the financial system sounder and strengthened its ability to help the recovery. packagere is a third that we have been referring to a regularly which is the structural reforms. we don't believe this is the

third chapter. is veryve that it important and it has to be country specific. juncture of demand and supply driven measures, we have strongly held views that infrastructure and investment in infrastructure can be a good way to support growth in the short term by launching major construction efforts for but can alsoobs impact on the supply side in the median side by facilitating and accelerating the creation of value down the road. this is what we are forecasting, what we hope to get past in the next few days. we would be happy to take questions with david on any topic that you care to ask questions about.

>> i was wondering if your global policy agenda, your analysis of the world looks familiar. you have been saying it for the past three years since the crisis countries need to do these structural reforms. they are free some of their limits and that is why we are turning to infrastructure spending. would you agree with that analysis and do countries need to step up their game? agree and we hope to convince those countries to satisfy the various conditions. it is not investment in infrastructure at any rate under any circumstances. it is clearly beneficial.

with enough depth from the economy and it sticks up from there. there is a need for infrastructure. on that basis, i believe that it bothlpful and it addresses and thend short-term supply side of the economy. , yes, we haveorms said that. in a way, it is the common factor to many of the countries in the various regions. what we are seeing is that they have to be country specific. they have to be adjusted to the political acceptability, to the multiplying effect it can produce on those economy.

it is a question of doing it. we can talk, we can public reports, we can do that and we will continue to do so. it is not necessarily the domain and of competence. we can cooperate with them, we can continue to reinforce the message. it is a question of getting on with the job and doing it. >> according to data released willweek by the imf, china take the u.s. as the largest power. how challenging is it for the imf seen as china holds less than 4% of rights. you think the legitimacy of that risk and do think that the imf

will have to go beyond the 2010 reform that is currently stuck? government of reform is an absolute must, it has to and everybody stuckthat it is currently before the u.s. congress. hope that the different branches of the u.s. authorities from executive and legislative and members of the legislative amongst themselves will understand the relevance of having an imf that is representative of the global economy and includes the people that should sit at the table. now, this has not happened. in 2012.e it is overdue in 2014.

i strongly hope that under president obama is and with the right understanding of the parties, the role of the imf warns that ratification. was first on the job concerning ukraine? the imf. who minister disbursed disperse quickly and put cash in the banks of guinea, sierra leone, and liberia? not to say that others are not doing their job but we are capable of dealing with crisis .ituations of that nature i also want to say that notwithstanding the fact that the reform has not been ratified. we include a representative of china, one of the deputy managing directors place full

part of the management. we have a lot of the underrepresented staff members and heads of departments. i would like to march the topic to say those underrepresented. are underrepresented in. we certainly pay as much attention as we should to all and not just to the big players. >> i'm going to stay down here. lot ofave seen a countries speaking with the imf, even working with the imf with

regards to the make and assistance. extent do you think that african countries are taking his money and pumping it into the right projects as the imf has and not makingo the same mistakes of the past? >> quite a few countries have issued sovereign bonds and hundred very successful. thereis more stability, is more reliable as seen by the financial markets. i think it should be done with measure like everything, no excess, no views. thatld like to point out we are currently working within the fiscal affairs department on specific research work to

actually focus on how public service inw civil each country can actually well discharge of major infrastructure projects and we will make that expertise available through the us chilean presidency of the g 20. howake sure they appreciate good management of public finance, how good evidence of public finance and how focused project management can be in order to serve the efficiency of infrastructure. this is what we have advocated. it would be efficient if it is well handled by those in charge. there is a way to do that.

>> the question is about greece. after four and a half years of there is enough austerity and enough paint. he is convinced that greece can meet its financial needs in the coming years without needing the money from eu and the imf. as a understanding, he is sending a team in washington. mayquestion is, congress .et without the help of the imf

>> first of all, it is obviously for each country and greece is clearly a point in case to and how it it wants wants to handle its financial situation. thate very pleased to see greece has significantly improved its new position. markets, therel has been significant improvements. we also believe that going deliverand in order to a continuous satisfactory outcome, the country would be in our view in a better position if it had precautionary support. we are talking about evolution in the relationship but we believe the relationship can

still be extremely helpful for on andntry to move ultimately on its own. we are ready to help and we believe that it could be effective. >> good morning. stands in the economies in the arab world, some are still coping with that. reallye undertaking some painful reforms. imf price and those factors? in the old exporting countries, that is considered a mean driver. thank you. >> first of all, we are very

engaged and involved in the arab world in general. about the arab countries. there are countries that did not go through that transition phase which are struggling at the moment with very complicated issues that have to do with significant military problems, disruption of the entire ofrastructure, abundance migration, people who have been displaced, about 11 million of them in that whole area. we are trying to help in all of these directions and not only the arab countries in transition. we go beyond that. we have quite a few programs in place, the latest one that was .pproved

a lot has been achieved, let's face it. when i look at the program to remove subsidies and to use outlook finance to better use as support for health and education, a lot has been done. but, there is still a lot more that needs to be done and we appreciate how difficult it is under the circumstances faced by those countries. they to their credit that have done what they have done. there is a strong delegation coming from egypt on the occasion of the meeting. i very much hope that we will be able to do an article four with our egyptian friends. we are focused, we are going to continue to being gauged. this is a part of the world that

needs the attention, the support , and the financial support of the international community. >> thank you. >> thank you, madam lagardere. you are normally asked about risks and problems and i do want about the fact that as you mentioned the euro area, whether that in your mind is connected to the sanctions and counter sanctions. want to ask you, when you look at our part of the world, where do you see grounds for optimism? thank you. >> the development in ukraine as

a triggering and very unfortunate triggering factor of the sanctions and counter sanctions is one of the geopolitical risks that we identify as a cloud on the global economy. so, the very modest growth of the euro area and modest forecast for next year because is partlyvised down but only partly achievable to the risks we see in that part of the world. hope if i see a result to conduct both reform on the investment on the other hand. i think it goes hand in hand, give and take and surface and deficit countries have to rally

around better growth in that part of the world. >> i'm jennifer lee. my question is regarding the federal reserve's monetary policy. as the imf has indicated that the global recovery is still relying on the advanced economies might take -- monetary policy, the federal reserve has a growing concern over the global growth. do you think to what extent the federal reserve will be able to raise the interest rate later than expected? also, what is the latest assessment? live in delft and i

cannot predict what the fed will do. i also believe that chairman yellen is giving very clear, very understandable explanations and guidance about the monetary policy of the fed. i think that we can all breathe the same thing, we can all understand what is meant by what she said and we have also seen delivery of what she has messaged from six months ago, nine months ago. so, that is on the fed question. the other question you had for me, spillover and spill back. we do quitea where a lot of work, a lot of analysis to identify what the outcome of what we call the papering intrum, you remember back

may, june, 2013, when there was the perception that there would be change in the monetary policy. there was immediate waves and outflow of capital and variation in the currency and exchange rates of quite a few countries and markets in the emerging world. we have studied that in detail. we have also studied the response by those countries to actually draw lessons from that. we are trying to make sure that the countries that will be exposed to more volatility when the time comes have built the defense and have the tools in the toolkit to respond to necessary volatility. i doubt with the spillover but spill back is one as well. when large emerging market economies are in difficulty or

are, at the risk of instability, it can spill back to the originating country. >> larry elliott of the guardian. looking at the eurozone, a very very slow growth rate. it has an aging population, it does not seem to have recovered from the downside -- downturn of 2008. how close do you think the eurozone is to becoming the new japan? >> has been commented upon by olivier. about a year ago to the risk of low inflation.

this is one of the attributes of what you described as the new japan. inflation was a risk, we identified that. the measures have been taken by the ecb to try to reverse that risk. more, hope. also alerted to the risk of recession in the eurozone and i think that risk has been identified as a probability of about dirty five percent. this is not insignificant. we are not suggesting that that zone is heading towards recession. , it doesa serious risk happen if nothing is done. also that if the

right policies are decided, if both surplus and deficit countries do what they have to do, it is avoidable. >> a follow-up question on ppp. thateriously do you think this data? if we look at more commonly used data, china's economy is way behind in the united states. to what extent do you think that this could reflect the real economies? undertake thet debate of what is the best measurement. there are lots of ideas at the moment. the measurements inspired by the commission. is one indicator amongst many others. if you look at gdp per capita,

china is way behind of course. you have to take all of the factors into account to assess the stability and the future of the economy. that by that particular criteria, china is growing. it is a fact. >> i want to go to one of our fellows at the back. where are you? foreign-language]

>> it has had in them the -- a negative impact on countries such as peru. i want to know what other sources of growth a country the fall, to given the metal prices are falling. to showld they tap into that they can move and continue to grow. what measures could be taken to address the slowdown in the partner countries? >> for those that not get the translation, it was a very copper heads of question from

who wasuvian colleague happy to say that peru will be hosting the next annual meeting of the imf and the world bank next october. he hopes that you were coming. there's the current economic situation of peru. these have suffered from the recent decline in the price of commodities. >> on behalf of our entire institution i would like to express gratitude to the peruvian authorities. there is work underway, and major construction being completed hopefully by july, 2015 and we can all be together under one roof on the occasion of the annual meetings in lima.

we are all looking forward to it. concerning the peruvian economy, it is one which has grown very fast, one of the fastest in latin america. in the earlya hit months of 2014. combinationof the of the lower price of is adities which peru great producer of and a great exporter of and second as a result also of bottlenecks in the countries given that it has grown so fast and that the notastructure is necessarily followed as fast as it should have. the combination of these two reasons, the growth rate has gone seriously down in the first few months of 2014.

significantly slower growth for the country compared to what it has produced in the last decade. the policy measures that have been decided both from a fiscal standpoint and from monetary standpoint should be conducive to restoring the situation. easy fromnecessarily a policy point of view. there is a coalition government that we hope that all members will be focused on delivering the right supply and monetary redressix in order to the situation. >> thanks to all of you for coming. we will see you over the coming days. [captions copyright national cable satellite corp. 2014] 0, lifeght at 7:3 coverage of the illinois u.s.

house debate. later at 9:00, live coverage of the illinois governors debate with incumbent evan or democrat pat quinn and bruce rauner. saturday night, live coverage of the iowa senate debate wil. at 6 p.m. eastern, the michigan governors debate between rick snyder and democrat chauer. mclean, regina, a senate debate was held between mark .arner and ed gillespie here is son of the debate.

-- some of the debate. >> when you're not in the white house, my party doesn't have one thing to stand up to but i will share with you some things were i think i'm probably at odds with some embers of my party. i believe in the early 90's when congress passed mandatory minimum in the early 1990's, we swung too far. i believe that we need we need to revisit those. in particular for nonviolent offenders. and allow more discretion for judges and frankly more discretion for the states to make determinations in terms of what are the proper sentencing guidelines for these things. i think we went overboard in terms of federal sentencing minimum mandatory sentences. i'm someone who believes in redemption and reconciliation and i also believe that we need to look at the prospect of checking if you've served your