creates a tremendous financial burden. diagnosis and treatment of patients with dementia is not a routine part of clinical training for most providers and staff and many care settings. it's critical that our prie primary care system become prepared to deal with cognitive assessment and care planning to provide resources that individuals and their families need to deal with this progressive disease. currently dementia is a chronic, terminal illness and we need to prepare our health care system and communities to provide planning and support to patients once diagnosed, even as we search for that cure. i would like to take a moment to share a couple of stories. i have utilized student m's for these stories. i first met mr. and mrs. keller about 10 years ago when i diagnosed mr. keller with mild cognitive impairment. sadly, his disease progressed to alzheimer's, dementia and

over the next several years he had a gradual decline and developed issues with walking and swallowing. eventually, he began having more issues with eating and frequent pneumonia. i began visiting him in the home as it as it was impossible for him to make it into the office. he had support by his wife, paid caregivers and eventually other family. eventually we involved hospice and he was able to die in his own apartment with the support of his wife and family. during that time period i got to know his wife well. she was a very active woman, involved in her senior community. she suffered significant anxiety as her husband's disease progressed and required care for her own. i did not see her for a year. she then appeared in my schedule as a patient.

she developed a memory loss. her children were away. they were around in the summer and really couldn't provide support. mrs. keller continued to live fairly independently and needed to transfer an assisted level of environment. her transition did not go well. she fell, she had a head injury, she developed deleer yum and has continued to decline today. she and her husband tried to plan financially for all their needs but their private caregivers are expensive and the money ran out. she now resides in a nursing home. her children felt very guilty that they were not able to provide the same support for their mother that allowed their father to die at home but the resources are simply not there. we need more flexibility and funding for caregiver support and alternative options for housing to care for individuals with dementia. and i believe in this case we could have had a better outcome. i have other cases and

scenarios that i can share but i see i am running out of time so i would like to thank you for taking the time to hear my story. i implore you to continue to support increased funding for the support of caregivers and individuals with dementia now to support alternative housing options and creative community supports for individuals with dementia. ultimately of the utmost importance is increase in funding to identify ways for prevention and cure of this devastating disease. thank you. senator mccaskill: thank you very much for your testimony. mr. gas bee, when we were talking informerly before this hearing you talked about a public service announcement that you had made. senator collins: could you share with everyone here what you did to try to expand awareness and participation in

clinical trials. dan: yeah. it goes to get people to participate and giving information so they can be considered for drug trials. one of the main impediments to getting more funding, more research, more drugs online is that we don't have enough people to participate so that they can be considered for these drug trials and particularly in minority communities that there's been a -- what the tuss key gee experiment, with things that happened in the past, myths and some reality african-americans and people who are not caucasian are not participating. what most people don't realize is that to bring a drug to market costs billions of dollars and you need to have a

genetic pool, a diverse pool. and so you need people from different backgrounds. you need women, you need men you need asians, you need latinos, you need african-americans. and this brain health registry registers folks so they can be considered for these drug trials. what we wanted to do is we wanted to break down that stigma that it's ok that, you know, government does do good things and going to trial, it's not going to be the tuss key gee experiment all over again -- tuskegee experiment all over again. there are so many myths and taboos that have been existing out there and we wanted to make sure by being involved we wanted to let people know we have to do this, not just for ourselves but for the future. to find the right medicines. senator collins: thank you. i want to thank you for doing that p.s.a. also. i had the opportunity to -- dan: well, one of the great

things about that p.s.a. that we did is it increased the overall participation by -- you know 6% within the minority community but also overall more people signed up because they weren't aware that they needed this diversity in the gene pool. senator collins: that's really terrific. particularly since african-americans are more likely, as you pointed out in your testimony, to get alzheimer's. i think your being out there has really helped to increase awareness and i thank you both for that. dan: thank you, senator. senator collins: thank you hodes, i started visiting research centers and i've talked to doctor petersen at length about the wonderful work at mayo and i spent an hour and a half at massachusetts general hospital talking to the alzheimer's researchers there, and i must say -- and i want to share with this body and say i

see great promise and great hope on the horizon. one of your charts talked about the imaging that is now possible which wasn't just a few years ago. alzheimer's could only be diagnosed definitively through a brain autopsy. now we can do imaging that shows the beta amaloid plaques and i learned at mass general that there's an antibody that can be given when the betaamaloid is developed. i don't know how effective or what stage that is at, but there was so much exciting research going on just at mayo and mass general. i can't wait to go to the university of pennsylvania and to other research centers.

i'm sure there's one in missouri as well. but the problem is with only $600 million you can't possibly fund all those exciting research applications. can you give us some idea of what percentage you are able to fund of the promising projects that are out there? richard: thank you for the question. the wealth of excitement opportunities gifted to committed scientists are proposing research that's far in excess for our ability to fund it now. the answer to your question in terms of percent can be answered in a very real but in superficial way just by looking at the success rate we have or the pay line for applications so that of the applications that come in in the area of alzheimer's research, we are

able to fund now in the range of 11% to 12%. it is easily said that twice that number or more are considered by peer review experts in the field as absolutely outstanding and meritorious support. in terms of the research we have proposed there's great room for more that could and should be funded if there are adequate resources. beyond that, with sufficient resources, the ability to recruit and initiate new areas that are not even in the minds yet of investigators is a dividend that we very much look forward to. senator collins: and of course, if researchers saw a bigger pot of money available that, too, would produce more submissions but 11% to 12% when at least double that number are worthy of funding i think is another strong argument. senator mccaskill. senator mccaskill: thank you. i want to thank all of you.

let me ask -- this disease disproportionately affects women, correct, more women and men and more african-americans than caucasians? let's talk a little bit about the reality of medicaid in this equation. we have two issues really we're talking about here. one is investing in the research. the other is making sure that care can be given. ms. stemley, we live in a state where they have refused to expand medicaid, refused to drawdown the federal dollars that are available for health care in our state and the budget that we are currently debating cuts medicaid by another $400 billion in this country. i'm not sure that most people realize the percentage of nursing home patients that are a, suffering from alzheimer's and that are b needing help from medicaid. what would you have done -- i

mean, i think there are stereotypes around medicaid that are terribly unfair to women like your mother. your mother worked 33 years. she had a pension. she had a plan and then she got alzheimer's. and you found yourself having to access medicaid services for her long-term care. what would you have done if those medicaid services were not available? if there had been a block grant in missouri, like the house has done in their budget, and the money was gone because it was october, what would you have had to do? kimberly: senator mccaskill, i don't know. that thought -- first of all, i was not familiar with the medicaid process until this. and so there have been many nights through this process when understanding the cost of long-term care and the realities of what we were

facing because you now face the financial fight because now you have an extraordinary price tag to this disease and then you have the emotional, the physical and then you have that fight to go through. initially just understanding the cost that we were about to go down this path there were many nights that i was very scared because i know she does have a good pension but she doesn't have the pension and rewe don't have the resources to pay $5,000-plus $8,000, $10,000 in certain cases, a month to have a long-term care facility. i didn't know what we would do if we were going to be denied. i didn't know if she made too much if she had -- you know, all of these fears come into your mind. do i make too much do i make too little, am i going to be denied? and it wasn't an option for us to be denied. i had to have the care.

one of the very disheartening parts for this for me, and you pointed it out, is my mother's a very proud woman. and she did work for 33 years. and she worked for the federal government for 33 years and she's very proud of it and even today her mind sometimes thinks she still has to go to work for the government. and so we, you know, we play and do those sorts of things. but to know that all of those years of work are exhausted by a disease and not transported forward through an inheritance or her grandchildren don't get to see it and there aren't things that she is leaving behind for her family but this disease is exhausting everything is heartbreaking. so i don't know what we would do. but that alone has been my fear

many a nights and that's why i said, i thank god for medicaid. and at the same time we've never needed for anything. you know, we are i guess a middle-class family. i've never been in a position to have a need and that was humbling, to be honest. but i sure am and are grateful for it because where would we be? senator mccaskill: i sure hope you and all of the advocates in the room carry that message because i think there is the stereotype is harming the medicaid program. i think there are people that are comfortable assuming that only people who need medicaid are people who haven't worked hard or people who aren't trying. and nobody can be further from the truth. particularly when it relates to long-term care in this country. it seems to me that not funding research is dumb because it's going to cost us a lot of money and refusing to fund care is cruel, and so i hoe you all

will continue to advocate in every office in the capitol on those two issues. thank you, madam chair. senator collins: senator warren. senator warren: thank you, madam chair. i apologize for my delay in getting here. i was also trying to cover a banking hearing so -- but i wanted to be here. alzheimer's forces families to watch helplessly as their loved ones slip away. the high cost of care also frequently stretches families to the breaking point, as you've just testified. according to the alzheimer's association, we will spend $226 billion caring for people with alzheimer's this year. and by the year 2050, the yearly cost will be more than $1.1 trillion. now, when the director of the national institute of mental health testified in front of the health committee during last congress, he noted that if we can prevent or even delay the onset of dementia, we can save billions of dollars. he also said that this is

really a matter of choosing to invest in research now or choosing to pay up in a big way later on. clearly congress is choosing to pay up in a big way later on. congress has reduced the purchasing power of the n.i.h. by nearly 25% and last year n.i.h. spent only $562 million on alzheimer's disease research. that's about .2% of what the disease cost us last year. dr. hodes can you tell us very briefly how the reduction in support for n.i.h. funding affected the ability of you and your colleagues to advance research on alzheimer's? richard: thank you, senator warren for the question. it's certainly the case that progress in alzheimer's research is not being

eliminated by great ideas but our ability to support it. in an earlier comment i noted even if one looks at the number of outstanding applicationes that are currently being proposed by scientists and the portion of those we can fund it is a conservative estimate that we could fund twice as much as we do now by the outstanding meritorious ideas being proposed at a greater speed and that's really only the first iteration. undoubtedly with more resources we will be able to recruit new investigators, establish new infrastructure for new innovative approaches. that's the first order response. senator warren: what you're really saying is we're funding half or fewer of the potential research avenues that might give us a cure for alzheimer's? richard: of the outstanding proposals that are currently being submitted to us, yes? senator warren: dr. petersen, could you add to that, please? ronald: i think another ramification of that, senator warren, with the reduction in

federal funding, there's also a reduction of number of new investigators going into the field and that's going to cripple us down the road. so if the young investigators see the old guys like myself struggling for funding in a research setting they're saying how am i going to survive? so i'm afraid we're turning off a young generation of investigators that are going to be the ones who are going to lead us forth in the future. i see that's a rale, real concern. senator warren: so high cost right now by not funding research, high cost long term. everyone i've spoken to say they support n.i.h. and they support medical research but medical research takes money and congress has doing absolutely nothing to actually get more money into the agency. the house republican budget and the senate republican budget were released last week and both say that they support medical research funding. but what the republican budget's actually do is lower

the budget caps that are already crushing our research agencies, making it likely that agencies, like the n.i.h., will see cuts, not increases, under these plans. now, earlier this year i introduced the medical innovation act, a bill that would boost n.i.h. funding by about $6 billion a year. that's not enough but it's a start and we can do it without raising taxes, without gutting critical programs, without gutting vital research and without adding a dime to the deficit. i hope that my colleagues who are serious about funding the n.i.h. will join me in this effort or bring other ideas to the table because talk is cheap. we have an opportunity to make a real difference in the fight against alzheimer's, an opportunity to save billions of dollars in unnecessary health and long-term care spending.

and give families their loved ones for more precious time. we're going to miss that opportunity unless congress steps up and funds the n.i.h. thank you, madam chairman. [applause] collins senator scott. -- senator collins: senator scott. senator scott, welcome. senator scott: thank you, senator collins, for holding this hearing and give us an opportunity to interface with so many people who are committed to the cause and those out there in purple, thank you for your investment of time and your energy on such an incredibly important topic. i know that all of our offices have been filled with your enthusiasm and your real-life stories. i can't think of anyone here on this panel who has not been impacted personally by alzheimer's, for me alzheimer's and parkin sons and watching

the challenges of your loved ones -- my grandmother passed away april 29, 2001, and just seeing the devastation, the challenges that she faced. also those who have been support systems. if you've had to -- huh been blessed with the opportunity to care for someone with alzheimer's, would you raise your hands? god bless you. and thank you. it's amazing the impact that the disease has not only on the patient but on the family and on the loved ones and it's such a powerful witness the folks that stop by my office today spent a lot of time talking about their loved ones, their commitment to making sure that the research and the resources are available for the others who may be impacted by the disease as well. so i thank you for your energy and your enthusiasm. it keeps all of us focused on

the topic. my question is for dr. hodes. thank you for your expertise and thank you for your contribution here today. it's a great opportunity for me to really spend some time talking about the success we've had at home in south carolina the medical university of south carolina and so many folks representing st. francis hospital system that's invested a lot of time looking for the resources to make progress. st. francis in charleston has received more than $20 million in grants researching treatments and caring for hundreds of alzheimer's patients each and every month. since 2006 the south carolina aging research network has also been doing some really great work on this issue in conjunction with other hospitals and research universities. there is still so much work to be done. i hear optimism, though, from researchers in our state who believe with the right resources they can do the most amazing things. the question i have for you

doctor is what does progress look like over the next 10 years, from your perspective? and are we meeting the national alzheimer's project act milestones and updating them appropriately so that our researchers are working on the most critical projects? can you point to specific achievements in collaboration in discovery that has advanced the science on this issue? richard: thank you for your comments, senator scott. i think there is well-justified and enthusiasm about the protension for -- potential for progress as we have more and more insight about basic molecular activities in terms of alzheimer's disease. in terms of the planning that is now in place, an intensified product of the national plan, we on a regular basis, most recently the summit held just last month here in bethesda, in the washington area convened regularly experts to help us update and renew the areas of highest priority and then to

translating priorities into the success that is the object of the plan. in terms of some of the accomplishments that we've seen in recent years, as noted in some of my opening comments and comments for the record, we've seen progress in the ability to identify early stages of alzheimer's disease in individuals long before the appearance of symptoms giving us opportunities that just didn't exist years ago to intervene with new treatments aimed at newly identified molecular targets and to understand if they are working or not to track biomarkers, again, long before we would identify progression to the symptom attic disease. i should add much as we're pursuing this kind of research we're also committed to important work to sustain the quality of life for those affected and their caregivers. the research proposals that are coming from your state and across the country are enormously gratifying and exciting. coupled with it, i'll say from

our perspective, is the enormous disappointment. in fact, pain and anguish of the great number of those meritorious applications that we're unable to support. we're making progress without question towards an ultimate goal. the amount is what we can support. senator scott: thank you. senator collins: thank you. senator whitehouse. senator whitehouse: thank you, madam chair. let me open with a question and then make a comment. the question will be for i guess, dr. hodes and dr. petersen. i was -- i'm on the budget committee and we have the budget on the floor so i vent been here for the whole hearing. could you be a little bit more specific about what you think the prospects are or a cure how confident you are, how many viable paths towards a cure there are so that a nondoctor like me can get a sense of how much confidence we can have?

ronald: thank you, senator whitehouse. difficult question to answer, of course. there is enough exciting research. this is a complex disease. it's not just a single cell disease but really involves networks in the brain so there are multiple targets out there and we're somewhat encouraged by a report just last week that one of the drugs that's under investigation for alzheimer's disease to remove one of the culprits, the plaques, the amyloid plaques in the brain. one result indicated in fact there may be a path forward for this therapeutic in so far the plaquing were reduced as they measured them in patients over the year and the patients improved clinically relative to those who were on placebo. very early phase one study. they're moving with a phase three.

i think it's this type of discovery that's going to lead to a hit or more than one hit in the relatively near future. to say how many, when is very difficult, but i'm encouraged that we're on the precipice of really handling this disease one way or another. senator whitehouse: dr. hodes. richard: i'd reinforce what ron has said. we don't know in this complex disease which will be the optimal targets or the combination of targets so that our integrated approach now with input again, from all the brilliance and minds we can converge on this question is to be taking examples which ron mentioned, some of the best candidates for treatments now and beginning the most rigorous clinical trials while recognizing it's important to maintain early discovery efforts in basic science looking for molecular and genetic targets and building those into the next candidates for intervention so that we may have short-term successes with some of the current understanding we have but we

couple that with a commitment towards developing deeper and deeper into the future. senator whitehouse: well it's inspiring to hear that but i'm struck by the same fact that my colleague, senator warren, was struck by and having just worked through the budget at the committee level, having seen the house budget, being on the floor with the republican budgets right now, you know, people can talk a good game but the fact of the matter is if you like sequester the house budget cuts below sequester on discretionary nondefense spending by nearly $300 billion. it's going to be devastating if a budget like that goes through and the fact that the house republicans were willing to support that is a statement that nobody in this room should ignore. about the value of the support,

not just for the research, but also for the support of families who got it already as ms. stemley said so so eloquently. i heard speeches how critical our deficit is and how we have to address our deficit. we had a pair of republican senators last night on the floor saying how critical it was to invest more in national security. we hear how critical it is to invest more in medical research. but when it actually comes to the budget, well over $1 trillion goes out the back door of the tax code through tax loopholes, through favored rates for people and guess what, a lot of that stuff got brought in by people who are using their political power to get benefits for themselves. a lot of this stuff is pretty disgraceful on the merits. and do you know how many tax loopholes either the senate republican budget or the house

republican budget closed to address the deficit or close to address national security or close to address medical research? zero. so the true primary operating principle of both budgets is that every tax loophole is sacred and everything else comes second. and it's very frustrating to sit here and hear you testify in such good faith and hear such prospects for progress and know how many people this illness affects and being in an environment in which every tax loophole, no matter how disgraceful, is viewed by some of us as more important than all of those issues. my time has expired. senator collins: before i call on the former chairman -- [applause] senator collins: before i call on the former chairman of this committee, senator nelson, with whom i worked so closely within

the last congress, i do feel compelled to respond to the senator's comments. you know, alzheimer's affects people whether they're democrats, republicans independents greens, males, females, caucasians, asians, african-americans. it affects all of us. and it touches all of us. and the worst thing we can do is to make this a partisan issue. [applause] senator collins: and -- and i have led the fight for years and we made not nearly enough progress but we have made some incremental progress, and it has never been a partisan issue.

so with all due respect to my dear friend from rhode island, i would say if we want to achieve what everyone in this room wants us to achieve and that is to get a doubling of the funding as soon as possible and then increase the funding to the $2 billion that has been recommended by the council let's work together. together. [applause] collins >> and i agree with everything the chairman has said. senator mccaskill: i just want to say we do have our colleagues will work together and we're fortunate that one of them is chairman of this committee. but we do have challenges that are represented by -- and i'm not pointing out just republicans or just democrats. but there are members of

congress that do not see the value in funding government agencies that do research. and, you know, what will -- what we'll find is there will be -- some of our colleagues that will work in a bipartisan way -- and i hope i think you know senator nelson is one of those. i am one of those. you are one of those. but what we have to work at and what we want -- >> don't leave me out. and i'm one of those. senator mccaskill: you are one of those. i want the advocates to realize it's time to hold everyone's feet to the fire regardless of their party that the reality needs to match their rhetoric. that you can't ingauge in the rhetoric is i support alzheimer's research and then vote to cut funding to n.i.h. that doesn't work. and it won't be my colleague susan collins, that will be in favor of that, but there will be some and those are the people you need to focus in on no matter what party they are and i think that is the issue that some of my colleagues on other side were discussing that not everyone is as reasonable

as the chairman of this committee in terms of working in a bipartisan way. some just want to dismantle public funding of everything from many of the long-term care programs to in fact n.i.h. funding. so not you. others. senator collins: senator nelson it's great to have you here today. senator nelson: well, it's great to be back, madam chairman. thank you for the great partner that you were in leading this committee over the last couple of years. now, to those of you in the audience, you applauded to two things. higher money spending for n.i.h. for research. and certainly that bar graph right there indicates that more is needed.

over $5 billion for cancer, $3 billion for liv aids, $586 million for alzheimer's. you also applauded bipartisanship. well, i want to give you an assignment. now, this committee is bipartisan. that's the way it has been run the last couple years and the way it's being run now by the two leaders. but when money is being cut, according to something called the sequester, which is nothing more than a meat cleaver across the board of the entire budget, and that happens to get n.i.h. as it did three years ago when dr. francis collins, the head

of n.i.h., had to cancel 700 medical research grants to research institutions around the country including universities and medical research institutions, then that's going to affect the very thing that you are so concerned . and so my assignment is that you need to have a prayer session with the members of congress who are voting to cut n.i.h. now, let me say to mrs. stemley and mr. gasby, you are doing incredible work to make sure your family is taken care of and we understand the sacrifice and the unselfishment with which you approached it.

and ms. smith, it takes courage to raise awareness of the disease. so thank you for being here in highlighting that. and dr. hodes and dr. petersen, it's great to see both of you again. thank you for coming back to update us and thank you for your continuing work. and dr. wierman when you have conversations with your patients, can you broach the subject? do you tell them what they're going to have to plan? because here's a report in "the washington post" that says that less than half the people with alzheimer's reported that they had been told about their dementia. so what do you do when you advise your patients?

heidi: i work with folks with dementia at all stages so what they hear is different at different stages. early on it's about the diagnosis and what treatments are available. and where they're at now, addressing current issues. usually in subsequent visits it's about future planning and that involves them and their caregivers or surrogate decisionmakers assuring they have a plan in place for what they want to do, what's important to them. but also includes looking at what their financial situation is and understanding what's realistic for them to plan for in the future. i recommend a lot of consultation with other law attorneys. and ask caregivers to be realistic about what they can offer. and i think that that's really important, giving caregivers permission, not to take it all on their shoulders.

unfortunately, i do have to advise that at times our hospital system is the ultimate backup if they get into crisis. despite all of our planning, that's where people have to go in our community. and it's really unfortunate because it's really not a great place to be when you have cognitive impairment. it's very much a part of my practice to do that. i think it's really challenging for primary care physicians who take care of a broad array of patients to approach that routinely in their practices and we are working with them hopefully to begin incorporating that. i think whether you have dementia or anything else, you've got to talk with your families. you've got to make sure that you're thinking about the what ifs, and it's hard for us to do that but we all need to be doing that whether we have dementia or not. senator nelson: well, all of you, this is one of the larger audiences for a committee

hearing in the months that we've started this new congress. and i would take your concern, your energy, your activism and we are right on the cusp and the researchers out in n.i.h. will tell you this. we're right on the cusp of finding a lot of cures for many different kinds of cancers. we know a lot more about cardiovascular, and look at all of the advances in hiv-aids. they're even talking about taking some medicines attaching them to the h.i.v. virus as a way to attack some cancers. i mean, it just blows your mind

what's going on. so what we need to do now is to focus and get the research done to be on the cusp of solving this problem in alzheimer's. thank you, madam chairman. senator collins: thank you very much, senator nelson. i know that senator kaine is on his way. we will do a couple more questions in the hopes he can get here and boy, what good timing. [laughter] senator collins: while he's getting set up, i'll follow-up with a quick question for dr. wierman. i was surprised to learn from your testimony that the diagnosis and treatment of patients with dementia is not a routine part of the clinical training for most health care providers. if you look at the trajectory of alzheimer's and other

dementias and the number of people and their families that are going to be affected in the near term -- we hope we'll have a cure, a means of prevention or effective treatments for the long term -- that really -- that lack of training really surprises me. is that changing now, in your judgment? and why do you think there isn't more emphasis put on that training? heidi: there has been a lot more emphasis in the last few years as far as setting milestones for medical education all the way up through residency training. so i think we've made some headway in the medical community. i think it's incredibly variable when people go to different programs what they get. most individuals will get training in older adults but not specifically in cognitive impairment and working with dementia and what they get is

probably not enough at this time, in my experience, this -- each of us has our own individual personality and experiences and you throw a disease that affects your thinking ability on top of that and it looks very different in different individuals and so it takes a lot of experience and a lot of training to work with these individuals and their families. and you really need to do that. so there needs to be more emphasis and more time on this. and this goes from medical providers. it goes from your front line staff, whether they're office assistants and people answering the phone and scheduling appointments in medical communities. and then we need to be working within our -- outside the medical communities with education and training for identification. we've done a lot in the banking community about looking for exploitation and that sort of thing. we need to continue that much like at one time we were training hairdressers to look

for -- and talk with their clients about evidence for physical and emotional abuse. we need to be doing similar things with other people in our community to help us identify individuals who are having issues so that we can -- we can work with them. senator collins: thank you. senator kaine. senator kaine: thank you, madam chairwoman. thank you for fill bustering a bit until i got here. this was deeply important to me. i was in an armed services hearing. and particularly i want to thank mr. gasby and ms. smith, thank you guys so much for doing the work that you are doing to really educate and demonstrate the challenges of early onset alzheimer's. it's such a difficult thing. and obviously in the midst of a difficult thing to try to help others is really laudable. i really want to express my appreciation to you for that. this is an issue i'm dealing with in my own family. it's new and it's hard to figure out and the challenge

for family members and caregivers and it's just -- it's a hard thing. i -- can i just begin by expressing my gratitude to you for you willing to be courageous and hopefully educate others about this? dan: thank you very much senator kaine. you know, we're here because when -- we've been fortunate, we've been blessed with some of the great fruits of this great country of ours. and when you look around and you start to get involved and give back and you see people struggling and you see single head of households who don't have anyone, any resources and they're dependent totally upon the system and you see how they're falling through the cracks, you realize that if you're going to stand for something it's got to be more than just yourself. and coming from a -- from brooklyn from humble beginnings and having had a chance to meet one of the greatest human beings i've ever

met, my wife, the nicest person -- see, she taught me how to give and what philanthropy is all about. i know what we have to do and it's not about us. it's about those folks behind us. it's about those folks who you know, at night when you can't sleep because you know there's a person in another room that is going through holy hell and you've got to get up and go to work or you got to go and help change them or you got to go quiet them down or you just have to be able to just hold them you understand that if you're going to stand for anything, stand for people who need the help the most. and the caregivers need it and we got to make it -- we got to make a difference. i'm blessed i have a great partner, but i also am blessed that because of the opportunities we've been afforded to to try to give back. thank you. senator kaine: we don't necessarily choose what happens to us, but we do choose what we do with it. you guys have made a really

good the chair: and all who are here trying to -- you guys who have made a really good choice, and all who -- dan: you don't play the hand you're dealt with, you play to win. senator kaine: amen to that. i want to talk to the people from the research community. talk to me about early onset alzheimer's and from what the research is telling you, you know, how is it different or is it not really different, it just occurs earlier in life? is it the same medical condition as later onset or is it different in significant ways that we understand, if you could? ronald: thank you senator kaine, for that question and comment. early onset disease is really divided into various stages and really is defined by the age of onset but we learned in recent years it's probably the same

underlying disease process. now, having said that, a person who's affected with alzheimer's disease say in his or her 50's versus somebody in their 80's may have different contributions to the clinical picture. so they look the same they're forgetful, they develop problems with thinking and activities of daily living but in the older person there is the amyloid, the plaques but also some other pathology, vascular disease. in the young you are onset person, it's more likely to be a pure form of the disease with the amyloid protein. i think both of them are comparable. treatments that will work for earlyon set and oldon set. and a more genetic contribution for the younger onset. just like other diseases. basically the biology of the

diseases are quite comparable, late onset and early onset. senator kaine: in other answers to that question? how about the caregiver side? because we have folks representing organizations that do a lot of work with caregivers. i'm certain that you've already testified a good bit about recommendations you might have for us. just the sheer numbers of caregivers in my state and i'm sure in all of our states it's just kind of staggering. what are the kinds of things we ought to be considering from a policy level to make -- to make the caregiving task -- while not an easy one but to make it lighten the load a little bit? kimberly: thank you senator kaine. so i'm here on behalf of caregivers but i'm one of 15 million. and there are many caregivers in this room that have different stories. many of these stories this week

i've heard a lot of stories this week. and they're all different. we share very similar things, though. we share the same sorrow. we share the same pain. we also share the same hope and we share the same vision that this is going to end in our lifetime and that we're going to fight until we see this end. one of the things that we are here and that we're collectively coming together as 1/5 and that's asking -- you asking what do we need now and what we need now at this point is for the hope act to be passed and we need it to be passed in this congress and we need it because it's going to improve caregiving -- care planning services for individuals like myself, for families, for those who are living with dementia, that once they receive that diagnosis they walk out of their doctor's offices, one, receiving the diagnosis and then, two, knowing what the next steps are, that that alzheimer's disease diagnosis will be in their medical records and it

will follow them and it will go with them wherever their lives may take them. whether they begin to develop diabetes or anything else, they'll know that this doctor will know, hey this patient has alzheimer's. and there are some additional intory indicate needs that i need to provide -- intricate needs that i need to provide to get the best care. we need this bill passed in this congress. we need it now for -- my situation is a little different because i'm five, six years down the road now. caregiving -- care planning services didn't happen for me exactly the way i probably would have wanted it to. had the hope act been in place for me. but it can help a lot of other people. it can help millions of people. and we need that help to make this load easier because it's hard and we need help to carry this burden because we're carrying it the best we can but

we're just asking for help. senator kaine: thank you very much. and thank you, madam chair. [applause] senator collins: thank you, senator. senator tell is is on his way back. so that means i get to ask another question. and my question is both for dr. petersen and dr. wierman. dr. wierman, you said you look at deleer yum as well. and i'm wondering if there is research that deleer yum in older people after surgery, where a general anesthetic has been involved, which i have seen cases -- which can be a trigger. i see dr. hodes nodding. so maybe i'll start with him. is there a link? can that be a trigger of

alzheimer's? is there a -- is there a link between between the deleer yum that you sometimes see in people after an operation that involves a general anesthetic and dementias? richard: there's good data to a couple of points. the first, whether deleer yum can be succeeded or followed by decrease in cognitive function and progression of the demint yarks the answer appears to be yes. so also for general anesthesia, even if there's not deleer yum so often after general anesthetic there can be a short-term decline in cognitive function. the failure to recover quickly is also predictive of long-term decline. so both of these to the brain as a result of deep general anesthesia or deleer yum do seem to be capable of

accelerating the functional decline. senator collins: dr. petersen. ronald: we call cognitive reserve, that is if the brain is injured how much resilience does it have to respond? and sometimes with people who are developing a dementia, one kind or another, and then undergo general anesthesia, they may have a lower threshold for becoming deleer yuss in that context. so it may contribute to the downward decline but it also may just be a stress test on a system that is starting to gradually fail and consequently be a hash -- harbonger in the future. senator collins: i've been talking about this for a couple of years from enthese yolkses

from maine med where they should be doing more with older patients to be careful about what kind of anesthetics they use, only use a general one if it's really necessary, can you illuminate on this as well? heidi: i think this gets to why we are here, to get more research. clinically, i certainly see people who seem to be functioning quite well before a surgery and then are not doing so well after. and i think as we have more research now where we can identify there are changes happening before its evidence in day-to-day life, my suspicion is that it's those people we have see the decline after. it's like a stress test that you fail as kind of how i thought of it as well. i think we just don't know. i think that definitely in an older population doing more assessment prior to major surgeries, if it's a plan to

process so you can at least understand what the risks are going into it so that people could incorporate that into their decisionmaking i think is really important. but as outlined, i think we need more research into what anesthesia is best and how it further risks folks so we don't put them down this path that we can't stop. senator collins: dr. petersen and dr. hodes. ronald: if this is an important issue that the alzheimer's association has established a professional interest group that's looking at this very issue, they meet at the international conference every summer so this is a hot topic with regard to brain resilience and cognitive function and its role in the development of dementia. so it's a good question. senator collins: that's really interesting. i was not aware of that. dr. hodes. richard: an extremely good and important question. research directed at this

includes approaches to using e.e.g. measurements of brain function during anesthesia with an attempt to monitor the level of anesthetic with an eye towards brain activity and anesthesia and to look at the effect of that kind of monitoring on cognitive outcomes. that could make a difference. senator collins: interesting. thank you. senator tillis, we're delighted you made the effort to come back. senator tillis: if i'm out of breath or seem i'm out of breath i am. i had a conflicting committee summit. i want to thank the chair and the ranking member for their leadership. this is a very important issue to me personally because i've been a caregiver. so i just want to let you know that we not only need to focus on the research -- excuse me -- the research but we also need to make sure that we have the right funding madam chair --

excuse me -- to make sure that caregivers they have the resources and the education that they need to do the best job for caregiving because my personal experience, i was a grandson of a grandmother who got alzheimer's at a relatively early age. and i wasn't quite sure what i needed to do to help my grandmother, but i was pretty certain that my mother and her two sisters were not doing it the right way. and other family members. so that's why i went back and took some college courses to actually better prepare me to help my mother and my two aunts who were the primary caregivers to be a better caregiver. so i certainly -- i'm not going to ask you questions because i know you've been questioned to death and i'll read the record. but i just wanted to communicate, first, how important it is for something like this. this -- another area where i have a lot of passion is around alzheimer's -- not alzheimer's -- around autism. this is a classic example where

i think the head and the heart meet. because with the investment of resources we do the right fiscal thing but we do tremendous transformational impacts for those who are afflicted with alzheimer's. so we need to invest and we need to invest in the right research. we need to identify some of the most promising research, some that i read earlier this week about some other potentialal promisings treatments and make sure we're putting this in the front burner because over the state of north carolina, i'll see the population of 65 and over go up about 30% those suffering from alzheimer's, in a state that's growing increasingly large aging population. so we need to make sure that we educate our members here in the house and the senate on the compelling fiscal reasons to do something that produces a transformational outcome. and i want to thank you all for being here. i want to thank all the folks in purple. my daughter would love this because it's her favorite color. but i want to thank you all for being here and advocating you

and i really encourage you to reach out and explain the transformational opportunity for us to make this a priority. thank you, madam chair. senator collins: thank you very much, senator. and well said. we were talking earlier that when we're spending $226 billion as a society on a disease that's going to bankrupt our medicare and medicaid programs that if the suffering of families doesn't move you, the economics of it ought to move congress to do the investments that are necessary. . and your focus on caregivers is absolutely appropriate too. i want to thank our witnesses today for their extraordinary testimony, you should view has brought so much to the debate and discussion today, and i think you have given us some very comprehensive looks at a devastating disease.

i want to assure you, as the could chair of the alzheimer's -- co-chair of the alzheimer's task force in the senate, that i will continue to work with my colleagues like senator tillis and like senator mccaskill to make sure that we are keeping the focus on the disease that we are educating our colleagues, and that we are increasing the funding. we can't do it without your help, and as i said, i have an amendment in going to ask your help on on the budget, to have essentially to get the senate on record for increasing the funding level that nih gets for alzheimer's research. i hope as you do your office visits that you will urge your senators to support that

amendment, it's either going to come up its afternoon or tomorrow. you may not have time if it's this afternoon. my text messages work too. i want to thank all of you for traveling from all over the country to come to washington to tell your personal stories, and to help advance the fights against alzheimer's. as we have said today, the color purple represents the alzheimer's movement, it is my hope that someday soon, the color purple will also represents those who survived alzheimer's. [applause] we're going to keep the hearing record open until friday april 3. there may be additional testimony or questions for the record, but again, my sincere thanks to this wonderful panel and to all of the advocates who are here today, and everyone

who participated in today's hearing, including my staff and senator mccaskill's staff, which is worked very hard and also shares a real commitment to the cause. this concludes the hearing, thank you for being here. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2015]

>> c-span's live today at law state state community college in -- lawson state community college in alabama where president obama will be talking about consumer protections. that's coming up shortly on c-span. take a look at capitol hill earlier today. the u.s. house approved a permanent formula for medicare payments to doctors. members had been passing temporary fixes. 17 fixes over the past 11 years. also congressman aaron schock, republican from illinois, gave his final floor speech today. he's resigning at the end of the month as an investigation into his spending continues. here's his speech. schock schock thank you mr. speaker -- mr. schock: thank you mr. speaker. six years ago i entered this chamber and raised my right arm to take the oath of office as a member of the united states

house of representatives. i remember feeling so excited about the opportunity that lied ahead. i remember vividly this chamber and all that it meant to me and to the country. the men and women debating the issues of the day, not always agreeing, but always fighting without pie -- without apology for what they believed in. over the past six years i've come to understand that this institution is far more bigger than any one person and that freedom itself is even more important than this institution. some of the world's greatest debates have occurred right here in this chamber, for what happens here effects more than just the people of my district or even my country. over those six years, i've done my best to contribute constructively to the process and to serve the people of my district and high country. my guiding principle halls been rooted in the belief that -- has always been rooted in the bloof that washington should only do what people cannot do for themselves. i fought awe and opposed the

billion-dollar stimulus bill the government takeover of our health care and the massive new regulations put on small businesses. but more importantly, for the people of my district, so that -- i fought that their voice would be heard and respected among my colleagues. i heard that voice in every vote that i have cast. but i also knew that being in the majority was key to making a difference. and so i'm proud of the work i've done to contribute to a republican majority here in congress. to begin to scale back the overreaches of a bloated federal government and to begin to bend the curve on out-of-control spending. that has only happened because of a republican majority and i'm proud to have played a role in building it. during this time, i saw how slow the federal government can be and how frustrating congress can get. i also learned that one man can make a difference. working with my republican colleagues and across the aisle

with my democrat friends, we've been able to pass legislation that helped businesses across america create millions of jobs. some of them have been located in my home district, but many more across this great country. there was, is and will be so much to do and i'm honored to have played a small part in making a real difference. but these accomplishments come with some frustrations as well. that this body doesn't move quickly enough or as efficiently as it could to confront the challenges facing our country. i regret that i won't be here when we finally pass a smarter, simpler tax code so that every hardworking taxpayer in my district and across the country will know that washington not only cares about them, but respects them and their sacrifice. and i will miss joining my colleagues in saving and strengthening social security and medicare, that will directly improve the quality of life for millions of americans for generations to come.

to my constituents back home the good, hardworking taxpayers whom i've had -- been lucky enough to call friends, i will never be able to thank you enough for the opportunity you gave me to serve. together we have tackled some of the big problems at home, like economic development projects helping businesses expand improving our locks and dams along our riverways, and so much more. projects that have helped improve the quality of life in our community. we've also tackled some small problems. but big problems to the people who have been facing them. folks looking for help adopting children overseas or simply trying to get answers from an unresponsive bureaucracy here in d.c. solving those individual cases has been extremely fulfilling. and i'm particularly grateful to have played a role in helping so many veterans get the respect they deserve and the benefits that they earned. i'm proud of the good work that

my team has delivered to the tens of thousands of constituents who have turned to our office for their time in need. my staff delivered for me because they delivered for you every day, 24/7. i was never more excited than the day i walked into this chamber six years ago. i leave here with sadness and humility. for those whom i've let down, i will work tirelessly to make it up to you. i know that god has a plan for my life the good book tells us that before i formed you in the wombers i knew you -- womb, i knew you. i also know that every person faces adversity in life. abraham lincoln held this seat in congress for one term. but few faced as many defeats in his personal business and public life as he did. his continual perseverance in the face of these trials, never

giving up, is something all of us americans should be inspired by especially when going through a valley in life. i believe that through life's struggles, we learn from our mistakes and we learn more about ourselves. and i know that this is not the end of a story, but rather the beginning of a new chapter. thank you for the honor to serve. i look forward to keeping in touch with my friends in this chamber and my friends across the 18th district. may god continue to bless this awesome institution and the important role that it plays for america and the rest of the world. with that i yield back the balance of my t [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2015] >> congressman schock broke a few house rules, including bringing coffee onto the floor and as is reported, taking pictures, posing with members he's close to.

as he sat in the front row waiting to make his farewell dress, he -- address, he set his coffee cup on the floor and when he left, he left behind the cardboard sleeve. live coverage here, lawson state community college, birmingham alabama, president obama expected to talk about consumer protections and the economy. his comments were scheduled to begin at 10 past the hour. we'll just wait here watch the auditorium for a few more minutes, as the students and others gather here to await the president.

>> ladies and gentlemen, please silence your mobile devices. the program will continue shortly. >> ladies and gentlemen, please take your seats.

>> president obama held a round

table discussion earlier about the economy and consumer protections. his comments were scheduled to begin about six minutes ago. we're just going to wait here for him to arrive and expecting him shortly.

>> waiting here at lawson state community college in birmingham, alabama. president obama expected to be here any moment. he was scheduled to be here for remarks on the economy and consumer protections 10 minutes ago. running a little bit behind schedule. so while we wait for him to arrive, we're going to take a look at the latest debate over defense spending and the president's decision to stay in afghanistan through 2015. this is from today's "washington journal" and as soon as the president arrive we'll bring you back here to birmingham. host: your reaction to this charge of desertion and misbavegging with the enemy, were you briefed on this? guest: no, i have not been briefed on this yet. although i will tell you that

tomorrow we have a meeting overality the white house with respect to many issues of security for not only our homeland, but what's going on in ukraine, isis, etc., so i'm sure that will bring the details up on that. i would just have to say that the military generally takes its time in trying to find out the facts. it's always about the facts, when you decide to use the ucmj or even in the court system in the united states. so i would anticipate that they believe they have a set of facts that point towards desertion and collaborating or hanging out with the enemy, if you will. it's a sad day for us. host: you are going over to the white house tomorrow. you said. who's taking part in that meeting? are you meeting with the president? guest: it will be most likely his national security advisors. i don't know if the president will step in or not. i don't know what his schedule is. host: is it just democrats? guest: i have no idea.

they just told me it's going to be some of the top military and homeland people from the congress that work with that. since i'm number two for the democrats on wered services committee, and also on homeland security committee, they have asked me to go over. host: do you think that the prisoners at guantanamo bay that were released in exchange for bo bergdahl pose a threat to the united states? guest: yes, i do. i'll tell you why. first of all, at least in the beginning, as we began to release some of these prisoners, what we saw was a high recidivism rate. meaninging that many of these people went back into the fold to work against us and against western concerns. i think at that time it might have been a 70% or 80% recidivism rate which is very, very high. now, ok, so you can say 10 years later, 15 years later, that's come down a bit. but the reality is that you take a big risk when you --

[inaudible] -- there's a reason why we've been holding them for so long. maybe we haven't been able to try them because i think the previous -- the lieutenant colonel who was on was talking about how the ucmj and how the fog of war and how difficult it is to get a chain of evidence you're going into tora bore o'or whatever and you're under fire and trying to grab computers and information as much as you can. it's not like what you see on law and order d where everything's got little gloves on and you've got all the evidence. you've got the time and everything. everything is haphazard. and chaotic as you're trying to do some of this. so we may not have all the evidence to be able to try some of these people, but we probably know that they're bad people. host: we're talking with congresswoman loretta sanchez, democrat of california. she'll take your questions and comments. not only about this charge against the sergeant but also the president's announcements

that he is going to be keeping troop levels in afghanistan the same, as well as the situation in yenl. and other national security -- yemen. and other national security issues. she serves on both armed services and homeland security. the number two democrat on both of those committees. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2015] >> hello. how y'all doing? hello, my name is ali and i'm an ncaap member. [cheers and applause] it is this great organization that i received the opportunity to volunteer my time and service. since 2013, i said yes to the challenge of becoming the economic chairperson for the

alabama state conference naacp, when i was asked by the state president. little did i know that this position was going to be my breakthrough as well as my road to financial healing. not just for me but for everyone who is seeking the same road to financial recovery. you see i know what it felt like to be a financial -- to be financially stuck with bills on top of bills which led me to do what i thought would be the home way out of my financial situation. i made the decision to go to a payday loan company. it did not matter whether my credit was excellent fair or poor. to me it was my saving grace. which only required me to sign,

receive and go. i thought, what a relief. but reality hit me like a ton of bricks on my next paycheck, and the cycle began there, but i did not let that consume me. instead, what was the lesson that i learned from this? i now think about what i am about to purchase and ask myself is this really a need or just a want? and thus a new cycle begins which is called discipline. now, before i bring on our speaker, i must confess that when i was asked to introduce the speaker, i went into shock. [laughter] i'm still in shock. [laughter] i did not sleep any last night. so if you see me fall out of my chair, don't worry about it.

i'm just taking my nap from last night that i didn't get. so, ladies and gentlemen it is with great honor that i introduce to you a man who needs no introduction, a man who has a burning passion for this country -- [inaudible] [cheers and applause] [cheers and applause] ♪ [cheers and applause]

president obama: hello lawson state! [cheers and applause] yeah. it's good to be here. thank you so much. i love you back. i do. thank you. [cheers and applause] everybody have a seat. have a seat. i'm going to talk for a second. can everybody please give ali a big round of applause, please. [applause] i felt a little bad because she said, a man who needs no introduction so i start walking out. [laughter] as it turned out, she had a little introduction. but it is wonderful to be here. let me just say first of all, thank you to dr. ward. [cheers and applause] who is not only your president,

we named him a white house champion of change for the great work he's done here at lawson state. we got two outstanding public servants here as well. congresswoman teri sule is here. -- sewe -- terri sewell is here. where is she? she's way over there. and your mayor, william bell. who is in the house. [cheers and applause] sewell -- so i'm here in birmingham to just acknowledge that i didn't have u.a.b. making it out of the first round. [laughter] my bracket is so busted. but u.a.b., you know, that's a great accomplishment i want to congratulate them. [cheers and applause]

it's also great to be with students like those here at lawson state. a community college. i'm proud of all of you. i'm proud of you making this investment in yourselves, what you're doing takes effort and persistence and it takes faith in the idea that no matter how you started, no matter where you come from, no matter what zip code you were born in, in america if you work hard you can get ahead. [cheers and applause] i think it was yesterday i saw a story where someone said that a visit from the president of the potential -- was a potential game changer for the enabled. i don't know if just one visit is a game changer, but it's nice to be with you. the real game changes for any neighbor, for -- neighborhood, for any community, are the people there.

the folks who day in and day out are doing the work and raising families and participating in the community and through their churches and faith institutions are trying to provide that optimism and that lift and the young people who are here, you're the game changers because what you're studying and your ability to then apply that learning, that's going to make a difference. the love we put into our families and our communities every day, and embracing the joys of citizenship and participation, that's what is a game changer. that's what makes a difference. now, i won't deny i can help a little bit. [laughter] i can maybe make a little bit of difference. today i want to talk about what we can do as a country to reward hard work and keep the economy going and make sure that new jobs and opportunities exist. the good news is, right now we're on a 60-month streak of

private sector job creation. 60 months. that's five years. that's a long time. [applause] we created 12 million new jobs. nationwide the unemployment rate has fallen, when i came into office, that first year it was 10%. now it's 5.5%. there are more job openings than any time since 2001. meanwhile, our high school graduation rate is up. at an all-time high. more than 16 million americans have gained the security of health insurance. [cheers and applause] we're producing more energy than ever before. oil and gas, but also wind power and solar power and meanwhile lower gas prices should save a typical family this year about $700. and the good news is, wages are

even on the rise again. and that's going to help a lot of families. it's been a long, hard road but thanks to the hard work of the american people america's coming back. so the question now is, where do we go from here? do we accept an economy where just a few people do really, really well or are we going to keep building an economy that generates opportunity for everybody? who is willing to work? and what i believe is, is that america does best when the middle class does best. and when ordinary folks who maybe were born into poverty are able to climb their way into the middle class. that's good for everybody. the economy grows best not from the top down but from the bottom up. and from the middle out. so, what we've been pushing is

what i call middle class economics. the idea that the country does best when everybody's got a fair shot. everybody's doing their fair share. everybody's playing by the same rules. and we want not only everybody to share in america's success but contribute to it. because we know that if you feel the team and only half the folks get to play, that team will be less successful. if everybody is playing a part, that team's going to be more successful. so what does middle class economics mean in this new economy? it means that every american has to have the tools to get ahead. in a fast-paced, constantly changing global economy, that means that we've got to make sure that working families feel more secure. that their paychecks can go a little farther. that they're getting things like paid leave and triled care. not as sucks -- child care. not as luxuries but because they help support families. that we treat those things as

priorities for working moms and working dads. it's time to follow the example of states and cities and companies that are raising america's minimum wage. that will make a difference. [applause] it means preparing americans to earn good jobs and higher wages, which means every child getting a great education at the earliest age. making college more affordable so young people can afford to go to college without getting burdened with debt. [cheers and applause] it means working with businesses to provide apprenticeships and on the job d training and other -- on the- on -- on the job d training. i want to bring down the cost of community college down to zero. [cheers and applause] two years of community college should be as free and universal as high school is today. if we've got the best trained work force in the world, then businesses will come to alabama, they'll come to birmingham they'll come to america, and we will succeed.

[cheers and applause] middle class economics means building the most competitive economy anywhere. so we can keep churning out high wage jobs for the workers to fill. i want to put more people back to work. rebuilding our roads and our bridges. modern ports. faster trains. faster internet. we should invest in those things. they pay off. many times over. i want to invest in basic research so that jobs and industry for the future take root here, because we've invented new products and new services and innovative. and we can pay for these investments without blowing up our deficits. we just need to reform our tax code so it helps middle class families get ahead instead of letting folks who already got a lot get ahead. [cheers and applause] and i have to say, these ideas are not about ideology.

the reason i propose these ideas is because we know they work. now, let me talk about washington for a second. [laughter] let me just talk about washington for a second. the good news is that today the house of representatives passed a bill. no, no. you think i'm joking. i'm not. [laughter] it was a bipartisan bill designed to make sure that doctors in our medicare system get paid on time, that the children's health insurance program continues to work. i called the speaker, john boehner, and the democratic leader, nancy pelosi, and i said congratulations. this is how congress is supposed to work. they came together, they compromised.

they had a good idea. they didn't get everything they wanted. they passed a bill. now the senate hopefully will pass the bill and now i'll get to sign it and the american people will be better off for. it i thought this is great. -- for. it i thought, this is great. let's do more -- for it. i thought, this is great. let's do more of this. let's make it happen. so i want to give john boehner and nancy pelosi credit. they did good work today. and they deserve credit, the house of representatives deserves credit for that. [applause] so that was the good news. [laughter] the bad news is the republicans in congress unveiled their budget and it represents the opposite of middle class economics. because it would hand out new tax cuts for millionaires and billionaires, let taxes go up for students and working families, because it would eliminate their tax credits on a variety of things, it would

cut investments in education to the lowest level since the year 2000. it would double the number of americans without health insurance. and so, you look at it and say, well, what are you trying to solve with this budget? they say the reason they wanted this budget is because we've got to do this to eliminate deficits and debt. keep in mind, the deficits came down by 2/3 since i became president. [cheers and applause] it's come down by 2/3. and the budget i put forward would continue to keep deficits low. but let's take them at their word. they said they wanted to reduce the deficit. before the ink was even dry on the budget that they put forward, that was already full of tax cuts for folks at the top, they rolled out their next big economic plan, which was another huge tax cut for folks at the top. this one would cost $250

billion, it would apply only to the top .1% of americans. in alabama this new tax cut they're proposing -- i got to laugh, because it would average $2 million per person in tax cuts and it would ally to -- apply to less than 50 people per year here in alabama. so, 50 people would get an average tax break of $2 million. not 50,000 people. 50. fiddy. now -- [laughter]

what would lead you, when you're saying you're concerned about the deficit what would lead to you put in your budget and then propose right after your budget something like that? i mean they look at the budget, they already have tax cuts for the wealthy, for millionaires and billionaires, and they say, you know what we forgot to put in here, another deficit-busting tax cut for the top .1% of americans, that's what's really going to move the country forward, is that what they were thinking? i guess. [laughter] i don't think our top economic priorities should be helping a tiny number of americans who are already doing really, really well. and then asking everybody else to foot the bill. and keep in mind one of the things about being president you meet people from all walks of life. you meet folks with very modest incomes, you meet the wealthiest people in the world. and let me just say some of

these folks at the very top, the top .1% are wonderful people. warren buffett's a great friend of mine. they've done amazing things, they've invested. they've created businesses. they deserve great success. but they really don't need a tax cut. [laughter] and if you talk to them they'll tell you, i already got a couple planes, i already got a boat. i already got five or six houses. i'm ok. [laughter] and the idea that you would do it at the same time as you're eliminating tax credits for students or working families, that doesn't make sense. our top priority should be helping everybody who works hard get ahead. it doesn't mean everybody's going to be equal. it doesn't mean that we're going to punish people who started businesses and have taken risks. they should be rewarded. but we want to make sure

everybody has a chance to do ok. if they're working hard. and that brings me to one of the main reasons that i'm here in birmingham today. one of the main ways to make sure paychecks go farther is to make sure working families don't get ripped off. [applause] all right? and that's why we've taken action, to protect americans from financial advisers who don't necessarily have the interests of their clients at heart. that's why we've taken steps to protect student borrowers from unaffordable debt. we want them to know before they owe. it's why five years ago we passed historic wall street reform, to end this era of too big to fail. where banks on wall street, some of them would make

reckless bets and everybody else would have to clean up after them. and why we've been working to protect people so they understand mortgages and they don't buy homes they can't afford and end up in a situation not only hurting themselves, but hurting the financial system. and that's why as parts of this reform we created an independent consumer watchdog with just one mission, and that is to look out for all of you. it's called the consumer financial protection bureau. or cfpb. now, these folks -- [applause] the cfpb hasn't been around for a long time but because of the work they've done, it's not a big agency, but they've already put over $5 billion back into the pockets of more than 15 million families. because they've taken on unfair lending practices and unscrupulous mortgage brokers and they've gotten refunds for folks and are working with state and local officials to make sure that people are protected when it comes to

their finances. because if you work hard, you shouldn't be taken advantage of. [applause] today they're taking new steps towards cracking down on some of the most abusive practices involving payday loans and title loans. [applause] now, ali was talking about this in a very personal way. i want to just break this down for folks. every year millions of americans take out these payday loans. here in alabama there are four times as many payday lending stores as there are mcdonald's. think about that. because there are a lot of mcdonald's. there are four times as many payday loan operations here in alabama as there are mcdonald's. what they'll say, the folks who

run these things, in theory, what they'll say is, these loans help you deal with a one-time expense. so your car breaks down you got to get to work, you go there, cash a check real quick, or get a quick loan, and then that's the end of it. in reality most payday loans aren't taken out for one-time expenses they're taken out to pay for previous loans. you borrow money to pay for the money you already borrowed. before you know, it you find yourselves trapped in a cycle of debt. at first it seems like easy money. but the average borrower ends up spending about 200 days out of the year in debt. you take out a $500 loan at the rates that they're charging in some cases 450% interest, you wind up paying more than $1,000

in interest and fees on the $500 that you borrowed. we were hearing a story from some of the advocates who were working here in will illinois -- here in alabama a story about a family the grandmother died. matriarch of the family. she passed away. they don't have quite enough to pay for the funeral. they go to a payday loan, borrow for the funeral, can't pay back the loan in time. the family's car gets taken away. and the two folks who are the bread winners in that family lose their jobs because they can't get to work. so what started off as a short-term emergency suddenly becomes a catastrophic financial situation for that family. and you don't need to be a mad genius to know that it's a pretty bad deal, if you're borrowing $500 and you have to pay back $1,000 in interest. so i just met with faith leaders and consumer advocates and civil rights leaders here

in alabama who are coming together to change that and i want to say that there's a bipartisan effort, you've got some very conservative folks here in alabama who recognize that they're reading their bible, they're saying, well, that ain't right. [laughter] right? i mean they're saying, the bible's not wild about somebody charging $1,000 worth of interest on a $500 loan. because it feels like you're taking advantage of somebody. if you're lending to somebody knowing they can't pay you back and you're going to put them on the hook and just squeeze them harder and harder and harder and taking more and more money out of them, you're taking advantage of them. and so i'm very proud of the bipartisan effort here in alabama to try to change this. but i want everybody to know,

they're not going to have to fight alone. because at the federal level the consumer finance protection bureau, the cfpb, announced today that it's going to take important steps toward protecting consumers from getting stuck in these cycles of debt. and the idea is -- [applause] the idea is pretty commonsense. if you lend out money, you have to first make sure that the borrower can afford to pay it back. don't lend somebody money if you know they can't pay it back. as americans, we don't mind seeing folks make a profit. and if somebody lends you money, then we expect you to charge interest on that loan. but if you're makinging that profit by trapping hardworking americans into a vicious cycle of debt, you got to find a new business model. you have to find a new way of doing business.

so this is just one more way that america's new consumer watchdog's making sure more of your paycheck stays in your pocket. and in the meantime, we're also going to be working to educate folks on how to think about their money. through consumer advocates at the local level, in high schools, we need to be teaching young people the dangers of taking out too much consumer debt. and this is one more way that wall street reform, what we passed five years ago, is protecting working families and taxpayers. and that strengthens the economy. and that's one more reason why it makes no sense that the republican budget would make it harder for the cfpb to do its job.

and would allow wall street to go back to the kind of recklessness that led to the crisis in the first place and would allow, you know, these kinds of lenders who are not doing the right thing to keep at it. i have to be clear. if republicans in congress send me a bill that unravels the reforms we've put in place, if they send me a bill that unravels wall street reform, i will veto it. [cheers and applause] and this is not about politics. it's about basic values of honesty and fair play. it's about the basic bargain that says, here in america hard work should pay off. responsibilities should be rewarded. one of the people who i met with was reverend shannon webster, birmingham's first presbyterian church. where's pastor? he's here somewhere.

there he is in the back. stand up. so everybody can see you. so, he's one of the pastors leading the effort to protect consumers here in alabama. at a public hearing a few years ago, he explained why he decided to work on this issue. when our people are trapped in debt, he said, they cannot escape and we're all hurt. we're all hurt. and that's a simple statement, but it captures so much of what it means to be an american. we are a country of rugged individuals. we don't expect folks to give us a handout, we expect people to work hard, we expect that hard work to be rewarded. if you're out there and you're working hard and start a business and do the right thing and looking after your family and not spending beyond your means folks like that shouldn't be punished or expected to pay for everybody else.

we expect everybody to be responsible. but we're also our brother's keeper. we're also our sister's keeper. [applause] we're also a country that was built on the idea that everybody gets a fair shot. and that we put laws in place to make sure that folks aren't taken advantage of. when this country does not live up to its promise of fairness and opportunity for all people, we're all hurt. when we do live up to those promises, all of us are better off. back in 2008 i came to birmingham as a candidate for this office and i said, there is nothing we cannot do if the american people decide it's time. seven years later i still believe there is nothing we cannot do if we decide it is time. we're all in this together, alabama. [applause]

we've been through some tough times together. but we're coming back together. if we decide this is our time, then together we're going to write the next great chapter in this country's history. we're going to do it not just because i came to town. but because of the wonderful people in this town who are already making it happen. thank you, alabama. god bless you. god bless the united states of america. [cheers and applause] ♪

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