be problematic. there is a lot of diplomacy i didn't know. and i had a wonderful number two , the deputy chief of admission in finland who was a career foreign service officer, and we worked as a team. she knew how to work the bureaucracy of the state department, for example, which reports needed to be done when. i had to generations worth of leadership experience, projecting goals, organizing cultures. i have long thought that the most important job of the leader is to get the culture right. so it worked out well. i saw it that way in much of the rest of europe. it tends to be not one to one but the more important countries

end up with political ambassadors who can afford it and have a lot of leadership experience to come in. one of the things federal government typically doesn't do well overall is train leaders. this is not a cut on federal employees. i love them. i have more in my district than any district in the country, but maximizing bureaucracy often means minimizing risk. you don't want to break things. you need a mix of inside and outside, i think. post: with the people you came across, european leaders, the people of europe in general, how do they view america and this president? guest: i think it has probably changed over the six and a half years. we do not have the fever pitch

of euphoria about the obama presidency. after the bush presidency, there was a lot of dismay in europe. two wars, guantanamo, abu ghraib, our environmental policies, the death penalty. a lot of them saw the election as america had changed. after all the years of racism, we hit actually elected an african-american president. the president would point out that he was much more popular in print -- in switzerland then he was in the united states. he had a 90% approval rating there. we spent a lot of our time trying to re-brand, pointing out that we were bringing health care to tens of millions more people that we had ended the wars, that no nation in the developed world had cut carbon emissions as much as we had after the obama election. it was a time of recovery in

terms of the european understanding and imagination. we have had setbacks. all the confusion in syria and the rise of isis continues to confuse it. and now we are threatened by russia and crimea and eastern ukraine. once again, things that looked like great ideas in 2009, we are trying to readjust on now. the recent is over. host: what have the first couple of years in congress been like for you? guest: i have really enjoyed it. it's easy to get up in the morning. the work is entertaining. you can turn on c-span and feel connected to everything they are talking about. i really enjoy it. the key for me is little by little to develop relationships and an understanding to have some impact on how decisions come out.

i have been one of 28 house democrats voting for trade promotion authority to give the president the tools he needs. it's a little lonely. but i also feel like hey, i am glad i am here, and this is going to have a different outcome because i won and i am showing up every day. host: on that issue and many other issues, you disagree with nancy pelosi. what is your relationship like with the leader? guest: it's very good with nancy pelosi, steny hoyer, and others. that is the other thing, i am not seeing any of these desertions on policy become personal. i have not felt any impersonal problem. even coming out of committee

meetings, the science committee or the natural resources committee, i may have voted against a republican friends bill, and you come out into the hall together and realize these are classes in philosophy, but it's not personal. host: when you ran for the house, you had a pretty contentious primary. how did you win? guest: campaigns our message and message delivery. the message that works the best for me was 40 years in business, lieutenant governor of the state, overseas ambassador. no one else had the resume and the experience to hit the ground running. we needed a congressman who would not be a newbie but someone who could be a factor right away, and that message work.

i also spent every waking minute running. i didn't read any books or watch any television or do anything else for those months, and it worked. guest: you -- host: you live near the district. you don't have to try too far -- drive to far. guest: i am very spoiled. host: what is your daily routine like? guest: i get up at 5:00 a.m. to get some exercise. i get to work about 8:00. there is a constant flow of constituents in the office every 15 minutes, on different issues, which is wonderful. and they do not just meet with me. i have a great staff doing meetings all day long. and then pretty much every night we will be out of here and back into the district to do something, a nonprofit, a town hall meeting, civic association,

lots of things. my friends in the house from california texas and montana say the good news is you're close to home. the bad news is, you are always on. guest: any interest in moving up to the leadership? -- host: any interest in moving up to the leadership? guest: i am at a point in my life i do not need to have a title, but i very much want to be a part of helping to lead the house, lead the democratic caucus, but i don't have to win an election to do that. i think a lot of it is just showing up.

if it is possible for me to go to a meeting, i go. if it is possible to make that call or make that ask, i do. it is a way to offer leadership without having to have the ego stroked. as a freshman, it would take me a long time to compete against people who have been here for 20 years or 30 years, which is fine. if i can help them, that's enough. guest: what is your wife think of your career in politics? host: i think she -- host: what is your wife think of your career in politics? guest: i think she likes it. she is the one who encouraged me to do it when i was thinking of retiring. we have been together in politics since the very beginning. host: your two daughters, how

old are they now? guest: i have three daughters 24, 23 and 20. they have all been in politics in one way or another. the youngest one is the one who pays the most attention to the policy issues day in and day out. so, we will see. the conversations are all about within the newspaper what is public policy. and it's not boring. host: what is your dad think of all of this? guest: i think he is very proud of me. he doesn't understand why i do this. but i think he is proud of me anyway. back when i was lieutenant governor, i would call him every night before we checked into the motel in virginia.

out of respect for his being 91, i don't call him every night now. but i update him regularly later, larry pratt of gun owners of america on gun control in the u.s. after that shooting at the ame church in south carolina. "washington journal" live every morning on c-span. you can tell us what you think by phone, and on facebook and twitter. c-span gives you the best access to coverage.

bringing you a events that shape public policy. every morning, he washington journal is live. your comments by phone facebook, and twitter. c-span, brought to you as a public service by your local cable or satellite provider. >> today president obama plans to open embassies in havana and washington dc in the next soon to be future. the president: good morning everybody. please have a seat. more than 54 years ago, at the height of the cold war, the united states closed its embassy in havana. today, i can announce that the united states has agreed to formally re-establish diplomatic relations with the republic of cuba, and re-open embassies in our respective countries.

this is a historic step forward in our efforts to normalize relations with the cuban government and people, and begin a new chapter with our neighbors in the americas. when the united states shuttered our embassy in 1961, i don't think anyone expected that it would be more than half a century before it re-opened. after all, our nations are separated by only 90 miles, and our deep bonds of family and friendship are present between our people. but there have been very real, profound differences between our governments, and sometimes we allow ourselves to be trapped by a certain way of doing things. for the united states, that meant clinging to a policy that was not working. instead of supporting democracy and opportunity for the cuban people, our efforts to isolate cuba despite good intentions increasingly had the opposite effect - cementing the status quo and isolating the united states from our neighbors in this hemisphere. the progress that we mark today is yet another demonstration that we don't have to be imprisoned by the past. when something isn't working, we

can - and will - change. last december, i announced that the united states and cuba had decided to take steps to normalize our relationship. as part of that effort president raul castro and i directed our teams to negotiate the re-establishment of embassies. since then, our state department has worked hard with their cuban counterparts to achieve that goal. and later this summer, secretary kerry will travel to havana formally to proudly raise the american flag over our embassy once more. this is not merely symbolic. with this change, we will be able to substantially increase our contacts with the cuban people. we'll have more personnel at our embassy. and our diplomats will have the ability to engage more broadly across the island. that will include the cuban government, civil society, and ordinary cubans who are reaching for a better life. on issues of common interest - like counterterrorism, disaster response, and development - we will find new ways to cooperate with cuba.

and i've been clear that we will also continue to have some very serious differences. that filling could america's enduring support for universal values, like freedom of speech and assembly, and the ability to access information. and we will not hesitate to speak out when we see actions that contradict those values. however, i strongly believe that the best way for america to support our values is through engagement. that's why we've already taken steps to allow for greater travel, people-to-people and commercial ties between the united states and cuba. and we will continue to do so going forward. since december, we've already seen enormous enthusiasm for this new approach. leaders across the americas have expressed support for our change in policy; you heard that expressed by president dilma rousseff of brazil yesterday. public opinion surveys in both our countries show broad support for this engagement.

one cuban said, “i have prepared for this all my life. another said that that, “this is like a shot of oxygen." one cuban teacher put it simply: “we are neighbors. now we can be friends." here in the united states, we've seen that same enthusiasm. there are americans who want to travel to cuba and american businesses who want to invest in cuba. american colleges and universities that want to partner with cuba. above all, americans who want to get to know their neighbors to the south. and through that engagement, we can also help the cuban people improve their own lives. one cuban american looked forward to “reuniting families and opening lines of communications." another put it bluntly: “you can't hold the future of cuba hostage to what happened in the past." and that's what this is about: a choice between the future and the past. americans and cubans alike are

ready to move forward. i believe it's time for congress to do the same. i've called on congress to take steps to lift the embargo that prevents americans from travelling or doing business in cuba. we've already seen members from both parties begin that work. after all, why should washington stand in the way of our own people? yes, there are those who want to turn back the clock and double down on a policy of isolation. but it's long past time for us to realize that this approach doesn't work. it hasn't worked for 50 years. it shuts america out of cuba's future, and it only makes life worse for the cuban people. so i'd ask congress to listen to the cuban people. listen to the american people. listen to the words of a proud cuban american, carlos gutierrez, who recently came out against the policy of the past saying, “i wonder if the cubans who have to stand in line for the most basic necessities for hours in the hot havana sun feel that this approach is helpful to them." of course, nobody expects cuba to be transformed overnight. but i believe that american engagement -- through our embassy, our businesses, and most of all, through our people -- is the best way to advance

our interests and support for democracy and human rights. time and again, america has demonstrated that part of our leadership in the world is our capacity to change. it's what inspires the world to reach for something better. a year ago, it might have seemed impossible that the united states would once again be raising our flag, the stars and stripes, over an embassy in havana. this is what change looks like. in january of 1961, the year i was born, when president eisenhower announced the termination of our relations with cuba, he said: it is my hope and my conviction that it is “in the not-too-distant future it will be possible for the historic friendship between us once again to find its reflection in normal relations of every sort." well, it took a while, but i believe that time has come. and a better future lies ahead. thank you very much. and i want to thank some of my team who worked diligently to make this happen. they're here. they don't always get acknowledged.

we're really proud of them. good work. [indiscernible] >> tomorrow, the president travels to wisconsin to talk about the economy. you can watch it here on c-span at 2:30 eastern time. >> here are a few of our featured programs for the three-day hollow -- holiday weekend. >> the annual talkers magazine

conference in new york. an interview with the publisher. sunday night, members of the church committee, former vice president, and former senator on their groundbreaking efforts to re-of form the central intelligence agency. >> author martin ford on the use of artificial intelligence can make good jobs obsolete. >> carol perkins on why the will of rights was created and the debates it has spurred. join our three-hour conversation with government accountability president peter schweizer. he has written over a dozen books. and on american history tv on

c-span-three. saturday night at 8:00 here a lecture on the revolution he -- revolutionary war. sunday afternoon at 4:00 on " real america." get our complete schedule at cspan.org. >> lucy hayes was the first first lady to earn a college degree. she was called the mother of the regiment. she influenced her husband to

switch from the whig party to the anti-slavery republican party. she hosted the first annual white house easter egg roll. first ladies, influence and image. their influence on the presidency. sunday at 8:00 p.m. eastern. watch this on c-span-3. >> today in the house of commons, the british prime minister answer questions about the terrorist attack that killed people, some of the british nationals. they have arrested seven suspects. the prime minister discussed at the fight against isis and the state of the british economy. this is 30 minutes. >> questions to the prime

minister, angela crawley. >> thank you mr.'s bigger. i am sure the whole house will wish to join with me. --wishing them well against their match this evening. >> angela crawley. >> the prime minister's plans for english votes -- reduce my rate hundreds of others -- [shouting] >> order, order. the honorable lady must and will be heard. angela crawley. >> the prime minister splines for english -- to reduce my rates and rates of other scottish mps in the house of commons. but the real issue is my at the

-- is my ability to protect the interests of my constituents. will the prime minister guarantee today under his plans a bill that has a direct or indirect fix on scotland's budget, will not be certifiable. >> what i will say to her is, i we will punish our proposals soon. there will be plenty of time to consider and vote on them. it may, we are not creating a system of two cheers for mps. all in these will still vote on all bills but what we're saying is laws which only applied in england should only pass if they are supported by a majority of english mps. that seems to me -- were scottish mps can determine their own future on health, housing and increasing number of subjects fairness across our united kingdom.

>> tran one. >> thank you, mr. speaker. yesterday the national audit office called for the introduction of a fair school funding formula so that at the -- and i quote, it is related more closely the people's needs and less affected by where they lived. can be prime minister can from dash cam the prime minister confirm today from the dispatch box that the additional and very welcome 390 million pounds last year as a first step towards a more fair funding system will be incorporated into the baseline for future years of? >> i can say we will implement the pledges in our manifesto on this issue because we do need to make funding more fair across the country. if you look at the figures today it is clearly unfair that a school in one part of the country can receive over 50% more funding than identical school in another part of the country. we've already made some progress

on this but it want us to go further. >> harriet harman. >> could i join the prime minister in his congratulations to england's women football team? they have only a fraction of the resources that men get. they are showing the men how it is done. sadly, mr. speaker, we now know that 22 british citizens have been confirmed dead in the tunisia attack. our thoughts are with the bereaved and injured come and help day and the families will need. those life-changing injuries will need long-term practical and emotional support. the experience after 77 was that to really help those affected families, there needs to be coordination across departments and agencies to will be established a dedicated task force reporting to a minister to support those who have suffered in this terrible attack? >> yes, i can give it the right honorable lady that assurance.

let me update the house because i'm sad to say that the confirmed number of british citizens killed in this appalling attack is now 27. as we said we do expect it to , rise still further. today we are repatriating eight bodies from tunisia on an raf c-17 plane. that plane is now in the air and it will land at the airport this afternoon for every family of a victim now has a dedicated liaison officer but i confirmed what she asked and i've asked of the cabinet sector for vice on -- cabinet sector a -- cabinet secretary for advice on creating a minister to me to ensure that work is coordinated right across government to provide all the support the victims of this attack deserts and also to make sure that as a nation we market can rate this event a properly. >> i think that's a really important step that he is taking and we fully support it and think those are going to be working in that respect. reports unless they suggest it wasn't just a lone gunman but an organized cell.

following the home secretary's -- and the development of 50 british police officers can me update us on the progress being made to identify the perpetrators and bring them to justice? >> on this specific issue there still a lot of work to be done to identify all of the circumstances this appalling attack in the support this gunman received. as we get information come from as we can confirm that information i will make sure the house is updated. in terms of the discussions between my right honorable friend the home secretary at the tunisia and i can confirm they wanted and were successful. this is looking at everything from the protective security in hotels and resorts all the way through to intelligence cooperation at the highest levels between britain and tunisia so we can help with the capacity to combat appalling events like this. is going to get a lot of long-term work between our two countries but we have the french and germans and americans also willing to help also willing to and we need to coordinate

between ourselves how best to support this country on its road to democracy. >> harriet harman. >> the prime minister has rightly said that this was an attack on our values and everything we stand for, and there is radicalization in this country, too. last november the intelligence and security committee said that the prevent program had not been given sufficient priority and that counterradicalization programs are not working. today a new statutory duty to challenge radicalization comes into affect. will there be sufficient training and support for those covered by the duty? will he look again at the concern that the present program hasn't sufficiently focused on engaging with the community's? >> the right of a lady raises the important issues and let me add to trek as again. personal incomes of prevent we have now put more money and resources into that program. her second point about the statutory duty on public sector bodies i think this is important

because we are saying to schools and universities and local authorities and others to have a duty to do with radicalization and confront extremism because this is an effort that's not just for the police and security services or for the government come isn't covered for us all. in terms of her specific question, which goes back to whether it was right to split the prevent work into work that is done to deal with extreme -- extremism under the aegis of the home office and then programs to encourage integration which will be done by the department of communities of local government, i maintain that was the right decision. it followed a review in 2011 who found and i quote there have been cases where groups who we would now consider to support an extremist ideology have received funding. it is very important, as we discussed in this house on monday that this does not happen. yes, we should work with community groups, but not those that encourage an extremist

narrative. harriet harman. >> i think it's important the prime minister doesn't just defend the decisions he's made a continues to reflect on this and really try to make absolutely sure that he gets it right. if he does that come then we will strongly, strongly support him on that. with all party support the prime minister if i can turn to another issue, with all party support the prime minister commission the davis reporter look at the question of airport capacity. now that the commission has recommended a third runway at heathrow does he agree with us that subject to key environmental testing met, there should be no further delay and they should go ahead? is he going to take that forward now? >> the first of all, let us all think davis and they team up for the arrow piece of work they have done. i think there is a lot of common ground across all sites of the house. or, almost all sides of the house.

there is a need for additional airport capacity in the southeast of england, not least to making this country's competitiveness. it is important now there's a very detailed report that we study. i'm very clear about the legal position that if we see anything now before studying the report actually you could endanger whatever decision is made. what they guarantee i can give is that a decision will be made by the end of the year. >> harriet harman. >> well, he says there's common ground and there is common ground across the house. the worry is the lack of common ground on his side. and he says, he says there will be come he gives the impression there's going to be a proper process but there's something different coming out of number 10 because they're briefing is not going to happen. it looks like the prime minister has been overruled by the member for oxbridge, and he should tell them that he is not the leader of the tory party yet.

he should tell them that. will he stand up for britain's interest, or will they just be bullied? >> i would have thought with all the years i've experienced the right honorable lady would know not with everything that she rates in her morning newspapers. it would probably be good for her blood pressure is good for -- as well as for mine. but let me give the mildest warnings of jumping to a conclusion before seeing the results. with a classic example of it last week when the shadow health secretary warned the government that the poverty figures would make us all hang our heads in shame. that's was of course, before the poverty figures were published showing the relativity -- relative poverty was at its lowest since the 1980's. [shouting] >> he thinks it would be keen to get off the issue of airport but it seems like he's in a holding pattern above heathrow and that boris won't let him land. mr. speaker, our economic

infrastructure is essential for future jobs, for growth and our productivity. but this week we've seen the government pull the plug on electrification of the railways, and seriously undermined the renewable energy sector. and now they are backing off over airport. and risking losing the opportunity of britain being at the heart of the global economy. if he makes a swift decision on the davis report we will support him and will be a majority in the house. so will he put britain's national interest first? >> well first of all it's an interesting day when the leader of the conservative party wants to talk about child poverty in the lead of the opposition wants to talk about an airport report that none of us have yet had time to read. [shouting] i seem to remember that the last leader of the labour party although we've been churning through a few recently, added to a different position on airports than the one that she is now

putting forward. what i can say is we will all read this report and a decision will be made by the end of the year. [shouting] >> mr. speaker my constituents -- broadband health and education, agriculture and business. will they commit the government to do all they can with the resources to ensure that the hole is filled as quickly as possible? >> first of all, let me welcome my honorable friend to his feet. before community was a very successful district council in area unfamiliar with what he help to achieve a second lowest council tax in the country and i'm sure he will bring that sense of good housekeeping to this place. he's absolutely right to raise the issue of superfast broadband and how we fill in the last five and 10% of homes, particularly in rural areas. we are providing action fun and look at all the different sorts of technology that can help to

deliver this. >> angus robertson. >> >> i associate myself and the scottish national party with all the tribute and condolences to the families and friends everyone caught up in the tragedy in tunisia. mr. speaker, because of the way the united kingdom is structured, decision on health education and much english legislation has an effect on the scottish budget. will the prime minister confirmed he plans to exclude scottish mps from parts of the democratic process of westminster that will have an impact on scotland? >> the point i would make to the honorable gentleman is mps from english mps are entirely excluded from any discussion of scottish health or scottish housing or of scottish education. what we are proposing is actually a very measured and sensible step which says wind is -- which says that when there is a bill that only affects for instant england, the committee stage should be of english mps

but then the whole house will vote at report stage and ended at third reading state. what this is going to introduce, as it were, is a system for making sure that the wishes of english mps cannot be overruled. that i think is only fair a system when the scottish parliament and the welsh part -- and the welsh parliament the northern ireland parliament have increased powers powers. >> on overruling, very interesting, because on the scotland build it the eight of 15 and scottish mps have voted for the legislation to be strengthened and the event outvoted by english -- [shouting] not content -- elected on a mandate to strengthen the scotland bill. now it's going to introduce second class status for mps elected from scotland on issues which can impact on the scottish -- even planned to make the membership of the scottish affairs select committee on minority pursued for a scottish mp.

isn't this what the prime minister means when he says he will respect of the agenda of? >> i'll tell him what i mean, but respected the gender. every single thing portsmouth represent in terms of welfare has gone into the bill. and isn't it interesting that he objects to a vote in the uk parliament on a uk issue which is what has happened. let's me say this to him again. instead of endlessly talking about the process, isn't it time the snp started to talk what are they going to use these powers? why don't you start your -- start telling us which benefits they want to put up ? which attacks as they want to increase? why don't you start to tell us what this debate. i know none of scotland's 59 mps are arguing that the state pension chevy cobalt. in other words, the principle of sharing our resources across the united kingdom which i believe in is apparently shared i the

scottish national party. [shouting] >> thank you, mr. speaker. my constituents showed great courage in the massacre last week by helping save a life of an injured victim with first aid skills he learned in the army. can the prime minister secretary powell measures and extremism that will tackle extremists and stand up for our values for democracy, equality, free speech and respect for minority's? >> well, first of all let me take the opportunity of praising her constituent and the skills we use on that dreadful day in tunisia. what our bill will do is reinforce the first aid skills we have already done and used in the army. then to go after this issue with the fact that there are groups and individuals that are very clever at endorsing extremism

but stopping one step short of condoning terrorism. that is what they aim to achieve. the extremist narrative has no place in our public debate. >> many families in the north of ireland will identify with the concerns from the commissioners point on tax credits. heating bills whiter -- wider warnings, will be take particular care to ensure that no supposedly more targeted benefits to child the credits will be misdirected to cross-border working families? >> well, first of all we talk

about cross-border working families it is still the case that welfare arrangements in the united kingdom are still far more generous than what is available in the republic of ireland. but look, our view is clear. the right answer is to create jobs, to cut taxes, to raise living standards and to reduce welfare i want an economy that is high pay, low taxes and low welfare instead of low pay, high taxes and high welfare. let me just share with the house when statistic which i think is important. under the last government, under the last labour government the number of working -- i know you want to talk about the last labour government. under the less the government -- under the last government, inequality fell. right. now for the history lesson. [shouting] right. let's go back to the last labour government. under labour the number of working age people in in work poverty rates by around 20%. now that was at the same time that welfare spending on people in work with up from 6 billion

-- went up from 6 billion pounds to 28 billion pounds. what this shows is the labour model of taking money off people in tax recycling it back in tax credits has not worked. it's time for a new approach of creating jobs, cutting taxes and having businesses that agree to the livelihoods that we need. >> thank you, mr. speaker. having led a campaign and offered a letter by -- signed over 100 members of parliament from across the house to the prime minister into the bbc, not -- not to call the islamic state isil i said. i respect the prime minister for not calling it an islamic state. can the prime minister lead the way by officially calling daesh as france, turkey and other countries in the least of which is acceptable to muslims around the world? >> i think he is spoken about

this what has making a very strong point of document i would make is islamic state is inappropriate because of this is neither islamic in the true meaning of the word, nor indeed is a state. it is a bunch of terrorist bugs. i think isil as an alternative because it doesn't come confirm such authority and i'm pleased the bbc seems to move their position because yesterday they were calling islamic state and it looks like they will change their approach had a really welcome that. >> given the importance the , the vital importance of , parliament and members of all sides of the house and from all parts of united kingdom able to hold properly and effectively incumbent of the day, can the prime minister confirm whether he intends to try to reduce the size of the next house of commons to 600 members? >> i'm committed to what is in the conservative manifesto which is to complete the work that should have been done in the last parliament so that we have equal sides constituencies with a small house of commons and cut

the cost of politics. [shouting] >> it due to -- due to ongoing issues around the post offices horizon software accounting system i believe many honest decent hard-working postmasters and post-mistresses have lost the reputations and livelihoods, savings and in the worst cases their liberty. this is a national disgrace. will my right honorable friend consider the request from mbs across this house for an inquiry into this matter and bring it to a conclusion? >> my right honorable friend has been a real service and campaigning on this issue and i know he has led a debate as well. the post offices answers to say they set up this independent inquiry which hasn't of evidence of wrongdoing that clearly this is not satisfied many members on all sides of the house who have seen individual constituency cases and want to find better answers. so what i think needs to happen , is for my right honorable

friend at the business department will convene a meeting involving members of this house, the post office, representatives of sub postmasters to discuss their concerns and see what should happen next. i believe it will not be necessary to have a full independent inquiry mid -- inquire meant to get to the bottom of this issue by get to the bottom of the issue we must. >> question five, closed question. >> number five, mr. speaker. >> i reflect on prime minister's question with cabinet colleagues and others. for all its thoughts, and our many -- faults, i would say there are two important points. it was the prime minister on the spot to the public but it also i would say put the government on the spot to the prime minister as it is an important mechanism of accountability needing to the issues right across every department before coming to the house at 12:00 on a wednesday. >> yes. >> given that parliament may be moving out of this place in 2020 --

[shouting] with the prime minister take this opportunity to share the joys of prime minister's question just just outlined and federal parliament by convening it in each of the nations of united kingdom and thereby symbolized this government and as part of its commitment to both the union and the devolution? >> as i've said in an earlier message i'm committed to try to , cut the cost of politics and i'm not sure that would help her i think it is important that we take our politics and issues to all the different regions of the country that is something the government is very committed to do, not least with original economic plans for every region of our country. as for the future of this house of commons and where we stand and when we debate, that is a matter for the house of commons but i have to say i have a slight emotional attachment to this place, this one specifically. [shouting]

>> they have been worn paper said by the sweat on the palms of prime ministers and ministers come and gone. it is a visual example of parliament to accountability. while our constituents rightly feel that the time this session is a little absurd, does my right honorable friend agree that it would be a great beauty of senior members were not held to account in that way of? >> i agree with my honorable friend. i remember taking some constituents on a tour when it first became a member of parliament entering for the first on something i had to know which, of course, when this chamber was born, some of the most important speeches in parliamentary occasions winston churchill actually took place in the other place rather than here. but, i do not want to start a complete fight between both houses. i think i will leave it at that.

[inaudible] >> his plans to exclude scottish mps from decisions that will directly and indirectly impact on scotland's budget and my constituents. will he finally tells his house and the people of scotland whether it is right to create a second class status for scottish mps, or is he content to press ahead with plans to bring about the breakup -- [shouting] >> i have to say i'm quite baffled about the whole point of the snp is they wanted to exclude themselves from the uk parliament for ever. i thought that was the whole point. actually, what we are putting in place is a fair and balanced system that is fair to all the parts of our united kingdom. >> thank you, mr. speaker. over the past five years increasing numbers of people in the east midlands and across the uk have been deciding to take the courageous and important step of setting up their own

businesses and becoming self-employed. what steps will the prime minister and the government take in the future to further support these entrepreneurs in my constituency and beyond to represent and personify aspiration and hard work? >> first of all let me welcome my honorable friend to his place and agree with them that actually people taking a step to become self-employed, to start up their own business has been a very big part of the java -- of the jobs and enterprise revolution that has been seen in the past five years. things like startup loans have made a difference and that's why we're increasing than in the parliament. they think it's important when looking at self-employed people to look at all the aspects of being self-employed, how you interact with pensions and benefits and maternity leave and public authorities and rolls over and social housing. that's what i'm asking for found a fantastic cambridge statue

company and among self-employed people can achieve great things to lead a review for the government. let's look at all of the ways in which we can help self-employed people. >> thank you, mr. speaker. given the prime minister's commitment to localism with the standby and respect a decision made by the council this week rejecting fracking, yes or no? >> these are decisions that must be met by local authorities in the proper way under the planning regime that we have. i hope that over time there will be unconventional gas sites that will go ahead, whether in lancashire or elsewhere, because i want to see our country x. -- country explore all of the natural resources that we have. i want us to keep energy bills down and be part of the revolution that can create thousands of jobs. i want us to go through our own gas reserves, rather than ship

gas on the other side of the world -- which has a hiebert -- higher carbon footprint, that we should do that as well but if the labour party wants to paint itself into a background of not wanting any unconventional gas at all, i think they should say so. >> thank you, mr. speaker. we recent received a damning report for not doing enough to help schools under the control. can the prime minister tell us what the government intends to do to make sure that systemically failing schools cannot continue to ruin the lifetime of our young people? >> here, here. >> >> i think my friend is right to raise this because, frankly one extra turn in a failing school is too long for our children. i think in the past governments have been too tolerant of a loving schools continue to fail -- up allowing schools to continue to fail year after year. this government has set there he crucial testing regimes for failing schools. we will do certain things for

schools that are defined as coasting. they can you doing better. frankly, you can now see the model of where an academy chain takes over a failing school, changes some of the leadership of the simplest the things that are necessary. you can seek radical increase in the result. that is what we want. today we're talking a how we tackle poverty in the long-term, and tackling schools and education underachieving is a vital to the life chances of our children. [shouting] >> mr. speaker, can i strongly ask the prime minister -- [shouting] he still hasn't answered the question dodging the impact of english courts were english laws. can the prime minister finally tell the people of my constituency that an elected mp will not be given minority status in matters that will affect the scottish project and consequently the life of the citizens of dundee? moreover, does he -- [shouting] spill we are very grateful because -- >> we are very grateful because

we have got the gist of it. he has had a very clear answer but maybe the snp don't like this answer but the proposal that we discussed at great length in the last parliament for solving this issue now be -- will now be introduced. the key point i will make is that if an severe -- in some future parliament, there is a disagreement between english mps who want one thing and the house of commons as a whole that was another thing, they would have to be away on resolving this deadlock. this is effectively a block for english mps. it is not the ability to legislate in willy-nilly, he should know that if you read the manifesto. >> here, here. like [shouting] >> does the prime minister to comfortable that a conservative and has integrated expanding target on port eight but would not commit to a target of a minimum of 2% of gdp on defense?

does he realize this is damaging the relationship with our allies, the united states entity or credibility with our nato allies and? >> what i say to my friend who i know cares deeply about this issue and also as in his -- also has in his constituencies some of the most important defense when you factual is in our country is that we have in every year met the 2% target. that's the european union where many countries don't even need a 1% amount for investing in defense. the commitment we've made already is to invest 160 billion pounds across 10 years into our equipment program with real increases every year and that is why we can say the aircraft carriers, a c-17, the new era planes they will all be coming forward. we will make spending decisions and the spending audit this fall fall. [shouting] >> for a man seemingly is never a way from europe, what is it

that these never took the opportunity when he's been there to put in a claim for state aid to save british miners jobs? he's the man who, during the election campaign, masqueraded as the workers champion, and he hasn't got the guts to help those miners. he took 10 million pounds out of the minor workers pension scheme and he has not given any of it back. no wonder they call him -- [shouting] >> order, order. [shouting] >> order. [shouting] >> very good to see the labour party in full voice cheering on jurassic park. [laughter]

>> i would stick to the movie. there's a serious point of this government has offered 20 million pounds to the owners of hatfield to keep that going. so we have been prepared to put forward money and unlike the last government we've been prepared to make ministerial direction because we got some coveragecourage when it comes to these things. [shouting] >> order. the house, most dear mr. goldsmith. it is a strong sense that the airport commission three years , or so ago with with a conclusion and then spent 29 pounds acting up a that conclusion to the prime minister will have to make a decision on the back of his recommendation shortly but what assurances can be given millions of londoners this can be affected by heath row that he will engage -- the way they have not? >> let me pay tribute to the honorable gentleman or how strong he campaigned on this issue. i know how strongly he cares about and australia his constituents feel about it at the promise i can get in is that is very thorough report landed on my desk yesterday afternoon

is going to get properly studied because this really does matter. if you make some precipitous decision or ruler one particular -- or rule out one particular option, you actually make the decision you would like to achieve. you may not like this, but those are the facts and those of us who want to those need to continue to operate. >> and north suffolk nhs mental health trusts which it serves my constituency -- published so-called alexander report into its operation to the report which i'd seen raises serious questions about patient safety and care due to cuts to services. does the prime minister to agree with me that the duty should apply equally to nhs management as it does to nhs frontline staff? and if so, well he joined me in the publication? >> first of all, let me welcome the honorable gentleman to these

-- to this house. i make no apology for the rigorous inspection regime which identified areas that need improvement. i would argue that two things we need is to uncover that practice and turn it around but didn't get back that up with the resources that the nhs needs including those recommended by the staving splinter as things stand it's only this party that is backing an extra 8 million pounds into the nhs and not the party opposite. >> order. >> from rick perry he represents his economic plan today. you can watch this on c-span, getting at 1:00 p.m. eastern time. >> on friday, you can watch the launch of rick perry's presidential campaign. as well as those of the 18 presidential hopefuls, seeking presidential nomination. that begins with the washington journal.

>> in the middle of july, where live at the harlem book fair. and the beginning of september we are live from the nation's capital for the national book festival. that is a few of the events this summer on c-span2. last week the supreme court upheld a key provision of the affordable care act. the case was a challenge to tax subsidies for insurance bought through federally run health exchanges. this forum hosted by politico is 50 minutes.

>> thank you to both of those. we are excited to continue this series of events. today, we have a nice timely discussion about the scenario. we will talk about how it will affect the politics in the future of the law. before i introduce our panelists i want to thank cvs. now here to say some words mary? [applause] >> good afternoon everyone. i am really happy we had this late turnout here.

a week or i thought you might be at the beach. i want to welcome you here on behalf of cvs health. last week's ruling had us all of the edge of our seat. now the court has spoken on obamacare twice. we now have to ask ourselves what is next? where do we go from here? it is been five years since the affordable care act past, and two years since marketplaces got up and running. a lot of positive disruption, a lot of the players adjusting and working together. as expected, there are specific challenges that lie ahead.

also other factors, and health care, by an aging population, by increasing the presence of chronic diseases. that will demand the entire system and all the players and it come together to focus on health care access and quality. cvs health our work in health care and health care innovation is done on the front lines to deliver better outcomes to people in their communities. there was a case behind us in the supreme court decision, the health care system has the opportunity to look to the future. cvs health is very pleased to be partnered with politico to host this discussion. thank you again for being here

i look forward to the discussion. [applause] >> thank you, mary. thanks to you, thanks to cvs for your partnership. they're great. for those of you in the room and those watching over the live stream, don't forget to join the conversation. twirt, the hash tag is prohc. as in health care. i have a panel on a tablet that i can take questions off of twitter and without further delay, i'd like to welcome our four panelists to the stage. drew altman is the president and ceo of a henry j. kye cierre foundation. sheila berg is the add junnct lecturer and i first met her years ago when working for senator dole on the hill and tom mill at the american enterprise institute.

i've instructed them to talk to each other not just me, and to be lively. before, we were going to talk partly about the court and the politics and we want to partly talk about how to we move ahead. but first, tom, you e-mailed me something last night, said before we start with our question, is is that the last lawsuit? >> this is the last big lawsuit. i was on the phone friday with a smaller one, but the ones that have, that's a shorter list than i had a couple of days before. i'll admit that. the big existential threats that go to the core of whether the law is fundamentally or needs to be reconsented in the near term. that part is over. there are some other things still brewing. on the margins could annoy some people or make a difference. the big lawsuits are over. big lawsuits are ending. that's as long as bill clinton's comment. >> so, we get june back next year. right? >> so, for you, is this the end is the king decision a turning point or did we just hit another mole in the game and something else is just going to pop up?

>> i think the aca dodged its own particular nightmare, but when you open up politico or god forbid more to the point, the world is going to feel strangely familiar because the politics of the aca will feel familiar. the implementation challenges will look a lot like the implementation challenges that you have known and loved for recent months, they would remain the lightening rod of partisan division in the country. it will be a focus in the election. there's another big moment in 2017 depending on what happens with the election. it's here to stay, but could change a lot. depending on what happens in the election and something that you know, we focus on a lot at kaiser, don't expect public opinion to change. and i have some news on that. >> we'll come back to that. >> so, that's a quick summary.

>> joel, you actually at ccio, oh, i should learn that, actually implementing and putting up the exchanges. the building blocks. what's different about this moment now? >> well, i think back then, none of us would have dreamed that the partisan shift that's been part of the story from the beginning would continue to get deeper and more entrenched each year. i think now, we have a potential for a lull in that and for the next election. it's an interesting question to me whether the end major issue between the parties, between now and the next major election, but i could see it stepping into the background now and the folks trying to implement the law, administration's preference would be that it's a little quieter and they can focus on that, on implementing the law and that we really do have the potential until the election that there's a relative quiet compared to the last years. there's been a drama every year

until now and unless something goes wrong again and there are many things that can go wrong here, including the lawsuit or the implementation issue again unless something goes wrong, i generally have the feeling that both parties will find it in their interest to kind of back away and not kind of keep it on the front burner as much although it will be talked about in the election. >> sheila, you know how the hill works. you've watched the republicans. is this a pivot point for them or are we just going to hear 52 more votes? >> i think it's certainly a period of time of reflection. i think you've seen in the course out of the last couple of months, a series of conversations occurring among republicans of things that might be done in the case of either king or burwell prevailing. i think there's less drama in the near term. i don't think by any stretch the conversation is over. i think there's a whole set of

issues between the states and federal government to be sorted out as they sort through how best to proceed at this point. i think we are as joel has suggested at a point where it will fall a bit to the backdrop, but we've still got reconciliation to go through. and the things that might be done, particularly since the baseline now doesn't have to be adjusted. you have issues in the context of appropriations which have begun to appear in the bill, so i think there will still be conversation, whether there will be another series of votes to repeal, not clear. but i think there's still a great deal yet to come and a great deal yet to be learned. >> tom, the people who have been fighting in court and politically didn't suddenly decide they loved the law just because king went in a way they didn't want it to. is there a change of, is is it a historic we'll look back and see june 2015 was the marking point or just -- >> turning point, but there are

ones before and each one, it's not over, we can go on. continue on for some period of time. i think on the legislature front, the opportunities are narrow. it may encourage more symbolic moves than real moves. we're going to make you feel good while you're doing it. they could be back in business. this pause that goes on where you can't get any action everybody's happy and incremental changes in law. but looking ahead to the presidential election, there will at least be a general sense by the republican side to say we're going to change this. not a lot of details i expect. i'm spending most of my time relearning administrative law because i expect to be involved with the regulatory team. >> so, you have some numbers. you have a poll saying how the country felt.

>> i agree basically that it will be a calmer period than the chaos which would have ensued, political chaos, and policy, too, if the plaintiffs had won. but you're going to see proposals made in the congress which almost certainly won't pass or would be vetoed if they did. which will mostly be about campaigning and they will not be in one place. the republican presidential candidates campaigning on this issue, there's a version of you know, the court failed to save you from obamacare. and that will be about motivating turnover. we've learned in the past and will see again this time that health reform is not a decisive

issue. it can move turnout. we are releasing another one of our polls later today. first of all, people weren't paying attention to the king case at all. attention did inch up as we got to a decision. 39% of the american people follow the case. doesn't sound like a lot, but if you drag these things, it edged up. it was 27% a month ago. more interestingly, 62% of american people supported the court's decision. 32% opposed it. that's very different from what we found in the last big court case, the constitutional challenge where the public was absolutely split about a third of republicans by the way. support the court's decision and then we've seen in our monthly tracking polls since 2010 that opinion on law has been locked

in a partisan paralysis since the beginning, so i wouldn't expect opinion to move very much and at least in the short-term it didn't. so, as of today, it's 42% favored, 40% don't like the law oppose the law, so it's inched into favorable territory where it was a couple of months ago, but no big swing as a result of the king decision. >> so, they like the king decision because of an equity issue. they think if you can have subsidies, it should be across all-states all-states. >> this was not a legal judgment. >> by the court. >> that's an interesting question. if you read the opinion, there's a lot of policy. >> like insurance 101. like wait. just the public at a very gut level. we just don't get why some people would get help and others wouldn't. don't talk to me about anything else. we just don't get that.

>> tom, the sort of stuckness of public opinion, you can have like -- >> keep many mind, i'm still counting on the 25% i think the law's been repealed. >> have you asked that recently? >> whether that's moved? it hasn't moved a lot. at this point, i swear to you, we could ask will the aca solve the climate change problem or take us to mars and we would get a perfect split between republicans and democrats. >> we're already in, congress can't repeal obamacare. 51 votes on reconciliation, they can't get rid of it. there's even among conservatives, there's acceptance, they can't. tom, you're talking about regulatory changes and how you do things. >> that's the subtle move down the road.

there are all kinds of things you can propose. they're just not going to pass and get a law for the next couple of years and i do think we'll still be at more of a level of generality than a well thought out detailed proposal coming out of the presidential candidate, say here's where we're going on day one. things can change. >> so, is the pressure on congress to still gin some of this up, not in a negative way but still read about it, have to deal with it, because there are 2016ers in the senate? >> there are several views on that. i think in the house, you're more than likely to get one with a a rhetorical run. the argument from a minority is to say we've got the tools, what the hell, let's finish through and get a full vote on it. another move will be in the senate which would be more thoughtful, just tee up a individual mandate, not to go

for full repeal and transfer full ownership. when you get into that day where it's important to have the elements together, it tends to cater to the more symbolic instincts. >> and i think i was going say i think you point out an interesting question. that is the number of people in the senate. certainly republicans, who are up in the '16 race. there are far more republicans. if question of the optics, reconciliation provides an opportunity. there's certainly the opportunity senator johnson and others have put out proposals. unlikely you would settle on one, but certainly issues that sort of have a -- questions about tax issues, cadillac tax and other issues, not likely to

be resolved this year, but teeing it up for a '17 conversation in the context of tax reform and a series of other issues. so the 16ers do have a reason to begin to profile some of what they might say. the chances of anything passing is right. >> or you could do both. we've seen that. they could do a laundry list and big one. >> i have a question for you guys, if there's some room to talk and accomplish something akin to what mcconnell and obama accomplished on trade, it would be around the mandate because the republicans actually traditionally have a strong position against the mandate and

there's 11 democratic interests now i think in saying when you add up a little coverage you'll get out of this and how much hassle we take. >> the white house has a sacrifice. >> you think there's a chance they're going to engage like that? >> it's like the medical device tax. you're going to see up something in the case of the employer mandate where the white house might be able to buy that. the question is, do they see it as an attempt to kind of piece male of the part. whether it's the device tax, the cadillac tax. each has a different impact. certainly, they have budgetary impacts that have to be taken into consideration. is there an opportunity? yes. the likelihood of many of those. >> those are all small trays. it doesn't rise to a level that gets people excited. throw in the kitchen sink and there's going to be a lot of stuff in here. maybe. >> the impact, for a lot of

people, but it's filled with -- >> it is just sitting there and a potential target. who have to have a proposal, but also a health platform that takes them beyond how should i put it, make up a word, a quaug meierish politics of the aca of the american people. you see hillary clinton talking about drug prices, high deductibles, talking about meat and potatoes pocketbook issues that really connect with people.

so, there'll be a lot of political tension on this issue. i am not sure that congress is really action as well as out in the states. >> one of their attack lines is the affordable care act is not affordable. the american voter doesn't understand per capita price trends and medicare, they're just seeing more money coming in their pocket. so, if the republicans are saying it's not affordable, your costs are going up and it's obamacare's fought, how can hillary talk about affordability without sounding like she's agreeing with the republicans? >> to drew's point, at least currently, her focus is on drugs. and it's really not positioned as an obamacare issue, but rather at a pocketbook issue and separately from the on going

conversation in terms of coverage. i think she has some among republicans in terms of certainly some of the introduction of new drugs and the out out of pocket costs. so, she's able to do that i think without getting caught up in the obamacare conversation by highlights a particular issue that has resonance. >> i think it's an explit is attempt to lay out a different agenda. one of the most striking findings in a recent poll we did, we just asked the american people in a fairly open ended way what their top health priorities were for the congress and president and the it was surprising. absolutely at the top of the list. were high cost drugs for the chronically ill, so it's not surprising to me that's at the top of the lists of some politicians. just these kind of meat and potatoes issues of pricing of medical care, transparency and the aca issues, which couple us, were way down the list. >> one of the things about that

poll that struck us, it was republicans, democrats and intds, all put in as the top. i can't remember the last time there was a poll in all the years i've been watching polls where everybody agreed on the top issue. >> it's interesting in this case, matches the substance. the actuaries are most worried about the trend lines on these drugs, so, other than what people care about is is not really related to the underlieying issue, but here, it is. if you're worried about hemt pricing from a perspective you're worried about how they're going to manage the drug costs and it's fascinating to watch big insurers and big pharma go after each other. >> i would also say that the high deductibles issue is the tip of the iceberg about how insurance is changing, more cost

sharing, which resonates with people and i think as particularly democratic candidates trying to find that issue, they wouldn't define it as an obamacare issue and affordability of policies and changes, but as a broad issue about how insurance is changing in the marketplace. now, whether they get away with it or not, it's true and correct. >> you were at cms when the state, the early process when the states were trying to decide whether to have an exchange and how to set it up and all that. the enrollment takes place at the state level. going to be going into 2016. medicaid enrollment was higher than people anticipated. you have affordability issues. political people. the administration has sort of drew and i were talking before try you like it kind of thing. wait until 2014, that didn't happen. what from an implementation standpoint has to break through because if you don't get people covered, the law is not doing

what it was intended to do. >> well, i think it's like a lot of parts. just on longer path than people thought. change is harder than we think. i think the secretary has it right to say let's step back from the statements made six seven years ago now and look at what we think we can accomplish and make it about this year to say get over ten million. >> it was way lower. >> right. way lower and cbo numbers will double that in the next two years. probably won't get there would be my guess and you'll see hhs come out with numbers that are based on real data looking at what's happened over the last couple of years and we will be slower. what political implications that have, i think are generally ok for the administration because as long as there's progress whether it's as fast as people thought it should be or not, i think it's still positive story.

at some point, someone may try to make an issue, gee, there's a lot more on the medicaid side in terms of how this is balancing out. that's true. you're accurate on that point, but i think if we continue to make coverage gaines and a big dynamic. that's happening is that the states are going to take back or take a back step on the i think functionality, the states are going to take a step forward in terms of their involvement in the insurance market. about 15 years and the one thing that united the most conservatives and the most liberals was we wanted to go over our state insurance markets and we've lost that in the last two years, but i think that will come back and you'll have a system where the states are the activity about grinding through

and all that. but not state by state. >> it will be more like what nevada and mexico are doing now. where they're controlling certain amount of on the ground, but everything technically because that's the one that ended up working. >> we had federal data, so the states pick up after enrollment. >> describe this as you've got a -- which can't be eliminated. you're growing slow. not working well. when the rich go up in 2017, the premiums go through the roof, so you've got your group of people that can go there, so nothing's wrong working with the small businesses. you've got something and it's going to be stuck in place. it's not going to take over the rest of the health care system.

>> you wonder if you reflecting on what joel has commented, in 17, the states have the opportunity to waive out. the states have an opportunity to use restructure what it is they want to do, but also down to the benefit issues, and raises states about the states rights. that opens up entirely in 2017. in the current environment whether they will take full advantage of the waiver. notwithstanding the rules say they have to cover the same population, have similar kind of benefits, there are enormous amounts of flexibility that in fact, the states could take back in '17 if they choose to do so under current law. i think there is a question of what the states are doing, what they've learned in this process raises a lot of issues about what the states may choose to take back. >> a couple of things on this. the issue of people, not just a political problem.

it is the biggest implementation challenge facing law. the need to sign up more people and reach more, which is a different group and a tougher youp group to reach. the coverage goal, more importantly as has been said, to stabilize the exchanges and the premiums on the premium increases are reasonable for people and also, tolerable politically and sheila was referring to there's a course of people i join interested in the so-called exception. which is the state health reform and one point i would make about that having been involved in getting federal waivers and giving them and also studying them, is that will also be a political process. a lot of flexibility, so democrats are in charge of the administration, there will be i think withering republican oversight. however, if republicans are in charge of everything, we will not have henry waxman sitting

over you know, on capitol hill. you will not have democratic oversight and so, if they decide, they could still push the state health reform waivers in lots of ways. >> happen though this year. >> no, no, no. >> that's 2017. >> when people look at, they're going to see mandate, the individual mandate. get rid of your exchange in favor of insurers, you can change the benefit structure and posture and very huge opportunities and what will play there is a lot is is going to edge up, which the president will have in 2017. >> we're going to have a loose definition of the three things. same coverage achievements. budget neutral. and seeing consumer protections. those are real -- i think they'll be re-examined. >> not going to be able to roll back the coverage. you say they're minor.

today, people have individual insurance in a way they never have. my 20 years of insurance regulation, you couldn't bet on the individual market. i came out of my role in pennsylvania, i had to have a job with insurance because i couldn't go to the individual market. today, people don't have to have a job to have insurance. you're not going to roll that back. >> i think it occurs in the context of the administration on the republican side. tom can correct me if i'm incorrect. i don't think there's a view towards rolling back some of the things we agree on the issue. coverage of you know -- >> there's no question. but to drew's point, and you're right. there are issues in your term, but recognize even in a democratic administration, there has been a fair amount of flexibility in some cases with the negotiation of the waivers because of the desire to increase coverage, so then, the context of both the medicaid discussions as well as these about exchange structures, this administration setting aside whatever public administration might do, were frantic to

essentially increase enrollment and i think went farther than you might have imagined in previous administrations, so what would happen depending on whether it was a republican administration or a democratic. i think there's a great desire to maintain coverage, to maintain the population of coverage. there are options about whether it's the individual mandate, but the fundamental reforms stay largely in place where some tinkers. the question is, do you create an environment where there's a death spiral because only people came in are essentially people that need the coverage. so, i think that has to be negotiated, but i think there will be flexibility regardless of these waivers. on both the medicaid side as well as the employee side. >> flexibility comes and goes depending on how desperate you are. in an environment where there are a lot more tools in this law that the administration has. when they're about to go out of office, they're going to blast out a lot more stuff because

they're not please, please, please, come in, establishing a template for maximum authority in the future. >> give an example of something you think is going to happen. >> i think much more in terms of converting what are the innovations, we say this is success. we can implement that. we don't want somebody in the administration playing around with it. there's a lot more clout where if you're not trying to be the nice guy in order to givw give out the grab, i think there's a wide range of discretion for this administration to go further than it has. >> taking place in medicare and some of the payment reforms. it's not just on the private size. put it in place without going through the normal process. that was one of the gifts that the ac provided was a ability to do that. to put it into practice that would have required a demonstration project.

the secretary can deem it as a challenge and put it in place. >> more flexibility to the states. i think that's probably going to continue all the way. if there's a huge federal play at the end of this administration, it's going to provoke a backlash among the states that they're cognizant of and i think the smarter play is to say this law here to stay. coverage and guaranteed accessibility and all that. it's going to be the ground that as much as possible in the states and give the states more flexibility and i think that's the realm in which the law doesnt continue to be a pinata

at the federal level. >> why isn't a state in a year or two, save someone from running on medicineaid. we're going to put everybody on the exchange. scott walker move before, ipg we'll see more of. >> you don't just grab medicaid say my -- >> roll back if you're above. >> on that point, i think one area where they may, this is not inside information, but i think there may be more flexibility now in the short-term on the state medicaid waivers, the thorny issue, but the thorny issue at the moment are these work requirements. those to be negotiated out. >> i want to start with one of our reporters. get the mike. remember, the it's pro hc for twitter questions. >> sorry to pull a fast one on

you guys but i want to ask a question about the exchange. a year from now, how many states do you think will be enrolling people through their own websites of the states that have state exchanges right now? we have 16 and the district. >> fewer. >> how many fewer? >> single digits. >> yeah. >> 38 today will be using the federal platform in 2016. states are not going to go the other way, so a number like 40, 41, maybe, but again, that's from the beginning. i think there will be a play against the federal government running i.t. if you say ten years from now who's going to deliver better, i.t. can create a consumer

experience, i say it's somebody out of the private sector, not the federal government. there's a lot of turmoil in that market to improve it and i think we need to think about i.t. separate from running exchange. who's running the marketplace. >> some of the exchanges federal exchange states where the governor is hostile, florida being the key example, they've had phenomenally high 1.6 something like that, enrolled in a state where they're not a state exchange and they don't have support on the ground and some of the state changes that are blue states have not had fantastic despite efforts to do outreach. >> medicaid, you have a much bigger population for the exchange.

that's some of the way those things go. >> who's going to pay for this stuff? the states don't want to pay for it. there's not budget money right now for the feds to run their marketplaces as aggressively as they'd like to. no one wants to pay and the question is how much can you add on to the premiums? i'd say the answer to the financial sustainability is a little unknown. >> biggest plus is the i.t. we've got ibm mainframes now. we're going to have something different five years from now, ten years from now. that's going to be a big part of the law to make it affordable, too. >> and the cost to be born by the states or feds. >> questions in the room. i've got one from twitter. is there anyone who has their hand up over here? >> there's somebody somebody to your left. >> right. >> will the private vendors will wary because they'll liable for hacking where as it might be insulated from that?

>> there are 50 private web brokers who signed up with the federal government gone through the security protocalls that the federal government has, so, so far, they've been willing to do this sort of thing. whoever can tell me what's going to happen with security generally in our society, i guess you could ramp up quite a bit because we've had real issues with breaches of security all over the place. >> including federal government. >> one question from twitter how does the king dynamic affect labor age? not sure there's, i guess it means labor age. gl the appropriations process. >> right, if the republicans want to go after the aca and the report didn't do it, they are trying to defund. >> well, they're both the house and senate have included provisions that would stop funding or call from stopping funding for those who essentially implementing the act for the risk corridors. obviously, they didn't go after

the subsidies, but didn't go after some of the infrastructure issues and again, moving on both house and senate sides, the outcome of that and whether they actually complete an appropriations bill this year remains to be seen. or you're the cr. >> it's the infrastructure kinds of issues. >> the house approach, which did not become law. we passed state exchanges, but ended up a federal exchange. >> depends what the meaning of state is. >> stop it, tom. [laughter] >> it's a new world. got a new vocabulary. >> you know why i invited him. but there's no money. there was never money to implement the federal exchange. there was like this chunk of money that had to stretch. >> sofa cushion money. >> right. we wrote about the money.

four years, there's got to be no more, by the time -- came in all the coins under the coaches were gone and i think labor age is trying to stop some of the flexibility they have to transfer money. >> yes. >> how on earth did you do it and how are they doing it now? >> in the end of the day, we're pretty much going down the road of what we should do with everything. people use it, pay for it. so user fees are used at the federal level, probably going to go up some. that's how it's going to be ultimately paid for, so it's not going to be a federal appropriation, competing with some other federal appropriations. it's going to be through user fees. you look at the exchanges, outside of the technologies, there's not a lot of costs, but some have been in outreach. some in regulating the plans and all that sort of thing, but mostly, the cost is on the i.t. side and obviously, the

subsidies. between the next two parties. >> you've been involved in the federal procurement for technology, you know how it works. last decade's technology is today's crisis. >> technology is a game changer and anybody who thinks that we're going to have the same technology running these exchanges ten years from now as we have today, i think is is not looking at where technology is moving. on the i.t. side, no, i think that's why the question over here, again, what we should have done from the beginning here the fight in congress was not about who runs the i.t. it's about who's regulating the insurers, that, those things

that are the policy issues that people care about are in health reform, those are going to allow states do those things already. those responsibilities are going to stay in the states as the bulk of the states and the i.t. who runs that, probably we should have hired google to do all of it for us. >> a couple of 12-year-olds might have had -- >> there are enormous administrative complexities. but there's no question that this added to that burden in terms of the state insurance commissioners. many of whom have said they don't have the resources or the capacity to do the kinds of things that need to be done. network adequacy.

have you ever gone beyond what was required in terms of review. i think the states have come into real issues in terms of being able to finance. the question is to how much can you shift to the premium and not simply put the premium out of reach and of course, you then have the feds looking at the premiums and saying no more than ten and looking at those and saying too high. i think the states are at risk of not being able to sustain them, but all the basic infrastructure in place. mr. ario: an example. rate review is one of many more complex tasks. 45 states have gotten certified to run rate reviews. the florida insurance departments has one of the best reviews of the country. they were tied their hands for two years. the legislature said no, we want our rate review guys to actually operate and they do operate in

the insurance regulars basely eating the cost to do that sort of thing through the way they get funded. so that's not a big charge. host: can we get a mic over here? i know who you are, but identify yourself. >> phil with kaiser health news. the future of the success of the aca, how much does it depend on texas, florida, georgia? florida, republicans were willing to shut down the government instead of expanding medicaid. any sign that now that we're past king burwell times could change -- ms. burke: expansion of medicaid? i think it's a state by state battle. tennessee's a good example. we know that governor haslem would like to expand, but reluctant to do so.

depend on the -- make up of the legislature and you've got some states where legislature out out for a big chunk of time. so, again, i think it will depend on the politics of the state. you've got a lot of governors up for re-election who are worried about positioning themselves you can't assume single answers for all the red states. i think it will be a state by state battle. >> but the state legislatures in many of those cases, are more important than the governor. mr. ario: look at the governors who tend to be driven, the governors in many of those states are in favor of moving forward. legislatures aren't. so, the real question is -- ideology, the answer to that president. one last question. anyone in the audience.

host: one last question? over there, paul. >> i'm wondering what your thoughts are on how the coming consolidation of the health insurers are going to affect some of the top implemenations as we discussed it. >> the fact that all the insurers are trying to buy each other right now. >> look, in you want to control people, it's better to have to control fewer of them. the real question is who's going to be captured and who's going to be the capturer. this is going on with the insurers. i don't think all the deals will get through for antitrust reasons. you've got doctors being bought up. the whole idea is you get a big enough box, you can say everything's a success.

i think that's a serious problem because you can't break through into the health space and it's getting harder. >> any other thoughts about the consolidation? >> we're seeing it on both sides. and so, how this works out really is very different market around the country. what i'm concerned about is is what it means for people. and there isn't enough attention to that. host: so, what, if you have two or three big insurers, doesn't that increase their ability to negotiate prices for providers? >> it does. >> i don't really care if i'm in the bay area. if there are 10 insurerers, i'm more concerned about whether there are two or three that are capable of really competing with each other. in my home state of

pennsylvania, upmc and high mark, there's plenty of competition just between the two of them. as they compete, aetna, united actually sneaks two into that market. you don't need huge number, but you don't want to get to a point where in a local market, a single hospital or a single carrier dominates and we don't really have that in most of our up the panelists, if i were to bring you back here next july 1, what would be the big health care story? tom? no more lawsuits. >> it's not working any better than it was yesterday. that would be the big story. in fact, sprung a few more leaks. >> sheila. >> i think drugs. i think drugs will continue to be an issue. and i think a lot of the pressure on what to do about high cost drugs will be with us. i don't disagree with tom that this -- the issues that have arisen may be the same, but in july of next year we'll all be focused on november. >> paul? >> it's working a lot better than we thought a year ago.

and the people are trying to make trouble whether they're on tom's side or my side going to have a harder -- >> you're making enough trouble for yourself. >> -- having trouble breaking through because people are going this is ok and we don't need anybody fighting anymore about this stuff in an ideological way. i think it's moving in that direction. >> and last -- >> the aca will be a focus as the election builds steam. the aca won't be the big health story. i think the big health story will be that costs will be starting to rise more sharply again. >> ok. time to wrap up. thank you all for being here for sharing your insights, for everybody in the room, for everybody in the live stream. and finally thank you to cvs health for their partnership on what's going to be a very compelling year-long series. we hope you're all here again at our next event. [applause] [no audio]

>> on the next washington journal. kevin catchart will discuss what is next for gay-rights. and larry pratt for gun owners of america after the shooting of the ame church in south carolina. washington journal live every morning at 7:00 a.m. on c-span. >> like many of us, first families take vacation time. like presidents and first ladies, a good read can be the

perfect companion. what better book than one that peers in such a personal life of every first lady in american history? inspiring stories of fascinating woman who survived the scrutiny of the white house. a great summertime read. available as a hardcover, or an e-book. >> now look at health insurance enrollment. policy analysts talked about who is getting coverage, and who remains uninsured by the law. this is an hour and a half.

>> good morning. my name is ed howard. i'm with the alliance for health reform. i want to welcome you to the first day of the fiscal year in many states. first day of one of our panelists official retirement. on behalf of senator blunt senator cardin, board of directors of the alliance, welcome you to today's program on access to health care and the coverage to facilitate that access in the wake of, i guess you call it the near-death experience of the affordable care act that took place just down the street in the supreme court. you know there was obviously heavy speculation about the impact of a decision that would have gone in favor of the plaintiffs in that case, and what it might have on insurance coverage. now we know that even with a finding that preserved one of

the basic mechanisms of the aca there is still a lot of concerns about coverage and access to care. enough interest that you showed up on a, on a recess week morning at an unusual time. in fact we had, i was telling my comoderator that we had to cut off registration about four hours after we sent out the announcement because the response was so robust. and that's obviously why we have our program here today. here's a sobering thought. open enrollment, the third period of open enrollment begins in just four months. especially in light of the uncertainty surrounding exchanges and subsidies in recent months, how well-prepared are states and the federal government for that third season and what have been the trends in these last two years in coverage

and what can we expect in the upcoming season. are consumers getting the right information they need to make choices and are people even with coverage getting the care they need as a result of that coverage? so we have a lot of unanswered questions and we're going to get to a lot of them. we may not solve all of them with you with your help in the discussion we'll address them with some care. we're very pleased to have as a partner in today's program, the commonwealth fund, a almost century-old if philanthropy created to help the common good. doubly pleased to have comoderator, sara collins, vice president for the health care coverage and access program at the fund and prominent health economist in her own right and you will hear from her in just a moment. a couple of housekeeping items

if you're in a twitter mode you can see the hashtag aca coverage on the screen behind me. if you want to tweet we encourage that. there are credentials that you can see on the screen and on the sheet on your table in front of you. so feel free to do that. that will get you into the wi-fi. there is lots of important information in your packets. all of that information is also available electronically at the alliance website, allhealth.org where tomorrow probably you will be able to get a video recording of this briefing a couple days after that, probably next week there will be a transcript that you can refer to. at the appropriate time you will be able to ask questions of our panel.

there are microphones that you can use to ask the question in your own voice or if you want to do a real zinger, pull out the green card and write your question and we'll have it brought forward at the appropriate time. if you happen to be watching on c-span you can feel free to use the hashtag to tweet a question at the appropriate time and we'll try to get those forward as well. so, and one final note, there is a blue evaluation form in your packets that we'd very much appreciate you filling out so that we can make these programs more responsive to you and better suited to your needs. so let's get to the program. let's start with my distinguished comoderator, sara collins. >> thank you. thank you, ed, and on behalf of the commonwealth fund i would like to thank the alliance and

the panelists for coming to today and extend a warm welcome to the audience this morning. i'm going to present some highlights from the commonwealth fund -- >> the timer control. i inadvertently fav the clicker to tim jones. >> timer would have been good. i could have had more time. so i'm going to present some highlights from the commonwealth fund affordable care act tracking survey that we released in a brief about two weeks ago. the survey interviewed a nationally representative sample of 4800, 19-64-year-old adults from march through may of this spring including a sample of people with marketplace or medicaid coverage or who were uninsured. we compared the results to two similar surveys we conducted before and after last year's open enrollment period. these recent data from cms show that by the spring of 2015, so

this just recently, more than 22 million people had gained coverage either through marketplace plans or medicaid. a majority of marketplace enrollees have subsidies that helped them reduce their premiums and also offset their cost sharing requirements. in the commonwealth fund's affordable care act tracking survey we looked at the effect of this new enrollment on

surveys of the law has been particularly targeted helping low and moderate income families gain health insurance. there are significant coverage gains in the income groups since 2013 but we do see in the survey a leveling off in gains among the lowest income adults in 2015. we find that the law is helping previously uninsured people gain coverage. more than half of adults enrolled in marketplace plans and 66% of those enrolled in medicaid were uninsured prior to getting their new coverage. we're also seeing that for many adults this new coverage ended long periods of time in their life without health insurance. among adults who had been uninsured prior to gaining their insurance, 80% in marketplace plans and 6% of the those in medicaid had gone without insurance for a year or longer. the survey indicates that coverage through the marketplaces and medicaid is improving people's ability to get health care. 68% of people currently enrolled in either source of coverage had used their plans to visit a doctor or hospital or fill a prescription. of those who got care, 62% said they would not have been able to get this care prior to getting their new insurance. while people who were uninsured previously were more likely to say they wouldn't be able to

afford or access this care nearly half of those who had insurance when they enrolled also said they wouldn't have been able to get this care before. there has been some concern that people with new coverage would have difficulty finding doctors or might not be able to get appointments without a long wait. we are not seeing as of yet at least in these survey data problems like these. about 21% of medicaid or marketplace enrollees had looked for a new primary care doctor with their coverage. 77% of those who had looked said it was very or somewhat easy to find a new doctor. we also questioned respondents who found a doctor, how long it took them to get a first-time appointment? 46% got an appaint point with one week. 14% got an appointment within one to two weeks. wait times for primary care physicians and with specialists

and similar set of questions we asked are nearly the same what we found last year during the first year of open enrollment. they're comparable to wait times among u.s. adults in other surveys we conducted. one week. in terms of satisfaction with their health plans, more than eight of 10 adults said they were somewhat or very satisfied with their insurance. this was true regardless of people's age, insurance type income level, or political affiliation. based on the survey, there are an estimated 25 million adults who remained uninsured march through may 2015. compared with the overall adult population, those who are uninsured are disproportionately younger, poorer, more likely to be of latino ethnicity. one factor behind these high rates of uninsurance in these groups is decision by 22 states so far not to extend eligibility for medicaid. 38% of adults with incomes under 100% of poverty are uninsured in states that haven't expanded their programs. this is more than twice the rate of those living in states that have expanded. but the medicaid expansion is not the only reason why many

adults remain uninsured. many uninsured adults in the survey were unaware of the marketplaces, of the financial assistance available to them for health plans or or the medicaid expansion. we also asked adults who told us they knew about the marketplaces why they hadn't visited a marketplace. among those currently uninsured, 60% said they hadn't visited because they didn't think they would be able to afford health insurance. 39% said they didn't think they would be eligible. decision resolved what are the key challenges ahead for coverage and access in the united states? would be eligible.