and the fcc authorization bills they are working on. that is where the politics of late next year overtakes congress. they are certainly trying to see what they can do on the rewrite side of the equation. i suspect those are probably more likely. handicapping those over this they are capable of doing both. host: one more follow-up? you have time for one more. if not we will leave it there. lynn: think the kinds of changes congress are considering, should they go to the greater issues? like should the fcc be a trust organization? should it be a consumer protection organization? what should its role long-term be? michael: this is an interesting question. this has been posed to me many different ways over the years.

people's adjust we use a model like the ftc. i think there is good work the fcc can do. i think it does its best work when it focuses narrowly on this law and is and try to get outside the bounds and try to be creative. the jobs that congress asks of it, that is plenty of work. in terms of what congress may contemplate in the bigger ticket universe, i'm not sure i know in terms of what is the best mechanism. we have some really good hard working people at the fcc and i really respect the work they do. i don't always agree with their outcomes. i wish there was more give-and-take and they were more susceptible to ideas. i think the tab -- i think the staff does a hard job with the tasks ahead. host: michael o'rielly, fcc commissioner, thank you for being on "the communicators."

michael: thank you a lot, i really appreciate it. [captions copyright national cable satellite corp. 2015] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] >> c-span brought to you as a public service by your local cable or satellite provider. the u.s. and cuba officially reopened embassies in havana and washington dc on monday. in washington cuban foreign minister bruno rodrigues par rea -- bruno rodriguez parilla raised the flag.

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viva! >> later in the day secretary of state john kerry and the cuban prime minister discussed the occasions of the opening. >> [speaking spanish]

>> her excellency, mrs. roberto jacobson, officials of the u.s. government accompanies her. honorable members of congress, esteemed representatives of the u.s. organizations, movement and institutions who made huge efforts in favor of the change in the u.s.-cuba policy and the improvement of bilateral relations. distinguished ambassadors. officials and workers of the cuban embassies, esteemed friends. [speaking spanish]

>> the flags that you revere at the entrance of this room is the same that was here 53 years ago which is kept in florida in the company of a family of

liberators and have in kept ever since then. as a sort of premonition that this day would come. the sacrifices made and the struggle which, for more than 100 years fire people for their independence and determination. facing the most fierce challenges and risks. today we pay homage to all those who died and renewed the commitment of the present generation with absolute confidence in the generation to come, to service with honor. >> [speaking spanish]

[applause] >> [speaking spanish]

>> we invoke the memory of [inaudible] was fully devoted to the struggle and freedom of cuba and was able to get a thorough knowledge of the united states. in his work, he made a vivid description of the great nation to the north and extolled its virtues. he warned against it extensive craving for domination which was confirmed by a long history of disagreement.

[inaudible] we now recall his presence in this city in a will 1959 for the purpose of [inaudible] the purposes that brought him to this country by the same that have in pursuit throughout these decades in coincide with the ones we pursue today. many in this room, politicians journalists, outstanding personalities and the fields of art and scientists, students and social activists have enabled to -- have been able to treasure unlimited hours with talks with the matter to get an understanding of our recent goals and decisions. >> [speaking spanish]

>> the ceremony has been possible thanks to the free of capable will, and work of our people. and also the strength of the cuban nation and its culture. several generations of the revolutionary policy has converged in this effort. the example and vibrant speech the chancellor of duty will

remain forever in the memory of the younger generation and future. >> [speaking spanish]

>> i bring greetings of an expression of the goodwill and determination to move forward. two incentivize coexistence despite the differences which makes it possible to solve i o problems -- bilateral problems. we know that this will contribute to peace, development, equity, and stability. the limitation of the the purposes and principles and the proclamation of latin america and the caribbean, which was signed by the second summit of the committee held in havana. >> [speaking spanish]

>> today the establishment of diplomatic relations and opening of embassies completes the first stage and paves the way to the long process of the establishment of i lateral relations. there have never been promote relations between -- normal relationship between the u.s. and cuba. in spite of one half century of intensive things that exist between both people. intensive links -- intensive

links that exist between both people. secretary kerry: good afternoon everybody. i apologize for our being a little bit late. we were down stairs and we had a lot to talk about, not just u.s. cuba relations but also the region. i think we had a constructive conversation. this is the first visit to the department of state by a cuban foreign minister since 1958. and today marks as well the resumption of normal diplomatic

ties between our countries and the reopening of our embassies after a rupture that has lasted 54 years. it is an historic day. a day for removing barriers. [speaking spanish]

of course this milestone does not signify an end to differences that still separate our governments. but it does reflect the reality that the cold war ended long ago. and that the interest of those countries are better served by engagement than by estrangement. and that we have begun a process of full normalization that is sure to take time but will benefit the people in both cuba and the united states. this shared result to look ahead is what drove our conversation

today and what has brought us to this moment. we touched on a wide range of issues of module concern, and -- mutual concern, including counter narcotics, telecommunications, the internet them a environmental issues, human rights, including trafficking and -- in persons and we discussed the opening of our embassies. we want to make sure that those embassies are able to function fully and i am confident the diplomats from both countries will have the freedom to travel and to converse with citizens from all walks of life. to help lead that effort, i am encouraged that we have a first rate embassy team in cuba led by our ambassador who is one of our widest and most experienced public servants. i congratulate foreign minister rodriguez on his -- this morning's opening of the embassy in washington.

i look forward to making my first trip to cuba and holding a comparable ceremony at our embassy in havana. before closing, i want to thank our colleagues from switzerland for the vital role they have played for many years as the protecting power for what has obviously proven to be a much longer time than originally anticipated. i think our friends around the hemisphere who have urged us, in some cases for decades, to restore our diplomatic ties and have warmly welcomed our decision to do so. i'm grateful for the outstanding leadership of assistant secretary roberta jacobson and the many representatives whose hard work made this day possible. i want to acknowledge the commitment of all who care about u.s.-cuba relations, whether they agree with the decision to normalize her, change is really easy especially when earlier

positions have been so deeply ingrained and so profoundly felt. but although we can and must learn from the past, nothing is more futile than trying to live in the past. president obama believes and so do i that our citizens benefit far more from policies that aim to shape a better future. there is, after all my nothing to be lost and much to be gained by encouraging travel between our nations, the free flow of information and ideas, the resumption of commerce, and the removal of obstacles that had made it harder for families to visit their loved ones. make the mistake, the process of fully normalizing relations between the u.s. and cuba will go on. it may be long and complex.

but along the way, we are sure to encounter a bump here and there and moments even of frustration. patients will be required. but that is all the more reason to get started now on this journey. this long-overdue journey. today with the opening of our embassies and the visit of the foreign minister, we are taking an historic and law over -- long-overdue step in the right direction. to keep moving forward, both governments must proceed in a spirit of openness and mutual respect. i can assure the world including the people of cuba that the united states will do its part.

[speaking spanish] and now it is my pleasure to yield the floor to our guest foreign minister bruno rodriguez. foreign minister rodriguez: we have had a meeting with secretary john kerry. the current status of the bilateral relations and the progress achieved since the announcements of december 17 2014 including the removal of cuba from the list of states sponsoring terrorism. and the reestablishment of diplomatic relations. i convey the recognition of our people for his determination to work for [inaudible]

and for his willingness to adopt executive measures that modify the of limitation of this -- implementation of this policy. their scope is still limited but the steps are taken in the right direction. likewise we empathize that in the meantime the president of the united states can continue using his executive powers to pay a significant contribution to not pursue changes in cuba something that falls -- and pretends to the interest of u.s. interest. -- and portends to the interest of u.s. interest.

as well as the full respect for the cuban sovereignty and the conversation for human and economic damages are crucial for the normalization of relations. we both have our interest in bilateral relations. this will be a long and complex process, which will require the willingness of both countries. there are profound differences between cuba and united states regarding our views about the exercise of human rights by all persons all over the world. we strongly believe that we can cooperate and coexist in a similar way based on respect for

differences and the develop meant of a dialogue between our countries and peoples and this continent and the entire world. i expressed with the secretary of state that he would be welcome in cuba on the occasion of reopening the u.s. embassy. >> we have had a constructive and respective discussion with secretary of state john kerry. it was significant to see the cuban flag was raised for the first time after fifth before years. we thought there was conduction of the historical leadership headed by fidel castro.

and for determination to continue working on the path chosen. we have been able to make it through this stage with the eternal support. many cuban citizens reside in these countries and persevere for so many years so that cuba and the united states could have better relations. for the secretary of state we have a change by barack obama during the historic encounter at the summit of canada. the announcement of december the 17, including cuba's removal from the list of state sponsors of terrorism. , a place were cuba never should have been, including a historic

meeting on issues of common interest. i can take the recognition of our people to president obama for his determination to lift the blockade and having urged congress to eliminate it once and for all and his willingness to adopt executive measures that modify the implementation of some aspect of these policies. although the scope is limited, these are steps taken in the right direction. we both emphasize the president of the u.s. can continue to use executive powers to pay a significant contribution to the blockade with the purpose of eliminating it. not seeking changes in cuba which fall under the assumed , sovereignty of the department of cuba and cubans, but rather to attend to the best interest

of the american citizens. the lifting of the blockade is essential for moving on stable as i -- stabilizing relations as well as the full respect of cuban sovereignty and the compensation to our people for human and economic damages. we reiterated our invitation to all u.s. citizens to exercise their right to travel to cuba as they do to the rest of the world and to take advantage of an equal footing of the opportunities offered by cuba. the secretary of state and i ratified our interest in normalizing bilateral relations knowing this will be a long and complex process.

i reiterated to the secretary of state the cuban government's willing to move on in the process toward normalizations with relations on the basis of respect and sovereign equality and without any interference in our internal affairs. it is true there are profound differences between the governments of cuba and the united states with regards to our views about the exercise of human rights by all citizens and in the whole planet and also when it comes to international law, which will inevitably persist. but we strongly believe we can cooperate and coexist in a civilized way based on the respect for these differences and the development of a constructive dialogue to the well-being of our countries and people and the entire world. i express to the secretary of state that he will be welcoming

that she will be welcome in havana on the occasion to celebrate the opening of the u.s. embassy. so i will be waiting for you and i thank you for your hospitality in washington. thank you. >> our first question comes from andrea mitchell at nbc. >> mr. foreign minister, mr. secretary, the foreign minister said today at the opening of the embassy that the continuing hold on guantánamo bay on the naval base is enough area's -- is a nefarious consequence of u.s. attempts to dominate hemisphere and only the lifting of the trade embargo and the return of guantánamo bay would lend meaning to today's historic events. can you respond to those comments and what they foreign minister just said come which seems to indicate does of the

preconditions and he did not want any interference by the united states in the domestic policies of cuba. and what would you like to see in terms of human rights changes or other policy changes, even absent those changes which are congressionally mandated? mr. foreign minister, welcome to the united states and welcome to the state department. for all of us who have watched the relationship for so many years, this is truly an historic event. but you seem to be indicating that there are preconditions including the lifting of the trade them are go and the return of guantánamo. do you see any other changes

cuba might be willing to afford under the request or influence of the u.s. prior to those events taking place? thank you. mr. kerry: i'll go first. it is absolutely knows the price because it has been a subject of discussion over the course of the time we have been examining our relationship and working toward today that there are things cuba would like to see happen, there are things the united states would like to see happen. we both have been crystal clear with the -- with each other, there has been no pulling of punches.

that is one of the reasons we told up and ability to be able to get to this moment. with respect to the embargo, president obama could not have been more clear -- the president has called on congress to lift the embargo. it is our hope that over the course of the development of the relationship in these next week's and months and years, and hopefully not too many years people will see the benefits that are emerging in both countries as a result of this change today. we would hope, obviously, that the embargo at the appropriate time will be lifted and a great deal more foundation can be built for this relationship. with respect -- and obviously, that is going to take more time. we all understand that. at this time, there is no discussion and it tension on our part at this moment do alter the existing lease treaty or other arrangements with respect to the naval station, but we understand cuba has strong feelings about it. i cannot tell you what the future will bring, but for the

moment, that is not part of the discussion on our side. on the other hand, both sides have fairly -- have very strong feelings. we will always express because it is part of the united states -- foreign policy as part of our dna, and that is our view of human rights and our thoughts about it. we have shared good thoughts about it and have had good exchanges. part of this arrangement that took place involved an exchange of people as well as the release of some people. our hope is that as time goes on, we will continue to develop that. what we did talk about the relationship and through a creation of a bilateral committee that might work together to put focus on these issues so that we can make the most out of this moment and not lose the future with respect to the embargo and other issues.

we are going to work at that. today is the beginning of a constructive effort and that is the way we want to keep it. translator: we have completed the exchanges to reestablish diplomatic relations as we open the embassy. we have managed to achieve something very important in the last few years and the u.s. government has recognized the embargo against cuba is the wrong policy, causing isolation and bringing about humanitarian damages and deprivation to our people and has committed to engage congress in a debate with the purpose of lifting the blockade. second, the president of the u.s. has adopted some executive measures which are limited in

scope, but which are headed in the right direction. i have had an exchange with secretary kerry with regard to the purposes for the following time for the normalization of bilateral relations. we have not spoken about conditions, but rather the need to move on through the dialogue through sovereign equality and each will respect and create a civilized behavior despite the profound differences that exist between both governments to better attend to the interests of our respective people. to me, it is very important the fact that today, and embassy was reopened in washington and the diplomatic and chairman could be created to carry full mutual

recognition, which is a practical contribution to the development of the bilateral dialogue. to cuba, the normalization of principles through a series of attending problems. among them is the cease of the blockade against cuba, the return of the territory of guantánamo, and the full respect for our country. we have confirmed there are conditions so that a dialogue can be expanded with the purpose of expanding mutually beneficial cooperation between both countries and of course, taking into account the fact the situation between the u.s. and cuba is asymmetric because our country has not implemented any

policy against american citizens or enterprises. cuba does not implement any unilateral course against u.s. and cuba does not occupy any piece of u.s. territory. we are looking at the proper conditions to move toward the normalization of relations. i can say i have been lease with the exchange with secretary kerry and as to the announcement of december 17, we have been able to establish diplomatic relations, we have been able to reopen the embassy, and now i have the opportunity to welcome secretary kerry to havana for the opening of the u.s. embassy there in the next two weeks. >> thank you very much. i would like to know what are the advantages that are now in place if the blockade is still in place and what are the advantages now that we have an embassy.

and secretary of state john kerry, the government of cuba has said several times in the past that american diplomats in havana have violated the the and a -- the in a -- vienna conventions on relations with cuba. is it going to be like that in the future? translator: the fact that diplomatic relations have been established shows the initial willingness to move on toward the improvement of relations between our countries.

new instruments are created to further deepen this dialogue under the circumstances i have described. during the process of our previous conversation, the historic letters exchanged between president role khosrow -- role castro and barack obama function for the o-matic missions for the purposes and principles in the u.n. charter of international law. the regulations containing the conventions on o-matic and popular relations, therefore we have reached agreement in these areas and i can say cuba would absolutely respect those provisions.

cuban diplomats will strictly abide by those rules and create in cuba every necessary condition for the functioning of the new u.s. embassy in our country. mr. kerry: let me reinforce what renault has said. part of the negotiations leading up to the opening of the embassies was a matter of coming to agreement with respect to all the diplomatic functions. we spend time -- assistant secretary jacobson was negotiating with her counterpart and the prime minister and i then met and signed off on an agreement which is in accord with the vienna conventions and meets both of our countries understandings of what is needed at this moment in time. it could be subject to change, but we are satisfied and we are living within the structure of the vienna conventions. >> good afternoon. welcome foreign minister rodriguez. in your discussions today, did you establish any sort of

roadmap for talks going forward? if so, what are your priorities? do you envision a political opening like greater freedom of speech and assembly and the legalization of opposition parties? and, secretary kerry, if i could ask you about iran nuclear, the u.n. security council voted and critics are saying of the nuclear deal that this vote will lock them in because it has taken place before congress has had the opportunity to debate the deal. what is your response to this criticism? mr. kerry: let me remind you that in the case twice of going to war in previous administrations, the un security council voted before the congress. but more importantly, in this

particular case, with respect to this agreement, we took pains to protect the prerogatives of congress. we got our colleagues in sovereign countries who had no obligation to the congress to agree to accept 90 days of no implementation of the resolution they voted on today. it is all well and good for congress to interact with the executive department and require us to do things, but frankly some of these other countries were resistant to the idea as sovereign nations that they are subject to the u.s. congress. we did so in a way that fully protects the prerogative of the united states congress to review this for the next 60 days. we put a 90 day time frame in

during which there will be no implementation. no ability of the congress has been impinged on. the rights of the congress to make its valuation have not changed. on the other hand, when you are negotiating with six other countries, it does require obviously, a measure of sensitivity and multilateral cooperation that has to take into account other nations desires at the same time. they were insistent the vote take place because they were negotiating under the umbrella of the united nations and they thought it was appropriate when they completed their work for the united nations to make its judgment. i look forward to having discussions and testimony in private meetings in whatever form is necessary to help

convince the congress that this deal does exactly what it says it does, which is prevent the possibility of nuclear weapons from falling into the hands of another country while simultaneously opening up the opportunity for the united states to at this moment in time put to test the verification measures and all of those things iran has agreed to rather than choosing today to force the potential of a conflict almost immediately, which is what would happen if congress does not accept this agreement. translator: my plans are to welcome mr. secretary kerry in the next the weeks to havana and continue our talks to establish

the appropriate mechanism to expand the dialogue in areas related to bilateral cooperation and not really think our thoughts about the essential aspects of the bilateral agreements. i have mentioned i am determined to move this process forward to see the normalization of relations and the political opening in cuba happened in the year 1959. the flag we raise in the cuban embassy waited for 54 years to be back to the flagpole to be put up and we cubans feel happy for the way which we manage our internal affairs and feel optimistic when it comes to our duties and we are serious about our sovereignties, so we will maintain permanent -- based on the sovereign and willingness of the cubans.

>> i have to emit -- i have to admit i'm a little lost with the language because i hear secretary kerry speaking perfect spanish and mr. rodriguez speaking perfect english. i don't know what you which i was to do the original question but let's start with secretary kerry. do you think this new era of relations with cuba is the recognition that the u.s. policies of isolating countries in latin america differ from your political views do not work? do you think recent trips to

caracas is the beginning of trying to rebuild the relationship with venezuela? and -- translator: is it possible to have relations when the u.s. as it is not going to lift the embargo and for those skeptical people who really see as a change in strategy -- they are now implementing a creative way to try to change cuba from the inside. thank you. translator: i can say that the fact that diplomatic relations are reestablished and opening

both embassies is a show of the mutual willingness to move on for the implementation of bilateral relations. on the 14th of december last, we heard the president of the united states, barack obama announced the policies against cuba had been wrong, causing damages and causing isolation to the u.s. today, we have open than them the and all the countries recognize as a sovereign country, though this is a small and neighboring island. the reestablishment of diplomatic relations is apprehended in my country as a ignoble toward a process of civilized relations despite the differences and if the blockade

is lifted -- if we are able to implement this type of relationship between the u.s. and cuba different from what has existed all along and history, in fact feel the recognition of the need to lift the blockade against cuba, the fact that during the talks we have had, we have perceived respect for cuba us independence to feel the determination of our people and that we can now talk as the secretary and i have now talked with absolute sovereignty despite differences show that the u.s. and cuba, by the american people and cuban people are conditions to move toward a

future of relations different from the ones accumulated throughout our history responding precisely to the best interest of our citizens. there is an international order, international law recognized as the civilized behavior to be adopted i states. there are universally accepted principles and these have allowed us to reach this date. mr. kerry: i have learned through my public life that there is nothing harder than

trying to change deeply ingrained attitudes and beliefs that are based on personal experience with the case of many people. i learned obviously in the experience of where i joined with senator john mccain in a 10 year effort to try and change our relationship with the it not -- with vietnam and try to make peace and and the war more than 20 years after the award allegedly had ended. but there were still deep battles in our own country over that issue. over time, with a great deal of effort, we were able to slowly work and show the people that there was a better path. just a week or two ago, the party secretary of the communist party of vietnam was here in washington visiting with the president and we are today trading and working and things are changing rapidly in that country. maybe not as rapidly to some people's desire as they might want, but they are changing. so it is in many ways with cuba,

where passions run deep, and the united states. there are many cuban-americans who have contributed in so many ways to life in our country. some of whom are still opposed to the change and some believe it is time to change. when i served in the united states senate, there were many of us who believed that over time, our policy of isolating was simply not working. we are isolating ourselves in many ways. we felt after all of those years, it was time to try something else. president obama is doing that now. the president said when he announced this shift of policy if you are digging a really deep

hole and you keep getting in deeper but you're not finding what you're looking for, it's time to start -- time to stop taking. it is clear we have chosen a different path. already, people tell me when they visit cuba they feel a sense of excitement and possibility. i am convinced as we work through these issues, we are going to find a better path forward that speaks to the needs of both peoples in both countries. that is why the president has set us on this course. for years and years and years, it was his perception that the people of cuba were paying the highest price and we were not achieving the kind of relationship we hoped to have. with respect to venezuela, the counselor of the state department, ambassador tom shannon, has had several conversations with venezuelans. we had a very productive conversation prior to the summit of the americas in panama. the united states has said many

times, we would like to have a normal relation with venezuela and have reached out in an effort to try to change the dialogue, change the dynamics. there are differences we have with the president and his government and we raised those differences and talked about them. just today, foreign minister rodriguez and i talked specifically about venezuela and our hopes that we can find a better way forward because all of the region will benefit if no country is being made a scapegoat for problems within a country and in fact all countries are working on solving those problems. that is our objective. we hope to continue the dialogue with venezuela. we hope our diplomatic relations with cuba can encourage not only greater dialogue with venezuela,

but perhaps even efforts to try to help colombia to and it's more than 50 years war and perhaps even other initiatives. we are not going to be overflowing with expressions of excessive optimism about where we will find this capacity. but we do know we are going to look for it. we do know that it makes a difference and we are going to try to work at it. that's the ultimate in a fit that comes out of today -- with the beginning of diplomatic relations, we are alleging to engage with each other, to talk about our differences, to find places of common endeavor and to try to build a relationship that

benefits the people of cuba, the people of the united states, the people of the region. thank you all very much. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] >> considered underrated by many first lady historians, caroline harris sign -- harrison was an accomplished painter. she was interested in women's issues and how to raise funds for john hopkins university on the condition that it admit women and she was the first president general of the daughters of the american revolution until she died in the white house from tuberculosis. caroline harrison this sunday night at 8:00 p.m. eastern on "first ladies: influence and image ."

sundays at 8:00 p.m. eastern on american history tv on c-span3. >> the national governors association continued its annual summer meeting today in west virginia. one of the sessions included the health and human services secretary sylvia burwell talking about health care issues. that is next on c-span. later, more from the nga what discussion on prescription drug abuse and what states can do to address the issue. >> it is not very loud.

that is better. if i can gavel us into order. i want to welcome everyone to our closing session of the 2015 nga summer meeting. i think this might proof the most fruitful of all the time we spent here. we will spend some of this session examining health care transformation. i am very pleased and grateful that health and human services secretary sylvia burwell is with us today. she been extremely generous with her time she oversees more than 77,000 employees and her work touches the lives of all americans.

she served as director of the office management as it. she served as president of the walmart foundation, and perhaps most importantly she is a native of west virginia. my home state of colorado is an example of working with cms on a variety of levels. for those of you may not be aware cms has approved the , largest combined data warehouse and analytics system for helping -- health and human services in the country in colorado. this hits all components of working to provide better care for individuals at higher quality, better health for populations as a whole. and reduce cost as a result of those improvements in health care quality for all of our

citizens. let me introduce the secretary of health and human services sylvia burwell. , [applause] ms. burwell: thank you governor hickenlooper. i am especially happy to welcome you to the mountain state. less than an hour away is my hometown across the mountain. i want to invite you all to visit kirk's home of the hungry smile. it is where my sister and i both started as waitresses many years ago. they have hard serve ice cream. if you want to go to the dairy queen it is only half a mile further. it is the most beautiful dairy queen in the nation. [laughter] ms. burwell: i am not one to brag but this is in a book. if you saw it, you would say it

is. so i want to invite everybody. just tell them i sent you. i'm from a town where everybody knows everybody. please do head down and check it out. kirks was my first job and where i really learned about hard work. if you got stuck serving the hard serve ice cream after church, you just kept dipping. it is not matter how the forearms felt after a wild and i am sure you can imagine the after church crowd, you weren't until you got it done. i also learned about community. you work together to get things done. i know those are the ideas we share. it is something i find particularly valuable.

it has been one year since i met you all. i literally had not been secretary for a month. i had the opportunity to get to know a number of view. some of you are around the table. and i understand and see your dedication for the passion and people you serve you few have been great supporters on a wide range of issues hhs has had, whether that is ebola, early education, preventative care. i want to thank you all for your partnership in this year. you all are on the frontline of governing. i know how you feel. you have to answer for your work every day. we depend on you because your citizens are depending on you. so we appreciate that and thank

you. i ask you for your leadership. at one of the most important things happening in the nation right now. that is transforming the quality and value of health care. it is a historic time and each of us has a chance to reshape the system, to make changes and help the lives of the american people. and it is a chance for us to lead together. for too long our system has failed to put the patient first. america has struggled to navigate an expensive and complex system. we pay for more care but sometimes we have gotten less. in the last few years we have started to see some turn. we reduce the number of hospital readmissions. with increased safety and hospitals, with a 17% production

and other things that happen to people in hospitals. that has reduced cost estimated by $10 billion. we made sure those with pre-existing conditions cannot deny coverage. there are 16 million fewer uninsured in our nation. this the foundation we can build on. we want to build a better health care system. one that puts educated and empowered consumers at the center of their care to keep them healthy. at hhs we have been taking steps to make that a reality.

in january, we announced historic goals to move 30% of medicare payments to alternative payment models, such as accountable care organizations and bundled payments and 50% of those payments by 2018, that means paying for value, not paying for volume. by doing so we can pay providers for how well, rather than how much care they provide people. a few months ago we announced a new payment model to encourage coordination among providers who take heart and hip and joint replacements to give this new model would create one payment with quality measures for an episode of care. 90 days from which the point you have your surgery to the 90 days you are supposed be fully recovered. rather than being incentivized by payments for each x-ray and

checkup, they are going to have an incentive on the quality and total cost of performing a replacement and the included recovery. since medicare and medicaid cover nearly one out of three americans we know we have a responsibility to lead where we can. we know we would be able to deliver significant and sustained change. and we work with the private sector. state efforts can go a long way. work with your providers and let us know how we can help. it is for private leaders to come together and share strategies and ideas.

many health care and business leaders are a part of it. there are 4000 members and 600 organizations. i want to thank you who states are participating and businesses. we hope all of you will join this conversation, because it is an important part of making sure we move through this transition as quickly as possible, that we do it in a way that ensures change in the private sector and public sector and if we work together to see around corners. if we work together we can minimize any of the negative impact. we work with many of you to establish medicaid. we are working with most of you all on that. through the medicaid acceleration program and state innovation model, many of you have grant funding to do that

kind of change. and we continue to fund those resources. another area where we see great collaboration with the states, and we spend a lot of time efforts to combat opioid and heroine abuse in our country. i wrote to each of you about the opioid epidemic, where we laid out our strategy to fight it. we are approving opioid prescribing practices. that is why a lot of this problem starts. we are increasing the use of the walk zone and we're expanding access to the medicaid treatment. many of you all have answered that call.

we had a chance to be with massachusetts -- be in massachusetts with governor baker to map out a plan -- map out a path that we can work with each state for real progress. him many of you are finding very innovative ways to combine behavioral and primary care relates to this issue. we are going to create new ways for states to use waivers to address substance use disorder. including developing care coordination models to better connect those with substance use to treatment. we have also heard your feedback about the waiver renewal process for existing demonstrations. medicaid and chip 1115 demonstrations.

this will streamline the extension process and reduce the administration process. we're going to award $11 million in grants to help states provide medicaid assisted treatment for open we avoid use -- avoid -- opioid abuse disorders. next week will make additional funding available for community health centers to improve and expand the delivery of substance use disorders and focus on treatment of opioid use disorders. i know i am probably not supposed to do that but that is $100 million in grant making. the president will not take care of the fact that we just announced that. [applause] i'm here, you're here. sorry. as we learn what is effective, it is important we share these best practices with each other.

that is why the prescription drug abuse policy academy is important. we are convening representatives of all 50 states to come together september so we can work to continue to build on that progress. i want to think the governors for their leadership on the recent policy academy's. i am confident this route will -- group will continue to do great work. i want to mention something else helping to change the system and move us to patients at the center. as we individualized medicine and transform our health system, we talk about the best way to get people care and how to get doctors the tools they need to deliver the most effective highest-quality treatments.

the revolution happening in biomedical research is also a place where we have a chance to change the very nature of care we provide. with sequencing of our own jeans and dna microbes and tumors, we can begin to personalize medicine like never before. i have had the opportunity to meet with scientists and the patient's who are a part of this. he came to the nih with kidney cancer in 1992. like his father and sister he had a rare hereditary cancer with a mutation. it causes tumors to just continuously grow. he had to have his full kidney removed. on his other kidney he had 96 tumors removed. they were able to determine the genetic cause of that particular cancer and develop a treatment.

what they were doing is understanding how they were growing and it caused them to shrink. eventually don received a trial drug that targets the and e.g. trina -- the meg gene. thanks to precision medicine don is doing just fine. often the best thing you can do is give somebody hope. some of the most interesting events i do are with the scientists and patients that are doing this. i would just encourage you all as part of this overall vision of where the science is going to meet with some of those folks. it is exciting to him it is interesting, and you really do see the vision of where we are going to go. before we close i wouldn't be doing my job if i didn't raise the issue of expanding health

care coverage for many working citizens in your state. i think you know what i'm talking about. i want to try to do it in a way that is helpful. i want to emphasize that this is about your citizens financial and health security. it is also about the economic health of your states. in every state that has expanded medicaid cometh every state did more than 4 million americans can have access to quality afford will health care. these are lives that would be changed in some cases and even saved. with more people covered the , economy actually benefits. in 2014 we reduced hospital care cost by an estimated $7.4 billion in the country. of that reduction $5 billion estimated 60% of it has come from the states that have done that expansion. we know there are challenges but we want to make sure you all know that i am committed to working with you to define

gosh to find solutions. -- to find solutions. we want to help you design a system that helps you and your state. one of my favorite parts about this last year has been building relationships with you. i have had a chance to see your beautiful state, drink the best lemonade around, and be sent home with homemade cookies. my children even got to eat doughnuts in a governors mansion . you know who you are. you are their favorite. a year ago i said we won't agree on everything, but we have more in common than we have in conflict. because of that we share common ground and a commitment to serve the american people. when we work together, we can do some great things. thank you all for having me back again and i look forward to your questions. [applause]

my twang is back. >> your approach reflected that combination of private sector experience and customer service you have done throughout your career. we have time for questions. who wants to ask the first question? governor hutchinson? governor hutchison: secretary burwell, thank you for your presentation and your desire to find middle ground with many governors and to look for more flexibility. i also have your connections --

like your connections to arkansas. i wanted to give you an opportunity to comment, if you haven't done so -- you mentioned the 1115 waivers. i would love you to comment on the 1332 waivers. there is an understanding, at least in my neck of the woods, that the 1332 waivers were designed to provide more innovation type grants, a more broader arena grants flexibility beyond the traditional medicaid. can you comment on your approach to these waivers and what guidance you can give the states? ms. burwell: 1332 are waivers about the marketplace. if you look at the legislative history, the legislative history that promoted 1332 waivers were those that want to the

-- wanted the single-payer option. that is not necessarily what 1332 is about. it is about an ability to actually meet the objectives and goals. in terms of budget neutrality, affordability, access, that it is happening through a marketplace approach where a citizen in your state receives a tax subsidy if they are eligible to go on to the marketplace and have helped. if a state can figure out a way to meet those conditions, and it is pretty clear in the statute in terms of the afford ability is about the quality and the access and about the budget neutrality. recently in the last week we

have put out additional ways state can come in and have these conversations with us. i think you all know they don't kick in until 2017. it is important that the application to medicaid funds -- it is about the subsidies and that funding. in terms of thinking how you spend your medicaid dollars and how you think about innovative ways to advance that program so they are different. >> thank you madam secretary. virginia is one of the states where we have not closed the coverage gap. we forfeit about $1,000,000,007

this year. we are working in a bipartisan way to get it done. i want to thank you and your office. they have been spectacular for coming up with creative ideas. we were successful on the state my offer innovation. this is driving innovation reform in virginia. i wonder what is the possibility for continued funding for these types of grants to do reforms at the state level? ms. burwell: i don't think we have a plan for round three. many of you know we did round two. that is something people have to go back and look. one of the conversations happening right now in washington, which is an important conversation not much attention is paid to, i'm sure you are focused on a transportation conversation. another important one is the budget conversation.

i think you all know right now current law is at sequester level. for some of us it will be the lowest levels of funding in a decade. i think some of these questions will be answered as we move forward as part of these conversations about where we are and where we are going to be. i am hopeful there will be another equivalent of a ryan murray approach and we can move forward. that is not the specific answer to your question. certainly as we think through things it is related. governor markell: delaware received one of the grants that has allowed us to accelerate significantly our work to try to move away from the fee-for-service model. my question, which means improving access, improving

quality and the cost curve, we are encouraged by how all the stakeholders are at the table and working together. my question is around the national cost issue. it seems like there are a lot of races around the country. and despite efforts underway to try to move away from that for service model, i'm wondering if you can comment on that little bit. sylvia: whether it is cost in the private market or cost in medicare, what we have seen as there was even an article this week by kaiser. we have seen some of the lowest growth on record. this week's article set 50 years . having done the medicare trustee

meeting over the last five years , medicare cost growth has been at 1.2%. it was the four years before at 3.6%. it is still growth but downward pressure. there is a second part of your question we are hearing a lot about. that is the issue of race in the individual market. one of the things about the affordable care act is the question of transparency. things have to be shown in the light of day, because we believe the light of day is an important market function. what happens is in each of your states any insurer is putting up

rates above 10%, it has to be public and has to be listed. most of you review those rates. that causes a lot of the conversation happening right now. the insurers say that they believe the people that will be in the marketplace it will be below 10%. we know the rates usually come down. a number of states -- some of your rates are out. you are actually in a state where we are seeing good rates and downward pressure. it is something we obviously spend a lot of time on. it is something we want to watch, make sure we are on top of. as i look at the numbers in the out years in terms of cost of medicare, because it will probably be reflected what happens in that market, and there is some pressure in the

drug space. we can have some conversations about that. i think there are a number of things. we think light of day is important in terms of what drugs are costing and how much, so that is something the public knows and understands. can we have the authority to negotiate? as you mentioned, i spent time in walmart. it is a place that negotiates with its suppliers and uses power of the market to actually put downward pressure on price. it is something we want to keep an eye on. i think we are watching but what the conversation is is it is reflective of the entire market. that issue is also another place we need to focus.

>> secretary thank you for your. you have great outreach to the state. we were trying to expand medicaid, which was a colossal failure by the way. it was not on your part. secretary, i wanted to tell you as you look at health care in the country i think one of the challenges we face in wyoming is that we are a very rural state. our challenges are somewhat different from other states. just on economies of sales. before the aca, we had 12 or so health insurance companies in the state. we have 2 now. the same is true with some of

the systems on payment, for example. we look to partner with other states. we think there are opportunities to do that. just a general question is that i think rural healtthcare within our native american populations there is a unique challenge. we are working to find some of those answers. i would just encourage you and your team to recognize that there are some differences between metropolitan areas in health care and rural areas just in terms of distances. how far you have to drive when your son has a broken arm, those types of challenges. it is not unique, it is not new. this has always been a challenge. certainly for smaller populated states, we continue to be very concerned. we have some different challenges than large states. >> i agree and recognize there is a difference. being from west virginia, where

we have a very large rural population. it something i understand and recognize. i look at some of the states around the table like your own. but similar types of issues with regard to concentration. when we are doing rulemaking, one thing you are pleased to know is now that senators for medicare and medicaid know they cannot bring a single rule in a for my review without telling the impact on rural americans. because it is hard to figure out. the announcement that i talked about, the hips and knee bundling announcement. it is in 75 markets. it is mandatory. the market had to be of a certain size. you needed enough of a population that you actuarially spread what was happening. we had the specific conversations. the conversation in rural

america, how do we work to make sure where there is not as much competition, how we create working markets? i think that is a challenge, but one we want to work with you on. it is one of the things that they now have is a listed thing that they have to talk about when they commit, because i am going to ask it, because you might as well be prepared. the markets are different. how we think about that is something we will have to figure through as a nation. we think about in terms of market. they are very regional and local. you all know that, even within some of your states, there is difference in terms of what the market looks like. >> governor herbert? governor herbert: thank you

madam secretary. we are honored to have your. many of us are having ongoing discussions. i want to express to you personally and to your staff the professionalism we have received. you have been very cordial and listening to our issues. we thank you for that. you said something that i was taken with, which is we have more in common than we have differences. i agree with that. i think what we have in common is a very similar goal as republicans and democrats and states and washington dc. to serve our people as best we can. the goal in regards to health care is to make sure as much as is practical and possible to provide health care, affordable, high-quality health care to all americans. where we sometimes have a different is how you do that. the goal is the same, but the

process and pathway we follow is sometimes different. that is part of the debate. you talked about the need and opportunity to have waivers. sometimes it is like burger king, you can't have it your way, we have to do it my way. how do you determine, when it comes to the health care issues, when you give waivers and flexibility, how do you determine how much leeway you get to the states? how much would you let us try our own way as opposed to having to do it, i won't say your way but under the affordable care act, how do you determine where that line is going to be drawn? >> usually in making news decisions, whether it is in this space or any other spaces, one

is working across a wide range of issues well beyond waivers. one turns generally to the intent of the statute and the intent of the policy. this is about what the core issues are. with regard to the specific issue, as we think about where those bright lines are it is often about affordability. that is what the additional funding is about. it was about creating a better match, more enhanced money for states, with in return providing broader access that is affordable. we try to think what is the core objective. generally speaking, as we have

the back and forth, try and find a place where we can be most flexible. i find that in all of my conversations with you. there are core principles that you have trouble moving beyond, even if i would like to do it a different way. we try and do is find that space. it isn't a negotiation. when i came in, some of my colleagues thought it would be easier if i just put lines. if i just outlined it and said, this is it. then it is easier. but i don't think that is what gets to our ability to listen. and hear. because i can look around this

table, and you guys have some ideas that i haven't been thought about. i might not know if it will work, but there is an of logic and evidence to indicate that we should try it. we try to work to create that space. >> governor mccoury, governor fallin, and governor walker. >> thank you for your incredible success. i hope you enjoyed the lemonade at the governor's mansion. >> i took some of it home. >> i want to congratulate you on your focus on mental health. i include that on addiction. i think that is one of the most serious issues our nation and our states are facing. and as i have found out in mike to an a half years -- out in my two and a half years addiction is an issue in our

county prisons, in our emergency rooms, and in our state prisons. that is not the solution. we have got to come up with a long-term partnership with the federal government and local government and everyone involved to deal with this very serious crisis. in fact, we had a previous seminar on the drug problems. it is getting worse. i commend you and we want to work with the partnership to come up with a balanced solution. two quick questions for you. one is, i'd love to get more information on the consistency on medicaid services across all states. were having a debate within my own legislature about what level of service you give for medicaid covering certain activex of medicine. -- covering certain aspects of medicine. some legislators want to increase that, and other legislatures say we are covering too much.

i was wondering if you have any consistent benchmark across states. the second thing is, you've been nice enough to have governor herbert and i visited the president in the oval office. we had a very frank and good discussion on many things. one about waivers. and i'm not sure if the line has moved at all but we are looking to see if there are waivers we can get for able-bodied people to require work or training in order to have medicaid expansion. we did this in public housing when i was mayor of charlotte which was very effective. we want to know if there is any more flexibility on that in that area. again, i want to congratulate you in your reaching out to us. >> on the first question, why don't we get back in terms of the benchmark in terms of service levels? we will get back to your team directly on.

with regard to the question of work and how we think about that ridiculous issue -- about that particular issue. one important thing that both sides agree on quite a bit is that pre-existing conditions shouldn't keep you from inability to get health insurance. how one gets to that -- the idea that health care is not a conditional thing. and health care different from a number of things. i think you know tenet -- taniff welfare is operated out of the government of health and human services. health care is actually different. having said that, i think we think there are incredibly strong ways, because we are with you on work. it would be great to have people earning a wage.

we have a number of places where we have worked with you to get to a place that has innovation, that derives this in a way that will get more people through your work turning programs than you would ever see. we're looking forward to have that conversation. we think we can get to a portion of what you want, which is work encouraged. that is the core of your comment. we think there are ways to do that. >> thank you for coming again. it is a pleasure to listen and have a dialogue with you. i think you have one of the toughest jobs in america. you certainly had a tough job this past year so thank you for

visiting with our governors. a couple of things i want to commend you on. you are talking about paying for outcomes vs. volume of time someone sees a doctor. we are all about improving the health of our services versus just what we hope might work. so thank you for that. your comment about trying to fast-track some of the waivers. if i remember one of the requests from one of our governors is that if we have a waiver that is already approved in the past, if you would consider being able to continue that improvement of that waiver. like in the state of oklahoma, we have a program called insure oklahoma where we have a three-way matchup medicaid money with a person paying a small portion of their insurance and the employer paying a small portion.

it comes back to the question about working and paying. you approved it for a short time, which i am grateful for. if we had some think that is already working and innovative, can we just go ahead and make that permanent versus trying to reapply it every year? i want to ask for your consideration of that particular issue. on the open right and prescription -- on the opioid and prescription abuse issues. one of the things we have done in the past is a prescription marketing bill to stop doctor shopping in the states. it is a hard thing to do. it took about three years to get that through because some doctors didn't want to have to spend time away from seeing their patients to check this and that. could we not do that for medicaid events under federal guidelines? if someone is on medicaid and receiving pain pills you

require a doctor to check in every time before they give that medicaid recipient continued addictive opioid? something to consider on that track. last thing i wanted to mention. we talk about rising costs of medicaid and expenditures to the state, which is a huge challenge for all of us. we're one of the states that over the last couple years, we have seen unemployment drop, and income go up. but as income went up, our estimate funds went down. it was about $90 million drop. we had more people coming into the system with less money from the federal government because our economy has changed. now going through another economic downturn with the energy sector. just something to consider. >> thank you.

on a wide range, i won't touch on all of them. encouraging movement to economic health and being in the private system where possible is something we want to think about. on opioids, the prescription drug monitoring plans, almost every state has one. in the conversations i have had around the country with a number of you it is a very important enforcement tool. the ease of being able to use it, publicly updated. some other states do it and some don't, the relationship with other states. because some people border shop. that is another issue that we need to work on. bringing folks together.

because when you talk to physicians about how easy or not it is to use in terms of the system. if you ask a doctor and ask how many clicks when you see a patient? you don't want to spend that time checking. the idea of how we can encourage and influence those with regard to the payment system is one we will look into. but i do think we need to get to a space where physicians are trained. when i asked physicians how much training you actually receive in terms of treating pain? that's one of the issues. we're working very hard. we had a represented from the cdc as part of your panel. we need to issue the new guidelines but then make sure people are trained in them. we hope we can make progress. we heard a tragic story of a young woman who had gotten her

wisdom teeth taken out took twoo o much of the prescription drug after her wisdom teeth, became addicted after only months. it became cheaper, easier, and better to use heroin. and just the trajectory, the good news is that for years she has been clean. but if we can stop that journey because there were many other stops along the way in that picture. we are just seeing it everywhere. it is not geographic anymore, it is not socioeconomic. the number of people that you know whose children have some of these issues, i'm sure everybody in this room does. that something we want to work on. >> governor walker and then governor nixon. >> more comments been a question, madam secretary, thank

you for being here. i appreciate you being in washington in february and beginning the process with me. i began the process for alaska becoming the 30th state to accept medicaid expansion. i share the governors concern talking about rural . we are pretty rural, too. [laughter] our methods of getting to those that need care don't always involve a road. we only have three roads. 110 airports, so we have our challenges. ice want to thank you for your passion in this area, also for your staff and access. i know you're the person that gets it done. we are a bit removed from mainstream america so to speak.

we can reach over to a neighboring state, we have russia and canada, so there are not many options there. but washington has been very helpful to watch. -- helpful to us. we have 45 days to get through before i can actually sign it. but we appreciate you helping this part and i look forward to working with you for the next 45 days and beyond. >> thank you and thank you for your leadership on this issue governor. >> hello. appreciate i will stimulate all the thinking. -- all the thankings. but we really appreciate not just you, you have pervaded that mentality through your entire to permit. we feel that on a lot of levels and appreciated deeply. -- through door entire department. this feels a lot different than a congressional hearing, i imagine. >> that will be on tuesday.

i spoke with a number of years -- a number of members from your state. >> that said, we have not expanded care to working misery -- working missourians. on the whip side of this, as you look at cost containment, there are triggers that are difficult or states and hospitals that are built into the affordable care act. whether it is on reimbursements for medicare, equaling out of payments, or the disproportionate share. i don't know what pressure you are under what a terribly to use those tools. -- what pressure you are under bugetarily to use those tools. some of the folks don't think that is going to happen. whether it is a year or two years from now, it is going to

happen. it could cause the delay of those instead of having it smooth , and could cause a cataclysmic effect in states that we don't move forward. if that becomes a clip instead of a slide -- a cliff instead of a slide it has a very cataclysmic effect in other rural area. >> my ability to predict on this one involves two things i don't have a lot of say in. one is when you're about 10-15 days, what it you're talking about is when i will no longer be here. congress is engaged on these issues. i'm not going to predict.

i think we should be focused on these as a nation. >> it's a congressional decision whether to opt it. >> to turn it off, and to date is is been turned off. >> take action to extend. >> right. the question of whether they will do that again is something i'm not going to get to. >> you have to answer this year obviously, but the question is whether the administration is going to ask them to continue to extend were not? >> with regard to the budget, i will be reviewing our mandatory proposals in the next couple months. the broader issue of how we think about cost containment, why those provisions were put in is because it was thought it would be more cost-effective to

pay for uncompensated care in indigent care through a systemic approach in the states instead of the way that we were doing it. there are a number of tools that exist, you mentioned a number of them. they have a low income pools. i had a very public conversation with one of your colleagues in florida about these issues. why it was put in place is about how to most cost-effectively help low income people have access. those were the decisions about it. how it plays out in the current environment is something we have to evaluate as we go through it. >> thank you. the expansion in kentucky could be enlightening on a couple of these issues. competition.

before we fully implanted the affordable air packed we had two companies in the state that would sell health insurance. we now have five. that obviously is encouraging to us. we have been working for 20-30 years trying to get other companies to come in. we just haven't, no success in it. and now we have that kind of competition. second thing regards rural healthcare. we are a state of about 4.4 million people. a lot of our folks live in rural areas. we particularly have always had issues with rural health care, hospitals, and how they can stay open. as the democrat exchange. -- as the demographics change.

our hospitals as a whole have gone from about 25% on commentated care to about 5%. -- 25% uncompensated care to about 5%. for the first time in their memories, and in mine, they are in the black. their bottom line is actually in the black because they are getting paid for the care they are delivering. there are still a lot of albums with rural healthcare and we will continue to juggle those. but at least from a revenue standpoint having expanded medicaid has been a boon to our providers in terms of getting more money into their pockets. it's been a boon to our economy in that before we get it, we got

price waterhouse cooper to protect what would happen and if we could afford it. the projected that over eight years, we would create about 17,000 new jobs and have about $15 million infused into her economy. we implement it aced on that. -- based on that. after the first year, i said let's take another look, because we have actual numbers. at least one year of hard numbers. i got consulting to go back in and take a look at the first year. they came back and said, we are sorry to tell you that price waterhouse cooper was wrong. they told you you were going to great 70,000 jobs in eight years, you've actually already created 12,000 jobs in the third year. it looks like you'll introduce about $40 billion -- $40 million into the economy instead of $15. for my friends who are concerned

that the federal government may back up at some point and not do their part or that these numbers at some point may change and we cannot afford it, my message would be this -- you can stop them. the court case says anytime we want to, we can stop. if either one of those things happen, you can say, we can't do it anymore because we can't afford. 400,000 people in kentucky now have health care coverage for the first time in their lives. i know a lot of legislatures have trouble just because of the name of the act. but if you can get past that kind of politics, this is a win-win for both your people and your economy.

you're going to create a lot of jobs and put a lot of money into your economy in addition to improving the lives of all these people. screenings for cervical cancer, breast cancer, diabetes, you name it, they have just gone like this because of the percentage of people that can get them. what that will do is cut down on the big costs down the road because when they were getting screenings the first time we saw them is when the ended up in the emergency room. now w'ere able to work with these people to teach them how to take care of themselves. and take responsibility for themselves. that is part of this deal, that your citizens need to learn how to do this. and they really want to know how to do it. that is what we are finding. if there are ways you can massage things around and get to this point, it's going to be a big benefit. >> thank you.

>> steve, you want to come up to virginia were a couple days? [laughter] >> i think we've almost worn out the secretary. on behalf of the entire organization, i want to express our gratitude for your patience with all of us over the past couple years. we really appreciate it. [applause] >> thank you, thank you very much. and i look forward to working with you all this year on a range of issues that i hope -- i'm looking at this table, and i didn't have to call you all about ebola. but i hope that we will have a good year moving forward on the many many places that the overlap and the many places that the fund. we wants to know when we are getting it right and getting it wrong. we have much bigger spaces of common ground then we do have laces of disagreement. there will be some of those, and i know