health care costs. health care costs is still a top priority for employers. it's a drain on the bottom line and they are concerned about the number of employees, who even in the employer system, are struggling with affordability, so it's a major concern. the second observation has to do with the shift we have seen among the large employer community to focus more on delivery system or supply-side opportunities. have been using health care cost management and plan design such as moving to high deductible plans for health plans for years to offset costs and manage the demand for healthcare services. what we are seeing now is employers point toward the delivery system and opportunities to purchase health care differently, using alternative payment and delivery models, looking at experimenting with the common care organizations. we are seeing more bundled payments and really trying to move away from fee-for-service and more to the value-based system and we will get to that data as we go through. the third ob

when you look at things like health coverage, health access, health outcomes by income, you see similar isparity with low and moderate income facing more challenges. host: in terms of access and kaiser, numbers from the family foundation, all things can be found on your website. hispanics to whites in america, hispanics likely to be diagnosed with hiv/aids and rate.r birth this chart showing uninsurance rate for hispanics in america, 2015, compared to whites at 8%. also noting medicaid and chip of coverage for hispanics, particularly for children. 25% of rt is showing uselderly adults, hispanics medicaid or chip, 53% are employer or ugh the other private insurers, 23% uninsured, compares to 9% uninsured for whites, 74% with employer, other private 16% using the medicaid and chip. ust some numbers in the data packets available on the kaiser family foundation's website. more numbers ugh as we have this discussion, want to continue to hear from viewers. nancy in new jersey in raleigh, new jersey. go ahead. caller: yes. would like to make this this segment connection with the previous segme

health challenges for them means health challenges for the nation. our goal for them is to demonstrate the importance of exercise, being legally fit, adhering to an appropriate diet, making certain you are not doing things that are likely to result in a horrible lifestyle. severe mental illness is an area we have been in an experiment in the last 40 or 50 years that says every single individual in this nation can be mainstreamed into public life. in the had huge success pharmaceutical area for severe medical desk severe mental illnesses. -- severe mental illnesses. the homeless population has a history of severe mental illness. we have moved from housing in substandard clinical settings and we have transferred them to by and large, being housed in substandard criminal justice settings that are no longer writing the care and treatment they need. that is irresponsible as a nation and we need to do all sorts of things to improve that situation so those that are almost forgetting the care they need from a mental illness standpoint so they can move into s

americans deserve health care and affordable health care and comprehensive health care. it is part of making a successful nation. i fully believe that you can and should get the care you need, and it is a stain on this nation that we are not doing it, especially when every other developed nation in the world figured out how to do it. host: you write in your book, having health insurance was once the equivalent of having help care. -- health care. that is no longer the case. having health insurance no longer means you have access to health care. it is an obvious problem for patients but it affects professionals, as well, in terms of their ability to care for patients and approaches in delivering care. it is one more distraction in the rising sea of them. tell us about that, when a patient does not have health care insurance. guest: you have to practice a different form of medicine, and talk about distractions, what do you do when you do not have the , to gethal to testing it is a completely different form of medicine. even when patients have been insurance today, some hav

but your health as well. but this is a system that forces you to look around every year and that isis absolutely correct.it is a good message. >> end of the caller continues tuesday enrolled. they need the market with a healthy young people.l or repea >> so with that federal appeals court to issue and this came from the court of appeals with 16 attorneys general that day may intervene with those cautionary subsidies. with those seven low income people so that attorney general with the motion with that legal political historyry and the subsidies and impractical terms to make them more difficult with house republicans to abandonwh the payments. what do you think?. >> there are some serious consequences to the insurance market if the subsidies are cut off. i do think they're right and ultimately over the long term they really are important to the halt the instability of these markets >> talking about those centrist lawmakers getting together with that stabilization bill as day plan to unveil a slate of obamacare

you have guaranteed health care until you leave your job and even when you retire, the health care program still benefits you. when i leave my job, i have to find health care elsewhere. you talk about how this is a market, it is not a market. you give us a bunch of bad choice and you say here, pick from these choices him whatever you get, you get. that is how we failed the american people, especially those who live in impoverished communities and who cannot afford much. working paycheck to paycheck every day. it is a shame i have to work three jobs just to support my family. as your average american does not make that much, that is the reality i live in. why don't we is live under the same guidelines as people in congress? why is it not equal. host: that is my concern. we do understand the point. let's hear from our guests. guest: people have multiple jobs .nd are concerned about future it reflects the state of the economy, the state of progress in the economy. changes,, --gy good jobs before, they lose their jobs and they get caught in the grinding of the economic system. that is largely

we see less health plan disruption in employer-sponsored health care then we see in individual market today. that is not to say that we do not appreciate the individual market. we need a robust and stable individual market. it's important to note what is going on with repeal and replace of obama care and the instability that exists within the public exchanges today is not reflective of what is going on in the employer-based system. employers are still concerned about the inefficiencies of the healthcare system and rising healthcare costs. healthcare cost is a top priority for employers. it is a drain on the bottom line and they are concerned about the number of employees who are struggling with affordability. it is still a major concern. the second observation has to do with the shift or seen among large employer community to focus more on delivery system or supply-side opportunities. employers have been using healthcare cost management and consumer directed health plans for years to help offset costs and manage healthcare services. the, we are seeing employers point toward the delive

i'm particularly pleased that the chairman with respect to health focused on the children's health program because that is a program that has a timestamp that expires on september 30. these are kids that have fallen between the cracks. in the office he always says stick with me. chip is a bipartisan effort. it's not just possible, it's the right thing to do so let me mention one other matter as you touched on in addition to the children's health program in light of the events of the last few weeks we know members are eager to bring up additional health-care ideas and additional upcoming hearing and i'm glad you made it clear that would be on the calendar. we've spent a significant amount of time the last few years writing the only two actual bipartisan tax reform plans this recently with dan coats who sat where senator cassidy is sitting today, so i know what this challenge is all about. some people were smart on the subject didn't like to say tax reform is hard and that's why it ought to be handled on a bipartisan basis. i told the chairman of my concern that the majority leader has dismi

debate health care. given his time serving in the house, he is keenly aware of the importance of the relationship between the legislative and executive branches. i am more than confident he will be responsive to member questions and concerns when confirmed which is so important. he is being nominated to fulfill an important role during an exceptionally critical time. i know that his experience and expertise will provide invaluable insight in meeting these challenges as we work to strengthen our health care system. as the chairman and ranking member pointed out, provide integrity and responsiveness. i know as a member, that's what i want in a person fulfilling that position and i cannot think of anybody that will do a better job. thank you and i yield the floor. senator hatch: thank you, senator, that's a good introduction. you have to feel pretty good about that, mr. bassett. [laughter] i feel pretty good about it myself. [laughter] taking timee you out of what we know is a busy schedule today to be with

i have not had health insurance since obamacare took place. they took my health care away. i can't afford to pay for it. i'm a construction worker. know, issues that most americans have but cannot go to a doctor. it is said because i don't qualify for medicaid. i can't pay for health insurance. there are millions and millions of people in my category they cannot afford this. because i heare so many people talk about why they voted for trump. i support him one of 2% still, -- 100% still, but i'm disappointed in how this whole health. she was going. -- whole health care issue is going. guest: the bill that went through congress of the approval ratings. a lot of people want to see bipartisanship. a large number of americans want to see congress work on a bipartisan basis to repair the law. i don't know what your particular situation is, but under obamacare, because medicaid was initially supposed to be expanded in every state and then the supreme court ruled states to decide whether they want to take the expansion, you had several people who maybe would have qualified for medi

chip is the health insurer just children's health insurance program. it was started because there were a lot of uninsured children that were in families that earn too much to qualify for medicaid , but not enough to where private insurance would be affordable or even available in some cases. maybe the parents work in were employer-sponsored coverage wasn't an option for the hall family. congress wanted to make this commitment to covering kids into getting more kids covered. they start of the chip program and since that time we have now reached historic coverage levels for kids in the u.s.. this is something we should be very proud of. we have 95% of kids covered in the u.s. and that is thanks in large part to the work of medicaid and chip and the commitment to covering kids in a bipartisan way. guest: what is -- host: what is the price tag and how does it compare under the medicaid coverage for children? guest: the price tag on the policies and how congress might want to change in the future. for this year it cost about $14.5 billion. it covers 9 milli

>> well, i can tell you first we need to have a health care system that provide mental health services through health insurance in america. [applause] members of the senate and congress where i have served have the most passion, most effective, when they're dealing with an issue that touches them personally. there was a time when paul well stone of minnesota, with a brother who suffered from mental illness, pete domenici, conservative republican of new mexico who had a son who suffered from mental illness. the two teamed up and four years, kept beating the insurance industry you have to absolutely include mental health services with other services in health insurance, they finally won it. we put it in the affordable care act. it makes a big difference for vast majority of people like us, most of us who in this room have health insurance through our employers. you start there. it is not enough. you make sure medicaid, serving many lower income populations has access to good mental health services, too. which means community clinics have to offer behavioral health. more and more are doin

>> senator alexander on health care on the health committee is going to meet to talk about stabilizing the system and in a bipartisan way. why go through six months again on tax reform which they went through on health care and then come together? we have shown time and time again if we are invited and we want to participate. we are going to get all our way. there'll be compromises. that's what it's all about. that's what the founding fathers created in this country so we are urging our republican colleagues not to go at it alone but to work with us. that may mean their dream of huge tax cuts on the rich and almost crumbs or nothing for the middle class won't happen but they will be better off and america will be better off for it. [inaudible] >> well look, the bottom line is policy has been so far away from where the american people are at. that's a big fault line here. on health care leader mcconnell, it's not his fault they couldn't get it done. they came up with a plan that was so far away from what the american people wanted it couldn't get done and that's what they are trying to

health care reform, you're just not going to do it.literally has to get done for the american people. somebody has to make it happen. >> absolutely. the thing is everybody talks about trump being the great negotiator but so far right now, all he's doing is issuing threats to cut off health care subsidies for congressmen and senators and just kind of throwing these fits on twitter. what he really should be doing is showing what a great negotiator he supposedly is and bring everybody to the table. why don't we take on both sides to get this done and we can pass in that action works for the american people? >> one of our producers in washington set up with broken senator from utah. using basically let's not talk in terms of repeal. we are going to have to replace it. what's important when they want to get health care generally semiright and agree on it would be a wonderful time as far as repeal goes, who cares about words. the semantic done? being so specific about something as repealed or replaced or fixed or retooled, can we move past t

reporter: health care. the ways nd means has health-care urisdiction right now. a lot of headlines about how the president wants to hasten the downward spiral of obamacare by stopping these cost-sharing subsidies. basically stopping president wants to hasten the any federal money from going to insurance companies. and there are a lot of republicans on capitol hill who push back against that. they think that republicans could ultimately be blamed if we start losing health care in the next few months. i want to know, have any republicans in congress seriously approach to about what they might do if trump or to do something like this? have you talked to brady or house republican leadership? do you actually think that democrats or republicans could come together so the government keeps trying to make the payments even if trump tries to stop them? rep. neal: kevin brady has art said that the cost-sharing initiative should continue. -- is that the same and he will convene hearings. the cost-sharing subsidies were agreed to and they should be paid. one reason we are hea

i am particularly pleased that the chairman, with respect too health, focused on the children's health program a because that is a program that has a timestamp on it. it expires on september 30th. it serves more than 8 million kids. these are kids that are falling between the cracks, kids who aren't eligible for medicaid but are still coming from families that are on an economic group. mr. chairman, one of the things that i enjoy the most about our working relationship is talking about 20 years ago when you and ted kennedy teamed up to create this back when you visit with chairman hatch in his office he always says stick with me, kid. i'll make you a legislator. that's what i did with kennedy. the fact is chip was a bipartisan effort and they demonstrated against all the odds that bipartisan healthcaref policy is not just possible but it's the right thing to do. so, let me mention one other matter. mr. chairman, as you touched on, in addition to the children's health program, in light of the events of the last few weeks, we know that members on both sides are eager to bring up addition

awarenessesources and among public health advocates. what thisnow emergency declaration will do but the one thing we can point to is the spotlight on the awareness. part of that is aimed at in courage and studies you are talking about. host: time for a few nor calls -- a few more calls. line for democrats. caller: one thing i have noticed , is when it is affecting men, it is fluffed to the side, it is just the men that are homeless. we don't gear up any social programs. rethinking -- we need a better startingall, anything to affect anyone, we need to get on it state-by-state. quicker. and start treating it like it is something serious, like our veterans, and different ones like this. look at theerall and our medical people and the doctors and stuff and have a good review yearly of everything. and put it out there and not side shuffle it. in the rural areas to, get medicine and more expertise to the smaller towns. host: got your point. thet: mark, you're raising points people are hoping this emergency declaration achieves and that is put

health care reform. you are a family physician in a little town in maryland. what made you want to attack this big issue? caller: ein

the healthregards to we need an american health care plan, not a trump health care plan, not obama health care plan. paul: what does that mean? an american plan? caller: something for the american people. political, like one side or the other. we need to come together in things, these issues. especially health care. it is good for everybody, not just the doctors or the government or the people. it is good for everybody. find the middle ground. and as far as the thing with trump and all the animosity, i think we need to stop cutting .own our president let's see what he is going to do. anyong as he is not doing really bad things, he is our president. recognize that and give him a chance to do his job. without all of the backbiting. paul: let's hear from al now in toledo, washington. good morning. caller: my favorite program. i wish i could get up at 4:00 out here and watch every minute. i have spent 30 years in active military service and every topic that is on this program is interesting to me. we -- if an intern doesn't show up, when there is a clinic scheduled, that means the on staff do

although public health advocates had advocated and even enacted health measures as early as the 1 20z, political resistance angkoruption prevented their effective implementation. among those unenforced regulation brz restrictions on the dispose of the waste that accompanied the slaughtering of animals that took place throughout the city limits. la bay and lurie tell us "in new orleans, animals were routinely herded through the streets, slaughtering sometimes took place in the open within sight of the public including children. when oh full was disposed of correctly, it was loaded into open carts and were driven leaking and reeking through the streets to news san wharfs where it was supposed to be dumped into the river but much of it was simply discarded into the streets or gutters and left to rot and fester in butchers' back yards." in 1359 report of the board of health described the gutters as squelterred with the blood and draining of slaughter pens. an 18168 estimate placed the total number of slaughter houses in new orleans at 150. the great majority of these were located in well

as far as health insurance, it is obsolete. insurerera for-profit to pay for my health care, which would cut into the profits, is ridiculous. we need a single-payer system where everybody pays in and everybody benefits. that would be my comment. guest: well, that is a position that a lot of people feel today. i do not think you are by yourself. the problem is is what is on the other side. when we began to get estimates of the cost of a single-payer system, it just goes through the roof. they tried to do it in california, and they found that they absolutely cannot afford it. i think they were looking at something like over $1 trillion in one state for the cost. so everything has a cost. and you mentioned the fact that there are in shares in -- there is insurance that might have to bear part of the cost, and even obama administration recognized this, a provision to subsidize the insurance companies in obamacare, that the insurance companies cannot simply take on the costs within their own structure without help. now that is getti

host: we are talking health care. our guests here -- grace-marie turner, president of the galen , bothute, and ron pollack members of what is called the convergence center for policy resolution. let's go to mark, joining us from san antonio. you say your wife is uninsured you do you have insurance? caller: yes. i am a disabled veteran, so i go through the v.a. but my wife is a type one diabetic. in the last seven years, she has become a brittle diabetic. but she still has her fingers and toes. she is very compliant. we have been denied four times for ssi. are throughbills the roof. she has been in the icu three or four times in the last three years. but we cannot get insurance. host: how old is your wife? caller: 44. host: is she working? caller: she cannot work. she does not recognize what her blood sugar gets low anymore, so it is a constant battle to keep her standing. i just do not understand it. i also do not understand how congress can say that we have to have insurance that they do not have to have a that is wr

there are a number of issues with the american health care system. but if your house is on fire, you want to put out the fire. and the fire in this case is the individual insurance market. andrew desideridesiderio, it soe the senator was working that up for a while and itching to get that hearing underway. >> that's right, he was for sure. he issued a stark warning to president trump. he said he actually encouraged president trump to continue allocating what are called the cost sharing reduction payments under obamacare which would give funds to insurers and poor americans under obama care. that is in and of itself a market stabilization measure. the president has threatened to cut out those funds. insurance bailouts$< essentiall is what they call them. but senator alexander, many republicans, even senator john tlun said that the president should at least in the short term continue these payments while those here in congress work on a solution to stabilize the markets. the existing markets. >> and senator patty murray tweeting a short while, with tru

what i would encourage or ask we have health care staffers in washington dc, and the health care staffer in kansas. the one in washington dc is very knowledgeable, and it was for that stuff out with him. what you're telling me is that there is a federal program that funds this effort, or partially funds, and that program is what you are telling me is important. of thosebsence dollars, we would lose even more in our battle against opioids? >> yes. you, i chair the community pharmacy committee in caucus, and we are trying to keep the firm is his around main street around a lot longer. if you think our hospitals and other health-care care providers are struggling, our pharmacists have a significant challenge. and a lot of it has to do with s, whichg we called pbm is how they manage the drug program to rid who gets money for prescriptions, all of the federal regulations. >> we have people who are battling cancer, and whatnot, and for every dose of a chemotherapy agent that is administered, under these new regulations your adding an additional cost of 15 to $25 per dose. when you need 400 dos

what really needs to change is a culture change among health care professionals. last year the cdc issued very important guidelines for health care professionals to make sure they are only prescribing opioids in select cases, usually for chronic pain. you should not turn to opioids as the first drug. a lot of education news to be done. most of this education is being called for voluntarily. what the commission has called for as well as the bipartisan policy center -- we have a governor's counsel made a former governors -- we have called for mandatory prescriber education before someone gets a controlled substance license from the drug enforcement of ministration. -- enforcement administration. we should have mandatory education. this epidemic is too large now really to go any other route. host: there's going to have to be a change of mind when it comes to the patient itself who is demanding the drugs in some cases to help manage pain. guest: absolutely. that leads to another important point. we need more options out there. opioids cannot be the only option out the

health care. excuse me. i need some health care. [laughing] my question, after seven years why can't i get on the internet and go to a secure website that the russians will not influence and the chinese cannot hack, an by health insurance from anybody in the country that's willing te provide it?try >> if i can remember, my mental health is sufficient, i'll try to say the three things. first of all, it doesn't make a lot of sense to me that industrial hemp can't be grown, and i cast those votes in washington, d.c., from time to time but mostly that's a state issue. secondly, in regard to the va, i'm sorry you've had thatank yor experience. i thank you for your service. there are way too many people s. cracks. through the i assume there will people in the room who will tell me the va has treated them well, theya appreciated the health care thee get but there's a lot of people particularly in the area of mental health, particularly ourd servicemen and women who have returned from multipleltip deployments. we do not have the professiona

let's increase health, reduce health care. what is your opinion about that? keith: we have not done anything on tobacco. the issue about changes that might reduce health care cost involves federal spending. that is a tough trade-off, right ? if you have the government spending money, then you have -- the money does not pay for itself, right? people become healthier that it somehow pays with a higher tax revenue, that sort of thing. that is always a big issue with us. trying to figure out the matching trade-off in something like that. it is difficult to analyze. if we had a serious legislation proposal to do something like you're suggesting, we would do an analysis of it. we would do our best. i cannot predict what the answer would be. >> can ask you one more question? you have those major health programs going up and up. after 30 years, what percent of gdp is going to health care? >> 17% now. keith: yes. it might be in one of my printouts here. let me cheap and get my graphs to give you some idea. >> we spend so much more than other countries. 30 years it loo

and yo the public health aspect of it. why is it that 52,000 americans succomb to an overdose death in 2015 and those numbers continue to increase? fourth is the research aspect. what is the nih doing, what can they do? exciting things to provide for hopefully pain medication that is not addictive or not e uphoric. they are working on a vaccine for addiction which is incredibly exciting prospect. finally, how do we treat pain in this patient? -- nation? as a formally practicing physician, i know that other providers have often times sense d that there is incentive to provide narcotic medication and we need to do all we can that yes, people are provided appropriate narcotic medication when necessary but no more than necessary. we wanted to make sure the president understood it is the entire cabinet and government involved. this is an inter-agency process that is moving forward. we've met previously with the department of state, justice, department of homeland security and others to make certain that we are working together

goal and desire is to have a health care system that works. thank you. >> is the president escalating the conflict in north korea? more on what is happening with opioids in the u.s. from "washington journal." joining us as the chief medical advisor who previously served as the deputy secretary for health. good morning to you. the president sent out a tweet earlier this morning taking a look at what he wanted to talk bout with the opioid crisis. at 3:00 in new jersey. this stems from his commission that takes a look at the similar topic last week putting out calls from him calling it a national emergency. can you tell us what you see from these events and what it says about the administration's concerns? >> this is a very important issue. i think this is one of the most important public health issues of our time. over 30,000 americans are dying every year because of opioid overdoses. there are 2 million americans who are addicted to opioids. the president issued an executive more -- order. -- a final report will be due in october. that report b

health bill passed. i was hoping in one of then meetings with senators, one of them was asked trump a substantive or technical question about health policy,he but they all wimped out. >> thank you so much. my name is back, i am the former budget committee staffer.ering, i'm wondering, when we talk about tax reform and reconciliation, we are going to have a lot of problems in addition to just the long-term deficit issue. do you see any regulatory to s of issues and tax reform that are going to get voted out? this was a big issue whether the house was going to be able to pass the cra after birdbath issues. thank you. >> i will say that is a right thing to be paying attention too. in part because of the level of detail which i've been following the healthcare site and i've been following the tax fight in a little less detail. i would say, what we should look first at where are the policy disagreements and until they figure out some of those, the idea of what are these ancillary questions, when they'll say a

>> well i can tell you first we need to have a health care system that provide mental health services through health insurance in america. [applause] members of the senate and congress where i have served have the most passion, most effective, when they're dealing with an issue that touches them personally. there was a time when paul well stone of minnesota, with a brother who suffered from mental illness, pete domenici, conservative republican of new mexico who had a son who suffered from mental illness. the two teamed up kept beating the insurance industry you have to absolutely include mental health services with other services in health insurance, they finally won it. it put it in the affordable care act. it makes a big difference for vast majority of people like us, most of us who in this room have health insurance through our employers. you start there. it is not enough. you make sure medicaid, serving many lower income populations has access to good mental health services too. which means community clinics have to offer behavioral health. more and more are doing that but we hav

you are trading to be a mental health nurse, so you see the service from the other side.n your day? i think people are trying their best, but because the resources are not there from the government and things, it is a massive struggle for everyone. thanks for that. tim, do you agree with what the judge had to say today? i do, i'm afraid. sir james munby is a senior and well respected judge, and am afraid what he said is nothing new. and it is one aspect of the shortcomings of mental health services in this country, especially for children and young people and vulnerable people, and i agree with everything that wasjust said, and it is right that she has come forward and will speak up about it. this is a severe wake—up call and we have got do much better for children in our country who are suffering these kind of mental illnesses. what will happen to x, the woman involved in the case the judge was talking about? he wants her in a low secure unit where she is not held to stop her attacking other people, although she is clearly a danger to herself, but there aren't many beds.

health care closest to the people is the best health care. lauren: he also talked about removing mandates. graham-cassidy plan looking pretty attractive especially to some governors right now. to discuss the current state of legislative affairs, let's bring in gerri willis. good to he zoo you. >> hey, lauren, that's right. a lot of people are asking can these senators do two things at once. they proved they can't do one thing at once, right? republicans on capitol hill and trump administration looking for a way forward on health care after the last week fail lure to. president trump said republican senators should not give up. several republicans are calling for more works on health care reform. several senators are looking to expand efforts across the aisle. >> we came very close. let's continue to work on it, come up with a good balance, insuring we're getting costs down. also protecting most vulnerable out there who need to have access to affordable health care. >> we desperately, desperately need reform. i think we're at the end of the ro

if you like your health insurance, you can keep it. not true. we heard the cost of health insurance was going to go down. that one sure wasn't true. in fact, we were promised families would save up to $2500 in health insurance premiums if this thing became law seven years ago. the average obamacare plan today costs nearly $3000 more than a planted in 2013. while premiums are soaring, choices are plummeting. next year at least 40% of american counties, including nine-hole states, will only have one choice of a health insurance provider. many counties will have no health insurance providers whatsoever in 2018 all across this country. it's not just about the statistics. it's about real people. it's about small business owners, family farmers all across this country that are struggling to make ends meet. i've heard these stories as i traveled across this country and so has the president. talk aboutbusinesses the heartache of struggling to keep their whole workforce in place, people who have worked for them for years and years but with skyrocketing c

t is a critical public health challenge for our country. host: what is funding or get over hat help to that recovery process, getting over the addiction process, what is available? guest: there are many federal gencies out there, substance abuse services has a hotline, resources there. dollars, federal grants going out to states. medicaid is very important public insurer perspective of medication treatment, medicare, as well, but less so than medicaid. there are federal providers out there, the va, indian health service, the commission called to increase prescribing of medication assisted treatment addiction.th opioid there are federal resources out there, certainly i think from locality and perspective, there needs to be ore, never quite enough given magnitude of the public health challenge and i think the commission referred to several possibilities. host: bipartisan policy center put together recommendations, look at this issue, our guest talked about some of them. tell us about the development of this. you able to talk about these issue