health and human services. we appreciate you being with us today, doctor. you are recognized for five minutes for an opening statement, please. >> chairman burgess, ranking member green and members on the subcommittee on health, thank you for inviting many he to testify at this important hearing. december, 2016 the 21st century cures acquisition was signed into law. i -- act was signed into law. i thank you for your vision and leadership on addressing the needs of americans living with substance abuse and mental disorders. we have actively implemented this law since enactment. as the first assistant secretary created by the cures act, i take seriously my duties including leadership and accountability for behavioral health, evidence-based program coordination across government. part of strengthening leadership and accountability includes a strong clinical perspective at the agency. it codifies the role of the chief medical officer and we have expanded the office of the chief medical officer to include two additi

health l health matters more than we think. health and health status are critical. number two on health insurance. yes, ensuring access to affordable health insurance is important to optimizing health and democrats should be all for universal health coverage. ideally with primary care at its center. that should be the goal. the current debate on how to attain the goals remains on tactics. you have a mix or a single payer system? i think it's important to not confuse the goal with the tactics. while the tactical debate is important, it ricks distracting us from the goal and immediate situation in the country where we face a rising uninsured rate from 8.9% to now 12.2%. rather than pursuing a highly ricky or uncertain proposition at this current time, the focus needs to be on, i believe, strengthening the private insurance market. congressman bera proposed many ideas on this front and working with nonexpanding states to continue reducing the uninsured rate in this country. income three on health care costs, according to a study, 33% of health care costs in this countr

but to brings to health care, we need some rules for the road and health care. first, we need a nationwide standard for sharing medical data. it's shortsighted for additional health companies to each use their own standards. every new technology goes but it isis period, also true at some point we need to come together, standardize how information is shared. think this was proven in other sectors to be the means by which we unlock true value. it happened in the railroads, it happened with automobiles on roads, it happened with the internet more broadly and 80's to happen with digital health, too. the federal government can play a key role. they tied one standard all medicaid and medicare reimbursement. i bet we would see conformity pretty quickly. second, we need to sell privacy challenges. patients must control their own data as it enters and exits the health care system. but i think there is a benefit to sharing data, when patients agree to use the health care system, we think there should be some agreement to share their data for the good of everyone, so we ca

their argument is that more access to health savings accounts disk people control to their health care. do republicans not want to be attached to the rising premiums? not necessarily to lower premiums but it is a chance for them to take on health care. result inecessarily lower premiums for insurance plans, it is a chance for republicans to say that they are lowering health care costs. host: let's look at specific topics. health savings accounts. tell us about the legislation at play? guest: the ways and means committee approved earlier this bills.wo they will broaden the types of things you can spend that money on. a tax-free account that you can spend money on. it is pretty specific what you can use it for. they're looking to open that up. exercise open up jim equipment. you could use your health savings account for things like that. it would also allow more coverage for hitting your deductible. direct primary care, things like that. -- sor bill would seek to for local seniors, one would allow them to establish a health savings account for additional health care costs they may have o

access to mental health disorder care with the overall health of our nation according to the national alliance one out of five adults experienced mental illness. of those who suffering only a little more than 40% received services. title ix of 21st century cures act focuses access on the care this is authorized to strengthen several existing programs that were not in the statute. provide mental health and substance abuse disorder the jail version programs additionally it authorized a program with my maryland -- primary care through a demonstration project notably the 21st century cures act act that the target population to include additional populations such as certain qualifying children and adolescents. cdc recently released a vital signs report showing arising suicide rate across united states. in 2016 we lost nearly 45000 lives to suicide. twenty-first century cures act aims to give additional resources by codifying the national suicide hotline to authorize the suicide prevention resource center and use suicide eight grant the existence of all these programs would be far less impa

be denied health coverage by health insurance to have a pre-existing condition? >> that is not my area of expertise at all feel comfortable commenting on the deed health health insurance. what i would say in that medicaid is one of the largest providers of mental health services their insurance programs and they serve millions of americans at this very momen moment. >> thank you mr. chairman i would also like to ask unanimous consent to place into the record a statement by the american had yet to idea psychiatric association opposing separation of children (and psychological association regarding the dramatic effects separate family and the national child traumatic stress network in those key points on that traumatic separation from refugee childre children. >> without objection so ordered your time expired the gentleman from kentucky 54 question and i thank you for being here dr. mccance-katz so the cdc found that less than half of the abuse disorder patient with multiple mental health issues ever received treatment for mental health the commission suggests this

i needed other things for mental health. i needed the help, health treatment. so many things that health care for the homeless helped me with. that, i have a lot of hope i don't have to use anymore. i feel like a better person. i feel like i need to pull somebody else up that is still struggling, and that is why i am here today, to try to help those that are still suffering and try to help them to come in out of the cold. with everything the mayor talked about, it is the thing that really helped me, though services and my dealing with the addiction part. i want to thank -- i am grateful to health care for the homeless because today i see a better future. [applause] >> my name is john. i am a baltimore county resident. i struggled with the disease for a long time, still struggling. the biggest thing is the health care and everything. getting to appointments, that is the biggest thing to me. i struggle getting around. i cannot walk far. think god for health care -- thank god for health care homeless. it has been a blessing for me. it is still a blessing. i work h

health savings account, okay?he point wasn't simply high deductible plans to shove burden on the patient. the point was high deductible plans that had that deductible able to be filled by tax-free savings or employer-funded savings. and i lived for a decade with hsa and i saw my own behaviors change knowing once that money hit that account, used the word my, that was my money, that was dear to me and i was very, very, careful about spending it and made choices that, you know, you might not think from income level or anything. i was very cautious about spending that, became a really consumer. i've told the story before, my doctor had wanted me to get an echocardiogram and stress test, just as a routine thing, they wanted to charge me $5500. normally if i had a regular old ppo plan, oh, go for it. it was an hour long negotiation on that one. eventually leading me to tear the wristband off my wrist and walk out of the hospital and say that's outrageous, i'm not paying the cash discount of $3500 for it. i wouldn't hav

public health has proven its power with infectious diseases, with common public health measures we arenow able to control and prevent infectious diseases better than ever before. in the time that we are here today, more than 100 americans will be newly diagnosed with dementia. each and everyone has a story, memories and a future left to finish while some of those precious memories may vanish due till alzheimer's, we are here to boldly hold out hope for a better future. i really appreciate all of your coming to washington, many of you will recognize the suit who have been here before. yes i bought it some 15 years ago and i swore i would not retire he until we had better treatment or a cure for alzheimer's. [applause] so it is woefully out of style and i'm really sick of it so let's get on with the job. thank you. i'm now delighted to turn to our ranking member senator casey for his opening statement and i will go vote in a german collins, thank you so much. had white top that. >> what you have a purple tie. this tie was just the dry cleaned yesterday but at lunch i got a spot on it. i

health plans. many individuals, especially in the post affordable care act world, have chosen to purchase high deductible health plans. while this is a reasonable choice for many consumers, there are some who are faced with high out-of-pocket costs. h.r. 6199 allows health plans to provide coverage for up to $250 per year for individuals or $500 per year for families before they meet their deductible. -- the goal of this provision is to incentivize service that is could reduce future health care cost, such as primary care visits and telehealth services. additionally, under current law, individuals who are unable to contribute --additionally under current law individuals are unable to contribute to an h.s.a. if they participate in a direct primary care service arrangement. representative erik paulsen's primary care ena act included in this rule -- enhancement act, included in this rureblings neighbors patients to participate in a direct primary care service arrangement, and remain qualified to contr

health care. because that's what the american people want. who wouldn't -- who wouldn't give everything they have if their spouse, their child, their relative was sick and needed a lot of money to be cured? that's why we have insurance and that's why we have the government involved with things like social security and medicare and medicaid. but the heritage foundation, the handful of rich people who fund them and the so many republicans who dance to their tune, they don't want that. they hide it from the american people because the american people don't agree with it. but they don't want it and they have pushed forward judge kavanaugh to be the torch bearer on the court for their mission. the list of 25 that president trump selected from was vetted and approved by this very heritage foundation. the heritage foundation would not give its stamp of approval to anyone who would maintain or grow our health care law, particularly for protection for americans with preexisting conditions. now the american people deserve to know where judge kavanaugh

-- vital health care protections in his decisive swing vote. on the president tells you that he is trying to eliminate basic rights and liberties, you take him at his word. and, i do. . if his words were not evidence enough, he has also allowed himself to become a puppet of right-wing fringe groups, the federal society and the heritage foundation, that have been trying to strike down roe v. wade for decades. working to undermine vital reforms to our health care laws since the very day they were passed. these prospects are not abstract. in the blink of an eye, the court could return us to the dark days when women died because he lacked access to .afe, legal , reproductive health care it could return us to the days when americans with high blood pressure or even pregnant women, could be denied health coverage because an insurance company classified them as having a pre-existing condition. . i areleagues and often asked by our constituents, what can we do? the answer is, stand up and be out. it is a call to action. . movie lines your galvanize the

important than health status itself or health. i think without a healthy population, it's always going to be pretty difficult to achieve affordable health insurance or get health insurance costs under control. that's why prevention and wellness are so important and why they need to be at the forefront of any health care policy discussion. beyond that, we also need to recognize that health does impact elections. if there is one article i encourage you to read it's from the november 19, 2016 economist right after the 2016 presidential election. the blue collar, non-educated whites were thought to be the biggest predictor of trump's victory, particularly in counties in the industrial midwest and in rural america. researchers found there was actually one bigger predictor, an index of public health statistics in terms of life length, obesity and diabetes. health status is critical. number two on health insurance. yes, ensuring access to affordable health insurance is to optimal in staying healthy with the primary health at its center.

health outcomes and reduce costs. today, medical homes serve individuals of all ages and income in at least 47 states. this legislation simplifies existing i.r.s. regular you layings and clarifies that direct primary care medical homes are qualified health expenses, medical services, and not a health plan. i personally questioned the i.r.s. ruling. we have debated with them, but we have lost that. we fix it with this legislation. as more individuals and employers seek to utilize the direct primary care delivery model, it is important that this important tax barrier not get in the way of patients accessing this successful model. the lemmings will allow plans to cover onsite employee clinics. think about the nursing stations that we have here in the house of representatives to provide that service. they can offer physical exams, over the counter drugs and testing, hearing and vision screening and other minor care services to help employees assemble a benefits package that is practical and give them a competitive edge. a

health matters even more than we think. health and health status are critical. on health insurance, having access is important to optimizing health. democrats ought to be all for that. ideally with universal primary care at its center. that should be the goal. the current debate on how to obtain that debate the is a mix of private and public structure or a single pair structure? it's important not to confuse the goal with the tactics. while the debates are important the goal and the immediate situation in the country where we face a rising uninsured rate from 10.9% goes out to 12.2%. rather than pursuing the uncertain proposition the focus needs to be on strengthening the private individual insurance market, the congressman has proposed many ideas and working with non- expansion states to continue reducing the uninsured rate in this country. number three, and healthcare costs, there's 30% of healthcare costs in this country are wasteful, they don't improve health outcomes. there are components to this and they each have to be tackled systematically. congressman

health matters even more than what we think. health and health status are critical. number two on health insurance, ensuring access is important to optimizing health. democrats ought to be for universal health coverage. ideally with a primary care at the center. that should be the goal. the current debate on how to attain the goal focuses on tactics. you have a mix of private structure to have a singular payer structure. it's important not to confuse the goal with the tactics. it's distracting us from the goal in the immediate situation in the country where we face a rising rate of 10.9% to now 12.2%. rather than pursuing this at the current time the focus needs to be on strengthening the private individual insurance marker, the congressman has many ideas on this front and working with non- expansion states to continue to reduce the uninsured rate in this country. number three on healthcare costs, according to a study, 30% of healthcare costs in this country are wasteful. they don't improve health outcomes. there are many components in many have to be tackled systema

health insurer sent in u.k. and to capitol to bring about this transition towards accountable care which is a u.s. health care concept used in medicaid which is their kind of threadbare safety net for the poorest people who can afford insurance there's certain.

the director of the global health policy center. we are delighted to have this major conference on polio and we are thrilled and honored to have senator mitch mcconnell here to kick things off. my boss will do the introductions in a moment. i would like to offer special thanks and congratulations to my colleagues. particularly nelly bristol, whose saying, pulling together the dinner last night, over the course of today include them, to medications from the doctor. we are at a period as you will see over the course of the day, and gain, on the global eradication effort, 30 years into this effort, it is a moment of pride and excitement and a certain amount of anxiety and debate. there's no question we've had truly remarkable progress, that this is a complicated and remarkable moment. for partners, rotary, cdc, deserving enormous praise for the disciplining commitments that have been made over these decades. the international alliance deserves enormous credit for the role. assuming now. there are many fundamental questions in front of

. >> health and human services secretary alex azar discussed free market principles and health care at the heritage foundation in washington d.c. he outlined why he believes the affordable care act isn't working for patients and criticized the expansion of medicaid. this is 40 minutes. >> good morning, everybody. it's a beautiful morning in washington, d.c. after the monsoons seem to have the relieved us of some of the rain. it's a beautiful day. my name's kim holmes, executive vice president of the heritage foundation, and i'd like to welcome all of you here. and for all of you or who are watching online are, i would ask that if any of you have not already done so, please turn off your cell phone ringers. that would be a great courtesy to us. it's a great honor for all of us to welcome today secretary of health and human services alex azar to speak at the heritage foundation on the importance of free market principles and american health care. we all know that health care is a vital topic in america today. americans care a great deal about it, about where it's going in the future. it

that's what health care is all about. and that's why you guys on the other side, you people, have not come up with an alternative. because you don't know how to pay for anything. so we paid for this. the protect the medical innovation act. well, when the affordable care act was being crafted, the medical device industry, and by the way, the medical device industry is probably the most scrutinized industry in the united states. most of those companies, the 7,000 in the united states, most of them are good actors. but a lot of them were not. and 10 years ago i stood on this throor, mr. speaker -- floor, mr. speaker, and pointed out all the cases against the medical device companies who were being -- who were bribing doctors in order for those doctors to recommend the device. that's a fact of life. i didn't make that up. that's not a political injenks here. this is what happened. and you could shove it off all you want. if i have to come back to the floor on another occasion and cite chapter and verse in the court cases, you

it is about women's health. it's about their economic security, about a woman's ability to contribute fully and equally in our country. and i'm confident people across the country who do not want to go backwards will stand up and make their voices heard and reject president trump and vice president pence's extreme ideology wherever it rears its head. so i'm hopeful that president trump takes this to heart as he thinks about his supreme court vacancy. and i'm hoping that my republican colleagues are paying attention. and i am truly hoping that president trump decides to listen to people across the country, listen to what republicans just said recently, and not jam

insurance and get health care. the focus of our discussion today is how states are responding to the actions and the likely implications. this first slide shows the first page of a new interactive tool in the commonwealth fund's website that shows how states are addressing the federal actions. sabrina who is here with us today developed the tool with her colleagues at georgetown and as you can see nearly half the states have taken up stabilization strategies like establishing reinsurance programs and increasing oversight of plans that don't comply with the affordable care act and creating financial incentives for people to maintain coverage like passing legislation or adding subsidies to the premium tax credits. georgetown and the commonwealth fund will be updating this tool as more states make changes in their markets. also out today is a new report by urban institute in which is also on the commonwealth fund's website where you can look and see what would happen to premiums and insurance coverage in your state if

finally, at the heart of public health are data. bold would direct the cdc to expand its data collection of cognitive decline care giving and health disparities. today today, the bold about has 35 cosponsors but i know by the time the members of this audience are finished with all their hill visits, that we will be up to 50. the challenge i gave you last night. or better yet, 60, the number that assures senate passage. i am proud of the actions that the state of maine is taking to promote early detection and improve data collection. the maine centers for disease control and prevention has distributed the state plan for alzheimer's, including its special insert with cognitive assessment tools, to help primary care professionals make early diagnoses. maine's cdc has also collected data from the cognitive decline and caregiver modules in its behavioral risk factors surveillance system. in bangor, maine, where i live, the public health department has distributed hundreds of know the ten signs brochures. in kennebunkport, the public heal

health care. because that's what the american people want. who wouldn't -- who wouldn't give everything they have if their spouse, their child, their relative was sick and needed a lot of money to be cured? that's why we have insurance and that's why we have the government involved with things like social security and medicare and medicaid. but the heritage foundation, the handful of rich people who fund them and the so many republicans who dance to their tune, they don't want that. they hide it from the american people because the american people don't agree with it. but they don't want it and they have pushed forward judge kavanaugh to be the torch bearer on the court for their mission. the list of 25 that president trump selected from was vetted and approved by this very heritage foundation. the heritage foundation would not give its stamp of approval to anyone who would maintain or grow our health care law, particularly for protection for americans with preexisting conditions. now the american people deserve to know where judge kavanaugh

host: the commissioner of health for baltimore city's health department. our first guest of many talking about the opioid crisis. we have learned about the city's perspective. now we're going to get a statewide perspective. clay stamp with the maryland operational command center. elijah cummings joining us talk about his legislative efforts for more money to cities and states for the opioid crisis. we want to thank an organization known as health care for the homeless for hosting our c-span cameras and guests today, treating those with opioid addictions. he spoke about, his message to washington toward treating addicts. >> one message is public policy matters. expansion, medicaid the percentage of our clients that health care for the homeless that gained access to care skyrocketed. in 201330 percent of those we serve every year had access to insurance. by 2014, 90% did. anddiately gained access primary services here, access to specialty services they needed. very transformative. organizationd our to focus as much attention on the housing that can stabilize

at the heart of public health our data. expandrects the cdc to on cognitiveon decline, caregiving and health disparities. today, the bold act has 35 cosponsors, but i know by the time the members of this audience are finished with their hill business, that we will be up to 50, the challenge i gave you last night. [applause] 60, the number that assures senate passage. [applause] i am proud of the actions that to state of maine is taking promote early detection and improved data collection. centers for disease control and prevention has distributed the state plan for alzheimer's, including a special insert with cognitive assessment tools to help primary-care professionals make early diagnoses. dataas also collected through the cognitive decline and itsgiver modules behavioral risk factors surveillance system. live,ngor, maine where i the health apartment has distributed hundreds of "no the 10 signs" brochures. "know the 10 signs" brochure. it is important that we all know that alzheimer's is not a normal part of aging. it is

a national developed public health roadmap to maintaining cognitive public health. cdc and the alzheimer's association will release a third public roadmap later this year, with an updated plan of 25 actions for state and local departments that are focused on accelerating the progress of risk reduction, early detection and diagnosis, safety and quality care for people with a cognitive impairment, and caregiver health. perhaps the greatest accomplishment of the healthy brain initiative is improved data collection. to measure the public health burden of cognitive decline in caregiving in the united states or the behavioral risk factor surveillance system, ongoing collection, analysis and interpretation of data is to identifying and addressing gaps in program delivery, monitoring and evaluation and progress in achieving health care goals. states and jurisdictions use these data, often the only available source of state-level data, to develop alzheimer's disease plans, increase awareness, and guide elder the one in nine middle-aged or older adults who reported their memo

people's health and welfare. i think we have to do a better job of converting that message into the strategic message that it is important to americans in iowa. gen. wald: let me just pile on. excuse me. there is a group in the united states call the u.s. global leadership coalition, maybe some of uf heard of there are 180 53 and four-star -- 185 three-star and its-star generals, and advocacy for foreign aid because foreign aid is always the last priority for a lot of people because of the folks at home. no offense, senators. is,the fact of the matter we give about 25% of our budget to foreign aid. it's actually about 1%. a quarter of it is what chris dodd talked about. to congressdvocate as well. there is a staffer here. you probably got the message. i hope you do. from a religious standpoint, he is pretty supportive of the foreign aid program. he is one of the last people most people would guess would do that. lindsey graham is way on top of this. it goes back to what the ambassador said. people don't necessari

health care. that's what the american people want. they gave everything they had if their spouse, their child, their relativech was sick and needed a lot of money to be cured. that's why we have insurance and the governments involved like social security and medicare and medicaid. the heritage foundation in so many republicans who dance to their tune. they don't wantt that. they haveve pushed forward judge kavanaugh from the court for theirth mission. the list of 25 that president trump select good was that it is approved by this very heritage foundation. the heritage foundation would notl give its stamp of approval to anyone who would maintain or grow our health care law, particularly protections for americans with preexisting conditions. the american people deserve to know what judge kavanaugh stands. this is a serious issue. this is not something we a can allow a nominate to hide behind following existing law. we need to deal with the governments ability to be involved with people's health care company to help it be funded with the

arm of a major us health insurance seventeen u.k. and to capita to bring about this transition towards accountable care which is a u.s. health care concept used in medicaid which is their kind of threadbare safety net for the poorest people who can afford insurance that's certainly not a model that we want to bring over here in the usual gait thank you after the break we speak to n.h.s. intensive care nurse jackie barry an award winning activist and last about the headlines on the flat lines of the n.h.s. at seventy. and twenty four do you know bloody revolution of. the demonstrations going from being relatively peaceful political protests to be increasingly violent revolution is always spontaneous or is it you know we hear. a new bill is that i knew colonial the former ukrainian president recalls the events of twenty fourteen. of those who took. it invested over five billion dollars to assist ukraine in these and other people that will ensure a secure and prosperous and democratic. donald trump will soon visit europe has a very busy

and office in parliament with health secretaries health ministers we're also seeing at the top levels of n.h.s. management there is a massive revolving door and started students as you've mentioned was alan milburn and tony blair's. the former health secretary defending the health service on the seventieth anniversary saying are wonderful it is well i'm in melbourne along with under obviously the blair era and to simon stevens and that whole team actually what they did was they expanded the limited market that existed in the ninety's into a much more extensive market with by bringing in outsourcing of clinical services on a bigger scale public private partnerships peer followed the most toxic disastrous legacy of that period so it's somewhat disingenuous i think of people like other melbourne to present themselves as defenders of the n.h.s. when in fact they have been responsible for privatisation and marketisation on a scale that perhaps even fashion never even dreamt of. this strange little goatees system that everyone seems to be criticizing right now who just finally about the rei

now is the time to demand a justice who will protect our health care, not strike it down. now is the time to demand a justice who recognizes a woman's personal liberty, her right to make her own health care choices . instead of one who will put the government between a woman and her doctor. for thehe time to fight freedoms and rights all americans deserve. that is what is at stake with this supreme court nomination. knew if president trump picked his nominee from the list that was written by special interest federal's list society and heritage foundation they would be overturned -- be prepared to strike down the health care law and overturn roe. those organizations are oficated to getting rid pharrell and getting rid of the affordable care act. has -- his goal of life is to get a supreme court to repeal roe. does anyone think anyone of those names including judge kavanaugh would protect roe? they wouldn't be on the list if they were. you know that. i know that. the president knows it. the american people are going to learn it. kavanaughat judge argued. that the trump admin

global public health capacity in terms of immunization and health security? so the panel today is going to focus on the u.s. role and the current and future role for eradication efforts. and i'm joined here by dr. will slough tear who is the director for the global immunization division of centers for disease control in atlanta. and following his remarks we'll have irene koek she's senior jeopardy assistant administrator for global health at u.s. aide. so we'll hear from both will and irene today about their agency perspectives about what they've been doing in terms tv the role for polio eradication but then also the challenges for complex and how the agencies role might evolve given a post polio world. so following the comments i'll ask a few questions. and then i'd love to open it up for questions and comments from you all and really encourage a discussion and dialogue this morning. so i'll turn it over to will to start us off. >> thanks, lori. so lori had asked us to address about three questions. and so i'll just go through those questions one by one. so

and office in parliament with health secretaries health ministers we're also seeing at the top levels of n.h.s. management there is a massive revolving door and started stephen's as you've mentioned was alan milburn and tony blair's lawyer and the former health secretary defending the health service on this seventieth anniversary saying are wonderful it is well i'm in melbourne along with under obviously the blair and to simon stevens and that whole team actually what they did was they expanded the limited market that existed in the ninety's into a much more.

wade, overturn health care protections. on november 11, 2016, then president-elect trump said, quote, i am pro-life. good judges will be pro-life. in a debate against secretary clinton, then-candidate trump said, because i am pro-life and i will be appointing pro-life judges, i think that we will go back to the individual states. unquote. it is impossibly -- i am -- it is impossible to conclude that president trump will appoint a justice whom we can have faith will leave roe v. wade unsettled law. president trump said in his own words that he wants to give them a justice to give the court a majority to overturn roe v. wade. so count on it. president trump will in all likelihood nominate a justice willing to send roe, quote, back to the states. again, those are president trump's own words, where several are preparing, if not already prepared, to roll back a woman's right to choose. in fact, according -- there ares where abortions would be wholly or partially illegal almost immediately. that is against what america wants. it

health care cost growth. he will back cleanup and provide some deeper analysis synthesizing what we have heard to develop a meaningful outlook for what is ahead. i will get the discussion started and we will be plenty of time for discussion for you folks. with the nomura do. , i turn it over to -- with no more a do i turn it over to matt. >> thanks, jason. my charge is talk about the federal policy landscape. i think the opening presentation on the prior -- in the prior conversation gave a good overview of the major issues. i want to go deeper on an analytic issue unrelated to one of these and flag another issue that i think is flying below the radar. my first point is about the impending disappearance of the individual mandate. i think there is a correct view that the disappearance of the individual mandate in 2019 is not going to be the end of the individual market. the presence of subsidies means that the market will stabilize at premiums that are somewhat higher, and enrollment that is meaningful lower. t

programs. >> it is not creating health programs. just underscore what commissioner loyce scahared, i think it's important that it's provided services in more than half of the states in the country and it's really showcasing the excellent work that's being done here in san francisco in terms of hiv prevention and getting to zero. >> president chow: wonderful. >> vice president loyce: i would also add to that that one of the thing that is this group does is it recognizes that we can learn from other communities and it's willing and receptive to hearing from other communities. i know that san francisco has a reputation of being all that and a bag of chips but in fact we can't learn. >> president chow: do you want to proceed with the second presentation? >> vice president loyce: the second presentation today was from the primary care unit of the san francisco health network. we've presented some very specific work that they are engaged in. they talked about their 3-year relationship with lane and in the lane process they developed and i

and our health care system. president trump even admitted in a campaign event just cited by my colleague from connecticut that he had gutted the a.c.a. this may resonate with the president's base. it may resonate with people he hopes will vote him back into office in the future election, but for millions of families across the country and in my home state, losing protections against preexisting conditions discrimination is a death sentence. it would be devastating for nicole and her daughter who i described before. it would be devastating for kim from my hometown and residence, wilmington, a thyroid cancer survivor now able to get insurance because her cancer isn't considered a preexisting condition under the affordable care act, she's not subject to preexisting condition discrimination. in my home state of delaware, gutting protections for preexisting conditions would leave one in five at risk of skyrocketing health insurance costs or losing coverage all together. this lawsuit impacts every corner of america's

tom's research and analysis covers a broad range of health policy issues including health insurance markets, the aca coverage provisions, high risk pools, medicare and healthcare cost growth. he will bat cleanup and provide deeper analysis synthesizing what we've heard to try to develop a meaningful outlook for what's ahead. after that i will get the discussion started with a couple thoughts and questions and then we will leave plenty of time for discussion with you folks. with no more adieu i will turn it over to matt. >> thanks, jason. so as jason laid out my charge is to talk a little bit about the federal policy landscape. i think the -- the -- mark's opening presentation and the prior conversation gives a pretty good overview of what the major issues are so i want to go deeper on analytic issue related to one of these and then flag one other issue that i think is flowing a little bit below the radar. my first point is just about the impending disappearance of the individual mandate. i think there is a correct view that the individual -- the disappearance of the individual mandate in 20

it's a big public health program. that gets you services and surveillance in about 70 countries and vaccination services to 400 million kids a year in 60 countries. the return on that investment has already been apparent. from inception to date it's estimated that 18 million infections have been averted. 18 million paralytic events have been inverted on the basis of the gpi effort to eradicate polio. that has resulted in $27 billion in cost savings to society through disability adjusted costs and the lack of ability to work for care providers and the individuals affected. it's also estimated that the overall savings when we finish will be between 40 and $50 billion for the first two decades that it's hard math to say this, but it started some years ago and would go through 30, 35 -- or 2035. so on the front end we're already saving money even though it's an expensive annual cost. and on the back end we will reap far greater savings. so i think thinking about what we have to do, the first thing we have to do is we have

officials on alzheimer's, brain health and health disparities as well as collecting much-needed data on alzheimer's and caregiving. investing in a nationwide public health response will help create a higher quality of life for those that are living with this disease. the caregivers also reduce the associated costs, but the things that i found the most stressful at some of the facilities we looked at and talking with some of my friends going through this is we tend to talk about treating the symptoms forgetting but these are people and the need to enjoy the best quality of life they can while they are going through a disease that takes very long time. the advocates from all over the country to make our voices heard in support of the bold infrastructure for alzheimer's act. i promised my dad i would be his advocate and his voice as long as i'm able to. i hope that my husband and children and grandchildren won't have to think of these issues because a cure word and should be found hopefully in time for me to see that and for my children to see that. as a caregiver and advocate, i am ask

at the world health assembly in may, member states approved the world health organization's strategic action plan on polio transition. gpi has worked with global and regional stakeholders to finalize the post certification strategy. this strategy provides global guidelines for maintaining a polio free world. including what we need to do to contain polioviruses and sustain eradication, to transition from the use of oral polio vaccine to an activated polio vaccine, and to help countries sustain strong disease surveillance programs in the decades following certification. as we prepare for the opportunities and the challenges of the future, i want to pause and recognize those who have brought us to the brink of ending polio for good. i want to particularly acknowledge other key partners in the global polio eradication initiative: the world health organization, the centers for disease control, unicef, and rotary international for their tireless work in helping to create a world where no child will suffer from polio again. i also want to highlight the critical role that the united states ha

to compare a large number of health health care indicators. scorecards have shown over time there've long been considerable variations in the state on key indicators of health care action, quality of care and health care costs. we have also found in recent years the aca has known the difference in access measures like the percentage of people who report not being able to get carere because of cost. this is because the affordable care act sets federal standards for health insurance such as services that health care plans have to cover in banning insurers from charging people more or denying them coverage on the basis of a pre-existing condition. the affordable care act provides a substantial amount of federal funding for subsidies in the individual market. medicaid expansion in the 50's like establishing marketplace navigator programs to help with plants. the scorecard also finds there still is considerable variation across states in the areas of access. for example the percentage of people who are uninsured ranges from a low of 3.5% in massach

, global public health capacity in terms of immunization and health security. the panel is going to focus on the u.s. role and the current and future role for eradication efforts. i'm joined by dr. will schrader. the director for the global up minization division within the center of global health at the center force disease control in atlanta and following his remarks, irene koek, the senior administrator for global health at us aid. >> we're going to hear from will and irene and also the challenges for completion and how the agency's role might evolve given a post-polio world. following the comments i'll ask a few questions. and then i'd love to open it up for questions and comments from you all and encourage a discussion and dialogue this morning. i'll turn it over to will to start us off. >> so lori had asked us to, to address about three questions and so i'll just go through those questions one by one. the first question was really is what is cdc's involvement in the global polio eradication initiative. cdc is a core partner of global pole he yoe eradicati

that is stupid. >> host: the link can found through cares health news website. kaiser health news! org on twitter they at kh news to find. >> is the chief washington correspondent with us for the next 40 minutes this morning take your calls on a wide variety of health care topics we that. do we appreciate. jerries in pennsylvania. insured under hed care. good morning. >> caller: toll me, think it is expensive. what do you think? >> well, the price of drugs and know, a number of different issues this the trump toinistration is trying encourage generic. they got other ideas for limiting drug prices but now in to drug markers themselves you have speck paters coming in and filing up on drugs and raising the prices and all wereese middle men who passing on theirs it is a huge problem and one of the pop problem force the public when you ask them what are you most youred about in health care. of good news there are a lot drugs that treat a lot of things that never used to be able to do drugs aroundold forever that are thousands of times more ebbs pes than they used to be. it is a big larg

health center. it's currently in the design phase. we've reached various design milestones and working towards finishing design towards the end of the year. i think currently we also working through two activity with the arts commission, one of which is to move towards our phase two review and civic design review which is currently targeted for the third quarter of 2018. yesterday we also had a kind of a round one review with the various -- our selection panel in the selection of the public art for this new facility. so that's -- currently construction is targeting for q3 of 2019. then moving on to the other community health center. we are primarily focused on two health centers in this component that includes maxine hall and commission health center. both projects are very similar in scope. we are proceeding with retrofit as well as an interior renovation to improve the work flow for the clinical staff. so maxine is currently going through the plan review and we are working towards starting constru