mr. murray stated that he aspects in terms of dispatches not being reliable okay. he also speaks in terms of it not working or not being a successful dispatch what he didn't say is that sf american dispatch taxi services has failed to meet the dispatch needs that they've been called on to provide dispatch- when individuals called for services no indication and could be no indication simply by a count of numbers we're failing to meet the dispatch needs of persons needing service he further made clear that their - one thing he further didn't clarify there is a clear this is clearly favors disproportionately larger organization larger dispatch services and when the president of the commission asked about the number of dispatch services you know have there been others placed on probation no hard numbers of data war provided which of the first is american the first of a series of which you'll be seeing no one that that information it is within - not being fairly being provided american dispatch was first placed on probation and it has implications first of all you can't

mr. murray. >> didn't go board members jarvis murray enforcement san francisco municipal transportation agency taxis and assessable services based upon what american dispatch has stated frankly in pits utilities briefs and comments today they demonstrate they shouldn't have a accountability for improving their dispatch or operate a successful factual our transportation code rules section

mr. murray you have 3 minutes of rebuttal. >> good evening frankly i don't have much more to add bear in mind every time an enforcement action against a company there's an accusation of point of conduct to the company by the mta we're very used to that if there's a dilation by any medallion holder or company or you said max cab regarding mta staff they canned go to another company we'll be modern happy to have it presented to the you and go from there we get a lot of accusations when we push on the enforcement issue without that i'm modern willingly you guys to get it and it would be great we don't know building this is happening. >> i'm sorry are you finished. >> yes. >> has that particular situation been brought to stooushgs regarding the sfmta personnel directing away from that dispatch company. >> no. well i take that back the gentleman routinely says that but no one has been presented. >> no one. >> as the person that's been told this is truly the case but we're willing to have it submitted we'll allow it as sufficient evidence it is there. >> you know murray we haven't seen you in

mr. murray had replaced him. the unabomber was very proud of himself. matter that his bomb had killed the wrong man. they were engaged in the same kind of work, which was anti-environment in his opinion. and so it was okay. >> i'd been to a number of bomb scenes over my career, and the last one in sacramento was probably one of the more horrific. the shrapnel is usually what maims or kills the victim. most of the cases, nails, staples, and screws were used. that's an antipersonnel device. that's used to maim or kill. >> when you go to those crime scenes or when you see the devastation that was left behind and then you read about what he says and how he felt about those bombs, it's really chilling. it's chilling that someone can think like that, behave like that, and do that kind of thing. >> by now, the unabomber had been at large for almost 17 years. >> we talk about lone actors a lot, how difficult they are to catch. the unabomber was the lone wolf in the most classic sense. >> socially, he defined himself as a social cripple. but technologically, iro

mrs. murray: mr. president? the presiding officer: the senator from washington. mrs. murray: mr. president a budget is far more than a series of numbers on a piece of paper. a budget really is a statement of values and priorities, a statement of the kind of nation we are and the kind of nation we want to be. for many of us, these values and priorities are clear. we believe that a budget should help us move towards an economy that is built from the middle out, not from the top down. and a government that works for all of our families, not just the wealthiest few. but, mr. president the republican budget that we are here debating today would move us in the opposite direction. instead of working with us to build on the bipartisan budget deal that we struck last congress, republicans have introduced a budget that would lock in sequestration it would hollow out defense and not defense investments and use gimmicks and games to paper over the problems. instead of putting jobs and wages and economic security first by prioritizing policies like paid sick leave that shouldn't be partisan i

senator murray? >> mr. morris, i'm a strong supporter of hrsa's work force health care training programs, in particular the critical support to physicians and other providers that agree to work in our rural and under served areas, and i want to recognize your agency's important role in documenting work force shortages through the national center analysis, and i wanted to ask you, what are the current projections -- what do the current projections say about our national health care work force shortage? >> sure. demand is expected to increase for primary care services through 2020 due to the effect of the population is ageing, growing, and then there are also impacts that you referenced earlier in terms of folks having coverage results in them seeking more services, and so the national center has done some projection work, and they estimate a shortage of 20,000 full-time equivalent physicians by 2020. this is mitigated somewhat by if we were able to take advantage of the supply of nurse practitioners and p.a.

mr. chairman, thank you very much. thank you for you and senator murray having this hearing. a very important one certainly from a senator from kansas. but really for the country. let me start with mr. morris. tell me what statistics are there that demonstrate over a period of time how many rural hospitals are closing or being -- in addition to that are threatened to close. i've seen an ap story just in the last few days indicating that 50 rural hospitals have closed that expectations for more -- a total of 50 hospitals in the rural u.s. have closed since 2010 according to the ap. and the pace has been accelerating with more closures in the past two years than the past ten. this is according to the national rural health association. i've also seen the study from the north carolina research agency, organization indicating 47 i think is the number of hospitals that have closed. my question is do you consider those numbers accurate? and what kind of study analysis do you have about cause? what are the -- what can we pinpoint the cause for those closures? and what is your expectat

murray. >> well thank you mr. chairman, for calling this hearing on such an important topic and i am very pleased to welcome all of our witnesses who are here today but i'm particularly excited to welcome julie peterson. hi. julie is the chief executive officer of pmh medical center in washington and through her work at pmh and the leadership and helping make sure that rural communities get the health care they need. so thank you for coming all the way out here testifying today. over the last few years we have taken historic steps forward when it comes to making our health care system work better for our families but i believe strongly there is much more we can do to continue to improve affordability, access and quality and to keep building a hel care system that works for women, families and seniors and puts their needs first. in my home state of washington where about 1 out of every 5 residents lives in a rural area, a critical part of this work is making sure that families can find the doctors they need right i

mr. stover. i think i'll go last this time. so the order would be senator murray, senator cochran senator moran. senator murray? >> thank you very much mr. chairman. thank you very much to all of our panelists. i really appreciate all of you participating today. ms. peterson, i'm really excited to hear about the delivery system reform work under way. and i'm proud that our hospitals have been recognized as national leaders in increasing the quality and safety of care. i'm particularly excited about the recent grant from the centers for medicare and medicaid innovation you mentioned in your testimony to support the healthy washington initiative efforts to improve care statewide that will reduce costs and stabilize some of our rural hospitals. what have you found to be the most significant barriers to integrating care in the first year of this effort? >> at this point and you're right, it is very exciting what is going on in the state of washington, i would go back to that fragmented reimbursement system. not only are the incentives different based on what line of s

mr. stover. i think i'll go last this time. so the order would be senator murray, senator cochran, senator moran. senator murray? >> thank you very much, mr. chairman. thank you very much to all of our panelists. i really appreciate all of you participating today. ms. peterson, i'm really excited to hear about the delivery system reform work under way. and i'm proud that our hospitals have been recognized as national leaders in increasing the quality and safety of care. i'm particularly excited about the recent grant from the centers for medicare and medicaid innovation you mentioned in your testimony to support the healthy washington initiative efforts to improve care statewide that will reduce costs and stabilize some of our rural hospitals. what have you found to be the most significant barriers to integrating care in the first year of this effort? >> at this point, and you're right, it is very exciting what is going on in the state of washington, i would go back to that fragmented reimbursement system. not only are the incentives different based on what line o

mr. chair. >> thanks, senator murray. dr.lins, we're eager to hear from you. >> well, good morning chairman blunt, ranking member murray chairman cochran members of the subcommittee. it's an honor to appear before this panel given its long history of supporting nih's mission, to seek fundamental knowledge and apply it in ways that enhance human health, lengthen life and reduce illness and disability. as a federal research agency, we are acutely aware that to achieve our mission we must serve as effective and efficient stewards of the resources provided by the american people. one way we're doing this is by focusing on prioritization of nih resources. this involves developing advanced methods of portfolio analysis identifying compelling scientific opportunities fostering creative trends in nih collaborations and enhancing the use of the common fund. we're also forcing interagency partnerships like the nih/darpa project to develop biochips as well as innovative public/private efforts like the accelerating medicines partnership

mr. bush: i like the charles murray books which means i'm a total nerd, i guess.hat book am i reading right now? he wrote the book about the colombian exposition, the chicago world's fair, i love that guy. i am reading all his books right now. that is what i am reading. mr. lowry: "the trail of the lusitania." mr. bush: i recommend those books because they are nonfiction, but written in a fiction kind of way. mr. lowry: governor, thanks very much. mr. bush: i still read "the national review." [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] >> remarkable partnerships iconic women come their stories in "first ladies"." >> she saved the portrait of washington. >> whoever could find out what francis was doing, what she was doing, that was going to help sell papers. >> she starts running the radio station. how do you do that? >> she exerted enormous influence because she would move on mountains to make sure her husband was pr

murray? >> well, thank you mr. chairman, for going fishing on such an important topic. i am very pleased to welcome all of our witnesses who are here today but i'm excited to welcome julie peterson. julie is the chief executive officer of the medical center in prosser, washington and to work at the may general leadership across our state julie is helping make sure rural communities get health care they need so julie thank you for coming all the way out here on this link today to difficult the last few years we've had taken historic steps forward when it comes to making our health care system work better for our families i believe stronger there's much more we can do to continue to improve affordability, access and quality amid to keep building a health care system that works for women, families and seniors come and put their needs first. in my home state of washington where about one out of every five residents live in a rural area, a critical part of this work is making sure that families can find a doctor's they need right in their own communities regardless of whethe

murray. >> thank you very much, mr. chairman and thank you to the witnesses for being here today. each of your agencies plays a critical role in the topic we're talking about and i'm grateful to have you here to share your expertise. i've approached our bipartisan effort to advance medical innovation focused on one question in particular, and that is what can congress do to help all patients and families get the safest most effective treatments and cure more quickly. our conversation today is about the promise of precision medicine and it's a crucial and truly exciting piece of the puzzle. there's in question we're at a critical moment in the medical field. researchers and medical experts are increasingly finding ways to treat patient, not just as the average patient but instead based on their own unique characteristics and history. this is the different in getting eyeglasses based on the average prescription and getting eyeglasses based on your own prescription. it's huge, especially for families across the country waiting and hoping for better cures. i'm proud that nay home stat

murray. >> thank you very much, mr. chairman and thank you to the witnesses for being here today. each of your agencies plays a critical role in the topic we're talking about and i'm grateful to have you here to share your expertise. i've approached our bipartisan effort to advance medical innovation focused on one question in particular, and that is what can congress do to help all patients and families get the safest most effective treatments and cure more quickly. our conversation today is about the promise of precision medicine and it's a crucial and truly exciting piece of the puzzle. there's in question we're at a critical moment in the medical field. researchers and medical experts are increasingly finding ways to treat patient, not just as the average patient but instead based on their own unique characteristics and history. this is the different in getting eyeglasses based on the average prescription and getting eyeglasses based on your own prescription. it's huge, especially for families across the country waiting and hoping for better cures. i'm proud that nay home stat

murray? >> thank you, mr. chairman, for calling this hearing on such an important topic. and i am very pleased to welcome all of our witnesses who are here today. i'm particularly excited to welcome julie peterson. she's hiding behind mr. whomorris. he's an executive officer in washington. through her work at pmh and her leadership across our state julie is helping make sure that rural communities get the health care they need. julie, thank you for coming out here to testify today. over the last few years, we have taken historic steps forward when it comes to making our health care system work better for our families. i believe strongly there is much more we can do to continue to improve affordability access and quality and to keep building a health care system that works for women, families and seniors and puts their needs first. in my home state of washington where about one out of every five residents lives in a rural area, a critical part of this work is making sure that families can find the doctors they need right in their own communities. regardless of whether they

mr. chair. chairman blunt: thanks senator murray. dr. collins, we're eager to hear from you. dr. collins: it is an honor to appear before this panel given its long history of supporting nih's mission. so seek fundamental knowledge and apply it in ways that enhance human health, lengthen life. as a federal reform agency we're acutely aware that to achieve our mission, we must serve as effective and efficient stewards of the resources provided by the american people. one way we're doing this is by focusing on prioritization of nih resources. this involves developing methods of portfolio analysis, of identifying scientific opportunities, fostering creative trends. enhancing the use of the common fund. we're also forging novel interagency partnerships like the nih f.d.a. project to build human biochips to test for human drug toxicity like the one i'm holding. seeking to identify new drug targets for alzheimer's disease, type 2 diabetes and autoimmune disorders. to help set priorities, we are developing an overarching nih strategic plan to be linked with institute and center plans and

mr. chairman. >> thank you on the senator murray. dr. collins, we are eager to hear from you. >> good morning, chairman blunt ranking member murray, chairman cochran. it's an honor to appear before the days and to apply in ways that enhance human health, link to my could reduce illness and disability. as a federal research agency we are acutely aware to achieve their mission in a service effect of inefficient storage of resources provided by the american people. when we do this is focusing on prioritization of nih resources. this involves developing portfolio analysis identifying compelling opportunities fostering creative trends in collaboration and enhancing the use of the common fund. we are also forging novel interagency partnerships like the nih darpa fda project to build human biochips for testing drug toxicity like the one i'm holding as well as innovative public-private effort like the accelerating medicines partnership seeking to identify new targets for alzheimer's disease, type-2 diabetes anatomy and disorders. to help set pri

mr. chairman. >> doctor, on your -- following up senator baldwin and senator murray, this was the high risk low risk difference you were talking about in the laboratory tests. you're focusing on the high risk areas, is that right? >> well, the high risk lower risk talking about earlier was on mobile -- on mobile technologies, but here too, we try to focus on -- when we implement this to focus on higher risk tests, and -- >> does any of your enforcement -- all prior approval, or is it where you might be acting on a complaint? >> well -- >> in other words to let the marketplace run for a while on the lower risk items and place it in effect. >> yes, for the lower risk tests, we would not enforce riemplts on them other than tell us what they are and if there's problems reported. we would not perform tests on rare disorders, and, geng, some tests were unmet needs as well. >> well this has been very useful and said to senator murray, this is like going back to college. it's very interesting, and we're very privileged to be students in a classroom with such distinguished teachers and witnesses on an import

mr. president i ask that the alexander-murray substitute amendment at the desk be agreed to, i further ask that the bill as amended be read a third time and passed and that the motion to recan -- reconsider be considered made and laid upon the table. the presiding officer: without objection. mr. inhofe: mr. president, i ask unanimous consent that the senate proceed to the consideration of s.r. 173. the presiding officer: the clerk will report. the clerk: senate resolution 173 -- mr. inhofe: i ask the clerk dispense with the reading. the presiding officer: without objection. mr. inhofe: mr. president, i ask unanimous consent that the resolution be agreed to, the preamble be agreed to and the motions to reconsider be considered made and laid upon the table with no intervening action or debate. the presiding officer: without objection. mr. inhofe: mr. president, i ask unanimous consent that the senate now proceed to the en bloc consideration of the following resolutions which were submitted earlier today. that's s.r. 170 s.r. 171 s.r. 172. the presiding officer: is there objection to proceed?

mr. obama and 10 senate democrats including letters ron wyden, pat murray, and tim kaine and mark warner. discussion was constructed. lawmakers discussed the need to advance legislation to get the president the support he needs to complete negotiations on the transpacific partnership. we will go to randy, missouri. democratic caller. caller: i think most people are missing what harry reid is doing. harry reid is a very crafty politician. if you listen to what he said last week, harry reid want the vote to take place before these deals expire. one is section 215 of the patriot act. he what that to take place. then the universal bank or whatever they call it. host: he want to see the infrastructure bill passed. caller: it is part of the banking issue. it expires next week. he wants confirmation that they will be voted on. what he is doing is he is using the filibuster, especially as it relates to the currency deal, which chuck schumer had said it should he a separate vote. harry reid is just tying it up. when it is all said and done this is going to pass. my count is 14 democrat minimum who

the bill senators john cornett and patty murray john mccain and charles schumer came to the floor to discuss the budget agreement. this runs 50 minutes. the >> mr. president, glad i had a chance to come to the floor and listen to the distinguished ranking membert and senior senator of the budget committeefeelike and senior senator from california to talk about this yo know, budget. i feel like it is two ships passing in the night. when i see this remarkable accomplishment under the leadership of chairman enzi on entire bud thege budget committee and the entire budget committee, this is a congressional budget that balances within 10 years.n's it doesn't raise taxes.it a array prioritizes our nation's citizens defense. it protects our most vulnerable risin citizens. it improvesde economic growth, doing which is literally the rising tide that lifts all boats and aps the federal growing economy, something our economy has not been doing very well lately. spending and it stops the federal government out of controlble federal spending. so this is a remarkable accomplishment. as a matter ofnt fact, this is the an first joint tenured balanced-budget rev

mr. ramirez had been inside that transmission shop. >> reporter: so, in 2010, 15 years after the murder, investigator fulcher brought the case to prosecutor mike murrayd cases. murray, in turn, contacted gonzalo's brothers. he says they were surprised to hear from him. >> both brothers said that they had figured that with all the years that had -- that had gone past since gonzalo's murder that nobody was paying attention anymore. that he was just another young hispanic man who had been killed. and the police probably weren't even investigating the case anymore. >> reporter: the confirmation of gonzalo's dna in the shop was an important step, but the prosecutor knew they needed more. a stronger connection between gonzalo ramirez and his suspected killer, gianni van. >> we still needed to establish how it is that gianni would have known who it was who allegedly raped ms. esparza. >> was that kind of the missing piece all along? >> to me, that was. >> reporter: patricia was the key to helping them connect the dots. but, as far as the authorities knew, she was still married to gianni and could not be compelled to testify against him. >> i was constantly

to that senators jon cornyn patty murray jon mccain debbie stabenow and charles schumer came to the floor to discuss the budget agreement. this runs 50 minutes. >> mr. president i'm glad i had a chance to come to the floor and listen to the distinguished ranking member and the distinguished senior senator on the budget committee and the senior senator from california to talk about this budget but i feel like it's two ships passing in the night. when i see this remarkable accomplishment under the leadership of chairman nancy on the budget committee and the entire budget committee this is a congressional budget that talents is within 10 years. it doesn't raise taxes. it re-prioritizes our nations defense. it protects our most vulnerable citizens. improves economic growth which is literally the rising tide that lifts all votes in the growing economy something our economy has not been doing very well lately and it stops the federal government out of control federal spending. so this is really a remarkable accomplishment. as a matter fact this is the first joint 10 year balance budget resolution since 2001. and i think what drives our friends across the

mrs. murray: thank you madam president. in congress, we should be working on ways to build an economy that works for all of our families, not just the wealthiest few and unfortunately once again instead of standing up for workers some of my republican colleagues are bound and determined to defend the biggest corporations that have an interest in keeping wages low and denying workers a voice to improve their workplace. president obama vetoed this resolution and i urge my colleagues to sustain that veto. to ensure workers are able to exercise that right the national labor relations board or the nlrb, helps make sure that workers have a fair up-or-down vote. unfortunately, tobacco often big corporations take advantage of loopholes in the current election process to delay a vote on union representation. the nlrb was absolutely right to carry out its mission to review and streamline its election process to bring down those barriers for workers who want a fair vote. these updates will make modest but important changes to moderniz

mrs. murray: mr. president? the presiding officer: the senator from washington. mrs. murray: mr. president a budget is far more than a series of numbers on a piece of paper. a budget really is a statement of values and priorities, a statement of the kind of nation we are and the kind of nation we want to be. for many of us, these values and priorities are clear. we believe that a budget should help us move towards an economy that is built from the middle out, not from the top down. and a government that works for all of our families, not just the wealthiest few. but, mr. president the republican budget that we are here debating today would move us in the opposite direction. instead of working with us to build on the bipartisan budget deal that we struck last congress, republicans have introduced a budget that would lock in sequestration it would hollow out defense and not defense investments and use gimmicks and games to paper over the problems. instead of putting jobs and wages and economic security first by prioritizing policies like paid sick leave that shouldn't be partisan i