ms. murphy: 70. senator cantwell: we love our rural economy and our rural communities, they're a great place for people who are aging to retire and live and it's more affordable, but that means it's a different mix of the population as it relates to how you build a health care delivery system. so the medicaid expansion is so critical to that. i also want to ask about telemedicine because that is another delivery system that i think for us, we have this project echo, the university of washington, working with harvard, you've heard of it obviously probably in your state as well. but it's allowed medical professionals from seattle to consult with people over in the yakima basis. some of our clinlics to talk about the decisions for really highly complex patients on -- for rep tites c and substance use disorders. so how do we -- what are what do we do about that as it relates to the payment system? i don't think fee for various is any kind of friend to that cost saving technology and that cost-saving coll

ms. murphy the chance to wrap up this round. i would like to keep the record open for you all to give us as many concrete ideas for getting more providers to rural america. this is enormously important. we have tried this and that and we all understand that year after year we are faced with this question of whether there's going to be and want to keep the lights on. in other words we have buildings and lights but you have to have people who can run them. ms. murphy your priority for medicare as we use this. where we have five years to push hard. >> expand the test for global budgets to different states. >> very good. only seven seconds over. >> senator roberts. >> thank you mr. chairman. i am very great for that we are holding this hearing. -- grateful that we are holding this hearing. it is well overdue. we try to focus on the unique needs as espoused by the witnesses of people in rural areas. the healthcare challenges faced by these constituents. i am the cochair of the senate rural healthcare caucus along with the ever enthus

ms. murphy, directing a briefing on modeling and simulation. amendment 243 by mr. scott regarding a report on urban warfare. amendment 249 r-1 by mr. gallagher, regarding continuous monitoring capabilities and comply to connect. and amendment 321 r-2 by mr mr. khanna on a briefing on information technologies. i yield back. >> is there further discussion? if not, the question is on the amendments offered by the gentle lady from new york. those that are in favor, say aye. those opposed say no. being the chair, the ayes have it. the ayes have it and the amendments en bloc are adopted. the gentle lady from new york. >> thank you, mr. chairman. i offer amendment 385, the national security commission on artificial intelligence act of 2018. this amendment would create an independent national security commission on artificial intelligence and is the bill i introduced as hr-5356. mr. chairman, this amendment will direct a comprehensive and national-level review of advances -- >> i'm sorry, if the gentle lady will suspend for just a second. >> yes. >> the clerk will distribu

ms. martin is right, dr. murphy is right, if we n spend some money up front to avoid some of the longer term problems and figure out what works, you mentioned information and the right kind of therapies to be able to help these babies as well as their moms take advantage of this. many of these moms are facing their addiction because of their pregnancy. in other words they don't want their kids to be born with this syndrome so they are willing to go into treatment where maybe previously they were not. dr. murphy is right, how do you then once the baby is born to keep them usually it is a weaning off of the opioid -- how do you then keep them in that treatment program and longer term recovery and use that family relationship to help kindle some better prospects for longer term recovery. so anyway we look forward to working with you all in that. i think in the rural hospitals, in the rural setting we have a particular challenge. and i appreciate you being here today. we look forward to following up. i have another ques

ms. murphy. >> thank you mr. chairman and gentlemen for your testimony, i represent a district in central florida that is home to team orlando, a public private partnership for modulation and training that is co-located with the university of central florida which is the second largest university in the country and a major institution. additionally, a key part of the ecosystem are small businesses that are drivers of innovation in the s and t and cyber industry. i hear from them that it is hard to survive along contracting leave time and crs and the impact of those. there is a consortium called the training and readiness excelerator, we affectionately call this t rex, it basically uses a flexible authorities to field prototypes . they are trying to focus those fielding prototypes in areas where we need the narrowest -- the most innovation, medical modeling, those types of things, can you talk about how you think the department of defense should utilize ota's and other unknown equivocal methods to start innovation

ms. murphy of florida, concerning energy efficient technology. amendment number 319 by mr. turner of ohio concerning fall prevention devices. amendment number 335 concerning additive manufacturing. and amendment number 399 by myself concerning life cycle costs and acquisition programs. >> is there further discussion of readiness on block package number one? gentleman from ohio. >> thank you, mr. chairman. i want to take a moment to thank chairman wilson for their support and help on the provision that ensures safety for military housing. i want to thank navy officer jason english and his family, who have worked tirelessly to try to ensure safety in military housing after the tragic loss of their son evan english. their continued work will make our housing more safer for our men and women in uniform, and i appreciate the support of chairman wilson. thank you. >> if there's no further discussion, a question occurs on the amendments offered by the gentleman from south carolina. those in favor say aye. those opposed say no. opinion of the chair, the ayes have it. the ayes have

ms. murphy. those in favor aye. that's opposed no. nos have it and the amendment is not adopted. we will now consider amendment 221 r-2 for mr. bishop. for what purpose does the gentleman seek recognition. madam chair, i have an amendment at wherever the mythic mythical desk is. >> we'll accept mr. bishop to explain the reading of the amendment. >> this is not necessarily new to any of you here. we've talked about that in the past. there are changes taking place over in the senate which will make this significant again. the issue still deals with the incredible cherry-- prairie chicken, and a certain beetle and it does have an impact. it impacts a grand total of 27 ranges and 19 training areas that are in the west. specifically a mountain home, which is an air force range, has areas that are off limits for practices and training for certain times of the year, specifically because of this. yakima has seven training areas off limits months of the year. and at nellis, and other trading ranges they are concerned over restricting training because of a prairie chicken and in idaho talk

ms. rosen votes aye. mr. knight votes no. mr. brown votes aye. mr. russell votes no. pl pl mrs. murphy votes aye. mr. panetta votes aye. mr. gates votes no. mr. bacon votes no. mr. banks votes no. ms. chainye votes no. mr. mitchell votes no. mr. longeman votes aye. mr. cooper? mr. cooper? >> how is mr. hunter recorded? >> excuse me, mr. hunter? >> mr. hunter votes no. the clerk will report the tally. mr. chairman, there were 26 aye votes. 34 no votes. >> the amendment is not adopted. question now occurs on russell amendment number 323 related to financial institutions on military bases. the clerk recorded vote has previously been reported. the clerk will call the roll. mr. thornberry votes aye. mr. smith votes no. mr. jones? mr. jones? mr. brady votes no. mr. wilson votes aye. mrs. davis votes no. mr. longman votes no. mr. bishop votes no. mr. larson votes no. mr. turner votes aye. mr. cooper votes no. mr. rogers votes aye. mr. shuster votes aye. mr. courtney votes no. mr. conway votes aye. mr. land warn votes aye. m mr. whitman votes aye. ms. spear votes no. mr. hunter votes aye. mr. gacy votes no. mr. coffman votes aye. m

ms. -- sally. votes no. carbohol. votes aye. knight. mr. knight votes aye. mr. brown. votes aye. mr. russell. no.russell votes mrs. murphy. votes aye. no.-- votes mr. conha votes aye. abraham. dr. abraham votes no. o'halleran. o'halleran votes aye. mr. kelly. kelly votes no. mr. swayze. votes aye. mr. gallagher. mr. gallagher votes no. panetta. mr. panetta votes aye. mr. gates. mr. gates votes no. mr. bacon. votes aye. mr. banks. mr. banks votes no. ms. cheney. ms. cheney votes no. mr. heiss. mr. heiss votes no. mitchell. mitchell votes no. >> mr. jones. will report. >> mr. chairman, there were 30 votes, 31 no votes. adopted.mendment is not if there are no further amendments, chair recognizes the gentleman from south carolina of offering a motion. mr. chairman, i move to adopt sub mmittee report on the committee on readiness as amended. >> questions on the motel from gentleman from south carolina. say aye. opposed. no. motion have it and the is adopted. onll postpone recorded votes the amendments in this particular subcommittee mark until the consideration of all he amendments to the subcommittee mark. the chair recognizes the chair

ms. murphy you'll be our first all west. -- i i spent two years with my roll as secretary of health.day i would like to share the development of an innovative payment and delivery model that was developed when i served as secretary of health in pennsylvania. i began my tenure as secretary of health assessing the status of the healthcare delivery systems in pennsylvania. i was struck by the financial instability of the rural hospitals. i found that in research i found the situation in pennsylvania was being copied across the country. 67 of our 169 hospitals in pennsylvania are in rural communities. more than 58% of those hospitals in rural areas have mounting financial pressure resulting in break even or negative operating margins. they began to look for a solution. after working and seeing the impressive results we decided to define a similar models. we worked with them on designing the matter and i would like to acknowledge senator casey in his office as we designed this model. the design was launched in january of 2017. the objective of the model are to provide a pass to improving