We are live this morning for remarks from outgoing joint chiefs of staff chair general Martin Dempsey. He will be talking with the children of parents in the military at the conference hosted by the military Child Education coalition. The wife of general dempsey is also speaking at this event today. Live coverage on cspan2 in washington, d. C. Your respect here from the general in just a moment. A special thanks to the many many volunteers that you will see battle in this room but throughout this National Training seminar, but also to those volunteers who support us day in and day out. We just get tremendous support. There is a special group that you will see of men and women running around in lieu tshirts. There from deloitte and for some years now weve gotten great volunteer support from deloitte and a special thanks to ed casey and the members of deloitte for their outstanding support. As you go through this next couple of days and you look through the program you will see an Outstanding Group of Speakers Panel members. Andi dont ask you to engage them and give them your thoughts, give them your ideas, and challenge them on some of the things they are telling you. One of the most important aspects of the National Training seminar for us is the feedback we get from you and the questions and in the comments. I was with a group yesterday, and listening to some the comments from a parent and to talk about what of the children had been before they graduate from high school. If you think about the population in this country, as mobile as it is but how many families experience in different schools for the children in 12 years . Some of you probably have experienced 12. So last night i called my wife, and we were talking and i said, by the way, i met this lady today whose child was in 10 different schools. And she said yeah the transition of the military families, she said come have you thought about how me schools your oldest daughter was in wrecks i said of course i was in the field, but nine different schools. So the challenge that we face in supporting military children around the world is one thats not going to be lessened by certain deployments, whether were fighting a war in iraq and afghanistan or someplace else. And its very important for those of us involved in this organization to share their thoughts with people because a lot of people just do not understand that. The other aspect of what we do in helping the military child and the military family is the second and Third Order Effects of the dazzling nonmilitary children. And thats so important. I know i preaching to the choir because with so many educators out here today. Next group id like to say special thanks to is dr. Murray keller dr. Mary keller. Are you in the room . Wr. Please stand. Most of the staff is involved in someplace else. We exist because of the tremendous job that mary keller and the statute in and the staff did in supporting us around the world. [applause] now id like for the members of the board of directors if you would please stand. I know who you are so stand. Come on, come on come on. Stay standing a second. [applause] these men and women represent i think the finest with respect and representing a constituency irregardless of what service you are from or if youre from the Education Career or whether youre from business world. And my special thanks to you and to those you represent the couldnt be here with us. And please join in a special round of applause. [applause] now i think we are covered here. Army, navy, air force marine coast guard, active guard reserve. Business world antieducation. On this board. So please engaged in while you were here asking questions. I can tell you the knowledge that they have is tremendous. Most have been involved in a military for many years. Some have not been involved with the military more in the education area but i feel very confident that this is just a tremendous board that represents me and represents you. Im always a little cautious on this one because it says here youre going to 30 s. To ask students poppe. So dont be surprised if so that you table pops up. Its one of those programs we have is the student to student program. But we like it every year is have three of our student to student participants stand up and take a look at about the program. So at this time i would like to were is the number one . Please. Dont watch the clock. Do what it does. Keep going. I am a senior from Allison High School in texas. I am making this quote part of my store. Thank you for making my story your mission. [applause] perfection is not attainable but if we chase perfection we can achieve excellence. I am a junior at Fort Campbell high school in kentucky and i am making this quarter a part of my story. Thank you for making my story your mission. [applause] with the teamwork and intelligence wins championships. Michael jordan. I am a sophomore in san antonio texas. By making this quote a part of my store to thank you for making my story your mission. [applause] thank you very much. Now its my honor to introduce representing our sponsor. Is a senior vice president. Please come up. [applause] good morning. Thank you, general. I want to start off by saying this is the first opportunity had to be this great conference but i must say its an honor to be here and have the opportunity to participate with you in this meaningful event. While i may be new to this event im proud to stand up and represent circle. As a pledge our support to mcec nine years running. To prepare for this i went with the office talk to other executives and leaders and individuals who have been involved with mcec and i must say im truly impressed youre in this world of Government Contracting i supported the military in many different ways the Intelligence Community and beauty community. At seeing the work you do for the troops at home in many ways is really powerful. I commend you. Friend i was on a mission of ensuring quality education express are all the military children. This is a welldeserved adequate a noble object and one that we believe them. The company a workforce built on the vision of making a positive difference in peoples lives. This is what mcec does, and congratulations. Both of our organizations share similar values and goals and we are both striving to make differences by pashley serving those who serve us. So our behalf of our company i want to thank each of you here for all the wonderful things you do for our military children and i would also take a minute to say thank you and give a special thanks to the brave men and women here with us today who have accepted the duty of protecting our great nation. Circo is proud to be part of mcec and we are committed to the future of this organization in supporting the wonderful calls. Thank you very much and have a good conference. [applause] next i have the honor and a pleasure to introduce to individuals who are no strangers to the military Child Education coalition. This is the fifth year that general dempsey and his wife deanie have joined us and participated with the military Child Education coalition. General dempsey is the 18th chairman of the joint chiefs of staff. Enda deanie have been married 39 years, and they have raised three children, all three of which have worn the uniform of this nation. Theres no couple that provides more support than the dempseys. Day in and day out have just been stalwart supporters to what we do, what we stand for after efforts to support the military child. So it is with great honor and pleasure to introduce to good friends, general Martin Dempsey and his wife deanie. [applause] we are glad to be back. This is our fifth year and so for those of you who know the military works i now qualify for my silver oak leaf cluster for the fifth appears. Every its been an absolute joy to see you and to feel the commitment you make to our children. Deanie will often remind me theres things that chairman and his lady that we have to do. I did one of those yesterday actually. And then theres things we get to do and we get to spend some time with people like you. And as we kind of come to the end of our career thats actually a part that we were really miss, as we just admire what you do so much. Really briefly at going to turn over to deanie and then we will bring up a panel of distinguished questioners, but to date in history Kris Kristofferson was one. He turned 79. Some of your old enough to remember Kris Kristofferson, but actually he kind of crosses generations. Many of us remember him as country western singer with johnny cash and the group the high women. Others may remember him as an actor in blade movies, as whistler. And in the dolphin tail, actually. I mentioned him because hes actually a military child. Hes the son of an air force general. Did pretty good for himself, in that way of making a living, entertainment. He described in a military child as magical privilege and painful all at the same time. And i think many of us can relate to what that means. He actually commissioned into the army and volunteer to go to vietnam but instead they sent him to west point to teach english. While at west point he decide to get out of the military and pursue his career in music. I mentioned that because i was a captain in the arm at west point teaching english and decided to stay, and ive often wondered [laughter] no, not really. But i did want to mention that image of painful privilege and magical all of the same time because i think a resident. With that let me turn it over to deanie and then we will bring those youngsters after to talk with us. I will reiterate what marty said. We are thrilled to be back. As a mom, thank you for what you get. As a kid privilege to travel around and talk with families and user issues, we often can answer with well, mcec is working on that, or mcec has handled that. You want to be proud of what you do for all those kids, many of which im sure are your own. I wish that mcec had been there when my kids were little ittybitty agenda now weve learned anything that we keep learning and move on. So thanks are being you. Thanks for what you do. Theres kids all over that are thank you and appreciate what youre doing even if you dont know. So thanks. Will look for to questions from the kids. You can bring them in. While theyre coming, ive been holding onto my ticket. Is there going to be a raffle . I heard it was going to be a raffle. What happened to the raffle . I was hoping to be part of that. [laughter] dont make eye contact. [laughter] they are here. So this is a great group of youngsters, military children. But i think we will start having to introduce yourselves and then i think youre going to ask the first question to go ahead and introduce yourself. Im Caitlin Jensen from Falcon High School in colorado and it going to be a junior. Im et cetera, from washington. Im going to be a senior next year and i could a silicon high school. Im a junior in florida. I am wrong will gonzalez and i am from sundeck spent im a junior at Falcon High School in colorado. How about a round of applause for them . [applause] okay, caitlin. General dempsey, how do you define your success . I dont know. [laughter] you want me to extrapolate on that . Yes, please. Thats a great question. It works at a whole bunch of levels. Obviously, the things im proud of about myself, pride is kind of counter to humility which i think is the greatest virtue of falcon Senior Leaders but im proud of being a soldier, and not much more than that mean its not about the stars although that surprises people sometimes the issue is not about the stars. Im editing a soldier, proud of being a husband and proud of being a father. Do you think failure plays a part in that success . I dont know if did you the question . Can you Say Something to make sure they hear you . Do you think that failure place apart in that success . Failure place apart in every success. Life come and give experienced it already unsure, overcome your own challenges and got back like chumbawamba. I get knocked down and i get back up again. [laughter] im trying to connect to the kids. [laughter] you dont want me to break down and funk you up do you . [laughter] it really is true that you kind of measure the path of life and the ability to stumble, and you know, keep on the path. You are some things come and i to youngsters, including my own kids, being someone whos in high school is about keeping doors open. Every door that you can imagine is opened to you right now and to do something to close a. Thats a great thing about being american. Com on the grandson of poor irish immigrants growth in new jersey. My father was a postman. My mother stocked shelves at a convenience store. And im the chairman of the joint chiefs of staff. I can tell you, that would not happen anyplace else. So the doors are open. You just cant close them. But you can stumble. You just cant fall flat on your face, and ill leave it to your imagination to decide which are stumbles and which are catastrophes. You want to add anything to the . You are getting your own questions . Okay. Im not helping you with yours. [laughter] you cant cheat. Anything else, caitlin . Not right now. Thank you very much. I have a question, mrs. Dems get if you had to start all over again at our age, would you have done anything differently . Not counting spend i was just going to say, what i was your age is when i met this guy sitting next to me. So the life that ive that i wouldve never endangers imagine at that age, and now looking back i would not have changed any of it. An amazing ride. So no, i also dont think i would. General dempsey, i have a question for you. Are you ready to . Im ready. Do you have any mentors . Of course. I think mentors are an important part of growing up. Mentoring is a kind of twoway street. You can want somebody to be a mentor. They have to want to be that mentor in return. Ive been blessed in particular the military leaders that i have chosen, and by the way they dont always have to be older. I have peers who i consider to be mentors and have learned a lot from those who have worked for me but i have military mentors, some of whom are still on active duty although i am now for better or for worse of the oldest office on active duty those pretty hard to find someone older to mentor me. But even, Mike Krzyzewski has become such a great friend and mentor. I love the way he carries himself and the confidence values. If youre not a duke fan you probably dont care for them frankly. But if youre a yankee fan, you have to live with people from boston, for example. But mentors can eliminate. They can actually do it for you. You have to do it yourself. But they can illuminate ideas that you may not have had the opportunity to think for yourself, and then you take them in. You are the aggregate of the things that impress you and inspire you. And im also not a person who believes you need one mentor. I think if you cast your net pretty wide so you can understand how other people have done it and then decide for yourself how much of each of them will become you are ultimately it is you. Have impacted your life . Constantly. I get phone calls sometimes unsolicited and sometimes i will reach out. Every week for sure but i wouldnt say every day but every week ill reach out or be reached, and particular, for example, on things like i am the only one that can really define for myself this issue of civilian and military relations. And its a challenging. Its challenging anytime but in the Information Age trying to stay centered as the senior military leader but the advisor to the president and secretary of defense, the mentor of the Combatant Commanders and the tier of service chiefs. I really have to work to find that the center line to make sure that we are providing a political best military advice. And so i will call up one of my mentors are some professor at duke or unc who would have a relationship with, and i will cite how did that go . Yesterdays congressional testimony, for example. And they will say we think you were, you moved a little closer to the shoulder of the road. I havent talked to them today so this is not about yesterday. [laughter] but they will tell me. Your kind of left or right of centerline and thats not the political left or political right. But they Health Center me really. So yeah, they affect the way i think about my job actually. Thank you. Youre welcome. Hey, man, we are proud of you. Take your time. In one word can you describe the wife of a common agenda and our armed forces . In one word . In one word. [laughter] spent i and english professor. I got this whole vocabulary. Humbling i think might be. To be in this position it is humbling. You get the opportunity to touch soldiers, sailors, airmen and marines as you travel around. Because of martys job that is some pride. I do have influence to try to help situations. And so to be given that gift is really humbling i think. Its been an honor. Theres probably 50 words i could give, not yours probably. But i think if i had to get what they would be humbling. Its been such an honor to get to do this. You are also ambassador for your country. Marty and i do a lot with our counterparts around the world and no matter where you go, you know, youre just held to is deemed as if we represent the United States of america. You land in the plane with United States of america and people are in awe. Taking pictures of the. Its pretty neat to know that weve been given this gift to represent our country at all our service members, just care about them into the best we can for them spew all right. Your word was better than mine. General dempsey, how did you become involved with mcec and how are you benefiting from seminars like these . Thats a great question because when you become i choose to when i was chief of staff of the army and we were asked to come to this thing called mcec. Frankly, i didnt know what it was. I did spend i didnt come early. The way it works for a 4star, general geoffrey been meeting in your office and you walk out and decide whats next. Literally you go from place to place and as youre walking or driving do you prepare for that event. I know you think that i took weeks to prepare for tonight for today. Is at night . [laughter] but its your life is mostly directed we. I walk out and i said to be a where are we going . He said were going to mcec. I said were only going . Mcec. I had no idea. I got your and much like happened to me when with two taps the first time, you cant help but fall in love with the organization and the idea. Just the idea that theres a group of people who gather together with sponsors to try to help military children navigate that path i talked about a moment ago. So i have missed it since. Its one of those the things that when i build can we build our calendar about six months out come and when i built my calendar theres about three or four things that we put on the calendar and would tell the rest of the world fit itself around it. Sometimes the white house is a low bit of a challenge in that. [laughter] although thats why this morning events are actually a lot easier for me because they dont really spring into action until early afternoon and well into the evening. But no seriously its just been a real privilege to be part of the. And how has it helped my development . The answer is you can become an isolated, and less you put yourself out there and try to try to find out whats going on. I learned a lot from the adults in the audience. Im going to ask a couple of you questions by the way. I hope youre ready. This is tennessee, same question for you. How did you become involved in mcec . I heard about it years ago. I was in germany at that time called awacs american women activity some crazy acronym. There was a mcec represented there. So having kids i wanted to learn more about it. So i did. I knew and then kind of as my kids gone out, you kind of get away from it and then like marty said would were asked to come back and speak, it just renewed that interest at our appreciation of what mcec does for all of these kids. Thank you. Is it my turn . Youve got a real future. I said is it my turn . She said, if you would like it to be. [laughter] do you have more questions to . We do. Go ahead of them. Ill be patient. General dempsey, what is some advise you to anyone interested on joining the military . Advice on joining the military. We are several things. We give young men and women purpose, meaning and variety. We give them a genuine purpose. You can feel like you are a cop wishing something. And dutch are part of a team. My instinct is that young men and women in america today, at some level because of electronic devices, our content to sit in a of a football field all by themselves with a laptop connected to the world. Do you know what i mean . They want to be kind of by themselves but in the Virtual World, connected to everybody and everything and all information. What the military does is take the instinct for belonging to something and metaphysical but we take it out of the Virtual World and from the moment you come in, any service you are part of a team. And idea is literally drilled into you and eventually becomes your own. So thats that purpose meaning, yeah, theres just no higher meaning than to be willing to protect your fellow citizens. And in variety, theres a notion that the military is just kind of monolithic giant faceless caring less, lack of caring organization. Actually it nurtures. It has a builtin system of mentoring, and importantly we change jobs almost constantly. I dont have to tell you but we moved 23 times. How many times have you moved . Once spent what . Is your father in the military . Neither of my pairs spin will we will get you in and move you a lot. [laughter] not only do we move you geographically but we move you from job to job so they can develop this versatility. We literally invest in your development from the time you come into the time you get out. The last thing i would tell you is theres no more fair place on the planet than in the military. We embrace every race every ethnic group every religion. We are literally genderless and becoming even more so. And so its genuinely a place where an irish immigrant can become the chairman of the joint chiefs of staff. Thats all ive got for you. Thank you. Youre welcome. Before we came here this week, we were all asked to decide on a defining moment that changes into we are to do and who we will eventually become. And i would like to know if you have a defining moment or in a in the with that kind of made you the man you are today . Well, thats a profound question, young lady. Thank you. A good question, actually. You know a defining moment is tough to pin down, but i will fill you this. The for about the first on when i talk about this often. I graduated from west point. I went to because my mother wanted me to. That is exactly what i went to west point. My mother wanted me to go. And so i got there and it kind of, as we say, let my fire and i got enthusiastic about it. Deanie and i were not sure we want to spend our entire lives in the military. So i made a promise to with a probably many of you have made to your spouses anapestic i said look after five years my obligation is over, ill get out, ill become a whatever. And in five years came and i said you know i was aiming and hauling and i said i would like to give Company Command a try. Hemming and hawing. We were on the slope of 41 years. But what was fascinating was that i got out about 18 or 19 years, or so, and i was contemplating, i was contemplating leaving at 20. And deanie and our kids were sitting around the dinner table and they said you cant get out. I said wait a minute, i thought i was the one keeping us in, you know . And what had happened to us, a conflict actually and my wife and children had become just as inspired, or maybe even more inspired. And so here we are. In fact, that was part of a conversation as my son was struggling about whether to go to west point or not. He had an appointment to west point as well as some really incredible rotc opportunities and he went to west point. It turns out my son went to west point. My daughter went to west point right behind them and our youngest went to wake forest on an rotc scholarship. So i suppose the profound moment for me was when it became not just my particular passion but our families nation. Families pashtun. General dempsey, what were your goals that you set out to accomplish in the joint of the military . Were or are . What were they . When i started . Welcome when you start, your goal is to survive. [laughter] its a great question because people ask me now, you know what do i have to do to become the chairman of the joint chiefs of staff. A young lieutenant, every once in a while will pop the question. My answer normally flippantly at first is the first thing is you shouldnt want to do that. Meaning its not because of the job, thats not the right question to be asking. At 22 years of age. The right question to be asking yourself is what exactly are you trying to do with your life or in my case the reason military was such a great it is that i found that i had a passion really for building teams and for trying to make the team better than the sum of its parts. So take as a platoon leader a third of income in those days it was all meant but now, of course, its men and women, a 30 man team and you try to literally make it the best it can be. Not out of some sense of ambition but because you just want to see that dean you know. One of the things im most proud of is the strength of the proteges that have now you know, succeeded behind me. So in terms of legacy your legacy is not a piece of equipment or a particular job. Its what you left behind in terms of the commitment that people make to this profession. Thats been the goal. Its just gotten a little bigger over time. Started with them i wanted to do the best i could for those 30 men, and now we can figure how we can do the best we can for to. 1 billion. Its a little daunting on occasion but it is the same goal 2. 1 million. Spiff what the support systems help you reach fiscal . You cant have come you cant have kind of a steady, Firm Foundation of work and go home unless that foundation is equally solid. In other words, to accomplish the goals that you set for yourself in whatever profession you do, and i hope you do choose professions, something you can be passionate about but you have to work equally as hard at himhome to make sure equal balance in life. So the first and foremost support system is your family come and always will be your family. In 58 days, not that im counting when i retire, thats it. Those of you whove been in the military know theres this wonderful ceremony we pass a flag from one officer to the next. He goes off to the Officers Club at fort myer, virginia, for a reception, and deanie stay here and shake hands. All of a sudden everybody is gone. I mean literally everybody is gone and some of you have experienced this. You realize you go from being invited to mcec to sit on a panel and talk to children and go to the white house situation room and appear before congress and when thats done, what you have is your family. You might get invited back if you do while i suppose, but what you have at that point. Okay, the second thing in the military is you have two lets call them chains of support, the noncommissioned officer corps who are fantastic and probably the only ones that will actually tell the emperor that they have no clothes. They are brutally honest. They are the standardbearers. They will tell you they will compliment you when you are doing well and they will plan a boot someplace when youre not. Then you of the officer chain of command which is actually challenged or chartered to nature you keep getting the right jobs to put yourself, we like to put Junior Officers in a position where they can succeed. So those are pretty incredible those three pillars the officer chain of command and noncommissioned chain of command and your family, provide a whole bunch of support. And what educational skills do you find do you find lacking in younger members . Thats a fair question i do want to be judgmental, meaning its not just youngsters who might have particular gaps in the education. Just as i said about balance in your life, with her family i think you have to balance your education. Im not one who thinks we should just probably nixon people in the audience squirm a bit but i dont think we should charge down the stem row. Like its all science technology, math. I dont know what the e stands for. Engineering. [laughter] issued just be about the humanities. Special at your age where you are trying to figure out what interests you and you are trying to build yourself into a wellrounded person, athletically or physically spiritually and intellectually. Im an advocate of that. One of the things ive heard said about technology this it makes younger folks kind of a mile wide but only an inch deep. They know a lot about a little know, a little about a lot. And so youll have to be your own judge of that. I do want to be judgment about it. I would just encourage you to learn for life. Youre going to get the mandatory education along the way but its kind of what you learn in between that will probably take the biggest difference. I had a little phrase i use with my general officers and admirals, leaders are readers because they have to keep learning. I dont care what they read. They could read poetry. They could read foreign policy. They could read whatever it is i dont care but Business Books about management leadership but theyve got to keep reading. You just got to keep challenging yourself. I think as long as that occurs, the gaps to themselves over time. I go to. Anything to add to that . Mathematics teachers in your are not gathering at the exits now to ambush me. [laughter] you are in a very high leadership position and should face the challenges along the way. Could you tell us some of what the Biggest Challenges you face in your career have been . The biggest challenge in military is always making sure that when we ask young men and women to go someplace to defend our homeland to promote our national interest, to put themselves in harms way, right . Said the biggest challenge is making sure they already. Its also the hardest part of a job. The decision to send young men and women into harms way cannot be made without the utmost care and consideration to it doesnt mean we have to be reluctant are reticent to use the military, but when we use it weve got to be confident it will achieve the purpose for which we use it. And then inside of that its getting him ready, making sure its not a cliche but we set off an weve got to be and should be the best trained him the best lead and the best equipped force on the planet. And so at every level, whether i was a second lieutenant, or now a 4star general its really about making sure that americas sons and daughters who are entrusted to our care are ready for what we could ask them to do. You know most of the time we accomplish that task. On occasion we dont get its heartbreaking when you dont. But thats the hardest part of the job. Im back. We have one more question. I have one more. Okay what department of Defense Systems of support are working for the benefit of military connected children speak with what department of Defense Systems that support . Im going to phone a friend here. [laughter] the policy and freshman rosemary williams. I know who has it. [inaudible] yes, and family policy. Thats the one. They are definitely connected to the kids. She runs the forum and she puts out information. We in turn give her information or issues to be worked. Now, thats the office and shes kind of a person who runs the office, but ill tell you the support group is for military families are the chiefs of staff in the services. And their senior enlisted leaders. And their spouses. One of the reasons we traveled is interact with counterparts around the world. But when we traveled domestically my principal purpose is to make sure that we are getting our young airmen and sailors coast guardsman what they need. Deanie goes out with a spouses and find out whats going right and important whats not going right. And we get back on the airplane and im going to fall asleep and she is wearing me out yap yap, yap. [laughter] did you know that . What are we going do about that . Lets fix it. The mr. Kobak and we take the step that we say okay heres the questions weve got to see if you can find answers, and they always do because everybody really cares. Its the chain of command. Its not just push a look at that. Theres a big sign that says five minutes. [laughter] well, what if i want six . [laughter] again, i met you to recruit you although i would be happy to do so. When you join the military, what we say is we recruit individuals. We recruit caitlin into the military but we retain families. In other words we get you as an individual but then we convince you and your family that its in your best interest as a family to stay with us. And we do really well at that. So it is one office but its the profession it is to support structure. Okay, we probably have four minutes now. Does anybody else have any more questions . Do you have any questions for us . I probably do. Where did it go . It went from five to two. [laughter] greenwich with that two minutes im not going to get to you. What i do want to do is tell you thanks. It is courageous. We do this all the time so sitting in front of people out there, it comes kind of Second Nature to us now but im sure for you is a little bit frightening. No, really. Maybe not. Maybe some we are studying theater or something, break out into song which im going to do right now. Okay, here we go. [applause] but you have to stand up and line up your with me. Deanie will educate you. This is a row but so we will get a little blood flowing. I do this every year and they get invited back so it must be okay. Despite whoever is running that thing, trying to kick me off the stage. Im not leaving until i finish this song. You cant make me. Its a little ditty little irish ditty called the unicorn song. Anybody ever heard of that . You have. You know the motions . You are going to learn emotions. Is have emotions go. They were green alligators and long neck deep. They over humpbacked camels and chimpanzees doesnt that look good . [laughter] there were cats mraps and elephants as sure as youre born. The loveliest of all was the unicorn. Okay. [applause] a long time ago. Will do wonders in one course and have to go. A long time ago when the earth was green and were more kind of animals than youve ever seen. They would run around free when the earth was being born and the loveliest of all those the unicorn. Well, there were green alligators and longnecked geese. They were humpty back to camels and chimpanzees. They were cats mraps and elephants, and sure as youre born, the loveliest of all was the unicorn well done. Ladies and gentlemen, another round of applause for my chorus. [applause] great jobs. You guys are great. Thanks so much. I wish you all the best. Thanks very much. Great questions. Okay. Spent please welcome back to the stage for special for a special presentation to general and mrs. Dempsey, general Benjamin Griffin and dr. Mary keller. So this year since it is your fifth year, this is a president for deanie for the special artist a hand blown purple ball for joint. Thank you. Thank you. [applause] the greatest is weak it is to see you all together doing what doing. So thanks so much. Thank you. [applause] general dempsey, general dempsey, before you leave i want to tell you there were wonderful words for children of any age and adults of any age. I want to thank both of you for your service to this nation and the tremendous job youve done in defense of this nation in support of the military. And begin in support of the military Child Education coalition. Youve been special for mcec and i know you well and i just wanted, from the bottom of my heart, thank you so much for what you do, not only for military children and military families but for the armed forces. All the best. Thanks. [applause] well, think again for the fifth time. What a privilege well thank you all for being here and welcome. Its great to see so many of you back again to old ones company ones speed as we will leave this program at this point if you missed any of the remarks from outgoing joint chiefs chair didnt you can see the entirety in the cspan video library. Go to cspan. Org. Chairman dempsey replacement was confirmed by the senate last night. Military times writing the Senate Confirm marine general joseph dunford, jr. As the mixture of the joint chief of staff yesterday after a brief dispute between pentagon would and the chambers leading critic on Sexual Assault policy. This spat between Kirsten Gillibrand of new york and military officials had nothing to do with general dunford credentials but instead centered on data of such assault and unfortunately, basis. Information shes been seeking for years. She stalled the confirmation process for about two days until Ashton Carter offered assurances to her yesterday the information would be made available soon. General dunford has served as commandant of the marine corps for the lester was confirmed without opposition just a few hours later. The u. S. Senate would be tablet into date in about an hour from now to wrap up work on a sixyear highway bill. They will take a final passage vote at noon today and later send it will put on house passed treatment passionate threemonth extension to. Watch live coverage of the senate when members gavels in at 10 eastern live on cspan2. This weekend on the cspan networks, politics, books in American History. And now health and Human Services secretary Sylvia Burwell delivers the keynote address at the National Governors association 2015 summer meeting. Focusing on implementation of the Affordable Care act in the states. Sounds pretty loud. Folks, thats better. Folks, if i can gamble us in to order gabble. Want to welcome everyone to our closing session to the 2015 nga summer meeting and were going, i think this might prove the most fruitful of all the time we spent a. We going to spend some time, some of the session examining health care transformation. And i am very pleased and grateful that health and Human Services secretary silvio burwell Sylvia Burwell is with us today. Shes been generous with her time come at any our last two meetings and speaking at our governors only lunches. At hh as she oversees more than 77,000 employees, and to work in touch is lives of all americans. Most recently she served as director of the office of management and budget. Shes also served as president of the walmart foundation, president of the Global Development program at the bill and melinda gates, and perhaps most importantly on come at this moment our parlays most importantly to govern, and she is a native of hinton, West Virginia. My home state of colorado is certainly an example of working with cms on Health Care Innovation on a variety of levels. For those of you who may not be aware, cms has approved the largest combined Data Warehouse and analytic system for health and Human Services in the country in colorado. This system gets all components of the cms crippling up working to provide better care for individuals at Higher Quality or health for our population as a whole and reduce costs as a result of those improvements in Health Care Quality for all of our citizens. Without further ado let me introduce the secretary of health and Human ServicesSylvia Burwell. [applause] thank you. Governor hickenlooper. Its great to be able to join you all today. I am especially happy as was mentioned to welcome you to the Mountain State along with governor tomblin. And less than an hour a way as my hometown of hinton right across them advantages want to invite all of you will do visit perks home of hungry small. All of my sister and i both start as which is a musical. I hope you provided if you dont want to go there because they have hearts or ice cream if want to go to dairy queen its only a half a mile further. It is the most beautiful dairy queen in the nation. Im not one to brag but its in a boat. It really is. This is triggered if you actually went and you sat on the patio and you saw the heavens and the bald eagles and you saw the new river, you would say it is. Someone to invite everybody come and tell everybody, just tell them i sent you. Im from a town where Everybody Knows everybody, so please do head down and check it out. Perks was my first job. Its whether i learned about hard work. If you got stuck serving the hearts or ice cream after church you just kept zip it. Didnt matter how the forum started to after while, and im sure you can imagine the after church crowd at trying to come you work until you got it done. Thats what lessons i learned at hinton and i also learned about community. That was what hinton, where we are just an hour away, is all about. He worked together to get things done. And i know that those are the ideas that we share as we had a conversation. Is something i found particularly fabled in want to do with you all. Its been one year since i first met you all. I literally had not been set second for a month when they came to visit you all and we were hosted by Governor Haslam in tennessee. Ive had the opportunity to get to know a number of you. Some of you are new around the table but even though i think ive got to spend some time with, and understand its your passion and dedication of the people you serve. You all have been great partners angry supporters on a wide range of issues that hhs has whether thats ebola Early Education preventive care, editors want to start by saying thank you to all for your partnership in this year. You all are on the frontline of governing, and i know how you feel. You have to answer for your work every day, and we depend on you because your citizens are depending on you and you are crucial to our partnerships. For too long our systems have failed to put the patient first. Americans have struggled to navigate an expensive and complex system. We pay for more care but sometimes weve actually gotten less. But in the last few years we have actually started to see some turn in now. We reduce the number of hospital admissions by 8 and that translates to 150000 fewer free admissions between january of 2012 and december 2013. We have increased the tea in hospitals with 17 reduction in the rate of hospital acquired infections and other things that happen to people when theyre in the hospitals. Thats reduce cost estimated over 10 billion. Preexisting conditions cant be denied coverage and they were implemented with 60 million fewer uninsured in our nation. This is the foundation that we can build on. Like all of you we want to build a Better Health care system, one that delivers better care, spend their dollars more wise input educated and empowered can do murders at the center of their care to keep them healthy. At hhs weve been trying to take steps to make that a reality. In january we announced historic goals to move 30 of medicare payments to alternative payment models such as Accountable Care organizations and bundled payment and 50 of those payments by 2018 means paying for value, not paying for volume. We can pay providers rather than how much care they provide people appeared a few weeks ago we also announced a new payment model to encourage better coordination among providers to take part in hip injury replacement for medicare patients. The new model will create one payment with quality measures for an episode of care 90 days from the point at which you have your surgery to the 90 days after you are supposed to be fully recovered from a hip replacement. Rather than being incentivized by payments, xray blood tests check out therell have an incentive to focus on quality and total cost of performing a hip replacement and included recovery. Since medicare and medicaid cover one out of three americans we know we can have a responsibility to lead where we can, but we will only be able to deliver truly significant sustained change if we have the support, input, participation from hospitals, providers, insurers and work with the turin state to make this happen. State effort go a long way in changing the status quo. We hope you will cite your own payment goal and work with your providers to find better ways to deliver quality. And to let us know how we can help. To continue the conversation with partners would establish a Health Care Payment learning Action Network a forum for public and private sector leaders to come together to share strategy and ideas. Many state health care and Business Leaders are part of it. 4000 members and 600 organizations. I want to thank you to the states who have participated in businesses participating as well. We hope all of you will join the conversation because its a very important part of making sure this is quickly through the transition as possible, that we do in an way that changes an way to change his work and in the air and Public Sector and that we Work Together to see around corners. Change is something that results in things sometimes known and unknown. If we were together we can minimize negative impact and were through the change were quickly. Weve are dissing great leadership for many of you to establish medicaid system redesigns. I could look around the table and we are working with most of the law on that. Through medicaid and accelerator programs in the state innovation model, and many of you have Grant Funding to do that kind of change and we continue to provide resources and technical assistance. Another area where we sing great collaboration with the states and you all spent time earlier today as efforts to combat prescription opioids and heroin abuse in our country. Last april i wrote to reach a view about the opioid academic or have a better strategy to fight it and we are improving opioid prescribing practices to tighten that up because that is where a lot of the problem starts. We increased use of melodic sound into reverse overdoses we are expanding access to medicaid assisted treatment. I didnt write to just inform you. I wrote because we need your help and we want your help in your ideas and many of you have answered that call in or leading in that space. I got the chance most recently to be in massachusetts with governor baker and to be in colorado with governor hickenlooper to map out a path that we the federal government can work with each state to make real progress. Many of you also find innovative ways to combine behavioral and primary care together which is related to the issue. Today im happy to announce we are going to create new ways for states to use waivers to address Substance Use disorder. Our new guidance will help states implement innovative treatment approaches including developing effective care coronation models to Better Connect those with Substance Use to treatment. We have also heard your feet back about the renewal process for existing demonstration and to address that we released guidance this week released guidance this week on a new fasttrack process related to reapproval of longstanding medicaid and chip 1115 demonstrations. This will streamline the process and reduce the Administrative Burden on states and federal government. Additionally we will award about the Million Dollars in grants to help states provide medicaid assisted treatment for opioid use disorders. Next week we will make additional funding available for hundreds of community Health Centers to improve and expand delivery of Substance Use disorders and focus on treatment of opioid use disorders. I know im probably not supposed to do that, but that is 100 million so you have a sense that is large. It was in my remarks. And look at the press person who will now go take care of the fact that i Just Announced that. [laughter] [applause] this is money that will make a difference in your state. Lets do it together. As we learn what is effect is it is important that we share these best practices with each other. And that is why the ngas Prescription Drug abuse policy academy is so important and we are also convening representatives of all 50 states. I sent a letter to you all asking for three for everybody to come together in september so we can work to continue to build on progress. I want to thank the governors for their leadership on the recent policy academy. Im confident the group will continue to do great work in this area. I want to mention Something Else hoping to change the system and move us to patients at the center and that is Precision Medicine. Or individualized medicine is sometimes referred to. As we transform our Health System we talk about the best ways to get people care and how to give dog hears the tools they need to deliver the most effective quality treatments. The revolution happening in Biomedical Research is also a place where we have a chance to change the very nature of care that we provide with more efficient sequencing of our own genes and the dna of microbes and tumors, we can begin to personalized medicine like never before. Ive had the opportunity to meet with scientists and patients have been a part of this. I was up at nih amendment the gentleman named john dean from south carolina. He came with Kidney Cancer in 1992. Like his father and sister he had a rare hereditary cant there with the mutation called the mbt mutation gene. It causes tumors to continuously grow. Since his first visit, he had to have a slow kidney removed in on the other kidney thieves had 96 termers removed. Thanks to Precision Medicine and doctors at nih, they were able to determine the genetic cause of that particular cancer and develop a treatment. At first that meant managing tumors. But that was doing as they were understanding how they were growing and cause them to shrink said they would need to be removed. Eventually, don received a trial drug that targeted the gene and his timorous rank and now we are at the point went en masse to fight this disease but thanks to Precision Medicine, dawn is doing just fine. He sent me a note and set off in the best thing you can do is give somebody hope. Some of the most interesting events i do her with scientists and patients doing this in your state, people doing the science everywhere. I would encourage you all as part of the overall vision of where the science is going to meet with folks. Its exciting interesting than you do see the vision of where were going to go. Before i close i wouldnt be doing my job if they didnt raise the issue of expanding Health Care Coverage for many working citizens in your state. I think you know what im talking about. I want to emphasize a way that is helpful. I want to emphasize that this is about your city since financial and Health Security and also the Economic Health of your state. In every state has expanded medicaid, if every state that more than 4 million americans could have access to quality Affordable Care. These are lives that would be changed in some cases they and with more people convert economies benefit. 2014 alone we reduce hospital uncompensated care costs by an estimated 7. 4 billion in the country and 5 billion of that reduction is estimated 60 from the states that do not expansion. We know there are challenges but i want to make sure you all know i am committed to working with you to find solutions. We welcome this conversation and we want to help you design a system that fits you and yours a period when my favorite parts about this last year has been building relationships with you all. Ive had the chance to see your beautiful date drink the best lemonade around and be sent home with homemade cookies after a meeting at one of your mansions. My children got to eat doughnuts in the governors mansion. You know who you are. You are their favorite. What i said a jericho i still believe, which is we wont agree on everything but we have more common than we have in conflict. We have common insurance because of that we share Common Ground and a commitment to serve the american people. When we were together, we can do very great danes. Thank you all for having me back again and i look forward to your questions. [applause] two things that are apparent there. One is the West Virginia would you say thats true . Your approach reflects a combination of privatesector expanse of Public Service too to read your whole career which i think all of us appreciate. Time for questions. Once asked the first question . Governor had sinned. Secretary burwell, thank you for your presentation and really your desire to find middle ground with many governors and to look for more flexibility. Ive enjoyed our discussions in that regard. I also appreciate the connection you have two dairy queen but also the connection you have to work out and the time he spent there. I mightve missed it but i wanted to give you an opportunity to comment if you havent done so you mentioned the 1115 waivers. I would like for you to comment also on the 1332 waivers because there is an understanding at least in my neck of the was that the third 1032 waivers was designed to provide for innovation and flexibility beyond simply traditional medicaid. Can you comment on your approach to these waivers and what guided you to give the states . In terms of 1332 versus 1115, 1115 are focused on medicaid. 1332 are the waivers about the marketplace. If you look at the legislative history, those that promoted or 1032 waivers or about one of the singlepayer option for states. That is not necessarily what 1332 days there will be about. What 1332 with about this about an ability to actually meet objectives and goals set up in statutes pretty clearly in terms of budget neutrality, affordability and access happening throughout marketplace approach whereas a citizen in your state receives a tax subsidy if theyre eligible to go onto the marketplace and have helped her powersharing in tax subsidy. If the state can figure out a way to meet those conditions and it is pretty clear in the statute in terms of the affordability it is about the quality, the access and the budget neutrality that we want to give states the opportunity to come in. We recently in the last week have put out additional ways in which states can come in and have conversations with us. I think you all know they dont kick in until 2017. Its probably pretty important that the 1332 application to medicaid waiver is about the other piece the subsidies and that funding. 1115 member want to work to be flexible as ive indicated in terms of thinking about how you spend your medicaid dollars in how you think about innovative ways to perhaps advance the programs that they are different. Thank you. We have questions from governor mcauliffe and governor markell. Thank you, madam secretary. We havent closed the gap family forget about a billion seven a year. We are working to do a bipartisan way. I want to thank you for the creative ideas. We were successful for the planning and funding of the state filed for innovation. This is driving innovation reform in virginia. What is the possibility of funding for these grants to help us to reforms that the state level or some mechanism. At this time i dont think we have a plan for round three. Many of you know weve done wrong to and that is something we will have to go back and one of the conversations happening right now in washington which is an important conversation that much attention is paid to right now. You are focused on transportation conversation which is extremely important. Another one that is very important to Office States in the nation is the budget conversation and you want no right now current law is a sequestered level interest that hhs will be the lowest levels of funding in a decade. Some of these questions will be answered as we move forward as part of these conversations about where we are and where we are going to be. I am hopeful they will be another equivalent of a ride in the way approach and that we can move forward, but that is not yet have been. That is not the specific answer to your question but as we think through things that is related. Governor markell. Thank you, madam secretary. One of the grand to accelerate significantly. Our work to move away from the feeforservice model. My question which means improving access improving quality of and the cost curve and we are encouraged how all of the stakeholders are really at the table in working together. My question is around the cost issue nationally. Certainly some of the stuff ive been reading recently in terms of National Health care costs and rates seems like a lot of increases around the country and despite efforts underway in many, many states to try to move away from the feeforservice. Wondered if you could comment a little bit. With regard to the issue of overall costs and whether its cost in the private market or cost in medicare, will be seen as an article this week by kaiser appeared within the lowest growth on record here this weeks article said 50 years in terms of the question of per capita cost growth. In medicare growth, over the last five years to give you a fan and the last five years medicare crossed growth has been at 1. 2 . It was four years before 3. 6. That is still growth but downward pressure. A second part of your question that we all hear a lot about and that is the issue of race in the individual market. What is interesting is one of the things about the Affordable Care act was the question of transparency so that things have to be shown in the light of day because we actually believe the light of day is an important market function because that is how people get information. What happens is now in each of your state miniature putting forward rates above 10 have to be made public. It has to be listed during the review. When most of your states review those. It causes conversation right now. The insurers have said they believed the people at the marketplace next year and this is just the individual market will be below 10 . We know the rates that, out usually come down. A number of states i can muck around, some of your rates are out. Youre actually in a state where we see good rates and downward pressure. We need to wait and see until theyre finalized. Its something obviously we spend a lot of time on. The question of the costs and rates and pressure is something we want to watch and make sure we are on top. One thing i would mention as i look at the numbers as we are a pair in terms of the cost in medicare because it will be reflect the about also happens in the market and a conversations with ceos and others. There is some pressure in the drug space in terms of upward pressure. We cannot conversations about that. The one thing i would say is there are a number of things. We think light of day is important in terms of knowing what drugs are costing them how much so that is some in the public knows and understands. Disaster authorities in our budget for Medicare Part d can we have the authority to negotiate. I spent time at walmart. Its a place to negotiate with suppliers and uses the power of the market to put downward pressure on price. It is something we want to keep an eye on. I think what the conversation ends a reflection of the entire market or where the market for land to want to be cautious as always and at the place we all need to focus. Governor meade commend governor herbert. Secretary thanks for being here. Appreciate the great average to the states in the teamwork with wyoming as we were trying to expand medicaid which was a colossal failure by the way. They blamed the governor so thats okay. Secretary, i want to tell you as you look at the health care in the state in the country one of the challenges we face in wyoming as we are a very rural state and our challenges are somewhat different enlargers dates. Just on the economies of scale before the aca we had 12 or 13 Health Insurance come needs in the state. We have to now. The same is true on the systems necessary for payment and we look to partner with another state and we think theres opportunities to do that. Just a general question is i think World Health Care and rural state in the native american populations, there are some challenges and we are working to find some answers. I would just encourage you in your team to continue to recognize theres some differences between large metropolitan areas and rural areas in terms of distances and how far you have to drive when your son has a broken arm and those challenges. It is not unique. It is not new. This has always been a challenge, but first of all we continue to be very concerned about some different challenges of large states. I agree and recognize there is a difference. Being from West Virginia in a state where we have a large rural population and some things i understand and recognize we dont have the geographic expanses. Some of the state like you around for similar types of issues with regard to concentration and not being. When i sit in my seat and do rulemaking, the one thing youll be pleased to know if the center for medicare and medicaid know they cannot bring a single role in for my review without telling me the impact of Rural America because it is hard to figure out where the amounts when i talked about, they had a need and delayed announcement is in 75 markets. For market to be chosen because of mandatory comment has to be a certain size because you have to have enough of a population he could actuarially spread what its doing. We have the specific conversations. The question and Rural America how do we work to make sure places where theres not as much competition that is one of the things how we create working markets is a challenge but it is one we want to work with the wild eyed. We want to think how we can work through that. It is one of the things they now have two talk about when they come in because im going to ask it. You may as well be prepared in terms of the impact on world markets. The markets are different and how we think about that is something we have to figure throughout the nation that we think about in terms of market but they are very regional and local. You will note that in terms of some of your states there is a difference in terms of what the market looks like. Great. Governor herbert. Thank you, madam secretary. We are honored to have you here. Another having ongoing discussions that i want to express to you and your staff of the professionalism weve received. We been cordially willing to listen and to issues and we thank you for that. He said something that was taken away and that is more in common than differences and i agree with that. What we have in common is a similar goal as republicans and democrats in state in washington d. C. To service this weekend. The goal in regards to health care is to make sure as much as is practical or possible to provide health care, affordable highquality health care to all americans. Are we sometimes have a difference is how you do that. The goal is the same but the process in the pathway we follow a sometimes different and that is part of the debate. You talked about the need and opportunity for waivers and more flexibility and sometimes as we do not specifically on this issue with you, but like burger king you cant have it your way. You have to do it my way. How do you determine when it comes to Health Care Issues when you give waivers and flexibility have you determine how much leeway you get to the states . How much will you let us try her own way as opposed to let us do it i do want to say your way but under the Affordable Care of them have you determine where the line is drawn to give us flexibility would like to have as states. Usually make your decisions and space or other spaces, in terms of decisions we make across a wide range of issues well beyond 1115 waivers, one turns generally to the intent of the statute and the policy of this is the core issue and with regard to the specific issue in 1115 as we think about what guides were the bright line card, its often about affordability and access the address of the additional funding was about. It was about creating a better match for state within return providing broader access that is affordable. It would have been much easier in medicaid and i think you know the couple places there are lines to say outlined it and made it this is it then its easier but i dont think thats what gets to our ability to listen and hear because i can look around this table into some of you have come with innovative ideas we havent thought about committing was like a little bit of work. But theres enough there is enough evidence and logic to indicate we should try to thats what we work to do. Governor alan governor walker. Thank you for your incredible access. The governors have enjoyed your visit and cookies and lemonade. Those are the ones i got to take home. We had a good time. First i want to congratulate you and your comments on Mental Health and addiction because that is one of the most serious issue is the nation and state are facing as governor sound off and governors found out and i found out in my two and a half years the addiction issue is ending up in the county prisons. We have to come up with a partnership and everyone involved to deal with this very serious crisis and we had a previous seminar and its getting worse, so i command you and we want to work in partnership to come up with a viable solution. Two quick questions, one, i would love to get more information on the consistency on Medicaid Services across all states. We are having a debate on medicaid covering certain aspects and we are fairly liberal in that aspect and i have some legislators who want to continue to increase that and i would be curious if you have a consistent benchmark across medicaid coverage into and the second thing is you have been nice enough to have us visit in the oval office and we had a very frank discussion on many things. One was about waivers and one i am not sure im not sure if the lines moved at all. We are attempting to see if we can get able ablebodied people to require work or training to have Medicaid Expansion and we did this in Public Housing when i was the mayor in charlotte which was effective and we want to know if there is any more flexibility or was that the line drawn on the area. Why dont we get back in the benchmarks on the Service Levels thats something that we might get back to you and the team directly on. With regards to the question of work and how we think about that particular issue to how in terms of one of the things that i think is an important thing on both sides is the preexisting conditions shouldnt keep you from an ability to get Health Insurance. And again maybe how one gets to that. But that is an agreement and the idea that healthcare is not a conditional thing in healthcare from a number of Different Things think that you all know tanif is operated out of the department of health and Human Services that health care is actually different. But having said that we think that there are incredibly strong ways because we are with you on work and that the place we would like to see it would be great to have people earning their way that would be in the market. About we have a number of places where they get to a place that has innovation that drives this in a way that will get more people through the Work Training program than youve ever seen. So we look forward to having that conversation because i think that we think we can get to a part a portion that is at the core of your comment and so we think there are ways to do that. Governor fallon governor walker. Thank you for coming to our readings. Its always a pleasure to be able to have a dialogue with you. I have to tell you i think you have one of the toughest jobs in america. Youve had a tough job this past year. A couple things i want to commend you on. One is when you are talking about paying for outcome versus the volume of time someone sees a doctor we are all about improving the health of our citizens to make sure that what we are working is of diverting its working. Also a comment about trying to fasttrack some of the requests from the governors if not all of the governors is if we had one that you have already approved in the past if he would consider being able to continue that improvement because you have already done it several times before so this state of the state of oklahoma we have agreed program where we had a three way match of medicaid money and the employer and coming back to the question of working and paying and you have approved that both third time. At one point in time we talked about if we had somebody already working can we just go ahead and make that versus trying to reapply for that so i could continue to ask. On the Prescription Drug abuse problem the governor and many others spoke earlier about one of the things we things weve done is pass a prescription monitoring bill to stop doctor shopping in the state. It was hard to do because the doctors for some of them didnt want to spend the time away but could we not do that under federal and state guidelines as someone is on medicaid receiving pain pills do you require a doctor to check it every time for addictive opioid for something to consider on the track and then i just want to mention we talk about the rising cost of medicaid and one of those states where weve seen the unemployment dropped really low and the per capita income go up into the per capita income went up the funds went down so we had a huge drop about 90 million we had a cost of 130 million in accrued a petition by 340 million people. So we have more people coming into the system and less money from the federal government because the economy changed. So now in the Energy Sector we are still short of money. We will work on the family encouragement meant to Economic Health and people being able to be when we continue to think about health and tried to try to get people to move and encourage. On the opioids i mentioned the Prescription Drug monitoring plans almost every state has one and in the conversations that ive had it out of the country with a member of the wall into the ears of the tool. Some of your states do it and some dont. People porter shot and so thats another issue that we need to work on it i think bringing folks together when you talk to physicians about how easy it is or not to use if you are asking a doctor and see how many clicks when youre seeing a patient. So how we can encourage and influence people in the Payment System is one that we will work into what we do need to get to the space where physicians are trained with most of the physicians. How much training did you receive clicks in terms of treating pain thats one of the issues we are working hard and we had a representative as a part of the panel because we need to issue the new guidelines in the picture people are trained in them because it is starting at that point the point of the physician and the tracking. We are a tragic story of a young woman who. Int her wisdom teeth taken out, took too much of the Prescription Drug after her wisdom teeth come it became addicted and after only months it became cheaper, easier and better to use heroine. She spent four years clean. But if we can stop the journey because there were many other stops along the way in terms of what happens in that picture its just for the nature as you said we are just seeing it everywhere. Its not socioeconomic. The number of people that youll probably know whose children have some of these issues. Im sure everybody in this room does and someone would want to work on them. Governor walker and then governor nixon. More of a comment and a question. I appreciate you being here in washington in february that began a process for me. As you know i begin the process for alaska beginning the 30th state to accept Medicaid Expansion, and i share the concern about the methods of getting to building the care that dont always go down the road so we have 110 airports and challenges but i want to thank you for the passion in this area and the staff and access. I know that you are the person that gets it done but they are the ones that answer the calls as well, so i appreciate that. They moved from the mainstream americas at his peak. We dont reach out to the neighboring states across the line. We have russia and canada so theres not a lot of options there, but we do feel when we have a need in washington its been helpful to us very much so it is a process that ive begun and we have 45 days to get through but we appreciate working with you. Thanks for your leadership on this. You really reached out and work hard and said that mentality in the department and we appreciate that deeply into this feels different than a congressional hearing i would imagine. That will be on tuesday. I talked to a number of folks from your state yesterday in preparing. And we have not yet succeeded in the task of expanding at the 138th level. Theres a term used that you look at the cost of containment that are difficult for states and for hospitals built into the Affordable Care act. And that medicare is going if medicare is going out payments are up a disproportionate share guess how much pressure and you do you are under budget really to use those tools. Some folks dont think that is going to happen to whether so whether it is a year or two years from now it is going to happen and it can cause the delay of those instead of having it caused a cataclysmic effect of states that dont move forward in a timely fashion to cause if that becomes a cliff and stability disproportionate share payment come it has a very cataclysmic effect on the rural areas and other certain areas. As picketing that it involves two things that i dont have a lot of say. One year five months. It will be a pure code that i will no longer be here and the other thing that i would say is if you know the congress has engaged on these issues that the ability to predict. The one thing is we think about it as a nation because i think we should be focused on these the congressional decision is whether to turn it off. And today it has been turned off and so when the congress has previously taken action to extend, the question whether they will do that is we dont have to answer it here but its whether the administration will ask them to continue to extend of the congress is here or not. With regards to where we will be in the budget i think the broad issue on the Cost Containment and why those provisions were put in is because they thought that it would be more Cost Effective for the uncompensated care through a systemic approach in the state instead of the way that we were doing it. I think there are a number of tools that exist. There theres a number of states that have low income pools. I had a conversation. That i think is why it was put in place how we can most Cost Effectively help low income people have access and those were the decisions about it how that plays out in the current environment is something that we have to evaluate as we go through. The experience and kentucky could be an lightening on a couple of these issues competition. Before we fully implemented the act we had two companies that would so Health Insurance. We now have five. That obviously is encouraging to us because weve been working for 20 or 30 years to get other companies to come in and we had no success. Now we have that kind of competition. Second thing regarding world healthcare because they are a state of about 4 million people. They love our folks living will areas live in the rural areas. We talk about hospitals and how they can stay open as the demographics change. We have gone and our hospitals as a whole have gone has gone from 25 uncompensated care to about 5 and the small hospitals have particularly benefited from this because for the first time in their memories, and in mine they are in the black. The bottom line is in the black because we are of the care they are getting. We are going to continue to jump after those but at least from a revenue standpoint. Having expanded medicaid is a boon to the providers in terms of getting more money in their pockets and its been a boon to their economy before we did it. It would predict what was going to happen and whether we could afford it on the road and we projected that it would create about 17,000 new jobs and have 15 billion our economy. Well, we implemented based on that and after the first year i said lets take another look because we have at least one year of hard numbers and so we got the consulting to go back and take a look at the first year. They came back and said we are sorry to tell you we will create 17,000 jobs in eight years and you already created 12,000 in the first year in the health care area. And it looks like you will infuse about 40 million into your economy over the next eight years. For my friends that are concerned that the federal government may back up at some point and not do their part or the numbers may change or we cant afford it. My message would be this, you can stop. The court case says any time we want to, we can stop. So, with either one of those things happened, you can say we cant do it anymore because we cant afford it. And in between now and if that ever happens a whole lot of people, 400,000 people in kentucky are not having Health Care Coverage most of them for the first time in our lives. So if you can get past and i know a lot of legislators have trouble just because of the name of the act but if you can get past that kind of politics, this is a winwin for both of your people and economy because you are going to create a lot of jobs and put a lot of money into your economy in addition to improving the lives of all of these people. Our screenings for cervical cancer, breast cancer, diabetes, you name it have gone like this because for the first time folks can get these screenings and what that is going to do is going to cut out on the big costs down the road because when they were not getting the screenings the first time we would see them is when they ended up in the emergency room or in the hospital. And now we are able to work with these people to teach them how to take care of themselves and to take responsibility for themselves. That is part of this deal is that the services need to learn how to do this and they really want to know how to do it. If there are ways you can massage things around and get to this point, it is going to be a big benefit for the folks in your state. Thank you. Did you go to virginia for a couple days . [laughter] i could use that. I think that we have already worn out to the secretary. If you have anymore questions on behalf of the organization i want to express our gratitude for all of your engagement with all of us the last couple years. [applause] thank you very much, and i look forward to working with you all this year on a range of issues that i hope well on im looking around this table. I didnt have to call any of you all about ebola but hopes we will have a good year moving the ball forward on many places that we overlap in it than many places that we find. We want to hear from you and we want to know when we are getting it right and getting it wrong and i believe that a much, much bigger Common Ground and we do have places of disagreement. There will be some of those i know that but i think we can work on a lot of areas we can move the ball forward so thank you very much and thanks for having me. The cspan city tour working with affiliates across the country this weekend we are joined by comcast to learn about the literary life and history of augusta georgia. Awarded the medal for her wisdom at the age of 19 committee was also awarded the medal of honor posthumously for his action in world war ii. We are sitting here in the museum of history, and about ten years ago a decision was made to do a military display, a Permanent Military display to honor jimmy. When i did my research on the book, i went through over 9,000 medal recipients in the last years and 3500 or so medal of honor recipients since the civil war, it turns out hes the only person ever to have earned both awards. He would almost for sure say he did not deserve it. He might point to someone else that was more heroic than he was. He was here a lack. He never talked about the Carnegie Medal. When i interview people that knew him when i did the book people knew him well and i said tell me what about the Carnegie Medal that he earned when he was 19. They didnt know anything about it. Ive known a lot of recipients in the medal of honor foundation. Most of them both how you i didnt deserve this medal. It should have been given to someone else. It is a piece of humility that he would have been in that category. We also visit the home in the 28th president woodrow wilson. President will send data wilson then moved to this house when he was three. President wilsons first memory was in november of 1860, before he was 4yearsold. He was standing on the front gate and two men came by in a hurry of excited voices it is that Abraham Lincoln has been elected president and there is going to be a war. So he ran inside to ask his father what was war. We think it is remarkable his first memory was about another president , Abraham Lincoln and another war the civil war. And nelson would have to leave the country through world war i. See all of our program from augusta saturday cspan book tv. And on American History tv on cspan. The senate is about to gavel and for the day and they will wrap up work on a sixyear highway bill with the passage vote at noon. Later they will vote on the house passed a threemonth extension of the highway funding bill, that would add 1 45. And now live coverage of ther. Senate. The chaplain, dr. Barry black, will lead the senate in prayer. The chaplain let us pray. Eternal god, enthroned above all other powers, thank you for the gift of this day. Use our lawmakers for your glory. May they find obedience to you not a burden but a delight