Transcripts For CSPAN Washington This Week 20240622 : vimars

Because, you know what . I can look around this table and some of you have come in with innovative ideas that i had not thought about. I dont know if it will work, but there is enough evidence and logic to indicate we should try it. Trying to create a space for that is what we are working to do. Governor mccrory, governor walker. Governor mccrory madam, thank you. I have enjoyed your visit and your cookies and your lemonade at the executive mansion, i hope you enjoyed it. A really good time. First of all, i want to congratulate you on your comments on your focus on Mental Health and i include that in addiction because i think that is one of the most serious issues we are facing, as i have found out in my 2. Ive years in my 2. 5 years. The addiction is ending up in our prisons, emergency rooms, and our state prisons and that is not the solution. We have got to come up with a longterm partnership with the federal government, local government, and everyone involved to deal with this very serious crisis. We had a seminar talking about the drug problems with somatic synthetic drugs and so on. I commend you and we want to work in partnership to come up with a viable solution. Two things, i would love to get more information on the consistency on Medicaid Services across all states. Were having a debate within my legislature on what level of service you get on medicaid covering certain aspects of medicine. We are certainly liberal in that aspect in north carolina, some legislators want to increase that, some say we are covering too much. I am curious as to if you have some benchmarks across states. Second you have been nice enough to have governor herbert and i and the president , in the oval office and we had a very frank discussion and a good discussion on many things. One was about waivers, and one im not sure the line has moved it all, we are attempting to look to see if there are waivers we can get for ablebodied people to require work or training in order to have medicaid expansion. We did this in Public Housing when i was mayor of charlotte, which was very effective. We want to know if there is any more flexibility or is that the line drawn in that area . Again, i want to congratulate you on your reaching out to us. So, on the first question, in terms of the benchmarks in terms of service levels, that might be something we will get back to you and your team directly on. With regard to the question of work and how we think about that particular issue with regard to health, in terms of one of the things that i think is an important thing that i think actually both sides agree on quite a bit that was an important change is preexisting conditions should not keep you from an ability to get health insurance. Again, maybe how one gets to that, maybe but i think that is an agreement. The idea that health care is not a conditional thing. Different from a number of things. Different than welfare operated out of the department of health and Human Services. Health care is actually different. But having said that, i think that we think that there are incredibly strong ways, because we are with you on that. You know, that is a place where i think we would like to see i mean, it would be great to have people working and earning a wage. We were just as soon have people in the market, and beyond. The work idea and work in concept, i think we have a number of places where we have worked with a number of you all to get took place that has innovation the derives this in a way that will get more people through your Work Training program then you have ever seen. I look forward to being able to have that conversation, because i think, we think we can get to, you know, a portion of what you want, which is i think you want more juncker ration. I think i think you want more consideration, and i think there is way to do that. Thank you. It is always a pleasure to listen to you and have a dialogue with you. I think you have one of the toughest jobs in america. You have certainly had a tough job this past year. Thank you for visiting with our governors. A couple things i want to commend you on. One was when you are talking about paying for outcome versus volume of time someone sees a doctor. We are all about improving the health of our citizens to make sure what we are doing is working versus what we hope white might work. What we hope might work. I wanted to talk to about trying to fasttrack some of the waivers. One of our requests from many of our governors, if not all of our governors, was that if we had a way for you it already approved in the past, if you would consider being able to continue that approved men of that waiver because you had already done it several times before. So like, and the state of oklahoma, we have a Great Program called in sure oklahoma where we have a threeway match with the person paying a very small portion of their insurance and the employee and the employer paying a portion. So there is a lot of biand. You have approved that for the third time, which im grateful for. At some point, i think we talked to about, if we have something that is already working innovative, can we make it permanent versus every year having to reapply for that . I continue to ask you for your consideration of that issue. On the opioid and Prescription Drug abuse program, we have had a session that governor mcauliffe and others led us through. One thing we did in oklahoma was passed a prescription monitoring bill to help prevent doctor shopping in the state. It took me three years to get that through. Some doctors did not want to have to spend the time away from patients to check this and check that could we not do that for medicaid recipients under federal guidelines certainly under state guidelines, if someone is on medicaid and they are receiving pain pills, to require a doctor to check it every time . Or could that medicaid recipient continue an addictive opioid . That is something to consider on a backtrack. The last thing i want to mention, we talk about rising costs of medicaid and expenses to our state, which is always been a huge challenge for all of us. We are in one of those states, where we have seen our unemployment up really low. Our bonds went down, we had a huge drop. 90 million. Our cost went up 130 million and we grew our population. We have more people coming into the system, less money for the federal government because the economy has changed. Now, we are going through another economic downturn yet we are still short on the money. Something to consider. Thank you. I wont touch on all of them. Figuring out how we, you know, work, and encourage, you know movement to encourage people to be in the private system where possible is something we want to consider which is part of how the reductions in funding are considered, getting people to move and encourage economic breath. On the opioids, i would mention the Prescription Drug monitoring plans you mention, almost every state has one. In the conversations i have had around the country with a number of you all, it is just a very important and enforcement tool. The ease of being able to use the tool, how quickly as updated, and the other things, some of your state stood on some of them dont, is the relationship with other states because people bordershop. That is another issue we need to work on, and i think bringing folks together because i think one of the things, when you talk about how easy it is or not to use and terms of the system. If youre asking a doctor, and you ask, how many clicks when you are seeing a patient, you dont want to spend that time checking. That is one of the things were working on. Your idea about how we can encourage and influence people with regards to our payment system, that is something we will look into. We need to get to the space where physicians are trained. With most of the physicians where they are trained, and i want to ask in this room, how much training did you actually receive in pain . In terms of treating pain . That is one of the issues. We are working very hard. We had one of the representatives from the cdc on your panel. We issue guidelines, but we want to make sure people are trained. Starting with the physician, and doing the tragic tracking your talking about. We had one young woman who had gotten her wisdom teeth taken out, to too much of the Prescription Drug after her wisdom teeth, became addicted, after only a few months, it became cheaper easier, and better to use heroin. And just, the trajectory. And the good news is, she has been clean for four years. But just, if we can stop that journey, because there are many other stops along the way and terms of what happens. Or the nation, we are seeing it everywhere, governor. It is not geographic, it is not socioeconomic. You know the number of people that you all probably know whose children have some of these issues you know, i am sure everybody in this room does. It is one we really want to work on. Governor walker, and then governor nixon. Governor walker more of a comment on a question, first of all, thank you madam secretary for being here for the second time. I appreciate your presentation in washington in february and that began a process with me. As you know, one week ago i became began the process to become a state to expand medicaid. We are pretty world, too. [laughter] our methods of getting to the needs do not always involve a road. We only have three roads. We have 110 airports. We have our challenges. I want to thank you for your passion in this area, and your staff. I know you are the person that gets it done, but they are the ones that answer the calls as well. I appreciate that. We are a little bit removed from mainstream america, so to speak. We do not reach out to a neighboring state. We have russia and canada, so not a lot of options there. But we do feel when we have a need, washington has been helpful to us very much. And so, it is a process i have begun. We have 45 days before i can actually sign it, but we appreciate you being with us this far and we look forward to you being with us through the next 45 days and beyond. Thank you, governor. Governor nixon hello. Appreciate, i will stipulate all the thinkings. You have really reached out and worked very hard and we really appreciate it. You put that mentality through the entirety of all your department, and on behalf of all of that, we feel it on a lot of levels and appreciated deeply. This feels a lot different than a congressional hearing. That will be on tuesday. I have talked to a a lot of folks from your state to prepare them. Ok. We have not yet succeeded in the important task of care to missouri. We are working on that. Sometimes you use the bridle, sometimes you use the web. On the website, as you look at costcontainment looking forward, you have some triggers that are difficult for states and hospitals and Everything Else that are built into the Affordable Health care act. Whether it is reimbursements, medicare, a going out payments, disproportionate share. Just tell much pressure are you under budget early to use those tools while being very politic in your comments in front of us in the cameras . Because i think that some of the folks dont think that is going to happen. And whether it is one year or two years from now, that is going to happen and it can cause the delay of those instead of having it be smoothly and it can cause a cataclysmic effect in terms of states that do not move forward in a timely fashion because if that becomes a clip instead of a slide it has a very cataclysmic effect in wirral areas and other underserved areas. So, you know, my ability to predict in this area because it involves two things i do not have a lot of say in. One is, one year, five months, and 10, 15 days, is all i will be here. Most of the decisions you are talking about is during a time i will no longer be here. As you know, congress is also engaged in these issues. So, you know, my ability to predict is limited. Where i dont know, i think you all know i tell you. I dont know. I think we should be focused on this as a nation. It is an executive branchs decision, whether you will move forward or not. It is a congressional decision whether to turn off. Tags know, to turn it off. To date, it has been turned off. When the congress has previously taken action to extend the question of whether they will do that again is something that i am, you know, not going to the question really is, and you dont have to answer here obviously, the question is whether the administration is going to ask them to continue to extend or not. With regard to where we are going to be in the budget, i will be reviewing our mandatory proposals in the next couple months. But the broader issue of how we think about the issues of costcontainment, why the provisions were put in is because it was thought it would be more costeffective to pay for uncompensated care and indigent care through a systemic approach and the states and set up the way we were doing it. There were a number of tools that exist. You mentioned a number of them. There are a number of states in the room that have low income pulls. I had a conversation with one of your colleagues in florida about these issues. And so, that, i think, why it was put in place is about how we can most costeffectively help low income people have access. Those were the decisions about it. How that plays out in the currently valued environment is something we have to evaluate as we go through it. Governor brochure gov. Brashear the experience in kentucky could be and lightning. Competition. Before we expanded medicaid, we had to companies in the state that would sell health insurance. We now have five. And, that, obviously, is encouraging to us because we have been working for 20 or 30 years trying to get other companies to come in and we had no success. And now, we have that kind of competition. The second thing regards riural health care. A lot of our folks live in rural areas. We have always had problems with rural health care, rural facilities how they can stay open as the demographics change. And, we have gone, and our hospitals as a whole have gone from about 25 uncompensated care to about 5 uncompensated care. And our small hospitals have particularly in a fitted from this because, for the first time, in their memories, and in mine, they are in the black. Their bottom line is actually in the black as they are getting aid for the care that they are delivering. Now, there are still a lot of problems with rirural health care but at least from a revenue standpoint, having expanded medicaid has been able to own to our has been a boon to our providers and our economy before we did it we got rice what her house cooper to come in and project what was going to happen and whether we could afford it. They projected that in over eight years we would create about 17,000 new jobs and have about 15 billion infused into our economy. Well we implemented based on that and after the first year, i said lets go take another look because now we have actual numbers. At least one year of hard numbers. And so i got Deloitte Consulting to go back in and take a look at our first year. They came back and said, we are sorry to tell you that Price Waterhouse cooper was wrong. You have created 12,000 jobs in the first year. In the health care area. And it looks like you are going to infuse about 40 billion into your economy over the next eight years and set up the 15 billion. And so, for my friends who are concerned that number one the federal government a backup at some point and not do their part or that these numbers, at some point may change and we cannot afford it, you know, my message would be this. You cant stop. You know, the court cases anytime we want to, we can stop. So if either one of those things happen, you can say, we cant do it anymore because we cannot afford it. And in between now and if that ever happens, a whole lot of people, 400,000 people in kentucky, are now having health care coverage. Most of them for the first time in their lives. And so, if you can get past and i know a lot of legislatures have a lot of trouble just because of the name of the act if you can get past that kind of politics this is a winwin for both your people and your 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 these people. Screenings for Cervical Cancer breast cancer, diabetes, you name it. They have gone just like this. Because for the first time these people can get these screenings. What that is one to do, it is going to cut down on the because on the road, because when they were not getting these screenings, the first time we would see them was when they went be in the emergency room or in the hospital. Now, we are able to work with these people to teach them how to work with themselves and take responsibility for themselves. That is part of the deal, that your citizens know how to do this. And they really want to know how to do it. That is what we are finding. If there are ways that you can massage things around and it to this point, it is going to be a big benefit to the folks in your state. Thank you. Steve, do you want to come up to virginia for a couple days . I could use that. [laughter] on behalf of the entire organization, i want to express our gratitude for your engagement with all of us over these last couple years. We really, really appreciated. [applause] thank you. I look forward to working with you this year on our range of issues looking around this table, i did not have to call and he of all of you about ebola, some other issues, but i hope we will have a good year moving the ball on the many places where we overlap and fund. We want to hear from you. We want to know when we are getting it right and when we are getting it wrong. I believe we have much, much bigger places of Common Ground than we do a disagreement. There will be some of that, and i know that but i think we can work on a lot of areas where we can move the ball forward. So, thanks for having me again. The National Labor association also heard from labor secretary thomas perez. His session was led by New Hampshire governor. Vice chair of the ngas workforce committee. Good afternoon, everyone. We are going to start our session,. So, the meeting of the National Governors Association Work force committee is called to order. Thank you all for joining us. I am the governor of New Hampshire and vice chair of the workforce committee. Governor sandoval is unable to attend because he is overseas bringing more jobs to his state. It has truly been an honor to lead the committee with him this year. So first, a bit of housekeeping. The proceed