Thank you for the briefing. Can you please explain to us the psychological impact that the alleged chemical weapons attack has had on the syrian population and also on humanitarian workers who are trying to get their work done . Well, i can only speak from what i have been told from the staff that i have spoken to. People feel very uncertain. In terms of the people i have spoken to, they continue to express concerns to me that the International Community has abandoned them and that they would like to see actions, that they would like to see the International Community come together and agree on action which would lead to a political solution inside of syria. It is very hard for me to speak about the psychology, but i can say that people remain fearful, and a lot of people are just fearful because the future remains so uncertain. I know you have a number of things on your schedule. Do you have time for one or two more questions . There are still a few hands up. Ive about two minutes, so if i take two questions together . Two questions together. My question is regarding the influx towards turkey. 6. 6 million seniors pay less for prescription drugs as the law begins to close the socalled donut hole in the medicare program. 105 million americans have seen the limits, the lifetime limits on their Insurance Coverage abolished and Preventive Care is less costly for them. 17 million children with preexisting conditions can no longer be denied coverage or charged higher rates for it. Almost 26 million women and almost 26 million men 27 women and 26 million men have been extended preventive benefits with no cost sharing including mammograms, colorectal treating, cholesterol and Blood Pressure tests, stop smoking programs, and regular child visits. 12 Million People have received rebates from Insurance Companies because Companies Must now spend 80 to 85 of your premiums on your health care. Not keep them for profits and promotions. This has also been a major factor in keeping rates lower than they would have otherwise been and slowing the rate of increase. Total savings from rebates and lower insurance have been estimated to have been 3. 9 billion. What does this mean for arkansas where nearly 500,000 people are uninsured, including about 25 of our working age people . Well, 865,000 people no longer have lifetime limits, more than 32,000 seniors have seen a reduction in their drug costs, 35,000 young people are now covered on their parents plans, more than 1 Million People are eligible for preventive services, and more than 120,000 arkansasens have received about 3. R5 million in rebates from their insurance policy. Now what . Whats next . In january, Insurance Companies in the individual and Small Group Markets will no longer be able to charge higher rates or deny coverage based on preexisting conditions. This affects a lot more people than you think. It is estimated that 129 million americans under age 65, roughly one in two of us, are at risk because of preexisting conditions and therefore pay some higher insurance rates. But lets be realistic. People who pay or cant get coverage at all are a much smaller percentage of that. But there are still a good number and ill bet everybody in this audience knows somebody with a severe preexisting condition that makes them uninsureable or increase their rates. So after january, this group and the most severe conditions are concentrated in the people age 5064, all those irresponsible young people. Its amazing what you can get away with saying when youre 67. Anyway, theyre concentrated there. They cant be charged higher rates. Which is an opportunity and a challenge. Ill talk more about that in a minute. Also, women can no longer be charged higher rates than men, which was a common practice before. And 8. 7 million of them with individual coverage will have Maternity Services for the first time. Now, what about the uninsured . How are they going to get insurance . How will it be more affordable . How will it affect Small Business . Currently, more than 41 million americans, mostly low and moderate income americans, have no Health Insurance. Roughly 221 2 million men and 181 2 million women. The racial breakdown is Something Like this. There are a little over 10 million latinos, nearly 7 million African Americans, about 13 million whites, and the rest are native americans, asians, pacific islanders. Included here are 1. 3 million American Veterans not currently enrolled in the v. A. What about them . Ople with incomes up to 138 ,000 poverty line, 18 for individuals, will receive support for their coverage through medicaid payments to the state and ill come back to what arkansas did in a minute. People with incomes between 138 of the poverty line and 400 of the federal poverty line will be eligible for tax credits for individual and family policies on a sliding scale, the lower your income, the higher your credit. Heres how it works. On an uninsured person can log on to a national site, health care. Gov, or a state site, and shop for the most affordable and appropriate policy. The prices, which includes the discount for the tax credit, will be shown. And when a policy is ordered, the tax credit will actually be automatically be sent by the government to the insuror so theres no other hassle for the person who is buying the insurance. You just pay what the computer screen says you owe. To get this done, you do have to sign up. On the state or federal web site or at a designated call center, between october 1 and march 31. Thats what is about to happen, thats what all the folks have been concerned about. The Toll Free National number 567 and the 21 website is health care. Gov. Look how arkansas is handling this. Currently, theres a massive education and Outreach Program to the half Million People who dont is have insurance. About half of them are at or below 138 of the federal Poverty Level. They are eligible for arkansas unique private option plan. This was a Bipartisan Initiative led by the governor, supports by the leaders of the house and senate, and other republicans, to replace traditional Medicaid Expansion with a plan to use the federal dollars to help eligible arkansasens to buy private insurance through the arkansas marketplace. Ensuring lower income working families will help not only them but as anybody who has ever worked in a hospital or been on a Hospital Board knows, it will dramatically reduce the burden of unexo compensated care to Health Care Providers. That burden was 338 million in arkansas in 2010. Today, that burden all over america is just normally shifted as a matter of requirement to people who have insurance, which means its kind of a hidden tax. You pay higher insurance rates to pay for the uncompensated care that your Health Care Providers are giving to people that they cant bear to turn away. Nobody wants to turn them away, but they ought to be reimbursed in a more direct and fair fashion. Now, whether or not you agree with the Affordable Care act, arkansas citizens are going to pay for it just like citizens of every other state. So in decide wlg you support the fact that this private option is set up and will later have to be funded by the legislator i think in february, you should consider what turning back the money means. And keep in mind, some states have done this. But as the governor said to me, this doesnt make any more sense than turning back federal highway funds. We pay federal gas tax. How would you feel if somebody gave a speech saying, i dont really like some of the requirements that the federal Highway Administration puts on us when we take this federal money. So why dont we just not take t and send our money to texas . You would think if somebody said that they were three bricks shy of a full load. It doesnt make any sense for us to do that. And it will aggravate the burden of uncompensated care substantially. Now, by 2015, Small Businesses with more than 50 employees also have to provide insurance for their employees or face paying a penalty. Without this private option, a lot of our Small Businesses, most of whom have far fewer than 50 employees, but the ones that are covered without this private option, they couldnt afford to provide insurance. And theres a bunch of people with fewer than 50 employees that would like to provide insurance and without the private option there is no way in the wide world they could do this. A real boon. But theres Something Else. If youve got more than 50 employees, youve got to pay a penalty in 2015 if you dont provide the health care. The aggregate cost of those Small Business penalties is 38 million. Is that right . Thats what i thought. I think i remembered that. Thats like a 38 million Small Business tax if you dont embrace the private option. So my view is that arkansas did a good thing, a bipartisan thing, a practical thing. It will help a lot of people and the rest of us ought to get behind them and help them to stay with the program. Now, what about people who who are uninsured who wont be covered by the private option because their incomes are above the poverty line . If theyre between 138 and 400 , they can go to the national website, health care. Gov, or the state site called rar health connector. Org, and theres a phone number for people who dont have a computer. 8552834483, and you just shop for the best valued policies. The buyers are eligible for tax credits, which will be reported automatically to insurers once they make a decision, as i just said, to simplify the Selection Process individual and family options are organized by categories. Bronze, silver, gold, and platinum. Its like the olympics. The bronze prices policies have the lowest costs and the least coverage. Silver is next, then gold. And platinum has the highest cost and the most coverage. Theres also, for young buyers who are just over 26, a special catastrophic option. But its not eligible for the tax credit. So most young buyers would be better off picking a bronze option and picking a tax credit. It will probably prove out to be cheaper than the catastrophic option. What about Small Businesses . Although businesses with 50 or more employees arent required to cover their employees until 2015, they can do so because theyll have their own market place called shop, Small BusinessHealth Insurance options. Or if they already offer insurance, they can just keep their present plans. There are tax credits for Small Business based on average wages, which go up to 35 this year and up to 50 next year. But beginning next year, its only for those who participate in the marketplace. And thats something i think that Congress Needs to reevaluate, as well as the size of the crets. Ill say more about that later. Now, if you put all these people in coverage, wont it drive up the price of health care . So far, given the significant improvements that have already been implemented that i mentioned earlier, the answer is no. For the last three years, the average increase in National Health care spending and in Health Care Spending here in arkansas has hovered around 4 . Thats the smallest increase in 50 years. Due at the it was beginning of the threeyear period, the hangover from the financial crash in 2008. But not any more. There are other things going on. The medicaid and medicare costs, for example, are going up at less than economic growth. And the governor told me the last time that happened was in 1988. That was in the dark ages when i was governor. So i think this is important to note. There is something going on here we are learning how to lower the inflation rate. For most of the last decade, the medical inflation rate was three times the overall rate of inflation. And thats how we got this huge p of spending 17. 9 of our income on health care and nobody else is higher than 12. So i think theres something going on here theres also Something Else you should know. There is one lifetime limit which was put into this law which i like. Under the new law, there is a limit on the percentage of income any person can be required to pay for insurance premiums in any given year. T goes from 9. 5 for people at 0 of the Poverty Level or 400 of the Poverty Level, down o 2 for those at 100 to 133 . And thats really important. Now, can this be continued . Can we continue to hold these costs down . The answer to that is i think yes, but. Yes, but only if we keep working together to cut unnecessary costs. A recent Rand Corporation study pegged unnecessary medical costs at a whopping 700 billion a year, about 30 of total spending. How are we going to do this . Well, there are some impressive efforts already under way. The Accountable Care organizations which are cropping up all over the country as a result of attempts to come to grips with Health Care Reform are basically proving it is possible to lower costs and improve care by base ing reimbursements on the quality of Health Care Outcomes, not on the number of procedures performed. Competitive bidding for durable medical equipment, the reduction of medical errors that the rise in the Electronic Medical records has spawned. New strategies to reduce readmissions to hospitals. All these things are making a difference. Blood stream infections, one of the most common medical errors, are down 40 since 2008. Increased sterlization requirements, which is a hightoned way of saying youve got to wash your hands than n more places than the hospital, are reducing infections all across america. In the past year, Hospital Readmissions under medicare lone are down 70,000 people. Also in the past year, finally the National Government began to publish comparative costs and outcome data. Pennsylvania has been doing this for years. I read the report every year. Heres what it shows in pennsylvania. There is no relationship between what something costs and the outcome you get. The closest correlation and lets just take surgical procedures. The closest correlation between good outcomes and a given procedure is to not the price of it but how many of those procedures are performed at a given place every year. And we now have years and years of data in pennsylvania to upport this. Pennsylvania also has an interesting certified but longstanding Accountable Care organization which has o hundreds and hundreds of doctors which started years ago getting all of its doctors to agree, whatever their ages, to adhere to a set of best medical practices contained in a mammoth book upgraded weekly by the group of best medical practices for any kind of procedure. And essentially, it operates opt premise that medicine is both an art and a science. Lets start with the science and then move to the art. That is, if youre operating on somebody and they turned out to have a bad bleeding problem, youve got to deal with that. But first, be like a pilot in the airplane, follow the check list. If for any reason anybody under heir care is in a hospital and released has, has to return to the hospital within three to six months i cant remember which they pay 100 of the cost and your premiums, copays, and deductibles cannot be raised. Guess what, their medical errors have dropped to nearly zero and their profit increased as a result. They didnt make less money, they made more money because they had a fixed income for enrollment in the program. Arkansas is also leading the way in doing that. This is really exciting to me. Getting all the payers in the Health Care System they now have about 95 of them employers, Insurance Companies, soon the governor set this morning to get medicare to episodes a flat rate which basically works this way. You do away with fee for service, and you reward performance. So if you get good results and you get them in a hurry, youre going to make a lot more money. And if you get bad results slowly, you will probably lose money. But the incentives are designed to lower the cost while improving the quality. And the reason it can be done, i believe, is because this is like what you did with the Public Health option. You got everybody in the room with you get all the employers, all the inshurors, the medicaid and medicare folks, youve got a pretty Broad Spectrum economically, socially, and politically, and you figure out how to make it work. Im very excited about this and i think the state deserves a lot of credit for doing this as well. Ok, so thats where we are. So you can say to me, come on, bill, theres got to be something wrong with this. Anything that sounds too good to be true is. This is pretty good. So what are the known and potential problems . And what could still go wrong but hasnt yet but could . Like any laws, tha