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tv   Public Affairs Events  CSPAN  November 4, 2016 12:00pm-2:01pm EDT

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to worth hundreds of millions, how did hillary end up filthy rich? pay to play politics, poured into the clinton foundation for criminals, dictators, countries that hate america. hillary cut deals for donors. now the fbi has launched a new investigation after decades of lies and scandal, her corruption is closing in. >> i am donald trump and i approve this message. >> election night on c-span. watch the results to be part of a national conversation about the outcome. be on location at the hillary clinton and donald trump election night headquarters and watch victory in concession speeches in senate house and governors races live at 8:00 pm eastern and throughout the following 24 hours. watch live on or listen to live coverage on the
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c-span radio apps. >> cbs news reports us intelligence is warning of a possible terror threat the day before the election next week. intelligence officials told joint terrorism task forces about the possibility al qaeda is planning to attack three states on monday sources telling cbs they report states with potential to be targeted i believe to be new york, texas and virginia. the credibility of the threat has not been confirmed but intelligence told counterterrorism officials about potential threat out of caution. you can read the cbs report as reported on the hill. coming up in a few minutes you will hear from fda commissioner robert taylor talking about disease research and innovation, part of washington journal. >> our guest is mary agnes carey of kaiser health news. give us an update on the affordable care act and the open enrollment period, has begun,
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started this week. what expectation does the administration have? >> trying to go after young and healthier folks to get them into the insurance pool to even out the risk pool. when you look at enrollment numbers they estimate enrollment will go up, the number of people who enroll will go to third teen -- to 7 million but what matters is the number of people who have to pay those premiums. on average that will be 11.4 million next year and for 2016, 10.6 million. a 10% expectation of growth. >> one of the current headlines is a premium increase had a push back from the president and others who say when you factor in subsidies, can you tell us what is going to happen and give some perspective? >> the headline number of people saw was average 25% increase in
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premiums but remember as you said once you factor in the subsidies for a lot of folks that increase, don't necessarily fill the entire thing. another thing to look at is a lot of discussion about insurers dropping out. you have areas that have one insurer for people to look at but a few things to elaborate on, one insurer, 10 plans they offer and for most people in the marketplace they have an option of 30 different plans to choose from. they are very significant for people who don't get the subsidies, there's more to the story. >> phone number is on the bottom of the screen, mary agnes carey. 202-748-8000 if your insurance comes through the afford will care act, if you have insurance through your employer, call 748-2001 and we want to hear from folks were uninsured as
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well. our guest is senior health correspondence for kaiser health news, mary agnes carey, previously worked for dow jones newswires, long experience covering healthcare issues, and what is the reporting? >> the number of insurers participating, people who come in who were very sick and expensive, that is one of the factors that cause the shakeup, the number of people who were more expensive to cover. and united healthcare, insurers still wrestling not only with the risk pool, to get more
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younger folks to balance out the risk for but managing those costs. going forward you will hear about narrow networks when insurers look at cutting tighter deals with hospitals and doctors to keep those costs low which means less choice for people in those plans depending what they need and a variety of factors, balancing the risk pool managing the risks, they have to have returns to shareholders but another factor is provisions in the law, programs to balance that risk, two are going away affecting the rate price and one didn't pay out anywhere near what they expected. >> with the other headline said, the enrollment efforts could be pivotal this time around. can you elaborate? >> the push of getting more people into the exchanges, the young invincibles who tend to be
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healthier. this has been a group they thought every year, the federal government, adding more of those people is important and looking beyond the exchanges, 21/2 million people are uninsured who could qualify for subsidies. getting the messaging out, aggressively pursuing this through advertising, social media, reaching out to people who may pay a penalty, paid a penalty in 2016, personal responsibility provision and individual mandates going after those folks to see if they get them to come to the exchange, look at market places, and sign up for college. >> host: lots of ideas for changes. let's get the first call for mary agnes carey from tennessee. question? comment? you get your insurance how you >> caller: we got it through a
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broker, not subsidized or through work or anything like that. we have to pay for our own insurance, $1000 for three people for a plan, in 2017 for two people, this is like financial right. the people buying their own insurance are the voiceless in all of this and we will be pushed into buying our insurance through we had to downgrade our policies, the $13,000 deductible and this is just ridiculous. we are being pushed into this, forget about buying across state lines. this is happening across the nation and no one is paying
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attention from 9 million to 16 million people, three months i spend every year now working on this, trying to figure this out, how low will we go on the pole? we had a ninth policy, not some crack policy but because of this law you have these exclusions for other people, my son makes $30,000 a year, he has bills, student loans, $345 a month. >> guest: thank you. i assume you don't qualify for subsidies. >> caller: my husband makes too much money. >> guest: she crystallized the frustration of so many people who might have had a plan that wasn't quite as generous as the affordable care act. there's something called central health benefits that require a
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variety of coverages, deborah may have had a policy before, more affordable for them, more limited in scope, and continue coverage for broader and more expensive, and competition when insurers drop out of a particular market, the competition is reduced. the items she talks about, someone out there buying their own health insurance, cannot get a subsidy, great frustration. my email boxes flooded with these, people who are really struggling to afford health insurance and it is definitely a problem as she articulated very well. >> host: uninsured caller named kenny. >> caller: how are you?
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i was going to ask the lady. i need to understand, 2010, if i am not mistaken, congress didn't go through with it and say we can't do it. we need a mandate to make everybody individual have insurance or they won't go through with it and the congress, i don't know if that is true. that is my question. >> guest: the law as passed by congress includes the individual mandate, this is something insurers have wanted and many democrats and many republicans endorsed the individual mandates over the years that says you have to have insurance or pay a penalty, some people can get an
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exemption from the individual mandates but the thought is if you don't have that you don't get the healthy people, just the sick people. insurance is that and so did others as part of the affordable care act. >> host: talking about changes the administration wants to make. >> there are changes that need to occur and the president articulated those in the journal of american medicine article and restated them last thursday. some of those are we need to further subsidize the portion, the 15%, 85, they get the subsidies, 15 that don't. we think some of that needs to be subsidized. >> the provision that keeps the group of people out, you need to
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bring it up further. >> that is for people in the marketplace not subsidized, if they are not subsidized on november 1st i recommend you shop but because the premiums of gone up you might be eligible. we estimate 20% of the people would be eligible that weren't before. >> cost went up. >> guest: for the other group of people, policy changes in terms of it so they are in the marketplace, but in terms of another change the president articulated that we believe in places where there is not adequate competition so those people are able to make sure they have a place in planes and choices in the option. a third change we believe is important is working on high cost drugs and there are a
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series of proposals that are part of the president's budget but let me highlight one, one of the biggest one is giving his apartment of health and human services the ability to negotiate on high cost and specialty drugs because that is not something we can do now. there are things we believe could be made better. we you it as building on progress and there are issues with some of them have to do with how do we encourage more competition to get lower price and those are policy approaches we propose. >> host: mary agnes carey, your thoughts? >> guest: the idea of helping people, your first, get some financial assistance, being talked about. the public option, uniform offering for people all over the country no matter where they
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live, could interject more competition into the market. the idea of medicare to negotiate the high cost and specialty drugs, we heard about that in the press, how prices are increasing and remember the department of health and human services purchases, negotiate on behalf of medicare fee-for-service beneficiary, medicaid beneficiary, but the thing about three of these is congressional action to make them happen. we have known ever since the afford will care act, a lot of division over this. republicans voted on the house 50 times to repeal the law. >> host: big topic later. john henry is on the line, good morning. i see that you are an employer. tell us what business you have. >> caller: i started my third
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business in the later part of my life. all i do is get out of bed and go to work every morning but here is the deal. i love when she says the president articulated a plan to make things happen. all you do is take money out of people who get out of bed and go to work every morning and say we are going to give that to somebody else so they can have a chance of doing something. i'm tired of my money being taken out of my pocket because somebody else doesn't have the responsibility to find a job, go to work, crawl out of bed and make a living. the hypocrisy you have is amazing. i don't want my money going to anybody else anymore. does that make sense or am i just being selfish? thank you very much.
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>> guest: in the context of the affordable care act some of the things proponents of the law will tell you are important to look at and not just prices for health insurance you are paying but they argue you get more for your money at this point. for example there is no discrimination if you are sick. they can't -- insurers can't decide not to cover you, no going back and canceling your coverage, no annual or lifetime limit with health insurance which has been there in the past if you had a serious cancer case, you had a particular coverage limit and then you were done. kids up to 26 can stay on health insurance, a provision a lot of people like. you are concerned about finances and taxes, far broader than the afford will care act. >> host: george is on the line from the pittsburgh. good morning.
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>> caller: i don't have insurance. i worked all my life. when i worked for corporations they paid for my insurance and now i am on disability. i have no way to get insurance and the money i get on disability puts me above the money you get on the affordable care act and the corporations have increased the cost, the government's health insurance so we are going to charge everything twice as much so i don't even have insurance. how can i -- i thought america would protect me. especially if i worked and put into the system all my life and when i really needed it everyone is turning their back on me. >> guest: you are on disability?
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couldn't you qualify for medicare after two years on disability? how long have you been on disability? >> caller: that is coming up now. that is exactly right but the last two years i got all these bills, they won't be taking care of all of them. their healthcare, the banks ruined it. >> host: if i could offer a couple ideas. there are community health centers that base payment for your healthcare on your income. that might be a help for you. there are some local programs. there may be one in your community at the county level or city level or state level that can help people who can't afford health insurance to pay for it. that helps pay for the affordable care act but the point you raised about employers paying for coverage is an important point of discussion
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because most of us do get health insurance from an employer or we get it through medicare program or the medicaid program. the affordable care act is an important discussion, we have to look at the overall population, 5% of people provide health insurance, get it on the exchanges, 10 to 11 million people was an important discussion but has to be in perspective. >> host: how long is open enrollment? >> guest: to the end of january. for a few months your health insurance starts january 1, 2017, you need to be enrolled by december 15th, lock that down because it takes time to process your application. >> host: the center for medicare and medicaid services put out target areas, we have a list here especially as they put out, you can see here different parts of the country, north, south, east, west, dallas, atlanta, new
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jersey, chicago, detroit, phoenix. >> guest: they represent 3 million uninsured people, supertarget markets. the open enrollment season, in some cases to people they already approach and haven't been rolled become newly uninsured. if you use to get your insurance, and another source and that changed you might not know about the affordable care act. she has her own business, we were discussing health insurance premiums, she had no idea about the exchange, well-educated smart woman but there is a public relations hurdle. >> host: how do they get to people? how do they inform them?
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wikipedia >> guest: there is social media outreach they are trying to do and going to people who paid this penalty. the individual mandate, personal responsibility requirement. the irs can identify people who paid that penalty the last tax year. so to get them to understand options for them and say you have been to the exchange, your cell number or email address as they follow up and try to get you. it is a full-court press. >> host: what is the price tag for the full court press? >> guest: i don't know, probably a different number. i recommend folks go to kaiser health news and look at what we
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have. >> host: let's hear from elizabeth who is getting insured by the aca. hello. elizabeth, are you there? >> caller: i am here. i am sorry. you caught me halfway to the party. i had multiple strokes. so health choice insurance company, which i contracted through the aca in 2014. i have turned out to be a rather expensive patient for them. and since there is no limit, lifetime on the coverage they have to comply with, what they
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did to me instead to get rid of me was send me over saying as of 2017, health choice will no longer offer individual policies. by doing that, they got out from under the requirements of. >> guest: arizona is a poster child for problems with the affordable care act. many counties down to one insurer. prices have doubled. the insurer made a decision to withdraw from the market most likely because they determined it wasn't profitable for them anymore. we see this not only in arizona but other states. >> host: good morning. >> caller: i had insurance on my
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life for my job. what i have noticed, insurance has always gone up. every year we did a new contract it went up $100, $50 and it is not due to aca, employer-based, $700 a month for $6000. the republicans would get together with the president, all 50 states pitched in, we could have a system that would work for the american people instead of working against them. find a way to make this work and put a on insurance, force them to participate, go to a
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single-payer asset like other countries. that is all i have to say. >> guest: donald points out a trend in the marketplace, premiums have premium rates, slowed in recent years, employers taking a variety of steps, employees pay more premium, have a higher deductible, may pay more for out-of-pocket expenses, shifting more financial responsibility to the employees. >> host: let's talk about the presidential candidates, donald trump in a speech he made where he talked about the affordable care act. >> when we win on november 8th. [cheers and applause] >> and elect a republican congress we will immediately repeal and replace obamacare.
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[applause] >> i will ask congress to convene a special session so we can repeal and replace and it will be such an honor for me, for you and everybody in this country because obamacare has to be replaced and we will do it and we will do it very quickly. it is a catastrophe. >> host: repeal is one thing, replace is entirely different. has the trump campaign put forward any thought how it would replace? >> guest: some ideas have been out there a while, high risk for offering insurance, there are some problems, it tends to be expensive, waiting limits are imposed, depends on the execution. selling insurance across state lines, there are a lot of problems including having one insurer over here, when in this state and how to get provider networks and what happens if you
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are a customer with an insurance plan, your state health insurance commissioner won't necessarily want to get involved with that. many ideas have been out there a while but there are difficulties executing them. >> host: hillary clinton talked about specific changes. >> guest: making premiums more affordable, and uniform choices no matter where you live, looking at high prescription drug costs, definitely specific ideas but it is all in the implementation. >> host: heard anything from independent candidates? >> guest: i have not. >> host: should the senate change and then democrats were to be in charge would you see action on their part to make changes? >> guest: they would try to but the key at issue is how republicans want to approach this. more than 60 votes in the house
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of representatives, you had heavy republican opposition in the senate and the house of representatives on the affordable care act. it has not been a huge issue in this campaign but with premium increases that elevated it up. and the key question, do republicans want to fight the law or do they want to make corrections to it? coming to a new congress in 2017, how do they want to pursue it? >> host: susan on the line, thank you for joining this program. >> caller: i don't feel comfortable in a so-called system. what i would like is an individual policy. there is no place for me and people like me who are involved in homeopathic medicine in this
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so-called system. buying clean food and filtered water is expensive alone. where do you see my situation? >> guest: the types of treatments you are talking about, insurance plans, that is what you are talking about. what you could do is look at a plan with a higher deductible but a lower premium cost so you are covered in case of a big emergency boot heaven for but you get a serious illness, you get in a car accident, if you buy on or off the exchange you might -- lowest here, the monthly premium would be lower but your out-of-pocket would be higher. there are also simple choice plans on the exchanges that mail out some care that you can get
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before you have to pay. it might still be worth taking a look. ..even if the treatment you prer are not covered. host: mike from randolph, wisconsin, good morning. we understand you are uninsured? insured. am i have been insured my whole life either by myself. host: go ahead and ask your question. caller: a paul mack by comment was i believe that the affordable cara act is a step forward. you know, when i get older i've been providing for my insurance or my pairs have been providing for the insurance my whole life. and i want insurance to be there when i need it. and that's what the affordable care act offers all of us. i don't understand why we al' are not working together as americans, one nation under god
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to make this happen for all of us. all america. >> you can catch this online at we'll take you live to hear from the fda commissioner robert califf talk about potential impacts of the election on research and innovation at the fda. live coverage on c-span2. >> and then open up to some questions from the and hopefully more questions from the audience. i should also point out that the audience for this session a larger than the previous one, you may notice the camera in the back. this is being filled by c-span. i was tempted to start with a true statement that dr. califf is well-known, for his long or as a clinical trial list, cardiologist and copied in academic medicine at duke.
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however, i think that this is one of the distinction features of his commissioner. he's different because he knows an extraordinary number of people in the broad drug develop an area very well. i recently signed moderate a panel on real-world evidence at the national academies of medicine that a sitting commissioner would moderate a panel is meetin amazing in its n right, but is also able to recognize each person in the audience who stepped to the microphone i first name. often adding an anecdote or personal aside about the speaker. he recognized fda drug reviewer's, academic medical readers and policy wonks, all by first name. i won't challenge and recognized each questioner today by first name, though he probably can and very well may. this wide knowledge of the people involved in drug develop it means he's been able to advance some issues during his
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tenure as the late administration appointee. history says some late administration appointees can have it outside importance of long-term fda policy. that was greg simon just mentioned the long lasting nature of some initiative started late in administration. it looks like dr. califf will fall that i believe a set up areas and initiatives that will be affordable into the next decade. so please join in welcoming and listening to commissioner califf. [applause] >> thanks a bunch and it's great to be here. it's funny, i phone goes off just as i'm getting up. it's my office. well, i guess i will call them back after this. if it's important they will call back. i do want to keep my remarks brief because i think i learned
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in this job it's better to have interchange with the audience than it is to just give another rendition of priorities. i do think based on a number of things that happened recently, it is worth emphasizing the bigger picture priorities that need to be kept in mind as we deal with what really is an amazing explosion of biotechnology. as i think about my job, i would urge you to consider each part of fda that may be important to you to think about the bigger picture a little bit because we've got to make all this fit together. for example, a lot of people now i'm really taken with just the concept of editing. i was in boston earlier this week and it was amazing to see the number of companies, the amount of venture capital going
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into gene editing. of course, if you're thinking about drugs as was bitching community this is an amazing time for human biology. let's think about plants and animals. what does this mean for farming technology, world hunger, ability change nutritional content of the food that we eat ask and was amazing the week before us that jackson labs and connecticut. i'm on a bit of a college tour, because my kids but because of the sort of amazing rapid consolidation of health systems around academia. 's almost everything we do in the ftse with an increasingly definable group of nstic tuitions that are dominant economic forces and scientific forces. when i was that jackson labs, just as they were concerned about the viability and the growth of -- now gene editing, it's like an entirely different world in the concept of
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developing animal models really do recapitulate at least parts of human biology. it's just a whole new era for that. all this stuff is increasingly interconnected as we get better in information and knowledge. so from that perspective i've only been here for the interchange and from the perspective the discussion about h.r. and the federal government is well worth consideration. it's not easy. and it's not just the payoff. i think it is some personal anecdotes until someone difficult things but we also need to keep in mind the federal government has a broad mandate and i it's ever so part of the government gets its own special form of h.r., then you would really have chaos. so getting this right is really hard or it's been a priority of mine.
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and to make things even more public aided i feel like we've made a lot of progress. we've done a lot of overhauling of the h.r. systems inside the fda. we are not out to change the whole federal government. and hiring has picked up considerably that just as we hire more people, thanks to the success of the thriving industries that we are regulating, the ceiling keeps going up on the number of people we need to hire. so we are going to crest at 17,000 ftes, and 5000 contractors but within two years it looks at we will need about 20,000. this is not just looking at the work to be done, this is looking at funding that's in the hopper, assuming the user fee negotiations that have just been completed on the sort of public fda industry access are agreed to by congress, which ultimately has to make the decision and pass the laws over the next year.
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it's a big job. that's a lot to do but what an amazing time to be at the fda. i can also say and i think people who know me are aware, i've not had a bad day in the fda. every day has been fun. i also to people if i was in my 40s come everyday would be held because you have to have a tolerance that i think comes with age for the fact that this is a long-term gain. the things i get to see in my job, like this for a started out with an interim meeting on precision medicine where our scientist working together to review advances in technology that they need to consider to be ready for precision medicine. i was telling paul earlier who's been at the fda, he readily recognize this phenomenon. the things that we see and have access to that are not yet publicly available but we can
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talk about and think about and try to understand how to move, and then had to make the best evaluations. it's really a remarkable privilege. and in many ways as we discussed it, the fda indian is a regulatory agency. it has to make decisions based on what comes to it. i think the sort of not adequate understood mission of the fda has come more and more important is the idea is really a giant tub of science. and if you look at product decisions having lived through the irb issues in academia, i still don't call it product approvals because that assumes the goal is to improve things even if they're not any good. so it's really a decision about approval whereas if it's not good it shouldn't be approved. but what's really happening is that through many, many meetings and discussions and interchanges can edit think rick did a good
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job of describing this related to cancer, most of the decision about what's networking are made well before anyone would think about putting an application together and given that 92% of drugs in phase one don't make it to market, this is a really, really critical part of the fda. it's underappreciated but it's a lot of fun while you were there. it doesn't surprise you that my second major priority is what i probably call evidence generation. i think we are very near tipping point in terms of the kinds of data people really need to do things like discussed value of therapies and the valley of technology. now that, just go back eight years ago. almost no one had a real electronic health record. now 320 million americans do thanks to $50 billion personal investment of our tax money. claims data was almost impossible to aggregate but
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thanks to janet woodcock and others at fda, the sentinel system 175 million americans claims data aggregate and we use it everyday, with 40 million actively we are able to look at overtime. there were no gadgets people were wearing the now we all have gadgets. i think the number now is there are 8 million personal devices in the world which is more than the number of people -- 8 billion. in some countries it's three to one ratio as i understand it. our ability to measure and detect just after revolutionized scale now, and it's my thesis that the regulated industry is behind almost every industry on the face of the earth right now in terms of automation, and taking advantage of that information to get more knowledge at a much lower cost.
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i think we're very close to doing that. it's been the topic of a lot of meetings and i think we'll really see it move along over the next couple of years. i know the fda has to embrace it and has to get accustomed to the nontraditional sort of ways of thinking about data and information and that's a major job that we're working hard on. up until two weeks ago part of my speech on this was that a source under the regulated industry, clinical trials are the only industry in america is getting less sufficient overtime. and if you look at the cost per unit of knowledge, there's no question that's the case. some really smart person in the audience two weeks ago said that he paid college tuition lately? [laughter] i think it's fair to say we have competition by universities right now in terms of cost per
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unit and useful activity. so i think i'll stop there and moved to the discussion phase. those are the two big priorities. we got 16 other topic specific parties like opioids and specific issues come and our 150 things on my list that i'm trying to get done in the next 77 days i think it is. until january 20. so thanks. i look forward to the discussion. [applause] >> thank you. apollo i on evidence generation which is a subject you've been speaking on quite frequently. i would like to start and you may recognize this question. this is the first question you asked about the national academy meeting three weeks ago. if we agree that at least some significant part of evidence generation needs to come from real-world evidence, with or without randomization document,
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what are the main limiting factors which was giving us moving into it? >> right now i think the limiting factor is purely cultural and religious some of the great -- simon referred to come if you wanted to call something that didn't sound good, you call it data hoarding. there are many incentives in the system now but cause people to regard information about madison as proprietary an asset to be carefully guarded and kept from other people. that's two in academia because of the way that you get research grants and claim your intellectual property and get promoted. it's true and health systems particularly right now because in order to have a successful health system you have to deal with hot relations and you need high quality data, and that's regard as a competitive
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advantage. it's been touring industry because of what's been regard as trade secrets. we have a fellow from ema it was over, it is people now, first of all let me just say i'm quite proud of what we did with clinical it's not just that everybody knows that it's illegal if you do a human experiment to not register your experiment and not register your results within a year. completion of the primary endpoint. i don't have my badge with me but i can find up to $10,000 per day. i think we'll get compliance. emk, that has said we will put the study summaries on the web and they've just done the first two. a lot of the objection and industry was called commercial confidential information, and the fellow told in the first two they looked really hard. they couldn't find any.
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i think a lot of this is just overblown protectiveness that needs to be solved. so that's the data -- the one thing i want to make in quickly and no reason to get into detail here, if you look at american health care, at least as the u.s. goes, as long as we talk about real-world evidence in the context of prospective study that requires an interaction between the patient and health care provider, for whatever reason we have not figured out how to create a system that's supporting that. in fact, in the college tour i've been on from seattle to boston, almost 100% of young doctors in training and told me there's no way they can stop to get consent from patients without clinical trials because they are under so much pressure to be sufficient in a clinic. we've got to solve the problem because as you heard in the meeting, i have enough patience for real-world evidence being equally with we'll just take a
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bunch of junk and had no plan and we will analyze it and make sense of the. unita protocol and you need an analysis plan, whether it is randomized or not. >> on the issue of aggregating real-world evidence, how do you feel the fda's future role of potential role in decisions support tools, like -- the idea in system i saw recently, a group of unc oncologists consulting with watson. was fda's role in that? you have said it sounds like -- >> yes. first of all, mike we released our with clinical databases in the 1970s, and the idea that you could aggregate information and give it back in the form of computerized decision support.
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the first article i wrote predicted that by the mid 1980s every major medical decision would be supported by computerized information giving clinician and patient information they need to make the best decision. so i was off by at least 30 years, maybe longer. but that time is now. watson to me is really almost allegorical. it's just symbolic of a much broader effort in multiple venues. and so we don't want to be in the way of that happening. were going to be light touch but also said publicly and i would just say begin because i really believe and, that decision support gets better much like other things with fda. we've got to keep an eye on it because as it gets better it's going to impact the people do. we learn things were regulation is really needed. for example, if you have a complex mathematical algorithm
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that's not right, even though i believe almost all decisions support will still need a human intermediary to take that information, but in context, some really bad decisions to be made on a large scale. as we learn how to deal with that systematically that will be an area for regulation in the future, but not now. >> some drug companies have recently been signing agreements with ibm, for watson to help in providing information in different therapeutic areas. does that movement make the issue although the more relevant or timely? >> i would say it's relevant and timely already but unless i'm misinterpreting you, it's always been the case that at least enlightened during development people use automated decision support to create a framework for net present value
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calculation. or, or understanding where a therapy might be beneficial. back in the days of, the 1980s can we use that kind of information every day to tell us how to design clinical trials. i think decision-support and making corporate decision about what to do is different than decision-support, given to the patient and the doctor that says here's the framework of which make a decision about what to do in practice. as we get into that, it's still light touch for stuff that we're going to learn a lot about it. >> i would be remiss if i didn't repeat dr. pazdur's questions. in fact, there should probably be a third share here because he was placing questions, the last panel, but what should fda look like in 22 if i? should it be disease orientation towards consolidated reviews?
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>> well, we are going through some internal exercises now to take our leaders and have been in vision the future. to leave for the next administration to think about, because i think things are changing so fast now that i think we owe it to people to think very carefully about the future. i say a few things. historically i think as almost everybody in the room knows, fda has been remarkably silent. academia and industry 1020 years ago moved to mostly a matrix organization, and 54 hole right the recent has been drugs, devices, biologic, food and a few things like cosmetics and such. then we added a bug which is another silo. what you hear loud and clear from patients is they would like
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to have a way to be in contact with the fda, to interact with the fda and you also have this from clinicians and practitioners in a way that's not ipod touch but more by what's relevant for their disease. we heard that loud and clear from the cancer patients who tend to be both more effective and more persuasive in their arguments. that's the first effort in the oncology center of excellence. but i also think that exactly how far the matrix goes is a matter of discussion. it may be quite different in different fields. we have something like 6000 diseases so we can't have 6000 centers of excellence. we have to think about how to group things and also i have learned a lot about the fact that at least my agreement with a number of leaders i'm talking
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with, as rick said, while there may be a reason to have cohesion around the clinical portion of it, what other things relevant to the disease and the risk-benefit trade-offs that people with different diseases are willing to make? devices are very iterative. their engineering, fundamentally different than drug. our florida biologics our summer in the middle because there's lot of tweaking the can and does go on with biologics. that gives you some idea of the thinking, and the question is if you were thinking 20, 25 is too far away, thinking in five years, how far would you go in this sphere and i would've very according to clinical area. >> that gets into the subjects of government management and decision-making.
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you should be happy to know that last night andy slavitt from cms some of his happiest moments in government are in meetings with you and francis collins, a collaborative group going. i wonder if you would take a few minutes to rip on the adage attributed to former secretary of state kissinger about the difference between academic politics and government decisions? academic disputes are so vicious because the stakes are so low. what are the disputes like between agencies or within the agency that he had to deal with? are they worse than duke? [laughter] >> what i would say, and my friends i think know this quite well, my stress level work in my current job is lower than my stress level in academia.
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i think it is partly because of what you described. they can get vicious over very small things in academia. so you know, in this job the devotion of people to the mission, even when they disagree, is quite profound. another way of thinking about this, there's nothing wrong with his in the tradition of academia. academia traditionally particularly on the intellectual side it's been every person for him or herself. and so the mission of a great purpose in academia tradition is whatever is in that great professors self-interest. whereas in government people are very, they just wouldn't be there if they didn't believe in the mission of the government agency. at that does sometimes lead to a situation i really notice within an agency has devotion to the mission of the agency which can make the of the agency the enemy.
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i don't think it's ever sort of personal light gets in academia either i think it's really devotion to mission. that's why i think andy and i have bonded quite well come and francis a bee been a great part. we just had our quarterly joint meeting with an age yesterday, and we covered nutrition policy, gene editing, and evidence generation it was like while back, but does give leadership of fda and nih -- >> that with today's? >> two hours. we made decisions. we actually made very meaningful decisions to move things along. and with cms, part of my fun with anti-is sometimes i feel like i am under fire. i still enjoy everyday but then i just call and the essay how many letters did you get from congress today? and i feel better. [laughter]
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this is a time when we're getting a lot of encouragement from all sides to collaborate with cms. if the vital to everybody that we get this worked out about how to move the payment system based on value because the number of widgets is just like what he can do. we are not going to be able to afford to do it that way. >> i'd like to make sure people in the audience, if they have interest in asking the commission to question, to -- yes. i can address or by first name. >> i will start it off. i'm not shy. canyon the? so you are remarkably open to patient groups and the agency has changed culturally and significantly, long history in cancer with that.
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but others are more insular. didn't get out as much. they're not eating as much. is essential to understand the needs of patient groups particularly in large diseases. how can you change that culture? because it's relatively new to the agency, you're great with it but it's uneven across the different areas. >> not that i would ever want to disagree with you but i would say that embracing patient advocacy is deeply ingrained in the fda, much more so that i thought. for example, in the device arena one of the first questions asked when you come in is to get patients out of problem with you as you're developing your device? because engineers, i have two sons were engineers and they are really smart but they tend to solve the problems that they can solve, not necessarily knowing what the problems are that the people have that need installed. having said that, i am a bit
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obsessed with a thought that i'm not sure what to do with, but the thought is if i had a disease i would not want to have the disease that had an infected patient advocacy group or a review group at fda that was not -- so if you think, the reason for that is it's not just a decision about application. it's the other stuff i've already described, how do you get, how to get industry to the right place so the products they bring forward on the right one solving the right problems with the right endpoints that really matter to the patient's? so i think it's a public health agency and i think it's been fun to realize, fda, it's deeply upholding health agencies and assigns agency. the public health mole i think we do have a social obligation
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to help patients advocacy across the board which is one reason i'm always argue with you that it's not just cancer. there are 5999 other diseases who deserve the benefits of advocacy. then we need to work with an fta. at the is great place for introverts. i've often said this. you probably can guess, and actually not an extrovert if you know personalities. i feel like i understand introverts. to have a great role in society. sometimes they are not most comfortable in the to and fro it takes with patient groups are then when he to work with patient groups so that there are boundaries. it's much like i think industry understands very well that interact with fda is a really good thing to do up to a point and then you better back off because if you go too far, the professionalism at the fda will
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rebuff you and it won't be good for your company for your self to do things that are inappropriate. i think patient groups are going to come at fda, need to learn that space and it's more emotional because you can record industry as a net of us although you might get to know the people. people work for a company and has corporate golf but when you get to know patients who are really suffering, it's hard to separate yourself and make an objective decision. went to work on these things. so i defined a lack of willingness throughout the fda but i take, i know you're right when you say we afford to do this sort of work through it for all areas. >> we are getting near the end of the a lot of time and i think it's a little bit tighter because of the cameras, but on the other questions? this is really an unusual opportunity to get a chance to -- one over your.
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>> i'm with prevision policy. as fda commissioner, what has been the hardest decision that you had to make while you've been there? >> the hardest decision that i've had to make. it may surprise you to hear that it's not the -- decision. [laughter] just a quick word about that. i had to make him it took time but learning about the history of excellent approval and issues people brought forth in the fda was an amazing learning experience and help the document i wrote was a lot of hope that you could probably guess reading it from a lot of people with a history of writing fda documents. that was a learning experience but it was very worthwhile. and the conflicts that occurred in that case, i hope people realize that a great thing for a
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federal agency that has to make our decision is to encourage people who have differences of opinion to express them your ultimately and to make an announcer to running an intensive care unit, which i did for years, when you're the director of an intensive care unit most of the decisions are made by other people who actually are better equipped to make those decisions, and if you don't encourage incentives we learn and health care you have surgeons cutting off the wrong leg and things like that. the nurses can't speak up. and so in the end there is a hierarchy of decision-making. i had a decision to make which ended up being procedural because i didn't think that political appointee should be delving into individual decision. factor in a decision that express different opinions, that didn't bother me. it reminded me of being an intensive care unit. the hardest decisions about resource allocation where we see things at the fda that need to get fixed and we don't have the resources to fix them.
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and just because its consulate on my mind now since i made the field trip, i will just say i think everybody should go to the mayo facility and see the international male commit a watch our labrador retrievers, 200 of them sniffing the mail to see what's coming in that naïve americans are buying thinking they're buying like drugs from canada when they're actually coming from places that you wouldn't believe. and things that are mislabeled. we don't have the resources to do everything that we need to do and there's a legitimate argument that people should make their own decisions to some extent but that's the kind of thing that really is the hardest for me. you feel compelled to do something where you see a problem common sometimes you just can't. >> before i ask you how many labrador retrievers the agency should have -- [laughter]
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spent the answer, they do belong to the border patrol. [laughter] but they're extremely useful tol together with other agencies. i forget sometimes talk about the threat of decisions. very thoughtfully like have you gone out and talked to the reason -- the review decision at fda to express the policy speak with yes. i mean, we've had very direct discussions and feelings. by the way, again much like in the intensive care unit i never expected a resident or a fellow on with me to just give in and re director of the unit. consensus decision in a hierarchy is not about of everyone to agree. it's a matter of having a hierarchy that is there for a reason. it's fine for people to continue to disagree. and by the way, these same people he disagreed are still
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working together. last i went to meeting that went on after 630 on a very interesting issue that you will hear about later. these people are still working together. they are not adversaries. >> well, with that i would like to say thank you again and ask the audience to say thank you to a very interesting discussion. [applause] >> [inaudible conversations] you can see this speech on the fda commissioner online at some news on drug pricing. senator bernie sanders and elijah cummings both democrats calling for a federal investigation of possible price collusion between drug companies
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on diabetes treatment. they wrote a letter to the justice and federal and trade commission holding on them to investigate whether three drug companies are colluding to raise the price of insulin for people with diabetes. read more at the it's the final weekend before the election and the road to the white house coverage continues this afternoon with a rally in detroit for hillary clinton. that's at 5:15 p.m. eastern on c-span. donald trump campaign in pennsylvania today one of three states he is campaigning in. he will be in hershey, pennsylvania. we will have that for you at 7:00 eastern. >> election night on c-span. watch the results and be part of a national conversation about the outcome. the obligation of the hillary clinton and donald trump election night headquarters and watch victory and concession speeches in key senate house and governors races starting at 8 p.m. eastern and throughout
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the following 24 hours. watch live on c-span, on demand at or listen to our live coverage. >> income for his 21st congressional district, incumbent republican david valadao and democratic emilio huerta debate immigration, water quality, tax policy, infrastructure, national security and the health care law. david valadao is seeking his third term.
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>> good evening. could have you with us tonight i'm jim scott along with my colleague. we welcome you to our debate tonight between the two candidates are california's 21st congressional district. gop incumbent david valadao and his democratic challenger emilio huerta of bakersfield, an attorney's. we are broadcasting live from the students here at kget in bakersfield. before we start our debate we wanted to take a look at the race, take a look this 21st congressional district and see really what is at stake. >> representing the 21st congressional district in washington means covering a lot of ground. that way first, was much of the southern half of the san joaquin valley including parts of fresno, kings and tulare counties from a section of bakersfield to the south to just
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south of fresno to the north. david valadao is to use house of representatives since 2013. republican dairy farmer has one big twice despite democrats having a double-digit voter registration edge. emilio huerta plans to change that. a bakersfield lawyer and son of labor are gone delores wants to succeed where other democrats have failed. tonight is plenty to debate from farm worker overtime to a rising minimum wage and the best plan to bring more water to the valley. it's david valadao and emilio huerta, two men with a vision for the valley. tonight is a chance to make their case to voters. >> we've gone over the rules. we just flip the coin a few minutes ago. in fact, because of that we were taught by the open statement, mr. huerta you our first. >> thank you and good evening, everyone.
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thank you for allowing us to be here this evening and thank you for the opportunity to speak to residents of the central valley and your viewers throughout. i have been a resident of central valley my entire life. i was born in the valley. i was raised here in kern county. i attended local schools. i went to california state university bakersfield i was able to graduate in three years after dropping out of high school. from there i went on to law school at santa clara university and doctor graduated from law school i came back to the valley. my family, my mother and i have always been at the forefront of trying to make life better for working people in the central valley. as a young man i was a labor negotiator for the united farm workers, negotiating collective bargaining agreements to improve the wages and hours, the working conditions for farmworkers from the central valley. later in life i was able to represent many community nonprofits as board chair of the
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credit union representing workers who were the victims of wage theft here in central valley. i know when i go to washington that i will be able to fight to bring resources and to truly represent the true interests of the central valley. >> thank you, sir. >> thank you. thank you all for this opportunity. david valadao, rubbers at the toy first congressional district to avedon of doing so for the last three matches. i'm a dairy farmer by trade and stoke early farm and a part of that with my family. my wife and kids, we still all that out on the phone. nothing is really change. i just traveled back and forth to d.c. my goal was to make things better for my community and for my children to have the same opportunity i did. going to washington has been a huge learning experience but also whatever proud of what we fought for. number one is water.
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water for our validated something i spend a majority of my time on and will continue to fight make issue ever regulatory process that allows businesses to be successful. also come home and spending time with my family, in a part of the farm and trying to raise crop, keep people employed and raise good kids for the next generation. thanks for having me. >> thanks for being here. there are some political ads right now in television airing a lot. we wanted to start with that and my first question is going to be to you, congressman, the democratic party has tried to tie to donald trump as much as possible. we want to take a look at his political ads. is from the house but repack as well as solidarity. >> republican congressman valadao said he would absolutely support a donald trump. they slash education fund. trump denied water is a problem in california. it's why we need emilio huerta. he worked for the united farm you need.
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emilio huerta will fight to invest in education and health care and job creation for all of us. >> i know you've tried to distance yourself as much as possible from donald trump in recent months. how to respond to this ad speak one, it's dishonest to i never said those words that i support our company put those parentheses in there that's very creative in the way to try to do that. local paper even said they deserve an emmy award for that. i've had outside papers say the same thing, this is a sad a tactic that is what he does. wednesday but was was made that were 15 people in the race and since he became the nominee as soon as he became the nominee i separate myself and began a few weeks ago when he said, when the audio came out. it's a political world and we expect that when we get into these types of races. mr. huerta, your bottle? >> i think and for the most part is pretty accurate. i think that congressman valadao
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here decided to distance himself, put some distance between himself a donald trump after it was politically convenient to do so. when mr. trump dim out -- came out and condemned mexican immigrants and call them rapists and drug dealers, i myself am mexican-american, i was very offended and i'm sure most residents in the central valley, a majority of which and a toy first district are latinos are equally as offended as i was a. it was the obligation as a community leader, as our congressional representatives to stand up and condemn mr. donald trump. and. >> moderator: wait until months and months later when donald trump was the presumed nominee for the republican party. used the first generation son of immigrants. i don't understand how he can go home, faces parents and basically say that he agrees with a donald trump and he agreed with the view of the
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republican party. >> it i follow-up. that is not true. that's most important part of this whole conversation is i never said those words. it is not triggered i never supported the outcome. i supported his opponent and so we end up with this sort of this on us. others have noticed that. it was not my and. it was an ad by an independent expenditure but again as i just mentioned that the ad correctly portrayed mr. valadao's position with respect to his abuse of donald trump and the republican party. he allowed the creation of donald trump. he enabled a donald trump to be
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the republican nominee, their presidential candidate. he refused to stand up to donald trump even to this day he's not called for his resignation as his republican leader. spin he allowed to donald trump to become the nominee, is that what you said the? >> that's correct spirit i thought that was decided in the primary election. >> he had the opportunity and other leaders have the opportunity to condemn donald trump for his racism, bigotry, for his decisiveness. they did nothing. >> endorsing his opponent and supporting his opponent i shall, to others do to help in some of his opponents in a campaign and he can i would not support that. the one point i think really needs to be brought up on this is the fact the best they can throw at me is to attach me to someone i've never been connected to. that's a pretty strong place and is the kind of what i've been in congress in my three nephews. i'm proud of my record and again as the attacks came out, tried
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connecting to some i've never been connected to. it's deceiving, dishonest and for those who care about the community of those who fight for our community and do the right thing, this is the best they can come and throw at me. >> just this week a political ad that criticizes you, mr. huerta, for making a profit off the land deal in fresno county involving the ufw and low-income housing. let's roll that add right now. >> i david valadao and i approve this message spewed it was one of the worst scandal in central valley history. transit use includes to take land from united farm workers that was intended for low income family housing. but then he sold the land to developers for $1 million profit. abusing his power and turning his back on the families who needed an affordable place to live. emilio huerta is another politician looking out for himself.
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>> we should point out that the state attorney general found nothing illegal about that transaction. as to the assertion is mr. huerta that you acted in the own best interest and not of those a low-income comes in fresno how would you respond? >> is totally false but i've never taken advantage of my position with regard to anyone to benefit myself or my associates. that real estate transaction was a transaction for thought that wasn't property owned by united farm workers. is owned by the national farm workers service centric service it had entered into a contract to sell the property. the buyback now. they came to me. they asked me if i could put together a team to buy the property. we purchased the property and were able to sell it and were able to get a national farm workers service in the money that they needed in order to build educational radios and other affordable housing throughout the southwestern united states. investigation from the attorney general came as a result of false accusations on "l.a. times."
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you just mentioned the attorney general's office investigated and found nothing inappropriate with the transaction. >> congressman valadao, we bottle? >> i think it's unethical. when you try to represent an organization that's supposed be out there to help people and especially the most vulnerable and you heard all the stories and all the things we talk about, then you find out their personal profit of $1 billion. when you look at what's going on we've got pay for play politics going on, this is a scary situation. it's worth talking about. maybe it's not illegal but does that make it ethical? does that make it right? can you look at the faces of those people and say this is okay to profit that kind of money but i don't think it was right. >> you said it was one of the worst land deals, real estate deals and history of the central valley. that's a party strong statement. is that an exaggeration? >> i think after does a very good job were trying what happened. >> would you put mr. huerta in the same group as a david crisp and carl coles of california?
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>> i'm not familiar with those are probably the worst mortgage fraud scam in california history during the bust and boom of the real estate market. >> let me just at. the difference between my history as compared to mr. valadao is that i've been housing for poor people. he's never built anything. i've done clinics for poor people. i don't credit unions for poor people. this transaction you mention probably happened more than 10 years ago. even subsequent to that article by the "l.a. times" i continued to work with low income community based organizations with housing development corporations to continue to bring decent safe, affordable housing to communities such as bakersfield, fresno, phoenix, arizona, throughout the southwest united states. community groups have been willing to work with me. ibook with a federal home loan bank, agencies in california,
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arizona, texas an and new mexic. that's ever been any hesitation for anyone to bring me and bring together a deal to benefit the local community. >> the difference is the accusation i never built anything, typical of someone who's never done -- built a business, to undermine, to put down, we employ folks. we built a business. we continue to build and grow and provide for the economy. when we talk about jobs, what we give our community, especially all the different groups come to us as business owners and ask for resources, ask for money to support their -- there's a lot of things we do but to say that you'd never built anything. i would say that people work for us and our employees enjoy coming to work as bush once have been with us for over 30 years. i would say that shows we've done a good job. we've done a good job, we have created jobs and we've created a business that is successful, gets the economy going and provides some dollars for community. what more the net do you want?
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as far as helping out with the clinics, as my roll sitting on the appropriations committee making sure the resources are there so people can come in and help direct but in my will i provide quite a bit of assistance and a proud of the record as well. >> let's move on. congressman valadao, too many observers in the valley this republican-controlled congress that we have now has been really nothing to move forward on the issue of immigration reform. do you accept any of the blame for that? if reelected what would you do to get this issue resolved? >> there's a lot of folks i would say blame on the. i was out with depression and start with the former speaker. at the very beginning of this congress there was an opportunity to get something done. speaker boehner told president obama did not do anything. let us do something. but as before. he chose to take a different path and that really wrote this conversation on immigration. there's been some policies and things that have been part of a
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major piece of legislation but overall immigration form is something i'm still very supportive of and continue to work on behind the scenes especially other members who are interested and try to prepare for the next round because of leaders and opportunity for it. it is something i take very seriously. it is something i think there is a real opportunity and for us to just throw it out i think would be a mistake. but there is, the pressure was did not help the situation when he decided to make, what he did. >> we bottle? >> i think it's typical again, political convenience from mr. valadao. he says to us a fiesta latina comes in some develop a support immigration reform at every turn he does everything he can to block it. in march of this year he signed onto a house resolution to condemn president obama's executive order of the dreamers. he asked the u.s. supreme court to strike down president obama's action in that regard.
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and is in the appropriations committee refused to sign a discharge position, petition, to allow the immigration bill to go to the floor. when he was in the state assembly he voted against allowing dreamers to enroll in local universities and junior college as california residents so they could avoid paying out of state tuition. he voted against allowing dreamers have natural and so they could continue their education and be contributing members. at every turn he says he for immigration reform, his party leader, majority leader paul ryan made an agreement with conservative republicans do not bring the immigration bill to the floor. this is his party. this is his leader and that is why we don't have to immigration reform spent the response to that, as far as the amicus brief, that was a controversial issue because anybody who decides to run for congress and pushed them on about has understand their running to write laws.
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that is nothing to do with immigration. that was very specific on the president overstepped his bounds trying to write law. if anybody has read the constitution and now the president is an executive. that congress writes the law. we had to protect that because anybody who thinks that was, those who voted no on it, have to understand in four years, eight years, 12 years, 16 years, 50 years, whoever the president is a decent the president would have the ability to write laws without congress, what are you trying to tell and what we have in the future? do we end up with a dictatorship? we have to do her job to make sure we protect the institution and fight to do our job as well to pass immigration reform the right way. >> will again, when he voted to deny dreamers and the children of immigrants the right to attend college, the right to be able to have an affordable college education, the right to secure financial aid, those
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children are now in the valley. that was five, six, seven years ago. is that what he's going to tell the next generation of children that it was a political move to question the authority of a president, that his reasons were not endorsing to immigration reform because it wasn't the right time for the right -- [talking over each other] >> and then after signing on got attacked from the left. they had groups like his come out and attack me and made it more difficult because with the opportunity to get something done. as soon as the three of us stepped up to the plate got attacked on tv, a lot of other members who would've been there decided to back off because they figured out they didn't have the support they thought they did. >> i want to ask about amnesty. there were millions of undocumented immigrants in this country. a lot right in the center valley. where do you stand on the issue of amnesty for these people? >> in 1986 my mother along with the united farm workers union, my mother is sitting in the
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audience, was able to lobby for the passage of the bill which president reagan signed in which farmworkers tremendous a benefited from. we in the central valley a majority of farmworkers that pick our crops and put food on our tables leader in the center valley and are able to benefit from the amnesty provision. i'm not sure if amnesty is necessary for comprehensive immigration reform, but we do need to have a pathway to citizenship. we do need to have a mechanism where we can bring the 12 million undocumented immigrants, men and women that work every day that do the jobs nobody else wants to do in this country, and being able to give them legal status so we can bring them out of the shadows so they can become taxpaying community members and they can contribute to the building of roads and schools and make our communities better. >> there is no such bill in congress that is amnesty by
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definition the amnesty is a large group of people with a punishment at every piece of legislation i've been a part of a light dose of vintage gopher process so they can become legal. there will be some in that there probably are not the ones we want to stay because they got some criminal background. but for the people working hard in the field, working hard in the restaurant industry, in the service industry, we've got to come up with a system that addresses the 11 million. you have to of a process to make sure we have guest worker programs that were, visa worker programs to work and elsewhere to secure the border. at the end of the amnesty by definition, there is no such legislation proposed or in the process of being proposed in congress today. >> will step aside and take a break. ..
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welcome back. you're watching the debate right now. thank you for being here, gentlemen. we appreciate that. mr. huerta. i have a question for you. you have no prior experience in elective office. everybody starts at some point. your critics say you would not be in this race if it wasn't the fact that your mother is deloris water huerta. what do your say to your critics? >> i'm grateful for the upbringing and the life my mother has given us. i think it was very unique and we certainly were involved and have been involved and have been at the forefront of social change and bringing justice, social issues hereby in the valley, since i was a young child. think my track record peeks for
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itself. for -- speaks for itself. for the last 40 plus years, over 20 years as an attorney, i've been active in the community. just last book i was coaching in students at foothill high. i've traveled, done work throughout the central valley and throughout the state of california, both as an attorney and as helping nonprofit organizations develop, bidding credit unions, financial institutions to communities, credit unions to fresno and eastern -- western kearn county and so i think that when you look at the work that i've done, my commitment to the community, my dedication and just my work ethic, i'm certainly qualified and i believe i'm the best candidate for this office. >> okay. well, i'm just going to move to the next question. to you, sir. you spent two terms in office trying to push legislation that would modify federal environmental regulations,
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trying to bring more water into the valley. some people critics would say that you have not been able to do that. you have passed your own legislation but the end result is not a big change. how too you respond to that. >> we have gotten closer than we have been and if you chair where we have been on water, those situations have gotten so much worse because of all the environment contractual regulations. the legislation does not change environmental regular layings, just allows for some common sense reforms. but what we have done is we have actually got four our five different pieces of legislation on the senate side right now waiting for our senators to come to the table. we have turned it into an appropriations bill, getting our senators to introduce is bill is something they've never done before. so now we're getting people to the table and getting to the point where we're almost there as far as aside from that. i am mixing sure we have funding for clinics and the naval air
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station has enough money to prepare for the f35, and make sure thatwick programs have more axis points throughout the valley. those are things i put into those appropriation bills that would benefit the whole valley and laws i actually helped imminent and things in the farm bill that help our ac cultural producers. >> thank you, sir, mr. huerta. >> two years ago, mr. val la dough blame is harry reid and the u.s. senate for mott passing his legislation and not getting laws passed and signed by the president. now we have mitch mcdonnell there, a republican controlled senate, republican controlled house, and mr. valadao has been ineffective in getting his legislation passed so we in meantime we here in the central valley are waiting. our air is getting worse, water getting more contaminated. we're now on the fifth year of
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drug and plane of our small farm and agricultural communities are being impacted negatively because of the drought. so as a. as we loo week to boast he is explosion almost there and believes that we will get legislation passed that will benefit the valley, the bottom line, the truth is, he is probably one of the most ineeffective representatives we have ever had in the central valley. >> gentleman, mr. a winter tacoma as a freshman congressman, then, what use your approach be to legislating a solution to stabilize water deliveries from the delta too the valley. what would your strategy be? >> the first step would be to reach across the aisle to talk to folks from northern california, to invite stakeholders to the table way the legislation he has proposed, there have been no public hearings and not invite ited in inpout from the folks in northern california.
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the water crisis in the central valley is a statewide issue. not just a central valley issue, and if this drought continues this state and the valley will be in a much bigger crisis than today. so i would reach across the aisle and it won't be suspending the environmental regulations. it wouldn't be suspending the dappen dangered species act. east of here we have this place called mono lake and we have seen what unbridled drainage of water can do to an area, and a pristine area in the state. we're not going to want that to happen in northern california. they're not going to allow to us make that happen and we have to demonstrate to them that we would use and manage their water wiley to the benefit of all california residents. >> so anybody who has actually read the bill would know that most of the stuff he just said is absolutely false. no clue what we're doing and what's going on. the bill is bipartisan. has support from democrats, has support from northern california, even northern
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california water districts that manage a lot of those projects that we're worried about. so, no, we have worked across the aisle some. the problem is we have two senators from california oh need to step up to the plate and help deliver this because other senators from other states are not going to come into california unless we have at least one ours supporting. we need happen from our own senators. the legislation doings not touch endangered species act. is says before you turn the pumps off, make sure you're actually going to save something, and prove it to us. it's common sense. it's a reasonable piece of legislation. it's something i stand behind, and i would actually ask anybody who challenges it to sit down and read and it then call me. but to throw stones at it, read it first. it's pretty evident right here. >> the wreck legislation is that sank co sank here is the endangered species act. would you envision leading the charge to suspend any provisions
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within the endangered species act that restrict water supplies to farms and cities here in the valley in the name of preserving endangered fish species? mr. huerta? >> i'm not shower that's the answer and suspending and deregulating the environmental protections and the endangered species act is going to get us where we head to to be. what we have to do is we have to invite stakeholders to the table. we have to be able to convince them that the crisis here isn't just about water for ag. it's about water for families, water for those communities, that don't have water. there's communities here in the county, a community of arvin with contaminated water and up and down the valley. so no long just a question about water to sustain our can go -- agricultural areas and we have our own flint michigan going on
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here right now, today, we're going to need everyone's help in order to clean our water and in order to ensure the continued delivery of safe, drinking, cleaning water for families. >> okay. congressman, valadao rebuttal. >> i appreciate he named the communes because every one of those he mentions it is affected by the community. in fact, spiff live kettleman is mentioned 900-acre fee from the delta because communities on the west side who rely solely on water from the delta and today 55% of the historical use and the legislation i introduced and passed out of the house and sitting in four or five different pieces of legislation, does address that. as far as the east side, those who he claims to be friends with are the ones who sued to force us to put the water down the san joaquin river. that slate, environmentalists came in, sued, force is is to
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send water from the canal out to the san joaquin live and my legislation repeals. that sort of. 0 it's common sense legislation and as far as endangered species act, don't touch it. if you're go together try town our pumps you've, perform to us with science that you're going to save a species and then turn the pumps off. just turning pumps off is not the way to operate. >> polling of you are involved in agriculture in different ways. what do you think of the new form worker overtime laws. congressman? >> so, the problem with agriculture is it's a different world because when wow can use at any other industry they're year-around and when you look as harvesting crops on a tight seed all, giving farmworkers the opportunity to work more hours to get more money is something they've benefited from.
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with this change i expect to see more people make less money. >> let's money? one thing i've heard from a lot of growers, farmers, they say they're going to be cutting hours to their -- >> that's going to have a direct impact on salaries. they'll be working eight-hour days and that will have an impact and make it harder to feed your family. >> as tar as your farm do you plan to make hourly cottage's. >> we have to make decisions athey come. it's long period it's worked in so we'll see how it plays out. that's something that my brothers and my uncles have to play a role in because i don't have that much of a management role. >> mr. huerta, farm worker overtime. >> they're the haddest people working in the valley. we know their vault uand contributions. what is the reason for deeing overtime for farm workers? every industry pays their workers overtime.
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we have laws for years and years in california and throughout the nation giving workers the right to overtime, paid rest periods and for years farmworkers have been summited. the wheats the united farmworkers started in the first place. when i was negotiating contracts in the early '80s, we had overtime in those contracts for farm farm workers and not once did the employers complain that they were going to have to shorten hours. not once did employers complain they would receive less hours. so they can it's very appropriate. think the assembly maybe did a great job of ensuring the passage of overtime legislation to protect farm workers and we need laws throughout the country in 49 other stateses that don't provide the same level of protection for farmworkers throwing the country. >> i don't think i've heard a single political ad since i've been covering politics for 30 plus year that has not included
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a promise to bring more jobs to a constituency. i think our viewer disease serve some -- deserve some specifics. you promise to bring nor job to the 21st district. can you point to one specific strategy that would serve as a catalyst for job creation? we start with you, congressman. >> well, obviously the water is the one that has the largest impact here in valley because it's not just about farming and just about communities but if you look at any city around that is trying to attracted investments, diversify your economy, not having a steady water supply is one that does play a role and if i'm invest e vesting in an area i want to make sure they have enough water so i can mop my floors. aside from that, other things that i've worked on is energy policy. energy policy is a big deal here. we have a lot of people, the last pile price we lost thumps of jobs in valley. so making sure -- one thing i've done and was part of was the oil export ban, allowing more
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markets for the oil industry so we have lifted oil export pans to be more opportunity and competition for the product and hopefully that should help and i feel like it has helped create jobs. as far as the energy site of it. make sure we have affordable energy, look at solar and wind and different things but anytime you make investment in any type of technology you have to make sure it's affordable and efficient so people can keep their families comfortable but if you're going to invest in the valley you have to have the ability to operate whatever kind of piece of equipment. >> mr. a huerta, generating job. >> the reality is we won't be able to attract industries to come into the valley until we have a skilled work force, and that starts with education. and our educational conditions are deplorable. we have more -- less than 50% -- a little more 50% of our kids graduate from high school.
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of that less than 10% graduate from collegement that means 90% of the children here in the central valley will not have other four year college education. how can we attract new industries if we don't have the skilled work force to be able to attract the type of industries and develop to the industries. not enough just to have job raining programs we have continue vest in our candidate space in our community colleges and apprenticeship programs and develop a skilled work force. it's been too long -- the 21st 21st congressional district its one of the poorest districts in the country and it has remained poor during mr. valadao's tenure. we need to invest in our community. >> i agree that education is a big deal and one thing at the pass inside congress is every student seconds act and making sure we brought back education to the local level. a build signed by the president,
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one thing we did at the very end of the years' something that will have a reality impact. another thing that has to play a role is making sure that we have good teachers and luckily -- not luck di -- because of my hard work on education, i've got the support of the teacherrers association here in california and the national education associate. they support me because they know i've been there for them on education, not every stunt succeed -- student seeds agent. >> we'll give you the last word before we good to break here. if you have anything else to add to that. >> misdaughter went to public high school. from there she went off to uc san diego, got law degree and decided to come back to this community as i dod a an attorney in order to serve our community with need to invest. if we're gilling if on our children and if we continue to do that we're not going to be able to attract new industries. not be able to give them the future, not be able to give them the opportunity to achieve the american dream, which they deserve.
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>> all right, gentlemen, thank you so much. we'll take a quick break, back in a couple minutes with the candidate are foe the 21st 21st congressional district. >> welcome back. let's turn to homeland security how much should thest proceed with the processing of middle eastern immigrants seeking entry into this country? this is something that is coming up front of us, comingman? >> there's a process in mess and it is a long process that syrian refugees have been waiting to come in have a process of three or four years, the president wag trying to get in 10,000 last year and i achieved that number but something we have to be nervous about and continue to watch because we really don't have a way to know they're background, and to allow people -- we can wait three
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years with them in a refugee camp but not knowing where they came from itself a scary situation and have been strong in opposition to allowing so many in. i think we have to also look it's from a different perspective. when we're looking at the countries and them having the ability to defend themselves or allow going people to take over the country so isis and other terrorist organizations don't run those countries, pouring refugees out of there i think thing new are numbers are against it and well the people that should be our friends and on to our soil and they're not helping them'm and they're not fighting. >> hillary clinton wants to greatly increase the number of immigrants come the middle east, places like syria. do you aggrieve with her on that. >> absolutely. the united states -- the american people have always been generous with lieing refugees and immigrants to come into our country and we have to be able to welcome the victims of war, people who have no other option, and to be able to preserve their
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family unity to come into our country. not use religion or cull are cultural identity or nationality as a litmus test but to look at the circumstances in which they have applied for refugee status near our country, and then give them the opportunity to become american citizens here in the united states once they have been here a while. >> if i may, it only takes a couple of bad apples to cause big problems. we've seen it here in california and florida. individual people, homegrown terrorists not to mention terrorists who may come over from another country, seeking refugee status. do you not feel that there should be any vetting process involved with these refugees? >> well, sure should be some sort of vetting process, but there is no unique way to determine who is going to be a criminal and who has the predisposition to engage in a criminal act. criminality is not unique to a muslim or a syrian or someone
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from the middle east. so i think that race litmus should not be a factor in determining who is eligible for refugee status here in the united states. >> so that's a squarey situation about this. we don't know anything about these people's background and i know there is a slow process, and that's something i've looked into myself. it is a three or four year process but in three or four years still not enough, not knowing where they were raised or knowing anything about their background, if they have a criminal record because there's nothing there it's a scary situation and pulling them away from their home country to bring them to the u.s. and the talk of citizenship i think is absurd. you have to look at the situation and when you look at country like that, when we look for allies, people to help fight the terrorists always trying to take these countries over, we should work with. the if we need to put up more camps and make them more comfortable, invest mow, i support that and allow thing tome stay in their countries with their nationallies and friends in the communities they recognize. something we have to pay attention to.
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>> okay. if the next president decided to put american boots on the ground in the overall effort to eradicate isis from, let's start with iraq, is that something you could support, mr. huerta? as a freshman congressman. >> isis is an international problem and i think the entire international community should be prepared and should contribute to eradicating isis itch don't think we also the united states should take on constant fronting isis alone, particularly overseas. >> certainly not alone but should our soldiers by there on the ground? our regular troops? would you support putting our regular troops as part of a coalition force? >> i think -- have to be great deliberation, compelling reasons for sending american troops, our young men and women, overseas to fight isis. and only after we have had full disclose sure, the exact circumstances, the time frame,
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the introduction strategy, the exit strategy, for when those men and women would be there and for how long. >> congress mosquito valadao. >> i've gone and visited and spent this past christmas with our troops in iraq, had the opportunity to take time from my family in kuwait. and had to chance to visit our troops along the sinai peninsula in egypt. and it's something i thought about a lot. and i think we have to play a role in this. think the u.s. has played a leadership role and needs to continue. there is a coalition -- every time i traveled to these bases we have or work with, there are lots and lots of countries who are playing a role in this so i've been briefed by british, by canadian, even seen some of the colombian soldiers on the field. so, it nice to see the coalition there but as far as making the decision to go forward and keep more on the ground, again, you have to look at the intelligence and look at the exact situation but something i'm willing to look at and have the
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conversation. but again, it's going to take a lot of background and a lot of research and have to have the commander in chief you trust to stand behind the troops and make sure we're taking care of them when their and when they come back home. >> of course, there's really almost no such thing as traditional war, two divisional threats. that's cyberthreats, threats to the power grid which could be destabilizing to the country. in your view -- congressman -- how vulnerable is our country's power grid and how vulnerable are we to cyber attack right now, and as a cockman, what are you doing to help protect america? >> so, through energy and water subcommittee, and appropriations, cyber attacks and especially on electrical grid is something i brought up quite a bit with them and i continue to put pressure on the department -- secretary of energy and to department of energy in general. secretary moniz had heard from me on this specific issue. we are usual and the more we get into smart smart meters and
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things like that and a more -- as technology include advanced systems more commuters, opens the door for more hacking and when you get into faster and stronger computers like super commuters or quantum computers this could play a role and something we are aware of, but something we are vulnerable and so, yeah, it's on my radar. >> mr. huerta, how use you prop the tollic. >> have not had the privilege of being briefed on national security issues but i believe we have to protect our infrastructure, we have to protect our water delivery systems. have to brecht ore electrical delivery systems systems and hao protect those resources and the -- you know, our infrastructure so that we aren't vulnerable and aren't stodge attack, aren't subject to cyber attacks. so i think that it's appropriate to make the investment and the commitment to protect the american people in the infrastructure that we have here in the united states. >> so, it's not a briefing where
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you get this information. one, it's open, public actionness and you don't have any classified credentials but there is books thought hived a some good friends recommend to me and also people just right here in kearn county that have talked to me and made investments into computing technology get ahead of this. >> let me ask about governor brown'sing a. obviously gone all in on addressing climate change. wants to reduce fossil fuels here in california. like to do it rather. mr. huerta, do you support the governor in this regard? >> well, i support clean air and i support a clean environment. particularly for us residents here in the southern central san joaquin valley where we have the worst air in the country,seems to be very little movement on the part of congress to help clean our air and to ensure our families that live here that they will be able to live a healthy life, that their children life expect tansive will not be shortened because of
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the bad air. believe we have to reduce carbon gas emissions and have to have policies that will lead to a healthy, clean environment for us here in the central valley. >> the epa, however, continues to punish the southern san joaquin valley for our poor air quality even though in the face of new studies that show a considerable amount of the air contaminants come from northern california. and that we some say carry a disproportionate share of the burden other people's pollution. its that a fight you're willing to fight in congress, with the epa? mr. huerta? >> absolutely. i agree with you that significant portion of our air gets trapped here in the central -- that the bad air that comes from the bay area and down south to the central valley gets trapped here and has no way out. so we have to begin to clean up the air. it's a manhead problem should be a man-made solution. >> congressman? >> so you bring up a very good point. even the head of the regulatory
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agency here in the central valley has said if we get rid of every single combustible engine in valley we'll never immediate the standards there are monitoring stations in the bay area that say some of the standards we're supposed to meet, the air comping in before it touches california, does not meet the standards. so that's a real problem. obviously we all want clean air and clean water but when you have the head of the regulatory agency saying we won't met the regulations and have to pay the fees, every single one of the hard working people in the central valley are paying knees for a goal that is not attainable. i thought we have to fix that. common sense regulation but, two, we have also looked at ways to make sure the fees paid, trying to keep them in the central valley so the val valley benefits. >> thank you, gentlemen. mr. huerta you policemenned to stand in the way for any effort to repeal or defunded obamacare.
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we did a story in fresno about a family whose premium ares going up 300%. why do you stand in support of this program? >> there are 20 million people here in the united states that now have health insurance, that did not have health insurance before the affordable care act. many insurance companies, including my own insurance company that refuse to cover and provide health insurance to my daughter because she has a heart murmur when she was born. farm for her, late northern life that wasn't an issue, but -- so without the affordable health care act, which prohibits insurance companies to discriminate against folks with pre-existing injuries and allowed the children of working families to continue on their parents insurance programs until they're 26 there would be hundreds of thousands boom here in the central valley that would be denied access to affordable health insurance.
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correct, you're correct in the terms that affordable care act needs some work. it's not a perfect model but it is a lot better than the alternative in terms of denying working families affordable health insurance. >> congressman, you can respond. >> there are things in the affordable care act that make sense. one, the preexisting conditions, the concern, but you want to make sure that people with preexisting conditions are seen. that's something that needed to be addressed. we have to make sure that continues to be addressed. allowing kids to stay on anywhere the 26. that's positive. if have family members who struggle because they hit the lifetime limits and that's something that families struggle with. the problem with the affordable care act everybody talk busy the 20 million that have insurance card and that makes people feel good. the problem is that people who had good insurance in the past and paid their bill, now they have this insure january card and doctors nor longer seeing them and they're going to the local hospitals and holmes not being ream billsment.
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i saw my opinion in coalinga and the hospital is starting off with half a million dollar deficit. they're on the verge of closing their doors in a community in the middle of -- on the edge of the valley like that so far away from fresno and bakersfield. we have to keep the are open. those reimbursement rates, the insurance card isn't what it is all about. we headache too marry make sure we keep the doors open on the hospital. >> huerta. >> some of miscommunity based clients have been primary healthcare clinics. from down south in san diego county, here in kearn county. my own father was the executive director of a primary health care clinic in fresno system brother is a doctor here in kearn county. we have seen the bottomed billion fit of thes a are affordable care act. the accessman that has been brought to our community here locally so that we can build new clinics and oildale, in western kearn county.
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there are hundreds and how much farmworkers, working families that now have access to permanent are primary health care that didn't have if before. >> time for closing statements. one mint each and by virtue of a coin toss, mr. huerta you go first. >> thank you for have us again. as i'm mentioned, my life has been dedicated to helping working families here in central valley. as a young negotiator, as a lawyer, representing women, who have been discriminated in the workplace because of their pregnant condition, as representing workers who have been denied employment because of a existing medical condition, helping workers regain lost wages. in california, on average, workers door doo privates of three or four thousand does because employers refuse pay overtime or break periods. i have dedicated my life and my


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