to open up from the outside you must have a solid form. you have to remain. to share you must have something to offer. without nations and family, the limits of the common good, collective morality, disappears as the reign of terrorism continues. [applause] >> today, even children have become merchandise. we have the right to deprive the child of a mother or father, no you don't. a child is not a right. is this the freedom that we want? we don't want this atomized world of individuals without gender, without father, without mother, without nation. [applause]

>> we believe these remarks to go live to a meeting of the national governors association to hear from policy items that they will address this weekend. >> can control, gun safety, healthcare afford to lose sight of that. we can't say frequently enough, we said rough justice, 50% more than any other developed country on health care, and everyone else less healthy. all three of us get to this point? the key is not to fix blame for the past but to accept responsibility for the future. a bipartisan approach is

complex and as difficult as this one is the only solution that will bear fruit. colorado close to 94% of the population has coverage, medicaid costs on a per capita basis reducing emergency room visits, finding ways to control costs and got to improve quality every year. we understand our costs are still too hi. we are not where we need to be in rural parts of colorado. a 60-year-old man making less than $50,000 spending a third of his income on health care. the field has been tilted against the middle class. what we are proposing will help

address those inequities. financing private-sector innovation, making sure we get targeted government action, trying to protect the most vulnerable that government doesn't, hospitals, doctors getting paid more when people are still sick. our goal is to make sure there is incentive and appropriate motivation to make sure that imbalance in the system gets changed. we should reduce incentives for unnecessary care, we should eliminate them. make sure they have access to primary care. let individuals take responsibility for addressing their healthcare challenges, way out ahead of what they have been doing historically. everyone deserves the chance to better health care.

they can't just do it by themselves. like trying to ski down a mountain without any boots. we need support from congress and the administration. it is a great pleasure to work with two remarkable governors. the gentleman from colorado, truly, governor john kasich from ohio and governor bill walker from alaska. it says a lot that we have a bipartisan approach to this. how do we use innovation towards a system that is going to reward all of our citizens and continue to expand coverage and quality. i will turn it over to john. >> always great to be with john hickenlooper. i learned a lot about alaska in the last few hours than i have done in my entire lifetime. it is a great learning experience. now i know to go there in the

middle of the winter. here is the situation. john is a forward thinking guy. governor walker has unique problems in alaska not just because of demographics, but because of the physical makeup of the state. we are all looking for ways to what? continue to provide great health care but at lower prices. i am pleased to say, by the way, pleased to take the slings and arrows on medicaid expansion which has one deck of the party was just aghast at. i was standing on stage the only person running for president that thought expanding medicaid was a great idea. now i find republican states beginning to figure out a way to expand medicaid because they realize you can't leave people without health care. we have taken on a lot of big issues and a lot of big special interest groups.

we figured out ways to get our costs under control. medicaid is growing slower than ours, under 2%. that required us to take on properly decide who should be in a nursing home and who should not. that is one of the biggest fights in the world because we believe in home health care. we are using technology to make sure we are not over zuber paying. we moved everybody into managed care except nursing homes which is another battle we are in the middle of and we have shrunk the number of providers to bring about more competition. any one of these things are tough. states really want to do some things they have to engage or take on special interest groups in order to have a significant impact. what are we proposing today?

transparency. people ought to know what they are paying for but another thing. we don't want to be paying for quantity in medicine which we want to pay for quality. if we don't stop pay for quantity and start paying for quality and lower prices we end up with - that is why this issue is important today - you have a drive towards a single-payer system which will strip all the innovation we need in healthcare because single-payer systems don't innovate. they are learning from innovation with the private sector and that is just a fact. the second thing, we start to see many americans in a two tiered healthcare system. if you have a lot of money, great. concierge care. if you don't have any money you do the best you can and hopefully you know somebody who can get you to the right place to get treatment. that is not a good thing in our country. what we are talking about his market-based incentives so that

we move away from fee for service medicine where you get paid for how many things you do for us to a system that says you pay for quality. it has taken us four years to get insurance companies and providers on the same page. we are now providing bonuses to primary care operations that deliver better healthcare at a lower price. that means they look at all their procedures and also work aggressively to make sure specialists do the best job they can do. great. what we are doing is like spitting in the ocean. because if you really want to control healthcare costs in this country it is up to businesses. big businesses have got to

start saying to insurance companies, they have to say to their providers, either you give me a lower price based on good quality that makes our people happy or we are going to find somebody else to do it. i don't understand why it is not happening more aggressively. in my state, the cleveland clinic told their employees they are going to get great healthcare, treat them for whatever they want but there are certain expectations that coming to those employees. some are telling insurance companies to give us a better deal with providers. that includes the ability to have transparency on drug prices, pharmaceuticals going through the roof. all i would suggest from my position in the state is doing a fantastic job beginning to lay down a pathway for how you can do this and pay for quality and offer incentives but we can't get it done. it has to be the businesses in this country who say they had

enough and frankly may be they do but i don't think enough. we need healthcare specialists hired by companies, one of the most uncontrolled costs, no excuse for it. there's no excuse for fee for service medicine that pays for quantity when an employee, associate, can get great quality at a lower price and that has to be demanded by the private sector in america. if you are not doing it as a ceo begin to do it. your people will be happier, your cost will be lower in your company will be healthier. between governor walker and governor hickenlooper and the team that i have, we can show you a roadmap and a pathway to success in this area. please get going. because if you don't, a lot of your people are going to get the shaft, not the kind of healthcare they are to have. >> what a pleasure to work with governor hickenlooper and governor kasich on this issue.

my point is similar but different. every state is unique. with our population in alaska we have the highest cost of healthcare by magnitude, by multipliers. our population is spread over a larger area. 82% of communities do not have roads. they have to go by air or boat. it is more expensive to bring somebody in, and ambulance ride might be a few minutes in some locations, for others might be 1000 miles of transport by air. what struck me in this issue of healthcare and debate was the solution was based on a certain number of boats - votes. the solution to healthcare is not a partisan issue. it is a human issue, and american issue we need to embrace. the pendulum swinging back and forth between the administration on healthcare, that has got to stop.

the ones who get hurt by that swing of the pendulum are those who need healthcare coverage. we make an expansion in our state. i am glad we did. 40,000 more alaskans are covered as a result of that. our legislature passed an insurance program, the cost of the premium down by 20%. that is very significant but we work together in the legislature and with the federal government. bringing insurance down is a big deal. we only have one carrier left in alaska. we have to watch that carefully. what i would love to see and that is why i enjoy working with my fellow governors, one a republican, one a democrat, no reason we can't - there should not be party lines on this issue. how did we get the quality of

care we need at lower cost and people are covered. for me it is all about progress. we have an opportunity as governors. these roll downhill. they coming to us eventually. we need to be part of that solution. when our phones ring, people provided coverage, there is a problem with healthcare they call us, that is our job. we are engaged in this to make sure the process is not just made of winners and losers. you plant the flag of where we want to be and how we want to get there together, not by arm-twisting by groups coming together to find a solution to this. the solution is there. it is all about process and one that will survive, not just be wiped off the table with any change of administration.

it is the long term we are looking for. it is an honor to be part of this process. we will continue to work and bring other governors into this effort as we move forward. members of congress i spoke to about this concept said thank you for doing what you are looking at doing. that is a great model that is bipartisan and we will see. thank you very much. >> governor hickenlooper. question about cost. any idea how much it will part that is cost about 7000 pages and to reality? >> we have not made specific projections. there are directions we can agree to in a bipartisan way that allows us to at least

contemplate getting our arms around the runaway inflation we have had for 30 or 40 years. this country cannot afford sucking money away from higher education, transportation, almost every function of government, k-12 education which was our goal was was to lay out a framework that was nonpartisan and didn't make winners and losers. so much of the dialogue around the chaos around healthcare has been trying to say afford this or that. and governor kasich said it well and governor walker said it well, we all said the same thing, get away from fee for service, to motivate doctors,

hospitals. >> this will save a ton of money. in my state of ohio we saved $1 billion. medicaid was growing at 9%, probably the same with hickenlooper, taken actions, really flat. i am going to check, verify that. that is really good. that is under 2%. we don't have this all, you can hold me to it. we think we can save $1 trillion in medicaid in this country, and medicaid. if people get healthcare who are in trouble.

if you make these fundamental systemic changes, you know how hard it is to fight the nursing home industry, they have a lot of legislatures fair and square, you can't let them win this. if people need a nursing home god bless them. we need quality nursing homes and need people to go there. they are not thrilled with the idea there ought to be quality estimates. they don't like that. we were really bad. we are now better in terms of balancing, if you let people stay in their own homes without going to a nursing home how much money is that? if you move people in medicaid into managed care, it is not where it was years ago. people have to be happy with their healthcare, if we were to go about doing systemic

changes, we would save tons of money for companies, call the cleveland clinic and ask how it is going. in a direction of personal responsibility, as much healthcare as you need, this is not complicated, it is not easy. for people who have a vested interest, how are we doing in pharmaceuticals. are you going to get on this drug thing? we want leverage. if people will not negotiate for medicare people we need to kick them off our formulary. that got their attention and i'm not putting drug companies down. it is out of control. there is lack of competition. what power do they have? what is it going to do? and the two tier system or single-payer system --

>> governor kasich, you talk about what the state of ohio with managed care and medicaid, governor walker, you talked about the reinsurance waiver. >> i would like to see the csrs continue. murray and alexander talked about bipartisan, can't seem to get this done and it is all politics, obama this and obama that. that system needs changed. and driving up the cost for the independent market. it is ridiculous that you have to do that, get more young people to buy in, with the medicaid side, i like to tailor medicaid to fit my population and tribal issues, colorado is

the same. that is why i hate him for that. and give us some flexibility. keep the issue alive, don't know if you heard that. i read that it is coming back. i hope it - we went politicians to feel safe going into the water. they don't want to get in because they are afraid they will get bitten by something but they have to get the market stabilized with what we are saying, lead a national effort to push quality over quantity. develop a system that makes total sense and do what you can to encourage businesses to do that. stabilize the system, give us flexibility at the state level, don't cut all our money off, start driving towards a system that makes sense long-term for

the country. >> not just across party lines but government lines, federal, state, local, tribal. in alaska our healthcare cost has coming down dramatically. the matter of working collaboratively rather than one office, we know the answer and no one else will be involved and we will sell your product, bring those together and work across that, those governmental lines. that is missing in this process. some are left out and bring much to the solution. it needs to be much broader. >> you are getting that. >> you have been able to work with them but it is not a holistic approach. there are specific one offs that we are able to get and that is helpful but not the whole process and the whole

product, pieces of the solution. >> it is fair to say it is a model for a lot of us. the reinsurance work he had to go through those different silos. how much work? a huge amount of work. that should be the natural inclination, to get the silos broken down and follow alaska, governors love to steal from each other so we will do it the same way they did but there is not that muscle tone. we are not used to working outside our silos. governor kasich was talking about a sense that we are all in it together. we need to get that. >> one other thing, let the design the medicaid program i once. let's change the obamacare essential benefit package to what i want and stabilize the

system. alexander murray, sounds like alexander murray, a figure in some movie, alexander murray but what happened to alexander murray? like healthcare doesn't matter anymore. i don't know if you know this or not. you know how much your kids have to pay to retire the national debt which is going through the roof? medicaid is a giant driver of this debt. there are ways to fix it. it is not easy. you will have people screaming at you but that is - you get hired as a governor or as a congressman to have people shout at you. then figure out what you are supposed to do and look yourself in the mirror and fade away into the sunset like i am likely to do. >> one in 5 americans live with some disability and many are trapped in the false dichotomy of access to the care they need

and opportunity to earn an income and become independent. i am curious how you are going to address that with particular critical needs of americans with disability which includes 56 million americans? >> this is one that is near and dear to all of us. we are doing everything we can to mainstream people, people who have disabilities, to get them out of the sheltered workshops and get them into work and make sure they get the kind of services they need. i salute a lot of these big companies actively searching to hire people who have special skills. far better skills than i have, things they do and the way they think. we are making progress. they need to have healthcare and sometimes it is medicaid

expansion, we are behind the curve providing health insurance for families that have somebody in their family who is autistic. we cannot let anybody live in the shadows, we have had a concerted effort, we are doing better and better and need to keep at it but mainstreaming and getting people where they need to be makes mom and dad listen to something like that, they are proud of their sons and daughters who have a satisfying and more meaningful life. this is the best of us. >> we went to see the end of this partisan special interests taken on. every dollar in healthcare, do you see any sign that either of these issues, any willingness

to tackle this on a federal level? >> i'm optimistic. what i heard from those in congress, the governor is coming together in a bipartisan, some have said thank you for doing what we have a hard time doing. the members of congress once what we are talking about but how to make that happen, that is what we are doing. we have a process that is a little different so we will bring this to them. >> an effective way to slow pharmaceutical costs? >> it is negotiation and job owning as much as you can. we try to get negotiated prices down. if you try to understand how this works, as a layman it is

easier to understand the hammurabi code than the way they get these rebates and other stuff. we made a couple -- a little bit of progress, if i told the president this january you told me the power to exclude somebody from the formulary that doesn't want to enter a negotiation, i will see a significant increase. if you invented the hepatitis c drug and that is understandable. all the drugs don't fit into that category and that is more complicated with hepatitis c and how they recover their costs. how much r&d did they actually do? or did they buy the r&d from the university and charge the university and claim r&d? mess of things need to be done.

a guy who is going to tackle this and understand the system, mental illness, diabetes, whatever it is, we need to get cost control on this. and i optimistic about congress getting this done. don't tell me, show me. i don't want to talk. i want action. i want alexander murray to pass on a bipartisan basis, the insurance market stabilize before more people get hurt. do i think they're ready to do it? let's take a vote in this room as to what you think? >> do you support adding work requirements in medicaid in the state legislature? >> it is okay with me because many vulnerable people are exempted and there is a sense

and i share it that i go to work, i struggle, my wife working, my husband working extra shifts or whatever, and i am barely getting by, other people hold this stuff for nothing. i understand that. that is not just trump voters but a lot of people. reasonable work requirements are fine with me. it has to be thought of in a way that will be practical. we will see what happens. there are work requirements for food stamps. everybody thinks you get this free stuff, sit at home and watch a flat screen and have obama phone and all this other stuff but the concern that i work hard like my mom and dad,

they didn't go to fancy dinner that didn't smoke, i'm putting my kids through college and someone else is getting something for nothing, there is a matter of fairness and justice. reasonable work requirements make sense. here is another problem. we all know this as governors. we want somebody to go to work. you can't have a welfare system where we say to a single mom you go to work and we will take a childcare away and when you go to work you will have less in your pocket then if you stay at home. you got to have a way to graduate people off of this dependence so they can get a full-time job so the job will give them progress. it doesn't mean they will lose more than what they gain. we work on that, particularly childcare in ohio but that welfare system needs to be understood and reinvented. >> one of the best cures for a social ill is a job. if you are not healthy, you

can't work, can't hunt to feed yourself, can't be productive. it goes hand in hand, to be healthy enough to have a job. speech is not to be taking care of sick family members that you can't get coverage for. >> last summer you came out with a bipartisan plan for healthcare but it didn't work out very well. how is your plan better than the one you presented last summer? >> this is laying out a framework that gets away from winners and losers and hopefully a catalyst to get new conversations going add new approach thes so we stop getting bogged down in the partisan year when i win, you lose, it is so frustrating to see the same old discussions. i agree with both these guys. csrs make sure private markets

succeed. it is hard to imagine how much damage will be done if we are unwilling to refinance those. that discussion has got to continue. i support governor kasich 100% in saying let's get alexander murray done. that being said, the goal is not to pick out specific issues but to provide a framework that will hopefully create new policies, new approach es, improve quality and lower costs. >> what is your answer to the work requirement question? >> i have no problem with it in the sense that take people who are healthy, a lot of people don't work because they are not healthy enough, a lot of people are taking care of a child or an elder, another person. we look at what that final number of people are that are healthy and it is a relatively small number.

we have got to get that as governor kasich said, they think people are freeloading on the system. the trick, the last thing any of us want to do is add a new level of bureaucracy, to compel a small number of people, do we want to make sure everybody works? our unemployment for several months had 2.3% unemployment. we need every able body, we would welcome every opportunity especially people who are differently abled. we worked to expand their opportunity to mainstreamed them into places where they got a job. that is a systemwide desire. are we going to put up some sort of penalty?

people are not going to work when they have the opportunity. with the overall cost of the system is. on the merits of it, most of the country has been built on people working. >> what about work requirements? >> the legislature is working on it. in 1334, the reinsurance. at the gen. assembly, i don't know where it is. >> i had a friend, bill paxton, when i was trying to get the budget balanced, he came to my office and said just keep sawing. that is what we are trying to do, we will keep raising this issue and doing things in the state and we - the feds let us have control, why don't they give us total control of job-training dollars, job

training programs in this country are just absurd the way they were. give us the ability to train people so they can get a job. don't just tell us, to get them to work. let's have a more rational welfare system, give states more control over medicaid, give us more control to do a lot of things. these young people, down in florida and across the country, we are entering a new era of activism, of citizenship and thank god because this country works best when we drive it from the bottom up and not the top-down. we in the state may be at the top, we think we will have a more vibrant country. >> governor walker, governor kasich and governor hickenlooper's policy teams will stay here in case you have any questions.

thank you for coming. >> tonight on c-span2 booktv in prime time. christopher scalia, the son of antonin scalia shares speech es by his father. and together we rise. after that republican national committee spokeswoman kaylee mcinerney, author of the book the new american revolution. ..but let >> sunday night on afterwards, growing up with survivalist parents in her book educated:a memoir. >> a lot of people have taken

to heart the idea that to learn something you have to have a degree and a whole institution in place to teach it to you. i am grateful to my parents but i was not raised to think that. it felt like something i could do not because i didn't have formal education but need to learn algebra. i barely -- kept going with that. my parents took it too far. i had never heard of it. they thought i was denying it. i had never heard of it before. this was the ideal education, i would not say that. >> watch afterwards that sunday night at 9:00 eastern. attorney for the doctor