a story to read back to them. not only are they more articulate, but they also are less hesitant over any of the words and more apt to read more. we don't do that anymore. we can assign that in high school or middle school or something like that, but does it get done? that's the problem. so we have a lot of il's. i'm not going to go into any more than that. but it is a matter again of being responsible and teaching responsibility. how do you do that? [applause] >> we will now open up to questions in the audience. keep in mind this is for questions, not statements. go ahead. >> thank you, gentlemen. can you hear me? thank you for speaking to us. my question is now that the

devices like a smart phones have put the infinite store of house knowledge in each of our pockets, the ability to immediately reference any subject we don't know about or are unfamiliar with does that undermine the necessity for learning and remembering information and undermine the value of critical thinking? >> the question is with ubiquitous smart phones and people's pockets is the undermining our ability to come up with things on our own? >> is my microphone on? testing, testing. this kind of question has been asked for two and a half thousand years. 2400 years ago, they rode a

dialogue where he complained the existence of writing would undermine people's ability to communicate with each other face-to-face so that these youngsters would go to someone and gain the knowledge that way to go up and read the scroll by themselves and learn that way and talk to people. anxiety about the impact of the media on the way of interacting are the technology itself. it is access to things like wikipedia. is this changing our ability to remember things and memorize? again it's always been the constant media driven change. so in the societies that didn't have writing, the ability to memorize long text was of value because there is no way to write

down knowledge so it is a tremendously valued skill of ancestors going all the way back when. in some cultures is a tradition to memorize the book. so that is a sign of mental progress and spiritual dedication. but as you say we live in a time of instant access to fact so memorizing stuff is no longer that important. now the jeopardy is an instant example of that. it is all about the ability to memorize useless facts and spit them out on command one. now what does this mean? one and it doesn't mean we're losing the ability to remember stuff. it allows us to develop new

kinds of tools and again this is what technology has always done. it's always changed the landscape and which we live and there would be loaned a loss of old skills. we develop new skills that are as powerful with than anything that has come before and we can see this have the internet has changed the way we think about information and treat information and to redistribute information, and i see that as good and a great many ways so they grow up not remembering what capital florida is i think today it's a much more valuable skill to teach kids how to look that up but as the professor mentioned you have to think about the information quickly so less time teaching them how to memorize and more time to think intelligently about will be

available in formation including the reliability and the fact that it's on the wikipedia doesn't mean that it's right. [applause] >> i would like to weigh in for a moment on this profound question. and that is worth what we if i know where the information is why do i need to memorize it and i think i remember coming through medical school and we had these big bucks to and i remember looking kind of bewildered to remember all that stuff you just need to know where it is so you can look it up. i always thought number 1i have a 15 minute appointment with a patient so that isn't going to work. so that information whether it is a medicine or any other field it's something that you need to have in your brain for several reasons.

one is that you are constantly synthesizing other information with what you've already got. and if all of the information you know where to get it it's not here so that when you add additional information my dad used to put it i'm going to give you the skeleton upon which to have all the information you are going to get from now on and that skillet and needs to be added to one thing i think i've noticed in children's adolescence and other adults we've lack -- we have a lot of disdain for things we don't need immediately. the idea of reading the classics why should i have to read the heart of darkness and plato? i'm going to go out and p.m. information management technician. that kind of thinking and when i talk to kids about that why do we really need this music or the text?

because each of these provides an illusion -- em what allusion to things are around us and when the children come and say i'm going to be this or that, i don't need all this other information, it means that they lose out on all that thinking that's going to have to be done for the world around them and if they don't know who plato was and all these other things and haven't memorized the basic skills, the one who says i don't need to know my multiplication tables because i know where to look up, that is how silly this sounds. you can't really get into algebra and do the precalculus until all of the operational information is at your fingertips and that's why it is so important that the operational information, which is facts, figures come all these kind of things are at your fingertips so then when you do the synthesizing any more formal thinking you now have that

information right there in this casserole that keeps getting more complex, more helpful in the context of the integrated with what you're going to be doing all your life which is going to be continuously learning and sharing the benefits of that with those around you that we served. [applause] >> the smart phones for me one real reason of good use. that is if we have a question in class, such as opposed to them, where and when was magellan killed? attack, attack, the find out its 1520. okay. the pieces on the beach. can you tell me why? there is no analysis. so, it has a good side. you can find a point of what i

would call a point of information but you can't find an analysis. it isn't there. [applause] >> to hear you speculate a little. >> can you hear me okay? , you're cochlear implant for example is that your most recent step in the advancement of the closely integrating technology with our other capabilities? and that is only going to get more extensive in the future. you will have implications for learning and how you are accessing information for the adolescent development and received in your 3-years-old for example when your system was more plastic what kind of the implications might that have for how you think and process

information. sue any thoughts you have on the evolution would be interesting to hear. >> the question was in relation to be in plant and is one example of how the new modern technology is evolving us and of the world. so just your thoughts on those implications. >> well i have a lot of thought on that and i just trying to figure out which one to pick up on first because it is a very general question. here is one of the key points that i try to make when i talk with people about the new technologies and what they make possible i think when a lot of people mentioned by on a future they basically imagine what we do today only bigger, better and

faster, see in the dark come here the ultrasonic. so this kind of thinking is the superhero fantasy thinking. it doesn't mengin e-mail before. the thing the new technologies do is they don't just let us do what we do now will mean better, this is the kind of thinking i try to write about in my books and my articles to try to imagine different kinds of futures so if you google search this you find other people use the word well but i use it in a very specific way of gathering information about one thing and that emotional state, have become anxious, fearful, sad. what is going on in that

person's activation in that moment. that is the kind of information that we get very quickly. we can get it over the telephone. but over the internet, that kind of information is fairly sparse. that's why it is prone to confusion. when i imagine the kind of future that people are linked together so they have access to each emotional state. i don't think that this so much powerful one on one but it could be powerful collective in the group's when you know how a group of people was feeling at any given moment. so, just think for a moment during the arab spurring on atwater, the ordinary shock, anger, hope, the whole wave of

feelings. that is the kind of collective communication that i had never seen before. that sense of collective reviewing of a large group of 4 million people. so i imagine this kind of information deploring. that is going to be a long way away because it is a trivial thing. when he. on the collective communication and we began to think about it today with. [applause] >> we can take the next question >> they don't do any sort of

video recording or listen to recorded music because they think that children need space to come up with things on their own and i was just comparing that to light my cousins have their little ipad, they are always on their ipad and stuff and i am just wondering like what are your thoughts? i don't have a good way of phrasing of the question. >> the question is about the cognitive development of young people with the access to the stories we have now. >> i appreciate that question because i think that the question was asked in such a way that a decision would be implied that i think this is a good or a bad thing. everybody has had problems with

new things that come along and say now what's going to happen with our children. as mike was talking about with just the art of writing but i do think that it's a very important question because many times people have those discussions on that level. that is we shouldn't have easy things or we shut. and what would that do. and as my colleague here was saying just a few minutes ago it has so much to do with what we do with that and what the parents and the teachers do with that. if you don't have limits on the use of the internet the absolute toxicity that is potentially coming from the internet to adults themselves is mind-boggling. the beneficial major warning it depends only on what they give

that kid. of the stories they read and the like i think it's important for us to have that reading out loud unwed. as mike said, we can decide at the adult level how can i use this technology to push us forward on things we couldn't do with other things that would be great. but we try to put our eggs in one basket so to speak if electronics are going to make it happen or if it is a lack of electronics that's going to keep us in good shape than i fink we are getting away from the question and we as adults need to be constantly synthesizing would have best to do that.

but that's very unwilling or even fearful of putting limits on these things what is your child and if he isn't doing homework it's about five minutes on the internet. i don't think that he has met any of them or talked to them really but he has 200 of them, what ever they are. and you would think that that would be a no-brainer in terms of response to the parents and that many of them have decided the limits. i've only been on for an hour and they started getting all bent out of shape because they are literally evicted to that part of the television. it can start as a 3-year-old. in montessori school i don't think that is appropriate in the

policy oliver montessori. i think the montessori people would be the first to say how do we teach the kids to make that the space or to utilize that in the discriminate that and use it in an efficient and an effective way. then how we teach them to use other things as well. one of the things we will end up teaching this generation is how to balance our lives and it's a metaphor balancing our lives with the electronics verses the ways of learning that we've had before. it's only a metaphor for balancing our lives and so many other things as we grow up. [applause] >> i would like to welcome you on that question. the last answers about technology it's great but there are also reasons for concern.

that's always been the case for new technology. when printing came out, the catholic church was concerned and they were right to be because a deteriorated the catholic church. these are things we need to be worried about. but today the things that we are worried about is how people form antonette bonds. smart phones are incredibly addictive. my wife is always trying to pry me away because it is so endlessly fascinating. there is always another story to read and e-mail and then the new york times. it's so compelling and it's very easy to stare at your iphone so there are a number of books that this is changing the way we form antonette relationships. she talks in great detail about

psychological profiles for the past 25 years the way they form friendships and a number of the friendships and the way they interact and seize an actual decline in the number of the relationships which is well worth learning about. so this is something that i tackle at length. i was imagining this much more communication, all of this cool stuff. the problem as it would be even more addictive than the iphone is that we have malcolm and it raises the ultimate possibility of the feature people live in synthesized world's and having virtual relationships and nothing else. i think we really do have to be concerned about a future like that. i think about this when i was writing the book. one thing i did is i took communication workshops where

you go into a resort in northern california which is where this was happening and you do exercises with other participants like sit down face-to-face a look someone in the eye for 60 seconds that is actually really hard to do. but it was very valuable to me to have that kind of practice in countering the other so i was trying to juxtaposed and say we can have both technology and the human communication together. it is not possible to imagine the future in which these things can happen. [applause] i would add a rhetorical question to that and that is can

and iphone or smartphone build pictures in the mind of the listener or are the pictures already shown so that you are forced to see the images that are built rather than to manufacture them yourself? which would you prefer? one is fast and the other takes a little skill. >> next question, please. >> i have heard reports that a lot of the young people -- this is more suicide. do you think that too much technology might be one of the problems to that? >> the question was there is a

rising suicide and do you think technology plays a role in this trend? >> the critical aspect to that as well as the philosophical one -- i was just sitting there is a clinical or a practical aspect answer to that question or the discussion of that question. but i'm very interested in knowing about the philosophical take in general as well. when you hear the high-profile suicide at least the ones i heard they've been in the context of someone being cyber bullied is the term now where the social interactions within something like facebook and the light are so out there and open that what used to ocher in the halls of the school of the children are among the high

school and middle school today kind of renamed so that it was more of a rumor thing and was very painful and destructive even then. but now it takes on the bubble in terms of the facebook type of socialization where any time anyone feels something it just splatters not to another person about the other person, but -- not to that person directly but it's bladders to the 100 people that happen to be stopping on somebody's facebook plus the hundreds of friends of those friends and the whole idea is that one of my professors used to tell me when we were coming out with a power point of slides and i was able to make slides and put together a presentation very quickly. you take your ideas and you can

have a very interesting and beautiful looking presentation. remember we used to have to graft the slides and do the notes and a lot of research and i would rather you not add to the noise out there. i was very insulted and hurt by that, but i think the lesson that i learned was. at least she wanted something that reflected some careful thinking about what was going to say. the problem with that is that there is so much -- i made a note here of premature how to send a response to a message

immediately to get back with them that it literally didn't necessarily reflect. it's on the social media in terms of the things people say. when you think of the number or put on the photographs, think of the implications of putting a photo out in public. i mean, we have parents that cringe at somebody having a photograph of their kids if they don't know who it is. think of it happening, millions of people having access to that and not being able to take that back. so, if anything, i think that from a clinical perspective in terms of the increase in suicide, i always kind of wonder how can you be cyber bullied? it's different to be on the playground and have somebody bigger than you beat you up. but i can't quite understand how to be cyber bullied because you

don't have to listen to that. you can just turn it off well, the way that happens, after i thought about it, is that it's a humiliation for. even if it isn't true there is no way to take that back. now instead of being humiliated to yourself and your fantasy about who else knows about this or has heard about this you don't have to fantasize anymore. you know that there are thousands of people out there that have seen less. that is one of the toxic things i've seen in the social media the way that it's organized now. the toxic thing about being able to speak your piece on the e-mail and ahmet media immediately before you have even had a chance to think about it and the destruction and the possibilities are very real. thank you. >> little follow-up on that same point is that google is coming out with the glasses -- sorry,

google is coming out with their new glasses the subtitle as they imagine it with the camera and your recorder. and we actually already have the memory capability now that not only can google take a picture but can record my every waking moment, everything i see. and i'm wondering if as people we will put up with any time we step out of the street and action, every word that we say in public may be recorded for all of time and may not ever get looked up. but now every gas and every stupid thing you do is now recorded and i am just wondering what your thoughts are and if we are going to be able to put up with that. stack the question related to the new google class is product and what your thoughts or on the ramifications of the product of that nature. >> i'm personally fascinated by

google glasses. i can't wait to get a crack at it myself. i think it's one of the product you can't really imagine the uses to which it will be cut. the experience with this as i interviewed a diet that is using a version of google class is for many years. he has built himself a new rig where the glass is a can see a computer screen in front of his face and he has a keyboard he keeps in his pocket so he can take notes on any conversation and then look at those notes when he meets that person ten or 15 years later and pick up the conversation from where it left off. so, i think that kind of technology which gives you that incredibly instant access of the information. you don't even have to look down to type, it's going to have both positive effects and negative

ones and one of the negative is that distraction. so, this guy is kind of hyper. when i talked to him it was stuff only he could see while talking to me at the same time. ..

4. at the same time. with google glass, i'm really excited about the benefits and i'm really interested to see what the dangers are. >> i just wanted to touch on one point that isn't specifically along the google glass but along the idea of children, adolescents who are not aware of the application what is they put on in terms of photos or maybe keeping track of minute to minute what they're doing with their lives and now i suppose everybody's had this experience, when you go in for an interview for a job, you have been googled. i had an attorney that we were going to do business with at home and i set it up. so i was talking to the lady at desk, well not lady, she was an assistant, she says,

hello, dr. hard a way. i will send you information you already already need. already got it. what have you got? i got your address and everything where you are looking and looked at some of the things you have written and very interesting. i was getting some chills. i was trying to think what else have i put on internet. when i think of kids playfully, because they could do this playfully before and put up crazy pictures of themselves or share that with a friend, what happens when the 12-year-old sex something or puts an inappropriate, well, we'll decide what's inappropriate put as picture they wish they would have never done? and a person applies for a certain school or any kind of a job and, revels in the indiscretions they have had at a certain point? that is kind of the toxic, scary things i think of in

terms of being able to record every event and have it for the public. >> on the subject of scary and hopeful, dr. hardaway is there any use of technology michael talks about, partially rewire, partially help people you find have problems? it seems like some of the things, some of the problems children have are kind of a wiring thing in their brain almost. is there anything being done that is hopeful? >> certainly the extent which neurotransmitters and pathways are getting, become more crystalized in terms of the assessment tools that are used, in terms of the use of glucose in the brain lights up certain pathways which is just incredible. it opens up whole new ways of thinking about brain disorders. the idea, i don't know whether you mentioned brain mapping to me earlier but

somebody had, that whole idea lends itself very much to the use of technology in terms of the way we're changing the effect on receptors in certain pathways. we do that with medications right now. a lot of times it is extremely helpful, in fact it is almost scary how helpful it is someone in the midst of a bipolar manic rage episode and not a manner of calming them down or putting them it sleep or drugging them out or something, it is a matter the mother the next day says i have got my child back. it is totally, it's gone. and so the extent to which the receptors are affected by many of the neurotransmitter replacements, medicationwise is a very real phenomenon. the idea that technologically we might be able to do a parallel what has been described by mike in terms of audio logic and other accident

communications devices, the vistas are wide open. you're not talking to an expert there. i'm talking in terms of philosophically. anything that has buttons on it i'm not supposed to be close to. >> in that context, is my mic on? one interesting fact in that context, there's a guy named ian stevenson who did a little historical study and asked how many neurons has it been possible for scientists to track in any give year between 1960 and now? so he went through the literature and he found out that the number of neurons that can be individually watched in the brain is doubling about every seven years. so that is now being called stevenson's law. it is an obvious analogy to moore's law. moore's law computer power doubles every 18 months. in stevenson's law, number of trackable neurons doubles

about every seven years. right now the numbers are fairly low. it is possible to track now somewhere between 60 and 200 neurons simultaneously in the brain. the numbers are on that order of magnitude. dozens, hundreds of every seven years of that number doubles, by 2040, 2050, it may be possible to track thousands, tens of thousands of neurons in the brain and have a much richer understanding what actually goes on in the brain during devastating disorders like parkinson's, epilepsy, bipolar and so forth and actually be able to treat them. >> thank you all very much. we have actually reached the time limit. thank you for coming. please give a warm welcome, thank you to our panelists. [applause] >> president obama today called on students and parents to call, e-mail, or tweet their congressional representatives and demand that he or she take action to prevent government-backed student loan interest rates

from increasing in july. speaking from the white house rose garden, here's a look. >> if congress doesn't act by july 1st, federal student loan rates are set to double. that means that the average student with these loans will rack up an additional $1,000 in debt. that is it like $1,000 tax hike. i assume most of you can not afford that. anybody here can afford that? no. now this sound like deja vu all over again, because it is. we went through this last summer. some of you were here. it wasn't as hot. i don't think we did this event outside. but we went through this and eventually congress listened to all the parents and young people who said, don't double my rates. and because folks made their voices heard, congress acted to keep interest rates low but only did it for a year and that year is almost up. so the test here is simple p

we've got to make sure federal student loan rates don't double on july 1st. now the house of representatives has already passed a student loan bill and i'm glad that they took action but, unfortunately their bill does in the meet that test. it fails to lock in low rates for students next year. that's not smart. it eliminates safeguards for lower income families. that's not fair. it could actually cost a freshman starting school this fall, more over the next four years than if we did nothing at all and let the interest rates double on july 1st. so the house bill isn't smart and it's not fair. i'm glad the house is paying attention to it but they didn't do it in the right way. so i'm asking young people to get involved and make your voices heard once again. last year you convinced 186 republicans in the house and 24 republicans in the senate to work with democrats to keep student loan rates low.

you made something bipartisan happen in this town that is, that's a powerful thing. >> c-span2 continues the live coverage of book expo america in new york city this afternoon, with a panel discussion, titled, self-publishing, disrupt tore or defender of the book business. coming up at 2:00 p.m. eastern. then at 3:30 a look what those new to the publishing industry think about its future. a panel of graduate students in the new york university publishing program will share their thoughts on the industry. c-span 2's live coverage from book expo america gets underway at 2:00 eastern. each evening this week we've been featuring booktv in prime time on c-span2. tonight at 8:00en, the in depth interview with melanie phillips. the author of 8:00 none fiction books. the global battle over god, truth and power.

miss phillips is also a journalist and a columnist for the london "daily mail". again that is tonight, 8:00 eastern, here on c-span2. >> when you first arrived four years ago i'm sure you never imagined at the end of that panel there would be a lady behind a podium talking to you in a funny accent. [laughter] this accent is the beige of my existence until in 1980 i moved to new york from england and i met henry kissinger. and he said it me, don't ever worry about your accent. in american public life you can never underestimate the advantages of complete and total income prehensability. >> this weekend, more stories and advice for new graduatedding class, with come men'sment speeches from government officials tonight at 8:00 eastern. fbi director robert mueller, federal reserve chairman ben bernanke, maryland governor

martin o'malley, florida governor, rick scott, attorney general eric holder and newtown, connecticut, first select man patricia lodra. saturday at 8:30 business leaders. nate silver. apple cofounder steve wozniak. new york stock exchange, euronext ceo duncan duncan niederauer. and arianna huffington. and wesley bush and former president bill clinton. >> on c-span3 tonight it is american history in prime time with highlights from a recent event honoring the vietnam war p.o.w.s.

>> yesterday, center forward released its study on the health care law's impact on insurance premiums. the study showed most people will see an increase in insurance premiums, particularly the young and healthy. former bush administration congressional budget office director, douglas holtz-eakin and former north dakota representative earl pomeroy talk about the study's findings. it is an hour and 10 minutes. >> on behalf of center forward we welcome you to our program this morning. as i hope you know center forward has existed now for three years. we're all about discussions. we're all about across the aisle conversations in this

hyper partisan atmosphere that we have up on the hill here. we think it is important for an organization like center forward to bring panel discussions together over issues that are currently very important to the american public, very important to those policymakers on the hill as well. so we view our role as aiding and assisting and providing information and today is about providing information as well. we bring together, in other smaller programs, we bring together members of congress from both sides of the aisle. both sides of the hill. we bring together staff. we invite trade associations, not-for-profits, corporations, union representatives as well, to come in with topical conversations. our stakeholders support us and we appreciate that support. this has been a very dynamic effort on our part. those of us that left the hill and moved downtown are eager to see that centrists conversations occur in this

particularly difficult atmosphere. so today, is to some extent of course about education. we provide educational programs for the general public as well, as i made reference a few seconds ago we like to produce information. today's issue is health care. center forward has come together with miliman incorporated to produce a study to look how certain aspects of the affordable care act will affect health care premiums for americans going forward. and already there's a lot of demagoguery. there's a lot of information out there, slants on that information about the affordable care act and health care premiums as well. we will see today a presentation. jim owe -- o'connor of miliman is here to lead the presentation. he flew here from chicago to lead the presentation. essentially we'll have a reaction to jim's presentation as well by our

other panelists. i want to make you aware who is participating in the program. at the end. program there will be time for questions from the audience and we'll make sure we guard our time to a certain extent to make sure that happens. but the first panelist is jim o'connor to my immediate left. let's warmly welcome jim and doug, and early pomeroy as well to our program this morning. jim is a principle and consulting actuary with miliman. he has considerable experience consulting in the individual health and small group insurance markets and has been very involved in assessing the potential impact of health care reform and the various provisions of the affordable care act. so that is very relevant to the conversation this morning. he has provided insight with regard to the implementation of the affordable care act to the national association of insurance kmegsers, the massachusetts connector and society of actuaries among others. jim, we well company you to

our program this morning. briefly before jim presents, we have doug holtz-eakin with us this morning. as many of you know doug currently serves as president of the american action forum, previously served as the chief economist after the president's council economic advisors. he was the sixth director of the nonpartisan congressional budget office and served as director of economic policy of john mccain's effort to be president. doug, welcome to this program this morning of then we have earl pomeroy joining us. earl, a former member of congress, currently serves as senior counsel at alston and bird. he brings 26 years of regulatory and experience to today's panel. proof perfect we continue to learn information we don't know as well as i know this nine-term former member, i did not know he served as north dakota insurance commissioner. he was president of the national association of insurance commissioners. so earl, welcome presence here this morning.

jim, i'm going to turn the presentation over to you now. jim o'connor. [applause] >> thanks, bud. the, the affordable care act of course, we've heard a lot about it and what its potential impact can be and what milliman has done, we've, on behalf of center forward they retained us to look at six specific states as to what those impacts might be. and the states that we looked at were, arizona,

florida, illinois, new jersey, ohio, and wisconsin. so each of those states presents its own type of characteristics. one of the things when we're talking about change, going from 2013 to 2014, is the regulatory environment, the current regulatory environment of each state right now. in each of these states varies somewhat in their current regulatory environment. and in particular, new jersey is a, has regulations different than the other five states that i mentioned. in that many of the reforms that are, that are being required through the aca, the affordable care act, are already in effect in states like new jersey.

so that's one of the reasons we chose a state like that so that we could see the contrasts between states that have already passed a lot of these rating and underwriting regulations compared to those that have not yet passed those and there's significant differences certainly in what we'll see as, as impacts. so our analysis included looking at the minimum benefit coverage. the essential benefits being required under the aca. the maximum and specified levels of member costs sharing or the act aerial values that you may hear. the premium rating restrictions regarding age, gender, the fact that you're no longer going to be able to rate by health status and some other insured

characteristics. the fact that coverage is now going to be guaranteed issue. that obviously is going to be a big impact in those states that currently allow medical underwriting. and the federal subsidies. so what is the impact after all is said and done? insurers come out with their premiums but we also have these federal premium subsidies that are going to be provided for people who have household incomes under 400% of the federal poverty level. we look that as well. that is really what the consumer will feel is the after-subsidy premium and those affect people in different ways clearly. and then finally the aca introduces new taxes assessments and fees to insurers that will get passed through in terms of premiums. and so those all affect

premiums. so those are some of the key driving forces that will affect premiums. we concentrated our studies, mainly on the individual market because the individual market is the one that is most affected by these changes. and, at the same time, the individual market today rep rents about 5% -- represents 5% of the population. we expect that to grow considerably over the next several years because of aca and we think it will at least double. so there's a lot of focus on the individual market for those two reasons. number one, it is the, it is most affected by aca. number two, it is expected to grow the fastest as well. we also looked at the small group market and i'll, i'll

have some comments on the small group market as well, in terms of how it gets affected and while the effect is not on average as great as we might think it, for the individual market, there's certainly effects on small employers. and i will have some comments on that. so, if we're talking about the individual market, the key observations we made is that certainly before aca, other than new jersey, these states allowed medical underwriting as i mentioned. they allowed carriers to vary their premium rates based on the risk characteristics of the applicants who are coming to them so they did vary their rates based on health status. they varied their rates

based on age, gender, geographic location, those things. with aca we're not longer going to be able to vary rates by health status or gender and our age rating will be compressed. so instead of having premium rates where the rate for a 64-year-old is five times as great as the rate of a 25-year-old, aca compresses that to 3 to 1. so they can't be more than 3 to 1. actually in the individual market because carriers are able to rate for health status and some other things that five to one actually can be, actually gets expanded quite a bit because of the premium add-ons for poor health status. so we see a much greater than five to one in today's

market and that's all going to be compressed to three to one. so that really affects a lot of people and we illustrate that in our report as to what those effects are. and as i mentioned, those effects depend on the characteristics of each person. so, that's certainly is one of the findings that we illustrate in the report. the other thing that is evident is that the participants in the individual market, because they're paying all the premium, out of their pockets, they're not getting any kind of help from their employer, they tend to choose lower cost policies that have much higher cost sharing. so aca has a new requirement that that cost sharing, the

percentage of benefits that the health plan has to pay, have to be at least 60%. well in today's individual market, in a lot of states, the average is less than 60%. so what's going to have to happen is that the, the person who today is insured with a policy of less than 60, let's say they're at 50%, are going to have to upgrade their coverage. so they're going to have to move from that 50% level to that 60, at least that 60% level and that's going to get reflected in their premiums as well. so they will bear the costs of getting those extra benefits. they do get extra benefits with that but of course it will cost them more. so they will, they will see that in their, in their premiums come 2014. those people who already

have plans that are above the 60% level, they're not going to be affected by that part. so they won't see that piece of the increase that will be coming through. so what we've done in our studies here, is we've looked at two sample plans in 2013. so we looked to see what our, what our popular plans that are being sold and, from those plans we chose two plans in each state. one of those plans was a popular plan that had an actuarial value of less than 60% and the other plan was a plan that had an actual value greater than 60% because we wanted to illustrate the impact of just that factor itself. so when you look at the details of our presentation you'll see that obviously the total rate changes for those who have plans less

than 60% actuarial value are greater than those who already have a plan with, that pays more than 60%. so, new jersey was a little different. because new jersey already passed a lot of these, these requirements such as guarranty issue in the individual market, such as unisection, the -- unisex, the changes in new jersey are far last than what we see in those other states. new jersey has standardized plans that are required in the individual market. so that also reduces somewhat the, the actuarial value impact in that state. so we see in new jersey that, people can certainly get reductions in their rates, even before the subsidies.

so the, the thing in new jersey is they have two different types of standardized plans of the one they call basic and essential and one they call standard plans the basic and essential are a little bit less regulated plans, less, less rich plans. those plans will get more impact in new jersey than the standard plans. so even in new jersey we see people, depending where they are and what plans they have today, get impacted differently than, than people who have the richer standard plans. some of the rating characteristics, or some of the rating provisions are different too for those basic and standard plans and that gets reflected in those new jersey rates. and finally, we look at the federal tax credits. those are the premium subsidies. those premium subsidies can

be very significant for people who qualify for them. as i mentioned, people who have household income under 400% of poverty will qualify for them. what does that mean? for a family of four, we're talking about a household income of about $95,000. so people, below that, threshold, and in a family of four are going to qualify for some consideration for premium subsidy. some things we have noted with subsidy, while they are very, very generous to people in the lowest income, in fact, they're so generous that for people, because, premium subsidies are based on what is called the silver

plan that, that's a plan with a 70% acutarial value, if someone chooses to purchase, what is called a bronze plan a plan with 60%, the minimum, some of those people can actually get their coverage for zero premium after subsidy. . . >> there are also some people, particularly younger people,

who, even after subsidy, you know, qualify for very little subsidy actually as it turns out. and that's because the way the subsidy formula is, it's based on household income. so whether you're 27 or 57, if you're at the same household income, for the same size family, you're going to get the same subsidy. well, because premiums are much higher for older people than younger people, some of the gender people, their premium rates are actually less than what the threshold for their subsidy. so they end up not even getting subsidy. that tends to happen somewhere above the 300% of poverty. so it varies by age in terms of who really gets the subsidy. it's not just quite the 400%

level. that's when you start looking at it, but in effect, younger people and a lot of situations its 300 or more. that do not get subsidy. so those were some of the key things we looked at. of findings that we have basically in the five states other than wisconsin, before subsidy the changes that we are seeing are going to be somewhere in the area of 15% up to 16% on average. so those are pretty wide range of potential changes. and certainly very high increases. now i need to note when were talking about these increases, we did this study just looking at the impact of aca on premium rates. in addition to these, there's also the normal type changes

that happen due to the annual increase of costs of care. so what we actuaries refer to as trend. so in addition to these you should consider that trend will also be added to these. and trend varies state-by-state, plan by plan, but it ranges typically somewhere from 5% to 9% that we are expecting for next year. so those will be some additional impacts that people will feel as well. now, one of the things that we did in our study is we looked at 2014 plants. so the 2014 plans were modeled. we assumed that those plans would have the same type of provider network and managed

care features as the plan that people are coming from. what is happening in the 2014 market, in order to keep rates as low as possible, health plans are introducing new plans that have alternative provider networks. you may have heard the term narrow network plan. so we number of plans will introduce alternative plans with these narrow networks, which can help drive down costs because they are able to negotiate lower rates with providers, if those providers want to be in this narrow network. and i think we have seen that that's been the case in the rates that were released by california last week, that a lot of those plans are narrow network plans and have been able to support lower premiums and

what we otherwise would have expected. so our study to did not want to look at what effect that might have. and that affect might be a 10 or 15% lower rate than might otherwise be effective. so that kind of counters for people who opt for those types of plans, counters the trend increased that i just mentioned, and maybe a little bit more than that. so we see increases on average between 15-16% in these states. new jersey on the other hand we see their average is going to be somewhere between minus 25 and 0%. that's where the sample plans that we looked at. there could be other results certainly. there's a myriad of current plans out there that will affect people.

now, of those, of those pieces, a good chunk of that is due to the fact that people will need to upgrade their benefits to that 16% level. so in our report we give an indication of what had become and it tends to be somewhere in the 10-25% range of that 15-60%. and final we also look at the subsidies again come and as i mentioned they can be anywhere from 0% to 100%. so the subsidies can vary quite a bit. what i encourage you to do is read the reports. the reports are out on the center forward website, but don't just read the reports. read the appendices, because in the appendices where the real detail is picked in that

appendix we look at the affect, both before and after subsidy, based on sample ages. so we look at ages 27, 37, 47, 57, 62 for males and females. will look at different health status level. so people who are very healthy all the way to people who are quite sick and who are getting a large rate ups right now on their premium rate. and look at different income levels. so they saw all those combinations, you can see in our appendices how those rate changes might be expected to come out for a person any given situation with their characteristics. that's where the real value i think of the study gives you that kind of detail that you can get a good sense of that it's true that there are winners and losers in this, and that kind of

illustrates who those people may be in terms of, of who's going to pay more, who's going to pay less than what their current premiums might be. and, finally, i want to talk about a small group market, and the small group market, we see that, you know, most states there will be increases. one of the things that most states allow is to very rates for small groups based on its composite health status. that's gone away. so we took a look at what the distribution of those rate ups is in each of these states. and based on that we are able to take a look at what impact that has. that lets our key focus in a

small group markets, is what impacts just that once you to change is going to have. and it average somewhere around six-12% foremost, for each of the states. and what's really key though is that that's just an average. and if we look at, you know, who are, what% ago groups are going to increases for the versus what percent are going to have decreases, we see that typically somewhere from 70-80% of the groups will get some kind of increase for that. and those increases will vary. the average in our study turn out to be somewhere between 10%-25%. again, new jersey had the least

increase of all those. included in those increases is the edition of the taxes and fees that are also going to impact those. they tend to be around 3-5%. then another percentage of the small groups is going to see decreases, and those decreases can be somewhere in the range of 10-15%. actually one of them, ohio, i is in excess of 15%. roughly 20. so small groups will also see differences based on their characteristics. what we didn't factor into our study for small group of though, small groups also be affected by the age changes and the unisex require but a vc. because an employer group can differ in its makeup in terms of age and gender, we really

couldn't look at that into much detail. but certainly groups that are made of younger, healthy males will tend to have higher rate increases than those groups that are unhealthy or are comprised mainly of older people. so the age gender impact also plays a role here, too. so those are our main findings, and with that i think we're ready to open our discussion. >> thank you. thank you, jim. and we are ready to begin our panel discussion. and doug, we will start with you. if you're comfortable there. >> first of all, thanks to bud and the center for fortunate to be here today. this is obviously a very important issue, and i'm thrilled that such a distinguished panel.

i forthwith gym in the past, have a lot of regard for his efforts and i worked for earl and i still live in terror of them. [laughter] i love this work, and there are a number of reasons. first, it accords with everyone's intuition about what some of the features of the affordable care act have to produce in terms of premium change. when you put in the age rate, if you tighten those and you see can charge higher premiums for older compared to the younger, and without question you would expect to see increases among the young and relatively increases among the old. this comes straight to in the analysis, and certainly at odds of a differential impact depending on what you have those regulations in place. given that we have had so much speculation about how the affordable care act will play out, it's nice to see a study that cements everyone's intuition about the pattern of

increases and the level of increases that are likely to prevail. the second reason i love this is it gets the same answers that i worked on. what could be better works in january, the american action forum put out a survey which was a survey of insurers, and asked that i should have a similar question, not identical, but we asked them questions like him if you have a 20 7a healthy meal in chicago in july, and this is the policy they have right now and we add the age bands and guaranteed issue and a variety of other regulatory restrictions that are placed on insurance, what happens to the premium, and we've got answer that look very much like the appendix that jim recommend you read. so there will be very different impacts depending on who you are. averages are not going to help. the young and healthy are going to seed the increases come in some cases our surveys had 200%.

they are number for him that is 197, very close. these are sharp premium increases. for others they will get relatively decreases as result of the regulatory framework. and so you just don't want to rely on an average. there isn't a single number that's going to tell you the story about the aca implantation. some people will get quite a bit of impact and others a lot less. that's important and raises a couple of wildcards that i think deserves some further work. we did a second survey which we put our recently last week that surveyed young americans, 18 to 40 year-old americans of interest. we actually took the time to find out their monthly premium and as result be able to turn into dollars what happens if the premiums go up 10%, 20% or 30%? which based on all the work that's been done including

today, are not crazy possibilities under the aca. and answers are quite striking. in a group that basically looks at the law and says i like some of it, i don't like parts of it, it's not an act or political calculation but it's a consumer price decision to a look at what happens to the cost of your product and that a certain price point they say we're done. if you look 10% ago someone had% of people having coverage, down 83%. we lose the 70%. they pay the penalty but if you raise it up to 20% it drops to 65% of them receiving coverage but if you raise up to 30% it's down to 55%. those are quite striking results about the price responsiveness of the young folks who are important part of the pool that are going to be on the state based exchanges. that leads me to the final point, which is this is going to depend a lot on money.

the way you solve that problem is easy. you throw money at it. either by having subsidies and this raises the importance of this subsidies jim talked about, yet subsidies for those young people, so their net of some supreme doesn't go up 10, 20 or 30%. they get a smaller increase and they need to purchase, they say in the pool. that's one way to solve the problem. or if you choose to exit and we're left with much more expensive pools, the reinsurance provisions of the aca and other ways of subsidizing issued a very costly, it will become important and i think how that plays out is something i don't know the answer to and i think merits a lot more consideration because it's at the heart of having this be an effective functioning expansion in insurance for americans. last piece i want to emphasize is something that i'm glad jim mentioned, which is there's a big difference often lost in the public debate between health

insurance coverage and health care, and the choices and care that people actually receive. and we are seeing this, and this innovation called the tight network where care choices will be far more limited and where the care people receive will be affected by these coverage regulations that have been imposed by the aca. that's the second thing that we don't really know yet how it will play out but i think it's very important, and merits watching it. other states are going to the process, picking up the insurers filing for coverages. what's the nature of that and how much of it is broad and open networks, some are very tight network, what other restrictions on care options in order to keep the coverage prices at minimal levels. the short version here is to i want to applaud both the work

i've done to think it's the exact right work we need, the five were having this debate to talk about, and to encourage everyone that one of the key takeaways is there isn't a single answer. this, sadly, will be a nuanced public policy issue and it has been my sad experience that nuance is not easily played in the public debates so get ready to be disappointed. thank you. >> irl? >> thank you. i'm very pleased to be on this panel. jim has produced a very interesting body of work here for mr. levin, and i do think that it should be commended for the level of detail it gets into showing the nuances of just mentioned in terms of the rating picture. doug holtz-eakin, we have known, respected for gosh at least 15 years. someone that has been very engaged in the political debates while keeping his intellectual integrity intact, which is kind

of no small trick. so doug, congratulations on that and it's good to be with you this morning. i have an interesting perspective on all of this, with my background as insurance commissioner, member of congress. voted for the bill. good reason why i and private sector today -- i thought of this a lot, and i'm fighting the debate on rate increases right now to be about as partisan and disappointed as much of the debate about the whole darn bill. got on the republican side rates and filing. if there's an uptick in the rate proposal they think, rates shock, the bill is a failure. democrats conversely looking where the rates are not impacted to severely and they will profound about as absolute proof that you can expand coverage to

those who cannot get coverage. you can limit surcharge to those who do not pay much higher premiums. and it's all free. there's no consequence whatsoever. obviously, either side is just continuing the kind of melodrama approach, and it's important to understand in context why the situation will for some involve some rate increases, but what are the trade of policy benefits that have been achieved? when i was insurance commissioner, 85-92 this is kind of the last period of serious efforts by th reinsurance indusy in my opinion to contain medical costs in order to keep the premiums affordable. in the end the increases in medical costs one today. and the business of health insurance changed. it became much more the business of identifying risks and either

exclude it from the pool or surcharge and it as a way of keeping premiums affordable. there were a number of schemes we addressed as regulators, trying to keep that from getting entirely out of bounds. you know, as a business practice segmenting out high risk, is certainly a legitimate approach from a business standpoint, and as a social policy stempel, however, you might think that this is not an acceptable foundation for health insurance for america in the 21st century. the affordable care act i think at its core tries to address it. basically says if you have been excluded from coverage because of a health condition, we will ensure that rules that keep you out our chains and you're not able to access coverage. if you have been surcharged to an unacceptable degree, and

unacceptable statute, 321, for example, are much lower, tighter than presently existed. you would not be charged over that period, over that amount. it's been in the event the cost consequences of this clobber you, your income levels you can't afford coverage and you don't get coverage at work, you can come into the insurance exchange to buy your individual coverage. and there will be premiums subsidies in order to keep it affordable. it is a hugely complicated piece of work with an awful lot of decisions taking from the marketplace and decided as a matter of social policy. leverage of coverage that jim mentioned, for example. the way coverage is our marketed. the loss ratios imposed upon insurance companies waging into this, this brave new world. all very savory limited and,

frankly, what we are seeing underway with the insurance company is the most complicated reading challenge i've ever seen, looking at insurance rating almost 30 years now, because it involves the great unknown. new systems and market structures, and behavior responses from the population that would be impossible to predict. i think that the political debate about whether or not the rates will be in this or whether there should be no great consequence, there's a real disservice to the different kinds of market is in getting coverage priced accurately for the next year. the way i like to think is we are shifting gears. we're moving from a system that has excluded risks or surcharged it to a system that expands the

cross subsidy, the rain nature of what insurance is, it's a cross subsidy. we expand the cross subsidy and we shift to where there's this greater coverage uncertainty, and more extensive coverage available. and we subsidize those who are out the moderate end of the scale. moderate defined up to 4000% of poverty which as a family of four is 95, $96,000. the premium, i think a lot about the print subsidy on this part, first of all, the individual market and a small group marketplace with a portion of health insurance marketplace most giving way under the old system. and so the changes are most dramatic in restructuring the marketplace into since. and basically the $64,000

question, as they used to say, that will ultimately determine rates in these new individual health insurance exchanges is who signs up. one can expect a behavioral response, for example, from people with health conditions that have excluded them from coverage, now they will sign a. they understand very actually the financial risk to the family of not having coverage to pay the medical bills that they were much more likely need to be incurring. on the other hand, you might make a case that, well, they're subsidies available for people who have been self insuring the risk that they don't have in adverse health event, or an accident, break a leg and had to see an emergency room doctor. now they're going to have subsidies making that coverage available. really -- will they respond? won't be up -- that is an

unknown question. politics again is weighing in on this one. i think we've taken efforts at voter suppression and we've moved them right over to efforts that is enrollment suppression but we're not funded information, getting information out to let people know who may be subsidy eligible. you've got a new shot at a formal coverage. secondly, we have seen where the sect of health and human services reduced, you know, shaking a tin cup, panhandling for some contribution because the congress would appropriate money for sign-up, to try to raise private money to assist the nonprofits, been accused of something as to assess to believe -- as disastrously as the iran-contra.

what is this about? this is really trying to first of all discourage the contributor universe and discourage any administration ever is to raise what they could not get funded publicly. to the end that we don't really want people to know about these exchanges, because we don't want them in the pool. so i think that that's, on the one hand, has been an unfortunate aspect of what we are seeing relative to the potential to get as many lives in april as possible, and you need allies in the pool in order to keep the premiums down. so that would be my being on one side but my being on the other side, i think the democrats have to be real. there will be rating consequences when you expand coverage and you guarantee access and you narrow premium surcharge and, of course, there's going to be

consequences. you might say, well, at least you are getting more. you're getting assurances you can get coverage. you're getting better coverage and that is true. but one facet of this, a small facet but one that jim raised maybe 4%, maybe even 5% related no improvement in the policy at all and this is insurance fees and taxes newly created under the bill. this happened in the senate by the way. [laughter] the insurers are faced with the new fees and guess what? they can't deduct them. i think there was some maybe on capitol hill are thought by golly, we're going to show them, they can't even deduct these new taxes. so then who pays them? the very people that are paying the premiums because that cost is passed on and priced at in the cost of coverage. and so that premium driver that doesn't contribute anything and enhanced coverage for the

policyholder. so jim ends up icing winners and losers. we see how that turns on who, where, how old, how much. who you are, have had health conditions, which are gender? where do you live? some states have made this shift already, got that much impact. how old? if you're younger you lose the trading band limitation if you're older, you are under the limitation. and finally how much coverage you bought also will very substantial in terms of whether there's a rating impact on the premiums or not. but finally i don't think of it as winners and losers because i don't think we had an acceptable health system, one that basically put its dead level best to either keep you out of coverage if you need the coverage, and did nothing to respond to those who couldn't afford coverage at all. that was a system where in a way

we were all losers. we have made ca come we're in te middle of a difficult transition, to on a very competent to redo but i think will end up with a stalker health insurance system as a result. spent thank you. terrific comments. before we go to the audience for some question, is it anything you want to ar discuss or react? >> certainly, the point girl and doug both made are very valid -- girl and doug both made a very valid. i think one of the keys that we need to understand is that i had mentioned that rates are different in different states right now. earl mentioned where you live can be important. when we talk about a state like new jersey, or we state look at a state like new york where a lot of these reforms have

already put in place, you look at their premiums today. they are quite a bit higher than the premiums better in other states that we looked at that haven't passed those reforms. i think that's a good indication as to what direction we think premiums for the individual market will probably move over time as the new requirements get put in place. so we do need to be cognizant of all of that. and again, as i've mentioned, everybody gets affected in one way. i really encourage you to look at that type of detail and not just look at averages. that's really where it's important. >> thank you, jim. now, if we could have question from the audience. bear with us here. we will need to get a microphone to you.

and for you to stay who you are and who you represent. >> guetapens from fox business. jim, could you tell us, and i haven't had a chance to read the full report but how and why you selected these six states? you i assume look at all 50 states and selected these based on some criteria. and just to follow up on that, to give us an idea about the geographic impact, how many states would you say are like new jersey and new york and massachusetts, and already have a lot of these reforms in place? and thus the residents might not see large increases and how many states are more like, or on the other side, without as many reforms? >> we selected the states largely due to several criteria. one is we were getting data from certain carriers, and so the

states where they were operating, where one of the criteria where we could get good data. the second criteria was we wanted a mix of states, as i've mentioned, where the regulatory environments were somewhat different. so new jersey obviously put out one with more restrictive regulatory environment. arizona was a state and ohio is a state where probably has far less regulatory requirements than other states. and then states like the other states in a state like illinois and florida were somewhere in between, though most of those states that even are in between, the middle, tend to be more summer to those with least restrictive than those are the most restrictive because they do allow for rating variation as

well as medical underwriting and the ability to decline. in terms of the number of states, pretty much the ratio that we have in our study is the same as what we we see if we look at all 50 states. so the states that have already passed a lot of these, like maybe five or six of these states that i would put into that bucket. and then the least restrictive and kind of no restrictive, certainly the other 40 or 45 states are falling into that, that category. and within that middle there's regulation the makes a

difference, the regulatory environment not only for the individual market which we can concentrate on, but small group markets. some states that are more liberal than individual markets are not necessarily all that liberal and a small group markets. so that makes a difference in terms of choices that employers may make going forward because today they may have made some choice based on the current regulatory environment. tomorrow when their revelatory environments are basically the same across the nation, those choices may be different. [inaudible] >> we need the microphone, sorry. >> to be fair than to assume that about five of the states will not see significant increases on their health care reform, and 45 will see, residents face a bigger

increases, everything else staying equal? >> i think that's a fair statement, that certainly not only will those five or six states not see increases, quite possible that quite a few of their members will actually see decreases in rates, provided that the inflow of new members are healthy. so we've got to get that help the inflow of new members in order to bring down the average health status in the risk pool. because right now in those states, because there isn't a mandate, a lot of the healthy people choose to stay out of the market simply because the premium rates in those markets are a lot higher than they are in the of the market. we don't need that inflow of new healthy lives, as well as those

lives that we expect to get who are certainly less healthy. we need the proper mix in the risk pool. >> one thing, as you look at most people and the coverage, jim mentioned in his opening remarks, covered in a large employer groups. from that part across the 50 states, you see much less an impact are talking about the smaller portion of the market, the individual market. >> a question back there. spent my name is sophie. i work for representative dan lipinski. a clarifying question for something you said in your previous answer about who responded to the study. i just wanted to confirm that in the states that are studied here, that the companies

covered, comprehensive. so the either companies that did not respond? >> no. what we did was we sought information from the blue cross and the national any of these 50 states. we didn't look to every kerry in the state. >> question down here. >> tony pugh. i wanted to ask you, commissioned that an estimated 5% of the injured market in the individual market, i wanted to find out what percentage is covered to the small group market. and of the five or six states that you said at the aca, like requirements already in place, you mentioned new jersey and new york but is hoping you could kind of fell into place on the other three or four. and i was hoping somebody could

address whether the availability of the castro the coverage that typically has lower premiums, is that not a viable option for the young healthy people that will face these higher premiums? >> okay, the other states that we're talking about would be new jersey, new york, massachusetts, vermont, you might consider main. we may consider washington, oregon, those types of state. those less states less so than the first several that i mentioned. what was your second question? [inaudible] >> the small group market, ma i don't have those numbers with me, but that would roughly be about 10, 12% i think of the

population. and that's true, we talk about small group, we're talking about companies with 50 or fewer employees. >> and in a catastrophic? >> the catastrophic coverage, certainly, certainly plans will be out there for young people, or people who find other coverage unaffordable, you know, purchased at a lower cost. so, i mean, there's some viability certainly to that plan. you know, i don't think it's the type of plan that's going to be attracted to everybody who qualifies for the plan, but certainly having that plan at least does give another choice of people. >> a couple things.

on the small group, a group of 25 and fewer there's a tax credit in support, 50% for the first two years of coverage. and my particularly two years, that's a bait and switch, getting in and charge them later. the rationale behind 50% credit for the first two years is you rearrange are pricing in their cost structure so that you work your way into employer coverage for the small employers on 25 and under. again that may not have had. that is not mentioned in jim's report on that. [inaudible] >> you need a microphone, sorry. [inaudible] >> is that a relatively small,

and your pain is that it relatively small slice of the total market that would be affected? >> clearly i think, you know, most people will not directly feel the impact of aca, at least to me at least. because most people are employed by large employers who come here, are not subject to the essential benefits. they're not subject to the minimum actual or -- they are subject to a minimum value of 60%. they are not subject to these rating requirements. so they won't feel type of impact that was hunting about the other 20% or so. they will feel some impact because, because the large employers are going to be subject to the taxes and fees. so they will see, yeah, some of

their premiums, these taxes passed on to them in the way of premiums. so yeah, i think that's right that certainly a majority of the population is not going to be impacted as greatly as the people in the small group in any particular market. >> i think it's important is beyond the proportion of people in it. and here's why. first, to the extent that employers change their coverage, another grandfather, they're going to get into a tighter and tighter regulatory web. second, anyone who has done the arithmetic on the affordable care act recognizes that for any employee up to about 300% of the poverty line it is quite clear that the employer and employee have a shared interest to stop

providing insurance, give the employee a raise, but the pay taxes on it, take the subsidies and by coverage that is as good or better than what had before. the employer in the same transaction can give them a raise of stopping health insurance and come of it. even pay the penalty and come out ahead. the only did lose there is the american taxpayer, i will point out. so an open question which we resolved only by the course of history is just how these exchanges devolve. while they remain a niche commodity, or will it be the case that there's large scale entities like people previously -- if it's as large as the arithmetic suggest, the majority of injured products will be conveyed to the exchanges in america's future that's a really big deal. and to how this plays out is very, very important out of proportion to exactly the initial startup. the startup matters in the following way as i voiced my

concern earlier. we know about risks will show a. they are high-risk pools in every state, both state based in federal. those people will be and escorted to the exchanges, i promise you. they will be there. the question is was the low risk, the young and healthy show up? if they face severe premiums shot and the gross impact of the aca is they will and they are not subsidized, they are not impervious, they will say goodbye. that leaves a very expensive pool that goes into potentially a death spiral. the kind of expense that some of the states that this regulatory regime. that's an open -- and he sings away. on the other hand, they could show up out of voluntary to the information because there subsidize and if they do exchanges survive, for later the employers to enter into it. so the ultimate outcome of this i think is highly unclear.

it's going to differ across as we put out ages and incomes and health status. but the implications are enormous for the future of american health insurance. it importance is not best measured by the fraction people are in. >> i wanted to just tackle award of agreement. i think doug has correctly express that situation. now, these exchanges come a couple of things. i think most employer groups will hold the tax incentives supporting employer health insurance remain. the importance of health insurance as part of employment relationships, the employee, the importance of insurance give it is going to work at a place of employment is paramount. it's a key recruiting tool. but it's a key intention tropic i don't think that will go away

overnight as some are kind of maintaining. on the other hand, these exchanges, this is a marketplace idea. when congressman cramer and i were in congress considering the clinton health insurance reform, the exchanges was really the republican alternative brought forward. it is a marketplace base concept. i think that there's a lot to be considered a in terms of whether they're going to work perfectly are not under the affordable care act. i wish w we're at a point in our political discourse with the parties were collaborating in terms of how to make this marketplace, more efficient marketplace where consumers can compare apples to apples and get better deals for the cubs. i wish we were working on improving them rather than a key and saying this is perfect as his, so whole thing out. we sure miss the whole days -- the old days which is pretty sad in political debate.

>> we agree on a lot of things. one of the key pieces of it is going to be, does it work? watch this which? on october 1, flip the switch on genuine for actual operation. will it work with open question in my view. lots of reasons to be concerned to imagine there are other options and the difficulty signing up on god forbid they showed genuine and the subsidies don't show up. there are lots of startup riskss associated with his vision proud exchange is point out. even if you agree, on sort of the notion of an exchanges, abstract concept. the next year is going to be a very interesting period for the insurance industry, how was that? >> well put. >> the one thing in terms of your question is in 2016 the definition small group expands to 100 employees.

so that increases then the percentage of people who are going to be affected by this. again, in 2016 will see a lease in the small group market, yeah, a resurgence of some of these questions and issues as that market expands. >> one last question from the audience. i don't see and. is it possible considering the detail that has to be discussed and where we are right now to give general advice to those folks that are listing, how do i avoid a large insurance premium? is that answerable? >> yes. yes. i think, i think one of the things, some people aren't going to go to avoid it.

but the insurers are putting uplands that will at least -- putting out plans, in terms of the premium rates that will be charged based on what was mentioned earlier, through plan design, through network design, or managed care, things like that that will help keep down costs. those will be options for people who otherwise, they would be getting even larger increases than what they will get from, you know, opting for those plants. >> i would offer, the industry has been evaluating how to present an array of options in the marketplace that will give plenty of choices to people. the very question you posed. sometimes the regulatory calls on whether the ideas would be acceptable or not in a the new department have, in my opinion,

been turned down. i think it's somewhere we ought to have flexibility and choice. we are making a very important market shift here, and so i would encourage the administration to have an open mind about alternatives and flexibility, especially in the early going of the affordable care act. >> i think it's an important, i think the reality is going to be at the level of states for a lot of these things. some states are opting for an active purchasing approach an exchange of a they go and actually decide in a revelatory fashion decide and others will say look, you want to sell something, come see who buys it, the latter would be preferable in an environment was going to have to be a lot of behavioral response, just the reality of registration, the reality of attacks in patients. that's all unavoidable. that's a nationwide imposition on health insurance. no way around it. you've got to maneuver within

the. the greater latitude of the better spent on behalf of the board i'm going at the end of the program now. i want to thank the board of center forward, the stakeholders to support center forward staff, center forward as well. panelist, jim, doug, earl, thank you very much. terrific presentation this morning. this is a perfect example of how we try to offer kindly information to the general public. in a general public that is awfully cynical about what's going on here in washington, d.c. maybe nothing insurance industry is viewed with a little more favorability than those in the house and senate right now, but it's still a world out there that's going to have to go through a lot of sorting through it. so we thank you for offering us information that you have offered us today, and we thank you for coming. [applause] [inaudible conversations]

>> president obama today telling students and parents to call, e-mail and tweak their congressional representatives and demand he or she take action to prevent student loan interest rates from dublin in july. speaking from the white house rose garden, here's a look. >> if congress doesn't act by july 1, federal student loan rates are set to double. that means the average student with these loans will rack up an additional $1000 in debt. that's like $1000 tax hike. i assume most of you cannot afford that. does anybody here can afford that? no. if this sounds like dataview all over again that's because it is. we went through this last summer, some of you were here. it wasn't as hot. i don't think we did this outside. but we went through this and eventually congress listen to all the parents and young people who said don't double my rate.

and because folks made their voices heard congress acted to keep interest rates low. but the only did it for year and the year is almost up. so the test a simple. we've got to make sure that federal student loan rates don't double on july 1. now, the house of representatives has already passed a student loan bill, and i'm glad that they took action. but, unfortunately, their bill does not meet that test. it fails to lock in low rates for students next year. that's not smart. it eliminates safeguards for lower income families. that's not fair. it could actually cost a freshman starting school this fall more over the next four years than if we did nothing at all and put the interest rates double on july 1. so the house bill isn't smart and it's not fair. i'm glad the house is being attention to it, but they didn't do it the right way. so i'm asking young people to

get involved and make your voices heard once again. last year, you convinced 186 republicans in the house and 24 republicans in the senate to work with democrats to keep student loan rates low. you made something bipartisan happen in this town that is, that's a powerful thing. you guys -- >> also a new social security and medicare trustees report released showing both programs long-term are on unsustainable fiscal path. treasury secretary jack lew responded saying that the trustees report is essentially unchanged from last year, and that more actions need to be taken to keep the programs financially solvent. >> so chez reavie and medicare boards of trustee trustees met e so we could complete the annual financial review of the program to transmit the report to congress. social security and medicare represent a fundamental obligation we have this country to provide income and health care security for fellow citizens. this obligation has been passed

down from one generation to the next and it has stood the test the recession and war and most of all time. social security and medicare are meeting the governments today and continue to make a commitment in the years it. the trustees report have been thinking for a while now these programs face long-term challenges in fact the projection and this year support for social security are essentially unchanged from last you and those are medicare improved modestly. as reported last year we consider on a combined basis osha to retirement and disability programs that dedicated funds sufficient to cover benefits until 2033. after that time it is expected that ongoing flows of tax income will be sufficient to finance about three quarters of the scheduled benefits. the medicare report demonstrates the importance of the affordable care act which is strengthen medicare finances by reining in health care costs. the health care law has also to extend the life of medical health trust fund. it will have resources sufficient to cover full

benefits until 2026. two years longer than was projected in last year's report. but more must be done to the president recognized the essential reform is and is determined to work on a bipartisan basis to the social strata medicare on stronger flavored for social security the president is ready to address future shortfalls and he's put forward a set of principles for reform. these principles underscore the need to find common ground to extend the life of the program and while making it clear that changes to social security that involve deep benefit cuts or privatization will be unacceptable. the president also has a specific plan to further strengthen medicare. he wants to shrink the cost of health has been a, reduce subsidies to prescription drug companies at ask seniors to consider a little more but this plan when on make medicare stronger it will help lower future budget deficits. >> when you first arrived, i'm sure you never imagined that at the end of that they would be a

lady behind the podium talking to you in a funny accent. [laughter] this accident has been the bane of my existence, and until 19 aei moved to new york from england and i met henry kissinger. and he said to me, don't ever worry about your accent. in america, a book life you can never underestimate the advantages of complete and total income for stability. spent this weekend more stories and advice for new graduating class with commencement speeches from government officials tonight at eight eastern. robert mueller, ben bernanke, martin o'malley, florida governor rick scott, eric holder, and saturday at 8:30 business leaders.

>> live here inside the jacob javits convention center i in te city for live coverage from book expo america with a panel discussion titled self-publishing, disrupt or defender of the book business. also want to let you know at 3:30 will cover a discussion looking at what's new to those in the published industry and what they think about its future. a panel of graduate students in the nude university publishing broke them will share their thoughts on the industry. live coverage now from book expo america here on c-span2. ..

publishing is one of the fastest growing sectors in the publishing industry that is under such a people with 211,000 self published titles released in 2011, the most recent figures of more than 60% or 133,000 titles in 2010. in the hour ahead, more than two dozen new books will appear in the