so we have been doing a lot of communication with the media. a lot of education in the media trying to help the media understand how those promises that were made as the passage of the affordable care act to keep your coverage etc., etc. how that is basically true, but everything is going to be individual. it's all individual. hell you are impacted by the affordable care act is really going to be how this fits you personally or your family. one of the things we did early in the year is we developed a web site called myhealthcarefuture.org. it was a five or six minute play -- quiz you could take that

might help you understand where you would sit in this new world of health. if you would be eligible for a subsidy, you might be eligible for a public program. you probably were not going to receive a subsidy, but he would have a sort of choice. it's very quick. we got a lot of hits and a lot of nice media coverage. and what we found, but i believe is that we started to managed towards the public understanding that this was going to be complicated and abbas and just going to be a straight line to get your insurance and that was one of our objectives. we did a lot of media pieces. i did an opinion piece the twin cities major paper picked up and published on the first of september this year that had a great graphic of the pie chart and it laid out in minnesota where people get their coverage and we were able to show that a

very small part of the paul i was going to be impacted by the insurance exchange and in effect by the accountable care act. we have done a lot to really manage. then of course we talk with the exchange at least two times a week we do conference calls with them. we worked hard and have an absolute agreement that we are trying to stay on the same message as them and not to let the public walk away from this. one of our biggest concerns in terms of the plans i work with is that we are going to lose a lot of medicaid enrollees in the process. we will have people falling through the cracks which is a great concern to us.

it's very complicated. the message that we have stuck to with the exchange organization at this point is that this is proceeding as we had basically expected. we didn't expect to have a fast start out of the gate. but doing it right and having secured a data transferred is the important thing and one of the things that has worked to our advantage, not so much the exchange organization is they have a security breach by their staff in the grand scheme this is a little security breach. they sent an encrypted file to a broker that had a list of other brokers names and i think there were social security numbers. that is a violation of our practices, that it was not planned specific information.

it got a lot of media and the legislative auditor got involved, but they really heightened the public perception and the need for this to be done right and we have really used that secure transfer of uncorrupted information as the most important thing we can do for you as a consumer. we are not off the runway yet. i think it is going to fly over, but i'm not sure. we are working on the next communication plan and the next communication plan is focused on 1114. how do you explain to people what they had -- how does it fit to these levels? things aren't exactly the same. it benefits for young folks.

i mean not have had to purchase maternity of mental health services but everybody's going to be doing this now and that's really hard for the public to understand. but we do think we have the media there said the media can help us with this. >> we are going to roll along. >> i could just say what julie said triet we have a lot of shared experiences. for those of you that were here yesterday i will repeat everything paul said but i do want to roll back and give a little bit of history. 2011 new york wanted to go out and build its own exchange. it was the first year that the governor's administration made it a top priority for his

legislative priorities that year was to set up in exchange and other top priority was to pass the game marriage bill. they passed to the gay marriage bill but only after a handful of republicans agreed to vote for the bill. as a result of that there was tremendous backlash against the republicans. you're looking much more like a democrat and we don't like that even though we are in a very blue state. so even though we had an agreed upon bill to create an exchange, the gop said we can't get behind obamacare right now and we are waiting for the supreme court to strike this down. we know that's going to happen. they just said we are not doing this. nothing stops andrew. he said fine i will create an exchange of executive order and that is exactly what he did. for those of you that decided to

go to the federal root new york thinks you because we got a lot of federal dollars that would have gone to other states. we gladly took those dollars. the good news about the new york exchange is that when they started staffing they went to the health plans and grabbed a lot of good people from the halt plans to help staff the exchange so we have some expertise and that was a good thing. as a result of that we've also had a good ongoing dialogue throughout the implementation of the exchange. the bad news is in 2012, the governor when he did the state of the street and talked about building the exchange he set expectations very high for how wonderful the exchange would be and how much of lower premiums for the new yorkers and the number that was thrown out was premiums will be 70% lower than they are currently today.

that's for a small percentage of the new york population that currently purchases individual coverage in a very expensive product. that's about 17,000 people in new york state so you talk about the pie chart that's less than one-tenth of the percentage of the population of new york state the dates set the bar at 70% lower premiums ho. plans were like folks you set the expectations so high you will have to be eating crow in the year when the premiums come out. we caution them about managing those expectations and that they were going to drive the premiums to meet the expectation. so we have some good news and bad news. when the rates did come out and were announced they were not 70% lower but they were 53% lower.

again, that small percentage of individuals. we've spent a lot of time at the association reminding the media, reminding lawmakers and anybody that would listen to us it was for a small percentage of the population and some people were going to see the premiums go up which is what people are beginning to find out as the shop on the exchange. we have about 16 plants participating on the exchange that includes three brand new health plans hostile systems put together an insurance companies, brand new entrants to actually new insurance companies that decided they wanted to get into business on the exchange. it also includes a number of the medicaid or the government programs that it decided to shift into the commercial market in addition to the promise of these greatly reduced premiums

another concern the plan had was the capability of the i.t. system the state spending a tremendous amount of money to build this brand new data system. we have three plans that were chosen to be early testers of the system. most of the testing involved transferring files and making sure that the protocols wouldn't have security breaches and things like that. a lot of plans -- others were invited to test as well but because of the way that the portal was set up, you can't do anonymous shopping on the individual exchange. so they were giving the plans screen shots of the consumers were going to see. they said we would really like to tested. so that's been a bit of a problem and a concern that then we will fast-forward to october 1st, the exchange opens

its doors. great fanfare. within two hours no one could law gone and there was a thing that came up on the screen that said deutsch to the overwhelming interest in the exchange the system is down. please try to login leader. the exchange said to increase the capability and the capacity of the portal overnight and then the next day the exchange came out and they said we would like to go big in new york. came out and said we had 30 million hits within three hours. they said 2.000000 uninsured in new york state. how can you have 30 million hits? the media became very skeptical. so then they backed off a little bit and said we had 30 million hits, those are individual page hits but we really had to and 50,000 unique visitors. and they said again what does

that mean? how many people have enrolled. we wanted to know how many people have enrolled. so they said we had to hundred 50 visitors, we had 40,000 shoppers who have been deemed eligible for the exchange. how many people have enrolled? last week the exchange officials in one of our ongoing meetings told us that about 600 applications had been processed. again they said how many people have enrolled? the bottom line is we still don't have a lot of enrollees. like in minnesota there haven't been any transmitted. earlier this week we were told that there were 2700 ready to be transmitted the they found a significant error and half of them said they were going to

hold them. we are from new york, the whole of broadway. i feel like to mauro from annie and like the song goes to margo is only a day away. we still don't have any 834's. jian-li reminded us of the president's promise that if you like your health care no one is going to take it away from you. last week "the new york post" ran a story last friday they found a self-employed woman, doesn't qualify for any subsidies, she was the sole proprietor said she was buying a group program as an individual. she found out that her coverage through the exchange because the product is going away her coverage will be to under $50 a month more expensive than her current coverage and her quote in the paper, and i do "newsweek" every week for the members and she is the quote to

know this week. the president said i could keep my coverage. he lied and i will never forgive him for that. so, we are working like minnesota working very closely with the exchange. we don't want to publicly say we told you so, but we are kind of saying to them we would like you to remember that there are winners and losers here. while there are some people who are going to see their premiums decrease, there are probably more people that are going to see them increase. we don't like to promote that too much. we are working with the exchange to try to make sure that this is a success and we are still grieving for tomorrow. >> thank you very much. i think that we have time for a couple of questions right here in the middle of the room. stacy?

thank you. >> from the samford health plan and sioux falls south dakota. do we have any concrete members? same sort of thing how many people have enrolled? we actually have received a few 834's, but does anybody have members in terms of nationally -- numbers in terms of nationally? >> we aren't getting feedback on that. and upon the federal marketplace in louisiana we have received some 834's filtered down to us for processing. we know there are other 834's in the system. we filed several tickets to get problems resolved. we have had a couple of folks that called us wanting to know about premiums and we can't find them so we know that they are out there being processed but we just haven't received them yet. they are not releasing any numbers as to what they are.

that speaks for where we are at. if the numbers were big you would be hearing about it in the media. >> other questions? i think we have time for one more. >> being a consumer, and as you know i also represent a nurse practitioner is but one of the things that strikes me when you're trying to shop for something you're going to go onto a site and look at it for awhile because they know they have more time. it seems i think we are dealing with a concern we know that there's misleading information put out in terms of how much money it really saves. but to assume that someone is going to go on line and look at this and then sign up the same day i think is expecting a great deal of the public. and i think we need to give this a little bit of time to see how

people do. our concern is making sure that the patient that see nurse practitioners are able to still see them and that's one of the things we still keep trying to keep in our finger on. i would love comments from you on that but we should be able to get a patient reaction to this. >> i would echo what you said. that's one of the things i deal with the media a lot and that's one of the things i've been telling the media is look nobody expected people to go on and a sign that the first day. one of the reasons we have this prolonged open enrollment period is so people can shop. we want them to be responsible and actually do their homework and make sure that when they are ready to push that button and select a plan that they are picking the right plan for them and that they've done their due diligence and they've done their homework. >> i would echo that. i think we've always assumed that people what register, shop,

make some comparisons and talk with their family, talk with friends and then go back. the big concern was the ability in such a short time frame to do this i t-bill. and we all knew -- everybody in this room knew it wasn't going to be possible to get this thing perfect. so i think it is just a matter of acknowledging that it's going to take some time to ramp up. but i totally agree with your comment. >> the first day, the first week there was a huge bite on the traffic to get into the marketplace, but that was curiosity seekers if you will. a lot of folks that i know members of my staff that had no intention of buying health insurance on the marketplace but just wanting to see if it was working and what it looked like

and what was out there. you see a lot of people doing that. so that's why i say we are open for a big second quarter to score some points. people are going to want to get enrolled before december 15th so the health coverage on january 1. and that's why we are hoping folks are sitting around their thanksgiving tables talking about this and we are going to have our internal portal opened the afternoon of thanksgiving day so if the folks want to take a look at what's out there in our program it will be available. but that's going to be our big push to get the enrollees we hope in our second quarter, the second half of the indolent before december 15th. >> thank you so much. i'm going to tell you what i took away. we are in the third quarter with our eyes on the super bowl. we are not off the runway yet.

communication is king. manage expectations. testing is important and giving it right is the most important thing. and tomorrow is only a day away. [laughter] with that help me think these guys for a great presentation. [applause] we are going to take a small break. we have two sessions that are up next so hopefully we can give you some choices. one is going to be on voluntary benefits in the new marketplaces and that one's going to be just across the hall in the studio and the enrollment education and outreach in the free-form marketplace is going to be right here in this room. is there a break or no break? there is a break. we will see you all back here at 10:30. thank you.

[inaudible conversations] [inaudible conversations] >> this event taking a short break now. when they return in about ten minutes or so the focus will be on insurance exchanges. in the meantime, here is a portion of the conference from yesterday. the former congressional budget

office director addressed the gathering. we are going to show you as much of this house we can until the next panel gets under way. [applause] >> good morning. it's a pleasure to be here. as karen was talking about partnership is a great partner for us. we work together a fair amount because we share objectives. governors and states are looking for new ways to give their constituents and other citizens better health and therefore reduce cost. we all know we have seen in the pastime sure it will be tried

again there are price controls, we tried lots of things but they never really quite work. that is probably because we haven't focused on the health of our patients and citizens enough and we need to do that more. so we rely on personal care and in some cases what is happening in the private sector and state. we have a good sense of what the government thinks. i want you to know how much we appreciate the help for us. we have as many of you know but may not have this data for yourselves reelection as this year. we have 36 elections for governor and 35 of the 36 more in office for the first time that have had less than three years. so they are relatively new and many of them are up for reelection. what that means in part is he probably won't see any initiatives on health care or anything else between now and

next november. there's going to be a year somewhat cautious new policy in governors and legislators alike to the and so we are not anticipating that the world will change a great deal. hopefully the insurance exchanges get up and running and the medicaid expansion takes place. so we are not looking beyond that, which is more than enough but beyond that a great deal of initiative outside the state. we are in just a bit of insight the nda is trying to work with states and governors in particular on virtually all aspects of health care delivery, not just medicaid and state employees necessarily. and i like to think that we are working on the top to bottom or bottom to top. last weekend we held a retreat in the state of wisconsin and nga co-sponsored the medicine. we are trying to bring content to some of these considerations the the notion was that they

were going to the health care side of the state and the governor would bring the policy side of the state. >> [inaudible] >> other things could happen that would be more embarrassing. so, we have hopefully a series of these retreats with the oim but it allows people to be in the room but are rarely in the room. some of you are colleagues along with academics, providers and the policy folks from the state, the legislature and elsewhere. i think we came away with some pretty specific things the governor wants to attempt to do even though he is up for reelection, things like a statewide workforce plan which is where in most states for health care. so, very specific things that came away from that and the follow-up is always it will dictate. also at the other end of the spectrum we are working with a couple companies right now to see whether we can experiment

more broadly communicating with medicaid patients by phone. that is not a new idea. a lot of your others have been doing that for a while. we want to test the measure on to very specific things. a pharmacy refill provides a different level of response than that alert and for my years, for doctors and other appointments for medicaid patients if there is better adherence if you are alerted by smartphone. we are going to test those and we hope and a way that we can take the data and replicate and it's a really successful way to work. as i said from the top we are trying to help governors along the way. i will spend most of this morning talking about what states can do at least in theory to the health care system within their state. all the powers that they have. before i get there i want to do a couple quick slides to put us in the same, hopefully the same frame of mind about health care challenges.

this chart i've lived with a hoof probably ten years and all the changes could every year we get more data and the averages go up. so we have last year's 2011 is the most current data that we have on the federal government and you can see the averages roughly $9,000 per capita. medicare. the that is the essentially what we have seen for a very long time. the point here that i want to get to sing you can think about what peace is coming from the chart that it's the inside of the distribution where the costs are. it's a per capita cost across the ways of the of the typical rule here of 20% of the population spending 80% of the money and medicaid 5% spending 50% and all of those things. some of you have even within your plans. frankly some health care institutions like hospitals and distribution is even more skewed. 5% will drive 80% of the cost very often because some folks that work at hospitals have

dependent who are in need of medical care. there's a lot of reasons you can look behind how we get there but the point is these folks are mostly expensive. most of them will stay with this. it depends of course on which population for many of the commercial populations. maternity maybe the most expensive and therefore maybe one year there's an expense on the right-hand side. but what we have to think about here is keeping people who are on the bottom from moving to the right and moving those on the right down to the bottom. it happens to be different for different populations. for medicare there's at least three. we have of course maternity. medicaid now pays for nearly half of all births in the country. we have long-term care and medicaid pays for over half in most states and we have a population i will spend a minute more on the inventory medicaid patients that are quite expensive and we know they have multiple chronic diseases. in medicaid therefore they have low income. they are not likely to be disqualified from medicaid.

yet the right to live a number of years since you have a fixed population in this group and unless you are actively going to leave they are going to stay on the right-hand side and those are the kind that we try to use in the state's to invite them to be more involved in how we treat these folks. the reason states are so interested in health care as we all are is because medicaid in particular is taking away from investing in a virtual halt. as you can see the line is between medicaid and education long ago and it continues to diverge. the same is true for transportation and other things. if you ask the governors in private with the three primary objectives are it's to reduce health care, reduce health care. in the public statements of course it's to invest in education and transportation and do something about health care. but they really understand they are under severe constraints and

need to bring the cost down and give people a better health. this is an example of the ways it can be done and medicaid without going into great debt because i can tell you what ever is on this chart and he would have no reason to know that there was not there. i often refer to these as my bullshit charts. [laughter] i was pointing to roughly 77% and that is the number of admissions to the hospital emergency rooms for kids with asthma attacks and they are probably avoidable. we've had several studies recently come out and show how you can keep kids from having to go to the emergency rooms because of an asthma attack. we know how to prevent it and how to stop it but we don't take the time to do it. so 77% of those expenditures are likewise recoverable if you will. so the point is if you look at the data in the medicaid population and others there are lots of places you can go for low hanging fruit to better manage their care so you give kids better health. they don't have asthma attacks

and they don't end up in the emergency room. everybody wins. infantry patients i mentioned in medicaid that are expensive but not in an institution that looks something like this. and there's some surprising numbers at least for me. not only with a yawn or female but you will see that in a lot of care drc physicians, they are seeing 20 specialists a year plus they have a medical home or clinic they are seeing primary care physicians so it's not access in this case at least it's the issue is other co morbidities' what it is alcoholism or addiction, diabetes, other things but also we are finding increasingly the fact that these folks need something that the system isn't giving them and they are accommodating. we've teamed up with -- >> you can see the rest of the segment any time at c-span.org. we now go back to the conference

where the next panel will talk about insurance exchanges. this is live coverage on c-span2. >> today we are going to give you some insight on some of the activities that are happening throughout the country and hopefully get some instigations and ideas for you all to take away from your own efforts. we will jump right into it with our panelists. the first speaker is when the bill, the president of hammet health services and past president for the san diego chapter of the association of health underwriters. bill has been in the hall entrances and individuals business individual side of purchasing insurance since 2002. he started his insurance carrier as a regional sales manager for blue shield of california, offered aid the individual family services department in san diego promoting and educating insurance professionals about individual and family health plans as well as medical eligible plans. after leaving blue shield, bill

started hammet health services and offers health and life insurance for individuals and small businesses and has a two and a half-year-old and eight month old so we are impressed that he is here and a week in -- a week. >> [inaudible] [laughter] >> and our next speaker is the director of political strategies for mcc media. he's an expert in cable usage, peter media and the fragment of the media landscape. he has experience in integrating voter, consumer and fewer data to optimize the speed media schedule to identify with the audiences are consuming. this experience helps political organizations develop integrated media strategies part of the key demographic geographic areas to better and effectively reach the voters. tim has over 15 years of experience in political the advertising and media planning and purchasing.

a wide experience planning and purchasing for strategic media campaigns throughout the united states, canada, europe and asia. he has worked in a variety working from president down to the county commission. the final speaker is from the state director of outreach. we are really glad she made it. she has a story to tell to what to ask her later in. a flat tire involved. she joined the team in april since she completed a fellowship in 2007, christie has developed a community initiative in baltimore city and volunteered as a policy of the cat on older adult issues. she helps from the university of maryland baltimore in the health administration policy, social workers and management of aging services. thank you for joining us. >> thank you very much for

having me out here and allowing me to get a good night sleep. i'm going to talk about three things in particular from their brokers perspective being on the front lines meeting with employers and individuals even though my focus is on the business side from, you know, five or so employees at several hundred employees. so that's going to be the focus on what you're seeing. the fuse is already let. the agents versus the exchange's we were told coming into this that we were a totally invaluable resource to the exchanges and rely on very heavily as it is rolled out that has just not been the case. of course the aging population represents millions of people, millions of people come to us for advice on finding the right plan, the right prices and the doctor network's yet the

exchange's have given us only lip service. in california there's about 17,000 licensed insurance agents. there's only 1200 synnott two sell covered californians which is the name of ours. they told us that they are in the process, they are working on it. but one thing that doesn't jibe is there's 5400 community organizers and union participants that are licensed to sell covered california business. so, we are a little upset that they found a way to license 5400 non-agents about are struggling to get the paperwork to those of us that have already taken our tests, taken the class, sat through all the stuff. so there is growing unrest in the agent population with the exchange's and how they are working with us. there's another 5,000 plus union and community organizer people in process for the application

and only 3,000 additional agents in the process. so, those people are going to out number us almost 5-1 and we are a little concerned about that and concerned about the exchange's living up to their word to make us a big part of it. the other thing is the family glitch. the employees are really just learning that if their spouse or employer offers a health plan that whether the employer pays anything for their coverage, that hold dependent population of the family is not eligible for any subsidies. and people are very upset about this because they are looking at the exchange price of a subsidy and they can't afford that and they are looking at the cost of the group policy and they can't afford that either. so people are very upset. very upset. they think i'm lying when i tell them this stuff. they think i'm wrong. so that's a big deal. and the fact that subsidies are available on the self reporting basis is scary as well because some of these people will just do what they have to do.

they will get subsidies they don't deserve, by an insurance plan and have to pay for it later said that's going to be very difficult thing when that starts blowing up. that's the headline for the first quarter next year when people realize they don't get subsidies because the employer of their spouse offers a plan. deductibles and out of pocket max. we are seeing a lot of advertisements how the rates aren't as bad as people fought. but they are comparing of course your 500-dollar admission copay plan to a $5,000 deductible bronze plan and of those two things are very similar. so the next thing to go is when people start realizing that these are not apples to apples plans. people are assuming a lot of the first dollar risk for premiums that they were paying before. so people are going to be upset about that. doctor networks is something that the exchanges in california have kept under wraps. talking to some of my carrier

friends, the networks are going to be buber skinny and i think that is something a lot of us in the room have known that the public does not. they think a plan is a plan and the doctor says if i get a p.o. everybody is in the network. that isn't so. there are major hospital providers that are just not in a network and that is something that will boil over very quickly when people start realizing that they bought a plan that was moderately affordable, but there is only the medicaid network that they can go to. some people are going to get upset about that. dependent level rating of course is something that families are going to have to deal with. and as we start to educate employees about that, they've not been so happy so that's going to bubble over soon. then just the math problem. talking to people my age and younger, they find out the penalty is $95 or one person or they can pay a couple hundred a month in premiums. and you see the wheels turning in their head and they figure out the math just doesn't pencil out for them. so the fear is that we are all

thinking about the young healthy people not enrolling in the plan. i am seeing a lot of that. a lot of people kind of laughing it off saying why should i enroll if i can pay a couple hundred bucks on the penalty or couple hundred dollars on the benefit. so using all of my powers of persuasion to help them understand that the panel you're paying for nothing and the benefits you're paying for something and held them make a good decision there. but the math problem exists. on employers and employees. a lot of the employer issues, and players understand full-time and part-time. the understand 30 hours is now the definition of full time. they're having a hard time with a variable our people. how do they segment their employees population into variable hours for full-time and how can they exploit the variable our, nuances of the affordable care act to help them not injure as many people? this has been something that i

as a broker spent a lot of time with employers trying to help them understand what is a variable our employees. you can't just say they are. they have to be high year with a reasonable expectation you don't know how many hours they are going to work so that is hard for the execution plan when you're hiring someone to do a job. so variable our employees are a big deal. full-time equivalents of course the calculation is there. it's mind numbing to employers and i think a lot of us have understood it. we get it. we know the calculation. it's kind of symbol once you understand it. but getting from never hearing about to trying to calculate it for an employer a lot of them give up on it and i have to go to their payroll people the full time equivalent is interesting and then once they get it, they think they have to ensure that many people and they say no forget all that you just did. it's just the full time people now. so that is it puts their mind again because they don't understand why we have to go

through that whole exercise just to talk about full-time people, but we do. control groups. of course the first reaction in 2010 and 2011 for a lot of employers was i've got a hundred employees i will split that into the life companies and i'm good to go. obviously they thought of that. and so, control groups are an issue. i've had many different scenarios presented to me mostly with in the restaurant business for whatever reason people of several different restaurants and different people and the control group found very little places where the control groups don't go. if you own businesses with other people, it's generally been a control group and so people are not very happy about that. that one client that owns a tree trimming business and mexican restaurant. neither one can employ more than 50 people but together they do. so she's not so happy about that could potentially mean for him. discrimination. we know that discrimination is not allowed under the affordable

care act. they've delayed guidance on that because of some of the backlash. and so, we are waiting for that guidance. but employers there's a ton of employers. once the mandate cannot i started finding so many of my clients with 20 or 30 employees really have 100 or 200 employees. they just have management carve out so it's been very interesting to see their reaction to this because they don't like the idea of not being allowed to carve this out. so, whatever happens with section 105h will be very interesting to see how it plays out for lots of rumors about what will ultimately happen. i would love to hear input from you as to what you think will happen but management car walz stila exist right now. they are something employers are actively and rolling in. but will they still exist? they are all being enrolled under the warning this couldn't be allowed soon, but they don't care. they still want to enroll because there are people that

want to insure and that do not. the basic understanding employers -- we talked about last might have employers with five or seven employees come to me and say i am to stand i have to offer this now or i pay a penalty. that's kind of the most basic part of this is no it is 50 plus. yet employers intelligent and informed people think that five or seven employees falls under the shared responsibility payment. so, basic understanding for employers has been a key you have to wind back where you start the conversation on the basic things. as far as brokers, education obviously of employers typing into that last point has been pretty obvious. many of them are wanting the education on how the avoid it and how they set things up to avoid this. a lot of the supporters of the affordable care act are saying that not very many people are going to go to this 29 hours a

week workweek and not many people are going to do the do not hire. that's not correct. i don't have a huge block of business but i've got close to 200 employer group clients and many of them are talking about the 29. some of them are talking about the 49ers. they are staying at the football reference of california forty-niners. a lot of them are just playing the system. this is a country based on the free-market and doing what is within the rules and so they are all trying to do that. so lots of 29 hours again in the restaurant business. i've got one restaurant that's got eleven stores in san diego and after all the calculations, we decided that we could afford to have three full-time people per store and everybody else works 29 hours. so there's a lot of people that are over 30 hours right now that are being cut back so it's a conversation about can your business sustain a model that only employs people 29 hours a

week? some people can't find it of the quality to operate a business on a part-time basis so that's definitely happening. the education of the employees is something i've taken a particular interest in mostly because the employees need to know what's coming. but as an advocate for the employer i think it's doing the employer a service to educate their employees to give them a heads up, tell them what dependent level rating means and tell them about that because your employer offers a health plan that is affordable and meets the minimum value coming your dependents are not eligible for subsidies if you get a subsidy you will have to pay that back to this of the education of the employees is the key in setting up the table for what happens in 14 and 15 and 16 and whatever that may be. so a lot of the full-time calculation spend a ton of time on this with employees in helping the business understand how to avoid the penalties.

one thing our agency is doing is proactively preparing our employers for that department of labor call. the question a lot of them have is hell is the government going to know that i offer a plan if my employee calls the exchange? we know there are parts of the very simplified 36 page california application. the employer -- i let the in player know that they will be reporting that they work for you and will be incumbent upon you to prove that those people did or did not as the serve to the to deserve the subsidy. i believe reacting to that phone call was going to take a lot of time. a lot of manpower for the employers. so we put together ways for the employer to be able to answer that so they say to you want to jane doe or all of my 140 people so we are putting things

together for the employers to be proactively to deal with that. the earlier renewals would be the broker community doing just about one thing and that is quoting the entire book of business all over again. squeezing the whole year's worth about two months. looking to see if the early renewal option moving the dates make sense. i would say 60% of businesses in our book of business makes sense. the other agencies in the office we have pushing 500 group accounts and about 65 to 75% of them will be moving. and we have that same thing where its third big push and they go off to hawaii after

words or will the carriers offer special incentives to jump back to the older renewal date for 15 to 18 month guarantee rates and the only way to get back to the renewal or are we in a new world of everybody in december and if that's the case the one thing to be considered is what kind of service levels will du astana no employer received if you are one of the 70% of the market and if it's not a huge advantage, maybe that is the kicker that leaves you out of june or july. so those are the big things. what does 121 look like in the coming years and will the service be there? and that is probably my portion and as we go to the q&a i would be happy to answer questions. >> each of the speakers and then we will take some questions.

>> just a little bit about us we are a company that is owned by comcast and time warner and we represent 98% of all of the cable providers throughout the united states. what we do is we sell cable tel advertising so you can buy a spot on espn and runs for all 200 million tv households in washington, d.c. and baltimore and new york city. so we handle that local land of it. we are working with a number of the state exchanges as well as the national exchange. it's been rehashed for the last day or so.

who are the targets for this? the reason i put this at this because it is interesting about this is it is an open book test. at least it was until the government shut down for 15 days but then you couldn't get into the census. this information is available through the senses and for a variety of different public websites where you can figure out who your targets are within the state and within national areas. and i think that is an advantage when you are talking about the paid advertising to target them. and second, when you look at this target most of the commercial law advertising goes towards the 25 to 54 higher to middle-income consumers. and when you look at this group is completely opposite. it's young males, minorities, low-income. it's not really from the marketer's perspectives the easiest route to reach.

if you have an old kids you know they consume differently than you consume, so it is a real research intensive and 80 that intensive outlook. you've probably seen this slide i put up. there are different types that reinforces the data that i just showed and the resurgence has a higher concentration and other states. texas and florida, california. these are areas that have gotten a lot at least in a national exchange. so, it is definitely a nationwide issue but it definitely affects the states differently. here are some of the state's i left it out with the top number of injured and what percentage is they are against the total population of the state. a lot of the paid media and targeting what area of the state are you focusing on. what area of the country are you

focusing on. where is the highest concentration of the uninsured and what is that typical person that you are going after? i'm sure you've seen this map with federal exchange for the state exchange. the reason i bring it up is from a perspective we see four different. we see the state exchanges focusing on their individual states. we see the federal exchanges working on the non-state exchanges and some of the partnerships. we see some of the providers that are going to go into those individual states and reinforce their message is a good provider of insurance and then also the groups that are for or against people signing up for the affordable care act. i will start with the first. like i said the state exchange, the federal exchange issue those

are the four buckets that i will focus on. i don't need to go into detail. you probably know the first to pretty well. you know the issue group i would put in their they are not necessarily an issue group but they are supporting the exchange for some of the other groups coming all that were involved. the 527 or whatever you want to call them. they were involved in the 2012 election in the various states like virginia and ohio against the ruling and we are working on a commercial standpoint and various places around the place. hospitals, companies like walgreen's or cvs in to help the exchanges to get a different business. when i listen to bill talk and

the panel and by of one who the targets of our, it is a difficult proposition for some of the state exchanges. they're physically trying to get their operations up and running. and then they have to do a branding so they have to make the product appealing to people and get the message out. there is a funny piece on some of the elite light comedy shows about people talking about i hate obamacare but i love the affordable care act. so you have that misconception. how are you supposed to get someone to come up and sign up for something when they don't even know what they are signing up for or what the rules and regulations are. there's a lot of fun and from consumers and a lot of misinformation. but there's a lot of things that are good or bad about the law that people are still trying to sort through so they have that branding aspect. and then at the end of the day

it is a direct response. you are getting someone to go to the website and figured out. i think you said it was 24 pages in california. it was personal and financial information and make its financial commitment and you're talking about low-income people and it's a hard decision to make. the direct response is to talk business to be i'm not surprised that the first few weeks have been a little rough from the computer technology standpoint but i think that there will be an evil thing campaign. as it goes i know it is a six month campaign with the first three months koppel. to get your specific they will be localized campaigns. most of the agency's handling the business or in state commercial agencies. that was my understanding from the local exchanges.

they are working diligently to partner up with various groups to help with their advertising or get money to various groups, whether it is the caucasus or african-american groups to carry the message out for them. in our conversations come if the interest in local celebrities or local news people in order to build that relationship and have a local message carried and we are part of the community. so we are trying to deal with local partnerships with a they are paid or unpaid they are trying to go to a lot of the local defense a defense. a lot of the information i showed you who is injured and where they live. in the district of columbia there is only two areas in the city that are affected when it comes to uninjured and that is going to be their focus and how they get down and dig deep into that.

the stages of federal dollars. they are trying to be as efficient and effective as possible. there is a realization from these groups are they going to be dragged before the members of congress. so it's how they spend the money. it's our job as a sales organization to help them with that added value extra weight, extra spot. anything that can make the eskridge will have additional reach a and additional value add a certain cost point so they're maximizing the dollar as much as possible and then going with a really broad media mix. obviously with the young male target and even the field target's it is a interpol part but they have to enforce that as billboards there's also a television advertising with it is broadcast or cable with what

i do. radio has been part of the mix. it's been pretty research based not only from a consumer standpoint like the nielsen research media base, but even during the individualized polls or focus groups to determine with the best media makes is. so it's important for them to make sure that they are stretching the dollars. and i think from a localized perspective and in the branding perspective they have to think differently. when he breaks his leg waterskiing so they are trying to make it localized for those individuals to make them feel like this is a state initiative. the national exchange well, they have to pick up the 34 states

that are not participating. my understanding is the state exchange obviously has a priority when it comes to signing up people for all the insurance. the national exchange they are targeting on the can't go to all 34 states. they don't have the resources or the budget. they are targeting high areas of concentration like in texas during going into florida, arizona but when they get to arizona, they are not going statewide arizona. they are looking at phoenix or texas or dallas. they are going into the detroit said they are hitting up the markets probably 50 or 60 markets and not even half of the target is. so they are trying to target. like the state exchanges it is partnerships looking for opportunities. they are talking about the olympics for the second quarter for the first quarter of next year's of the second part of

this campaign they're looking for is as big of a bank as they can. federal funds, once again very limited compared to some of the state exchanges. unfortunately, they have to have identical creative. they can't be unique like they were in minnesota or california running different ads or in colorado you run different ads. they are running similar branding tide of campaigns that they are doing a branding trying to get someone to sign a so it's a difficult 30 to 62nd message. they are trying to support the navigators as much as possible and going to events in different places. the event driven online is a big portion of that and the mix is very selective. for example, they are not buying any local cable. they are just doing some of the big broadcast stations in various places for this initial

first stage and they are cherry picking different other things so it is a different mix than what we've seen from the state exchange perspective where they were much more broad and they were research based. they try to get as many people to sign up as possible and try to reach a broad audience with limited resources. the third exchanges the issues group. for some of you that are not in d.c. that might not be familiar with the issue group concept these are organizations that are either pro or against a certain topic and obviously, i think i've read over a billion dollars has been spent in the advertising against the affordable care act since it was started in the legislation process all the way through. ..

>> it's more of emotional base as opposed to the broad getting people signed up. we don't know, our perspective is we've seen advertising, this summer we continue to some of the groups, the pro side the coming out of the government shut down. what's interesting, that was fundamentally done to stop the affordable care act. obviously, that brought a lot of information out in the marketplace which makes branding much more difficult. so we'll groups carry that message into the individual states? will it bleed into the election cycle of next year? there's a high possibility it's affecting everybody and it is a

vital issue among the public. >> finally, business. when i say business i'm talking about, like i said, the pharmacy or the cvs of the world or the blue cross blue shield, those different type of provider companies. my understanding is they're allocating new money, new budget against taking away from the general branding and they're going into individual states and targeting individuals to promote products that they have in those individual states. it's an interesting concept for us. it's something we are trying to keep track of because it's new money from our perspective and it's money that probably won't stay for the years to come because it is a rush to support and try to get people to sign up for their products. it is a new marketplace. will it last? as it goes, potentially, i think what's interesting is, is i

think everyone is sort of feeling out how it's going to go with the affordable care act and where they stand. and i know there's been a lot of pressure from the white house to certain organizations to be part of the affordable care act. so they're trying to make as much effort to go forward with that. you know, from our perspective we look at this as an opportunity for our products. one thing we've done is, i talked about the census data. they make their uninsured available of what they call their designation of a big 100,000, 100,000 people universe. so we've matched that information with our cable system so we can hyper target in certain areas. we've mapped this out and what's interesting is, when you look at places like texas, it's unfortunately, to use a bad

analogy, it's like the other side of the tracks. you'll see in downtown dallas the left side of the state will actually be, or left side of the city will actually be a lot of uninsured. when you look at the right side of the city, a lot of uninsured and when you look at the left side, it's likely not a lot of uninsured. so they are definitely pocketed together. there are certain areas in higher concentration that others. i gave you an example of washington, d.c., where a lot of the uninsured are in the northeast and southeast. which fits to an economic level. our cable networks are really trying to figure out what demographics best reach those, whether it's for young males like sports and offer opportunities there, tried to offer added value. like i said, we want to help the exchange as much as we can from and added value standpoint. obviously, offer then whether it's banners on our online

sites, or extra weight from a schedule perspective. so we're trying to work with them. we have also used a lot of the census data in proprietary data about uninsured within our targeting from an online perspective. when we go down to the household, so we're trying to be able to send messages into those individual households and use as much data as possible because it is 47 million people or 49 million people, that's a lot. like certain areas could be 1 million or two in a state, and where are those million people, like in a state like texas? like i mentioned the olympics but there's events around the country, we are trying to make those known and offer opportunities for them to get their message out. it is, like i said, it is one of those, it's been happening for two years but it is one of those things where there's a lot of

misperceptions, a lot of correct information been told. and i think there's a lot of confusing marketplace. if you are a car dealer or if you were, you know, any other industry, it would be very, very daunting to be in that situation. and that's it. >> thanks, tim. christy. >> so i have to start by telling you i am keen on getting here this morning but a flat tire and a close ramp to the highway made me have to fight all the harder to become -- you kind of and be in front of you this morning. so i am christy page, the associate state director for the state of maryland. so i represent from the western reaches all the way to the eastern shore in maryland, and about three quarters of my job is engaging our membership and opportunities in service in different ways. right now about 25% of my job is

to get the message out to our membership and beyond, what does the affordable care act mean to you, your family, and for those that you love, those that are in your community? so a lot of people ask me, why does aarp care? aarp as a nonpartisan membership driven organization, but at the end of the day there's a lot of concern, a lot of coverage has happened in our membership is very worried about what the affordable care act means for them. and, of course, that group of the 50-64 who are not yet medicare eligible are about 20% of them fall into this category of being uninsured. we also see this connection between people who are in their 45, 50, 55, who want to determine what their next it. you want to have a different light career path to change their life and they want have the flexibility and still knowing there's health insurance

their, and this is an opportunity for them to have that and still be a freelancer, to go out and start their own business. this is kind of helping our membership figure out there what's next and how to get there. as an organization, aarp is very keenly aware that what we do for our membership, the 50 plus, helps society on a broader scale. and so our founder of, her motto was what we do, we do for all. that applies to a lot of the work that i do. so as i got across the state and talk and bring in partners, go through different ways of trying to reach this uninsured population, what i find is on often talking to a room full of people who are not members of aarp. but what am also doing is talking to our membership and using them as informers, for

their families, for their communities. so our overall goals for the coming year was to make sure that marylanders who are 50 plus understand what this means for them, and we want them to understand that we're trying to provide the facts, just the facts, nothing but the facts. so that we can be viewed as a reliable source of information to aarp made a very specific choice not to be involved in any of the exchanges. we don't have any aarp branded insurance that is being offered through any of the exchanges. that was so we could remain kind of outside of the world that we wanted to make sure that we were credible and reliable for our membership. so the main reason i was brought here today was to talk about our outreach strategies, and you'll find that we've kind of covered everything from in person events. we are doing some media

campaigns, both paid and heard. we're doing a lot of work through our digital strategy. i'll walk you through all of that. so, i forgot about this next critical graphic. we built a lot of coalition and collaborations, of course our events and in person engages. we build a corps of volunteers. we're calling our ac eight ambassadors. our traditional media strategy and, of course, our virtual outreach. so national aarp has set up relationships with organizations that are tied into this uninsured population. i want to say that overall, we are committing about 80% of our resources of ach education on that 20%. so that means 20% of our resources are going to educate the 80% of our membership that this doesn't impact as much.

but we've set up these, i think you mentioned about some of these collaborations. so it's about making sure that these organizations are carrying forward the same message and we are seen as a reliable source of information for their membership. and then in maryland these are some the partnerships that we have started. he will seek health care for all. one of the media strategies we put in place is to work with a consortium, a collaboration of like-minded organizations to want to get the message out about the exchange, about the marketplace, excuse me. health care for all has put this together and i was ring on board sports stars from washington and baltimore, doing media strategies. they're doing radio ads during the ravens games. so it's been kind of interesting. we've also developed some partnerships with departments of health who are not necessary directly tied in to the actual

launch of the exchange but there also, they're the ones that have their hands on this community. one of the things that i'm kind of really excited about is that we've developed a partnership with the local historically black university, morgan state, with the baltimore city health department. and a consortium of different state leaders from across the baltimore city area to bring together about 500 religious leaders. so that we can educate them on what the affordable care act means for them and so that they can then be a source of information for the congregation, parishes, synagogues. specifically focusing on minority churches. so we've done in person engagement and events across the state. a lot of them are focused on senior centers. some of them have focused on the aarp chapters themselves. we've done professional trainings with the national

association of social workers, because social workers are often the folks that are on the ground. as a social worker myself i see that all the time. we have set up a trainings for nurses, for health practitioners at some of the local universities, some of the schools of public health. what we're trying to do is educate students who are going to be graduating and next year to really have a firm grasp on what this is going to be for the people that they're going to be working with when it the ground next year. we've also established the ach ambassador core. the ac ambassador core is a group of about 27 aarp volunteers in maryland who came together for the first time last month and have been meeting on a regular basis, either virtually or in person. so we have trained them with the basics of what the affordable care act is and then it got out to their churches, to their civic groups, to the neighborhood associations and

are spreading the word in that way. it is an exciting to see how many people were excited. our first training we had 27 people that came, and after that i had another 150 a week later contacted me because there was an ad in the paper that ran late, who wanted to be a part of this. so we're going to be doing another round and training another round of ambassadors to go out across the states and just educate people on what the affordable care act means and how to access the marketplace. as was mentioned, our strategy through kind of traditional media has been very, very, very, very local. when we talk about we have to reacreached minority population. we have to reach people in pockets. the state of maryland has kind of three central cores where those uninsured people live.

you know, the capital region, baltimore, and then on the eastern shore. but then there are a tiny little pockets out in the mountains of western maryland that still need to hear this message. we've been working with local cable providers to actually, to actually do interviews and provide some content. we've done a lot with local radio, public radio. but where we found more success iis not so much of me sitting up there and talking, but rather somebody who has gone through our aca ambassador train or so we just tried to access the marketplace, or even somebody who is a grandmother who's a little bit more personalized, more tailored to the audience on the other side. we've done a great deal nationally and locally with virtual outreach. the national office has set up every other week, there are webinars that are available. they are promoted to our

membership and beyond. they are free webinars but each one focus on a slightly different topic, so if you're a medicare beneficiary, how does this affect you. if you uninsured how does this affect you. that kind of cool component of the webinars is you can call in and ask questions much like on a radio show. and then those things are recorded and inevitable through the website, you know, going forward. also a great deal of tele-town hall stick this is one of those, where you call everybody on a list and they can press one to listen in. they can also press one to ask a question. so you get together, you know, a group. we found that tele-town hall's are marginally successful but do much better if you can do a specific target rechecks we're calling everybody today in this neighborhood or we're calling everybody today in this county. it tends to get people to

actually press want to participate and get the information. of course, we've been working a lot through social media, facebook, both promoted ads and conversations on blog post. maryland has been, of the 50 states, has been the most engaged online through aarp channels, which is kind of interesting. we've had the highest uptake in webinars and i think part of the reason for our virtual outreach has worked through social media is that we have kind of taken an attack of let's be a little flip about this. let's not, you, show a picture of a stethoscope and missing get more information about the affordable care act. let's actually make it something that's interesting, make it something that's going to create a conversation. this is one of my promoted ads that i think it fairly well across the state of maryland. it's silly. it catches your attention if you see it. and that's one of challenges i found with some of our

collaborative organizations is the are not necessary marketing geniuses. and so can we tap into the expertise of the gentleman next to me, and maybe look at different ways of how we are reaching people. and maybe look at the ways that means are created and kind of leverage that so that our folks are actually paying attention to what the message is. and then aarp has had a strategy of creating subspecialty urls that are geared towards different audiences and for different reasons. the major one is this helpful answers.org. it's one of the coolest things. it's a website where somebody can go in and answer seven questions, seven clicks to get ahead to provide a name. they don't have to brought -- provide any personally identifiable information. but after the answer those seven questions, they get a detailed report on how the affordable care act impacts of them

personally with links and information and phone numbers to call for the exchange at interstate or medicare if that's where they fall, or the va if that's what it's all. it's a cool website. it works across the 50 states. i have found this is the best tool that i have when individuals get into very sticky questions. it's a great tool. we talk about our membership as being in formal enforcers. sorry. in formal informers. but this turns them into enforcers. what we're trying to do, excuse me, get our membership to get their children and grandchildren to enroll. so it's a place where you can go and send virtual cards to your kids or grandkids. my favorite is, get health insurance and so i can suck passion you about insurance, and

so i can start pestering you about getting married. if you sign up for health insurance, i promise i will befriend you on facebook. those kinds of things. silly little time in cheek messages kind of snarky messages that are about helping our membership get what they want the kids have anyway which is health insurance. and then for the majority of our membership who are, i would say when i speak you're older audiences, the thing that they're most concerned about, the thing they don't understand is that they don't have to do anything. so are 65 and older, our medicare beneficiaries, they are very, very, very worried about the have to go and sign up for something. and so, and there's a lot of confusion still about that stinking donut hole, but likely

it will go away. one of the things that aarp -- the donut hole cockily which will be more and more useful as the discount rises. so this is the way that people can help understand what that means for them. and that's my part. >> thank you. so we will move to questions, and i will get us started. we touched on a lot of the strategies and challenges and we heard a lot about the technical glitches with the exchanges. but we're hopeful and optimistic we'll move past that phase. so i'd like to ask each of you, what do you see as the biggest challenge our top challenges of action getting people to enrollment? >> i think getting them to actually do it. talking about it. california's 94,500

applications. we heard about minnesota, the numbers as you whittle the numbers that is only a few hundred have done it. so talking about it is easy. educating people about is a little harder, but i for getting them to pull the trigger and get it done is the hardest part. >> yeah, i guess i would go with education. i always call it inside the beltway mentality that we are so new, consuming here in d.c. and we know everything. and i go to my sister in chicago and i said today is election day, i going to vote? today is election day? if you asked someone on the street, are you eligible for the affordable care act? are you within income level, the federal poverty level? there's a lot of education and confusion there. i think you'll have that initial group of people that really want it and you'll have those other people, what i going to do within? and other going to come and sign

up, spend 30 minutes filling out paperwork. >> christy, where are you focusing? >> i think the challenge for me is simple find the message enough so that, because you folks that fall into kind of three major categories. those were who are on medicare, those who are exchange elbow and those with some other insurance already injured. supplying that message is not easy. a lot of folks who will sit for an hour in front of me, i think i've done a great job explaining and they'll pull me aside after i get off the dais and the as picasso i have medicare, what do i need to do? so that's the challenge. you could spend an hour talking to folks, but until you get an individualized answer, it's very difficult. >> do we have questions from the audience?

>> hi. my name is deanna, i'm from a nonprofit that uses government data to get low-income individuals enrolled in public benefits. for years we've been using medicaid dedicated individuals enrolled in snape. because as tim said, we know the demographics, we know who was born in this country. using government data we see 40% response rate. and in may, cms put out guidance to states the city you want to get people enrolled in medicaid, you need to use your snap rolls. five states have taken advantage of this guidance and taking advantage of this option. and west virginia and arkansas have seen tremendous success in this area. and i just wanted to get your opinion on why states aren't really taking advantage of this, and one -- once states get on

board how can we use kind of a comprehensive approach to use something like a rp's brand recognition in something like tim's organizations, expertise and crafting messaging to really get the message out. because when you get the message directly in homes by doing market -- microtargeting. >> yeah, i think, you know, it's funny, we debated this issue about it's a political issue. i think there's a lot of things involved. it took a long time for people to move this forward. i think there is a lot of data out there on individuals and on targeting, but i think there is a little bit of a scared and is -- am i to targeted i guess in a sense. there's different ways to reach people obviously. like i said with a national

exchange driving people to the national exchange, they are buying very broad messages in a lot of different areas and we've been talking to them about going into individual markets and going to the individual counties or individuals and trying to target them. but for them, you know, they feel like the risk is not worth the reward i guess in a sense. they would rather go big and have the assurance. it's one of those, are you happy your region one out of 10? orgy want to have the potential to reach 10. and i guess that's the mentality a little bit on that front. >> to touch on the kind of policy advocacy site of the world, i think a lot of the states have their own state-based exchanges, kind of assumed that these navigators would be the ones -- the

exchanges themselves want to set up the exchange and the navigators were going to be in charge of outreach and let's let them go. other has been as much of a coordinated effort to reach folks. but i think what you've identified is an opportunity for agencies like aarp the kind of advocate to make sure that they're reaching the right target population. >> we have time for one more question. >> whom i have a question for bill. i was interested, it's unlike the agent broker community in california is having a difficult time interacting with the california exchange, which seems to be on. you think exchange would want to tie into a natural incentive sales force to deliver products as quickly as possible. i'm wondering what kind of interaction you've got with the california exchange that would explain it. in washington state agents and d

brokers have some are kind of complaint. there are over 3000 producers that have been certified by the exchange to bring business to the exchange, and yet hundreds have not had their names loaded into the exchange website. so to be able to deliver business, exchange is not even accepting electronic signatures for broker of record letters to be submitted to all of us have to be delivered in a web-based system in hard copy on the wet signature. it's s still there to what you described, and i'm interested to what your interaction with the exchange has, in terms of improvements. >> it's not been positive. to be frank. again, leading up to this whole process we were told how important we were, but the evidence, there's just no evidence to support that from the number, the effort they have made to the navigators and nonprofit union type people, community organizer together to help push this forward.

with the lack of effort from us. i was told i was invited to represent agents at the san diego launched of cover california and the big immediate push. and when i showed up nobody knew who it was or why i was there. i was told i was going to be introduced standing on the stage, agents are behind us. what i got there they did know it wasn't obvious event and the never mentioned the word agent. so the kind of in a nutshell has been our experience. i've had lots of age and friends have been copied on lots of e-mails buzzing around where somebody has taken the class, passed the test and got everything they needed to do, paid their $58 to cover california and has had a hard time getting the paperwork to sign a. when they finally do they submit it and are told it will take two weeks. not two weeks calendar weeks, but to business week.

in the question is, i have dozens and dozens of people waiting to apply. can i send that up to you guys and your no doubt, i will put my name on it and when i do get approved, or when it officially and put in the system and it would be fine, right? and answer is no. you're not allowed to write business. if you submit with your name on it before you're in our system and you won't get any credit for it. so some of the fears of the agent population going into this was that this was a way to get rid of agents. i thought that was kind of silly because we've proven that we are the most cost-effective way to connect consumers with products for decades. that there was a better what it would've been done a long time ago. but i'm starting to be pulled over because the communication from the exchanges to the agents with issues and problems has been pretty callous. and they are not very helpful. you can't write business and you

can't get credit for and we been promised a web portal link to put on a website. that's nowhere to be found but we're told on the online application there's a place to put an agent in but when you go through it there is not. not a very positive start right now. there's rumblings of boycotts and stuff, which i think is silly because we are here to help the public provide what's best for them, then we're supposed to do that. but agents are perturbed. >> please join me in thanking the panel for this discussion. [applause] >> we'll have a short break and then we're starting at 11:40. [inaudible conversations]

so this event fro from the group america's health insurance plan is taking a short break. when they returned in about 15 minutes or so, the focus will be on how the health care law is affecting state health policies. here's a portion of this conference from yesterday. we will show you as much of this as we can until our live coverage except again in about 10 to 15 minutes. >> good morning, everyone.

it's good to see a number of my former colleagues in the audience. and former client. thank you for being here. my name is nick thompson and senior vice president for records what affairs for unitedhealth group. i have here with me commissioner ted nickel. ted nickel was appointed the commission of insurance for the state of wisconsin by governor scott walker on january 3, 2011. as commissioner he currently serves in various positions for the national association of insurance commissioners. he's the secretary-treasurer of the midwest zone. is a member of the executive committee. is chair of the contingent deferred annuities working group. he is chair of the mortgage guaranty insurance working group. is chair of the health care reform regulatory alternatives working group, and he's vice chair of the health insurance and managed care committee.

and lastly he is a member of the audit committee. commissioner nickel and i have been asked to talk today about market reform, regulatory roles and responsibilities. we thought we would approach this from an informal manner, and at the end of our discussion, if there are any questions from the audience, if we have time we will be happy to attempt to answer those questions. as commissioner, as you know, with the advent of health care reform, there's been a tremendous amount of activity, both in terms of the details of the reforms that have to be implemented, the decisions that have to be made by the states and have been made by the states, and the expansion that's occurring. and i would be curious if you

could sort of give this audience a perspective about the options that the reforms made available to the states, what was the wisconsin experience, how did you make the decisions that you made, and what has been your experience thus far in terms of implementation of these reforms in wisconsin? >> and for the next four hours -- [laughter] i will go into every gory detail and how we got to where we are today. but i will keep a sort at a high level. that's a great question. and once again, thank you for having me here today. it's a pleasure to be working as a state employee, we are working, and it's a pleasure to be out here in d.c. today to share these thoughts with you on the wisconsin experience and can give you an update on where we are at today. and it's also, i didn't, i

haven't spent any time in front of this group before, and i didn't realize i would recognize so many friendly faces. so hello and good morning to everybody. wisconsin, wisconsin approach to health reform really started the day i took, the day i took office. walked in january 2011 and it was one of the first big things we're going to look at, figure out where wisconsin was headed. and it's important to remember for everyone, i'm sure you do, that the health care law presented choices. states could decide which direction they wanted to go. and it provided a number of choices, and as the law continue to be challenged and ended up going up in front of the supreme court, it presented other choices. so wisconsin took a very deliberative approach. we spent a lot of time trying to figure out how we wanted to

operationalize and understand the health law. and after a couple of months of looking at whether the state wanted to run its own exchange, we decided that it wouldn't be printed. it wouldn't make sense for the taxpayers -- wouldn't be prudent. operate on what would be offered for free by the fed. so we chose to go the route of being an fft. we've been promised since that date that the fft will be up and running on october 1 and running well. here we sit. but we also made some very other interesting decisions that no other states have made and we decided as a state that in terms of medicaid, what we found was that medicaid folks often went to their employers and said, don't give me a raise. don't promote me. i don't want any more hours

because i'm going to lose the insurance. i'm going to lose health insurance because they would all of a sudden be pumped out of -- bumped out of income eligible for medicaid. it created a barrier to moving forward. so what we did in wisconsin, we decided that's no way, a way to get people out of difficult situations other to move forward. what we decided was something different than other states in that we made the decision that you shouldn't have to lose your health care or your health insurance because you got a raise. so part of the decision we made moving forward was to lower the current eligibility in wisconsin from 138 i believe percent, down to 100%. and for those that were

currently on medicaid we said, well, there's this great thing out there called the exchange, and you have generous subsidies available for your income level. and we're going to ask you, because some of you have already been paying a little bit for your insurance, to go to the exchange and purchase commercial coverage with the subsidy so that when you get that raise your income i go up some, but you're not going to lose her health insurance. you can slowly work your way out of whatever situation you are in. the other interesting thing we did on that medicaid decision in wisconsin is too, for the first time we had a waiting list for those that wanted to get on medicaid. there were just too many folks who wanted to be on medicaid. the governor did, his decision was to allow everyone, all, even childless adults at 100% and down into the medicaid system.

and the state contracted a lot of it. they had several different medicaid plans going and assembled by bit into one program. so now for the first time all wisconsin residents will have access to affordable health insurance. so it was a, it was a very interesting change. they were doing all of this without accepting federal medicaid dollars. it's an interesting change, or it's an interesting choice. again, going back to choice, that we were able to achieve. so where does this, why does this all matter to the insurance commissioner? well, we needed to have, we want to make sure there was a statewide coverage out there when the companies began filing their plants. fortunately, when plans are

filing late spring, early summer, we did end up with statewide coverage so that check the box, provide the opportunity for folks anywhere around the state to access the exchange, and exchange plan. so we've got statewide coverage. so from there, i would say, and it's too bad teresa is a with us this morning, but i would be remiss to not give her a shout out, working with cms, working with hhs folks come as much of elected so them under the bus once in a while, they would have been a great partner and really identical set of decision points that wisconsin put forth to them. we help if you do the fire a little bit. to help our future the fire a little bit, and we did have a really good relationship with

there. would have a good relationship with her and folks out here. as we taken, again taken the federal law, federal health care law and fit it into the insurance fabric of wisconsin, the other thing that wisconsin has, or had, has for another couple of months but had was a high-risk pool. again, not all states have a high risk insurance plan. but we had a high risk insurance plan, which i would argue was functioning fairly well, but with all of the provisions of the affordable care act it made the idea of having another health plan out there from our perspective irrelevant, because there was going to be extra assessments and extra work putting that together. so we had, we took a sip of

eliminating the high risk insurance pool, and we're asking all of those folks to move again, move to the exchange if they have, if they believe they are of income eligibility. or just go shop like everyone else here there's no more preexisting condition laws, prohibitions. so they will be able to access coverage -- >> you can see the rest of the segment anytime at c-span.org. we now go back to the health care conference. this is live coverage. >> once again, before you head back, we have a great closing panel today. so thank you for being here with us to help us conclude this yearthisyear's conference, whice you agree has been quite informative, and thought-provoking. and this session will be no different. again, i'm mark pratt, senior

vice president of state of affairs here at ahip and i'm going to entities are three distinct panelists to talk with you a little bit from their perspective about many of the issues that we have chewed on for the last day and a half, certainly health care, policy has never been more prominent in the news, in the national discussion that it is in the last couple of years. we've always lived it, and our jobs back in the states, it's just a really exciting time that we are all in right now. we've got folks will tell you a little bit more about the pressing health policy issues of the day from their unique perspectives. we've asked of them come even as they do that to also get the crystal ball out, maybe just a little bit and even in the midst of block of current pressing issues to think a little bit ahead in terms of what's on the horizon for, if you will, health care reform to.

so we make a little bit on that as well with our panelist. i'm going to introduce them all. will hear from all of them and then we'll have a q&a at the end and i will try to limit the last 90 minutes of prepared remarks that had to extend the conference and to 2:30 p.m., condensed those into about two minutes to say goodbye to at the very end. let me introduce our panelist. and again, three distinguished folks who are here with us today. the first person you hear from is catherine hess. kathy is a managing director for coverage and access at the national academy of state health policy. they have just concluded a big conference last week or i know we were represented out there at that and we're just comparing war stories little bit about how you have to adjust on the fly as we've had to do, as they did you even last week. cathy worked to develop an intimate initiatives focus on public and private insurance coverage, access to care and

health care reform. she serves as codirector for maximizing enrollment, transforming state coverage, $50 million program of the robert wood johnson foundation, and co-expert director for the foundation sponsored state for a web-based platform for exchange on health reform. i know i've got that bookmark. i'm sure many of you do as well. she also oversees long-standing work funded by the david and lucille packard foundation to provide assistance and report on state children's health insurance program's as well as an atlantic philanthropic -- philanthropies. wow. a project to address children and health care reform. excuse me. then we'll hear from genevieve kenney, the codirector and senior fellow at health policy center at the urban institute. she received a doctorate in economics and masters in statistics from the university

of michigan and has been conducting policy research for over 25 years. she's a nationally known expert on medicaid, chip, and the private health insurance coverage and health issues facing low income children's and family. she's led a number of medicaid and chip devaluations and published over 100 articles on insurance coverage and access to care for low-income children, pregnant women, and other adults. in her current research she's examining the implications of the affordable care act, medicaid coverage, family planning services and state efforts to enroll more children and adults in medicaid and chip. that's quite a lot. our third speaker is thomas miller. tong is the resident fellow at the american enterprise institute, formally is a scene health economist for the joint economic committee. a former trial attorney am a journalist and sports broadcaster, another renaissance person speaking with us at this conference, we learned that dan

crippen, the head of the nga is a pilot among other things with the varied background. tom is co-author of why obamacare is wrong for america, and its apis beyond repeal and replace health reform project. we always at ahip tried to provide a broad array of perspective on each of our topics and you'll see even from our bias today that we are endeavoring to do that this morning. tom has testified before cards on issues including the uninsured, health care cost of medicare prescription drug benefits, health insurance tax credits, genetic information, social security and federal reinsurance of catastrophic events. he organized a number of hearings that focus on reforms and private health care markets such as information transparency and consumer driven health care. thank you for letting me share just a little bit of background on each of the panelist. now we'll go ahead and turn it over to them starting with cathy. >> thank you very much.

[inaudible] >> sorry. i was using i'm pleased to be here. noting just that it's nice that government is reopen. that means a lot to people that live in this area, as many of them are employed by or connected to government. so it's nice that the air is getting back to business as usual. for those of you who don't know the national academy for state health policy, over 11, where a national nonprofit that focuses on state health policy working with the whole range of state policymakers. we do policy analysis. we convened expert panels. we support learning networks and collaborative. we provide assistance. i was going to mention that we are at this point not surprisingly immersed in health care reform.

it's been our founding 20 secure to go. so given what's going on now it's occupied a great amount of our time and attention. i particularly one committed statstate reforms on pledged to. if if you don't know what state reform is, when they get to the q&a i would be happy to do more because i think it's a great resource that on to the state officials that we focus on but to others. today i'm going to start off the panel by giving you kind of a 10,000-foot overview of some of the issues that are on state policymakers minds. in terms of health policy. i've got five major categories i want to talk about. it's not an exhaustive list of categories. nevermind some the issues within them that i will focus on, but it's informed very much by the work we are doing in a range of ways with states, and very much so by the conference that mark just mentioned that we ended last week. we had over 700 people, over 250 state officials.

so i've got a fresh sense of what's on their mind. plus the conference is planned by state policymakers. subtopics are all in line with what they are most interested in. i have to start with eligibility enrollment in coverage. and within that do a fair amount of work on kids. i want to mention just a few things about children. first that we're going to have in 18 states i believe about over half a million children total among all those states moving from separate chip programs to medicaid programs. and because of the change in as billy limits as part of the affordable care act. so if you're in one of those states, and i don't have a list with me but if you're interested i can help get back to you about that. you are going to that movement of kids.

that's one of many factors that are feeding into questions about what the future of the chip program will be. and if the program will continue beyond 2015 through which it's funded, and if not, how kids will fair in qualified health plans, how those benefits cost sharing, et cetera will compare to what they are currently receiving and chip, whether that's through separate plans or through medicaid plans. something else very much on states mine is really as they get through this open enrollment period, stepping back and let examining what worked and what didn't. not just on technology but on processes, on consumer assistance, types, the training that consumers were provided. really looking at the whole system and figure out what needs

to be improved for the next time around which will not be that far off and will be a much shorter window for open enrollment in 2014. medicaid expansion. i think gene will talk about the morse i won't talk about it a lot but clearly there are states that are still thinking about it that are not there. without some recent action agenda in both ohio and new hampshire. and a lot of interest i think, and this was evident in a conference. a lot of interest in alternatives to traditional medicaid is states are point in fact expand coverage. had a workshop session on the. it was the most heavily subscribed workshop at the conference. there's a lot of interest related to that end using public money to buy private coverage. pennsylvania i think is one of the states most recently expressed some interest in that. there's a lot of work still to be done on simplification. a lot of the vision of the affordable care act was to simplify and streamline.

it's been very complicated to make this system simple for the consumer and i'm sure for all of you. and i think there's still a lot of room once we get past these initial phases to make some further improvements, including on technology. i don't just mean in the portals until all that's working but thinking about things like how we use handheld devices to help people control. there's a lot of them i think in technology to improve. in with the longer-term, who are the remaining uninsured, where are the gaps and what policy solutions to have? that's not that long term. there are states that such as minnesota better very much focused on that. the second group of issue that want to talk about is related to benefits. as you know, the guidance that was put out on the central health benefits by the fed was interim guidance. so it's not too early i think for anyone interested to start

thinking about what the feds might be putting out and how we might want to inform that guidance that will come out in the future. it will, unless they really stick with a similar approach to what they have now, it will raise issues around mandated benefits that we all expected to bubble up earlier than they are. i think that one area i'm sure you're focused on in thinking about end states very much our, our how we really refine our approach is to have been located services. and also to mental health parity and also to the intersection between those two benefit for some folks. the issue of climate of benefits across programs. i could've said in the beginning just state interest and alignment across the board is one of the watchwords of the future, but particularly and benefits. then again given the work i do i cannot leave the topic of benefits without saying something about the challenges of your children. chip and particularly medicaid

through the early periodic diagnosis and treatment benefit provides often a richer package of benefits for lower cost sharing both virtue and again that's some of the things of the look forward to especially if we did have a chip program in place. third area is accessed. we have the bump in the primary care rate. what kind of impact is that making, or not, on our availability of primary care providers? what's going to happen after two years? what about other key areas like mental health, particularly where we have shortages of providers? there is concern and interest about how we make sure that provider networks are serving the needs of unique populations, children, pregnant women, disabled, folks from different racial and ethnic groups. so as we sort of deal with the

issues, sort of basic accessor most people, how do we make sure we're also ensuring access to providers that are serving specific populations? thinking about new and different kinds of providers can't even nonmedical personnel and how they figure into the system and how we can use payment strategies to support their use. and last in the area we've also done a fair amount of work on, how do we better integrate safety net providers into networks? the fourth area, delivery and payment reform, and i would say that most states, if not all states, very much subscribed to the aaa and in guiding their efforts. there's a lot of interest in aco like approaches in medicaid programs. we keep track of those in a map on our nashp.org website. ..

there is not a lot of clarity that the public health community