that you have that option where you didn't have to basically provide all your information but good comparison shop without actually enrolling. i thought that was very good. and still, to encourage people to use alternatives. i know you're right. a lot of people like to use the website, but i know there a lot of people at my forum who were, you know, calling the 800 number, going to committee health centers. and also we had some interest agents and brokers there and i think, i know, i think we should encourage that as well as alternatives. >> we have been conducting some pilots with a large number of insurers in key states. i think they have gone extremely well. we are encouraging insurance companies to have their agents and brokers directly enrolled. and i think that experience has been very productive, and we're working closely with them on the kind of technology fixes that

they would find most effective. >> thank you. thank you, mr. chairman. >> thank you, madam secretary. the chair now recognize the chairman of the full committee for five minutes. >> thank you, mr. chairman. so the goal was to enroll seven americans by the end of march. 365,000 folks in rolled through the end of november. premiums are due beginning mid-december. i wonder, madam secretary, if you could tell us, after christmas somewhere between christmas and new year's, as to how many people actually do pay the premium that is due, if you could share that number during the christmas break with us. would that be possible? >> chairman upton, the deadline to enroll is the 23rd. the deadline to pay is the end of the year so we will not have a number until -- >> can you let us know that first week as to how many speakers i will let you know as

soon as we have the numbers. >> you indicated to mr. pallone that, in fact, the launch was flawed. knowing what you know today, do you wish in fact that you delayed the launch be on october 1? >> well, i certainly wish we could'vcould have saved millionf people a very frustrating experience and had a smoother technology launch. i acted on the best information that i had, and going forward i think that having an eight week delay in a fully functioning site is enormously frustrating, and to millions of americans and their families. having said that, i think our millions of people who are going to begin receiving health coverage that they never had january 1 and into the new year. and so on balance, i am not sure

what the right answer is. the loss benefits when into effect january 21. people need some time to sort out options. we clearly put a dent in that time, but you are going to be millions of americans with new health coverage and that will continue on. >> so you would have, knowing what you know today you would've started the launch october 1? >> i would have probably done a slower launch, maybe with fewer people and done some additional data testing which is part of what has happened, frankly, in the early months of the launch to identify what the problems we had. >> so what grade, if you could get yourself -- not you, but the grading of the launch from add, or incomplete, what would you give? >> mr. chairman, i've always said i think the launch was flawed and failed and frustrating for millions of people, unacceptable. we want to both figured out

exactly the chain of events what went wrong, which is why i've asked the inspector general to do this investigation. we've made some changes. what we are doing is moving forward. we want to make sure that the millions of people who are eager for affordable health coverage have that opportunity before march 31. >> so you announce the ig investigation yesterday. do you wish you had started that maybe this summer, asking some tough questions in terms of where things were? knowing what you knew back then? >> i didn't have cause to act the ig to be involved as summer. no, sir. >> the day after they seemed administration announced the states would be permitted to use incomplete enrollment information to sign people up for medicaid. is it possible that by using incomplete enrollment information, states could be

enrolling folks, the most vulnerable by the way, for medicaid who are not actually eligible? >> sir, we are working very closely with states around medicaid eligibility, making determinations based on state specific laws which they have an opportunity to sign off on. so when someone presents that website and we reviewed their eligibility criteria based on the law of michigan, we determined preliminary eligibility and send that file to the state. at the same time, the state is in the same thing for people from michigan who may come to the state medicaid office, thinking that there -- they are medicaid eligible at are determined to be marketplace eligible. they are returning -- >> by the information is incomplete, is it not? >> sir, i'm not sure what you're referring to. we are gathering data and information and eligibility. and again, the state makes the determination based on their

state law, and based on the information that we have collected. >> so our income and residency requirements a part of that information that has to be verified? >> i'm sorry? incoming -- >> income and residency. >> yes, sir. they -- the state again makes a final medicaid determination. we make the preliminary determination and send an individual to the state. if the state doesn't confirm that they meet those requirements, they will not enroll the individual. we have now as of last night, again, at the systems automated so these files will be sent automated but we are also sending what we call flat paper files with full information to the states, and working one at a time with states, particularly those states like michigan, which has expanded medicaid for their population to make sure that the data is verified. but the state makes the final

medicaid determination, not the federal government. >> thank you, madam secretary. the chair now recognize the ranking member of the full committee, mr. waxman. >> think you very much mr. chairman. i know that there's a lot of politics very -- this issue. i sorely understand that change to a system that is more fair and stable for every american, not just a few, at every american, it's not easy. but all of this is exacerbated why wild propagandist, politicized statements that it been made, even today. chairman said more people will have lost their coverage than we'll get coverage. well, that absolutely cannot be true. it is not true. the congressional budget office, which is not democratic or republican, nonpartisan, they estimated that 7 million people will sign up for health insurance in the first year, and that 25 million people will be

newly insured in 2016. that's really a major accomplishment. now, we hear republicans say, more people are losing their policy, but who are those people? we estimate 80 million people will lose their insurance. when you look at that statement, they are saying that people who have a change in the policy have lost it. for example, when they get free preventive services, now covered, all, that means they are losing the policy they had. or if young adults can stay on the policy up to age 26, republicans are saying, see, they are losing that policy. well, that doesn't make sense. and must be tried to exaggerate numbers. there are some small businesses in this country who have offered their employees skimpy plans. and now they are being told they've got to have minimum

standards in those plans. so they are complaining a lot, because everybody has to provide decent, quality, reliable insurance. and a lot of them are helping to fuel this argument. so to say that 80-100 million people may lose their insurance is absolutely crazy. it's just not true. and especially galling to some of us, when we hear republicans so saddened by people losing their insurance when we recognize that they are the status quo, which means repeal the affordable care act, where we have 50 million people uninsured. that didn't bother them. so i just think that we ought to put this in perspective, madam secretary. this is not about this law. and it's not sincerely concerned for the uninsured.

it's just a political, constant political attack. republicans do not want, did not want to work with the democrats. they did not want to work with the president. if this bill has problems, let's work together to fix them, not talk about how it's no good, it's all terrible. because i'm hearing from a lot of people -- i think a headline in "the new york times" captured this. the article was titled a new the uproar over health law, voices of quiet optimism and relief. there are voices like stephanie in pennsylvania but frustrating experience trying to submit your application for the first two months. said after visiting the navigator at a local library, she signed up for a policy that will cost $113 a month with no deductible. and what she said is i'm one of the people whose plans were canceled, and signing at this time was just the easiest thing

in the world. there are the voices in san diego come in 2012 they lost their coverage because they no longer live in the planned service area. when they applied for new coverage, allen was denied because of carpal tunnel syndrome. now they have a plan through the exchange. $142 a month instead of a $1300 per month they were paying before. they have a higher deductible than the old plan. lower co-pays. here's what they described their feelings but we felt we didn't have to panic or worry if not for the affordable care act our ability to get insurance would be very limited, if we could get it at all. madam secretary, you've traveled around the country talk to people about this law. do you think most people look at this as a political issue, or are they willing to put politics aside and look at the plans being offered to make the decisions of what is best for their family?

>> well, mr. waxman, what i find is a lot of people are eager for information. they are confused by what they read and hear. and, frankly, the launch didn't help that, but as people understand their options and choices, i find that there is enormous enthusiasm, often huge relief. a lot of individuals who received the notice of a cancellation, or unlocked from a policy choice that they did not feel was good for them or their families. they were kind of locked into a plan. and i talk to people everyday who now have 40 or 50 choices, a range of marketplace plans, the option to pick and choose. that isn't to say that there are

not some individuals who would've preferred to stay in the plans, which is why i think the president decided on the transition policy in the marketplace. but a lot of speed [talking over each other] spent are thrilled with the choices that are not available to them. >> the chair now recognize the vice chair of the full committee, five minutes for questions. >> thank you, madam secretary. i want to talk to you about data security and privacy. first up. i know you've seen the "usa today" story about people in california having their information released, insurance agents but this all happened after they've gone to the exchange. we are hearing from other states that people are having that same experience. with federal exchanges, so have you talked with the california exchange about releasing that information, help them to realize this is inappropriate to release that information? >> well, i don't think there's

any question that there is an issue about releasing anybody's personal health information as was done in california. and there have been certainly conversations about that. as you know, we don't run the california exchange. that's no excuse. privacy and security are hugely important. >> okay. how is the information being released? who is releasing it quacks who all has access to that? and when it is released, are people paying for that information? who gets the proceeds? ..

if there is a transaction on that, we need to know that. let's talk about -- >> i would suggest the fact that they are getting phone calls suggest customers of insurance companies contacting them because their policy may be up for renewal, those calls are under way. >> i don't think that is the case but let's talk about cost. $600 million is what was spent on the site so far. i am referencing washington post on that. how much money in total has been spent? we are still waiting for the answer to that question from

you. we would like to know how much you obligated since october 1st for the cleanup of this exchange, how much money do you anticipate obligating through march of 2014? since you have the ig do and investigation of the contacting of you going to make these contractors pay this tax their money back? >> congresswomen, date, through the end of october, i am giving you the most recent numbers we have, we have obligated $677 million for the total i t costs and out weighed $319 million of that 677. some of that includes work in the month of october. we will give you regular updates as we have new the audited numbers. task to the ig to become

involved because i think it is appropriate to look at all aspects not only of the management practices but contractor expenditures, the specs in the contract, payment issues and i will act based on his recommendation. >> so six seventy-seven million is what you have obligated through the end of october of this year. >> that is correct. through the end -- the obligated amount. we have spent $319 million of that 677 through the end of october. >> we will continue to watch that cost number very closely. delays. every holiday brings another delay. what should we expect for christmas and new year. we had a total of 13 administrative delays to major aspects of the law and its teams july 4th or any of the holidays, thanksgiving we get a delay.

what are we looking at for christmas eve and christmas and new year's eve and new year's day? >> i would say we have extended the deadline for enrollees from the middle of december until the twenty-third recognizing people need extra time over the holidays. have to pay until the end of december in order to be fully enrolled and working with insurance to make sure there is a smoother transition into the new year. >> i yield to ranking member and maraniss, mr. dingell for five minutes for questions. >> thank you for holding this important hearing. madame secretary, welcome and thank you for being here. we all know the secretary is the famous daughter of a former member of this committee, outstanding member from ohio.

madame secretary, we continued to hear nothing but scare tactics from the other side of the aisle. rather than encouraging people to sign up for health insurance doubt is being created where none exists or should. i am forced to admit the implementation of the law has not gone as smoothly as i would like to. that is in no small part due to the intransigence of many of my colleagues who have thrown ranchers in the deer's at every opportunity. my constituents continue to tell me about the benefit aca continues to bring them. i would like to a share a few letters i have received recently and entered into the record. one of my constituents wrote as follows:i find it absurd, embarrassing and an enormous waste of time, money and human capital to see the taxes being used in washington right now to defund the affordable care act.

as someone suffering with ms, a father with lung cancer and a sister with a high risk pregnancy, i can say with absolute personal authority the affordable care act will help in this critical to the welfare of families like mine. another constituent wrote, quote, i have registered with heathcare.gov so that i could study and compare premium prices i am currently paying for 60 plus employees in ohio and michigan. i am extremely pleased these plans are half of what we are paying now. there are 72 bold plans being offered. that is competition. so let's stop playing politics, look past spin and realize what tremendous good aca has already accomplished for the american people. and get together and make it as successful as it could be.

madame secretary, i would like to begin by asking you a few questions about access to the web site. madame secretary, is it correct the error rate on heathcare.gov is under 1%? >> yes. >> in your capacity that has increased to allow 50,000 confirmed users, more than 800,000 visitors, yes or no? >> 800,000 minimum. >> the web site has improved, we have seen an increase in the number of enrollments through the web site. today we got more good news about enrollments. is it correct that 258,000 people select a plan through both federal and state market places in november, bringing the overall enrollment coverage to

364,000? >> 365,000. >> 1.5 million people have been eligible or determined eligible for medicaid, yes or no? >> 800,000 medicaid eligibility is have been determined. >> thank you are you comfortable enrollment will continue to increase quickly in the coming weeks and months, yes or no? >> we're seeing a very positive trend, four times as many enrolled in the federal marketplace in november as opposed to october and we are seeing an upward trend in december. >> people like my constituents i mentioned earlier, seeing the reduce costs when purchasing insurance through the marketplace. is it correct that recent rand report found premium tax credits will reduce out of pocket costs for average marketplace participants by 35%, yes or no?

>> people are eligible for subsidies, they will see a significant decrease over the -- >> running out of time. you have got to give me a yes or no. the cbo projects, eight in ten americans who obtained coverage through marketplace will be eligible for assistance to make their coverage more affordable, yes or no? >> the preliminary estimates were that the uninsured population look like. >> aca benefits people who don't purchase their health insurance through the new marketplaces? is it correct that thanks to aca, 3.1 million young americans stay on their parents' plan? >> yes. >> 7.3 million seniors saved over $8.9 billion on their prescription drug costs thanks

to provisions in aca that closed medicare part b doughnut hole? that will be totally closed in the year 2020? >> yes, sir. >> the gentleman's time has expired. >> you have been very courteous and i thank you. >> recognize the chair and maraniss mr. burke for five minutes. >> before i ask my questions, merry christmas. who was your father who served on the committee? >> you may have served with my father-in-law keith sebelius. >> let me get to the non fun part and go to the questions. mr henry chow of cns when he was here several weeks ago in response to a question from

congressman gardner of colorado, made a statement that 40% of the computing system hadn't even been built yet. what he called the back end hadn't been built which i assume would be the accounts payable, accounts receivable, income verification, things like that. could you tell us what is being done to get that ready by january 1st? since almost half the system hadn't even been built yet? >> i am not exactly sure what he was referring to but i can tell you where we are in the bill. the emphasis was getting the consumer facing portion ready for october 1st. as you know that didn't go so well.

the financial management system which is getting the insurance companies their money for accelerated tax credits and cost sharing is due to go into effect in mid january. there are also other pieces of the puzzle, not income verification at the front end in order to qualify someone. >> do you agree with mr. chao that a large part of the system hasn't been put together yet? and if so are you concerned? >> it is in the process currently of being put together. the income issues, i want to clarify for the committee that it has been a bit of a misunderstanding. accelerated tax credit and cost sharing don't go to consumers. they go to companies. and we have a system we have

announced working with companies where they will be paid in a timely fashion. >> i don't want to beat a dead horse but we agree the web site to try to enroll people has not worked very well. that is the easy part. so now we are down in january to lots of people that think they are going to have insurance that don't have it now and the part of the system that when they go to the doctor, to the hospital, give them their new insurance card, they check to see if they are covered and what the coverage is, that is not there and there isn't a system to pay people, there is no system to determine if the stock or hospital is eligible and you still want to get this started on january 1st? >> that is not an accurate statement. we have a plan and we have discussed it with insurers. they are comfortable, to get

them -- >> it is going to work -- >> people will be enrolled. that system is in place. >> in mid january or february we will be talking about this problem. >> this is reimbursing insurance companies at the end of the day. it has nothing to do with enrollment. >> i am not saying it does have to do with a roman. >> people go to the doctor and go to the hospital they will have a card. >> i have a minute left and one more question. i want to put a slide up the says on section 1401, under the law section 1401 says if you go through a state exchange to get insurance under what we call obamacare that you are eligible for subsidy. if you don't go through that state exchange you are not

eligible for a subsidy. irs has ruled we are going to give the subsidies we come to the state exchanges are not. what is the position on obeying the law and doing what the law says which means everybody who signs up for obamacare is not eligible for a subsidy because they're not going through the state exchanges. >> we have deferred to our partners at the justice department and the treasury. >> what is your position? >> our partners, this is in litigation. we feel -- >> i am asking the question. >> we are not worried about obeying the law. >> the law covers state and federal exchanges. >> the gentleman, thank you,

madam secretary, recognize the gentleman from utah for five minutes for questions. >> thank you, mr. chairman. thanks for joining us today. we already had one hearing on the web site before now. we are aware of the challenges to the rollout. when you come forward there are all kinds of topics i would like to raise about the health insurance tax, difficulties providers have with meaningful use stage ii the this hearing is about the website and focus on that and my questions today. we all know that you acknowledged the criticism of the web site when it was coming out. let me ask you a question. as we go forward have you developed a master list of the issues that need to be resolved for the issues you are trying to anticipate as we move forward? >> we are doing that on an updated basis on the policy side and the technology and user

side. >> that is not a static list but any evolving list. is it possible for the list to be shared with the committee? something we could see on this committee? >> it is not a static list. it is a dynamic list and anticipating what the neck policy choices are, what happens. we are happy to give the committee and outline but i don't think there's any great secret to it. >> i want to talk about some of the issues with the 34 perform. i know the error rate has been dropping and enrollment is increasing so you have these lines going in opposite directions both favorable directions but that being said do you have a sense of how many enrollees may have the 34 errors that need to be addressed? >> what i can tell you as much as we know in your early days there were serious number of

errors and we are hand making individuals lose that important personnel to the tech team so that they are helping to identify where the bottlenecks were and fixes we are seeing, a vastly improved system but we want to go back and make sure anyone who thinks they are enrolled in the early days actually is matched with the company and the company folks are matched on our end and that process is underway and a lot of fixes have been added in october and november for the 834. >> the declining error rate, how do you calculate that? is that an average of all the plans or snapshot as you go forward? >> it isn't really plans. it is looking at the site and determining the errors that occur along the way so pages that come out where people got locked out or dumped out or

wooden decks of the id. that has been a road map. >> the issues on the back end, cbo predicted six million individuals potentially going to see subsidies and as these premiums are coming up, are we going to have this system in place where these subsidies and payments, is the system structured where the subsidy payments are going to be made for the first month of participation? >> they will be made and they will be made in a timely fashion in a way that insurers have agreed that works for them. as the full system is being automated, there is a step in

the early months to make sure the payment, an individual be enrolled, qualified for a subsidy, the insurer would like that the premium at that point, the individual is in short and has full benefits. starting in mid january the insurance company that receives reimbursement for the tax credit and cost sharing if it is eligible for individuals. it is the two step process. one accept the individual, the second affect the company, 300 companies total. we have a system that again has been signed up by them. in terms of getting some paid in a timely fashion we will absolutely do that. >> subsidies go to the insurance company. >> not to the individual. >> when we hear about these problems building up the back end this particular components -- >> there is a manual work around for everything that isn't fully

automated yet. is in place. it will be manual until the information is complete and we make sure its is complete but the payment system will go forward. >> i yield back, thank you. >> i recognize the vice-chairman dr. burgess for five minutes. >> welcome back to the committee. an opportunity to go through everything on the list, we have not received answers so let me encourage you to respond to previous questions because they are important and constituents are asking at the town hall earlier this week, single mother earns just over the amount so good for her, she has a good job, work for small employer, lost their insurance in a small group market, now she is being hit with a premium, and subsidize premium, not eligible for subsidy of $1,500 a month for her and her child.

when you were working through the nuts and bolts of establishing this what did that situation come to mind? were you concerned about that individual? >> i am concerned about all individuals having affordable health coverage. >> apparently she doesn't have affordable health coverage. she lost her employer, small group market coverage. >> her employer chose to drop the coverage. >> because of the expense involved with that. you were here in april, april 18th. you received two weeks prior a red team discussion document from mckenzie group. my information is you were briefed on this report two weeks prior. that was listed on the final page of the report. let me play a little clip of our interaction from april.

sounds better today than it did then. okay. that is going to take -- let me just tell you what we were dealing with. the study of the mckenzie group put together dealt with the readiness of heathcare.gov. i was asking you about the readiness and you replied that we are moving ahead, we have federal contracts and on time. do you recall that exchange between the two of us? >> i am sure that exchange took place. >> two weeks before you were told by the mckenzie group that number one, they found extensive problems, were not allowed to change the launch date, it had to launch a full volume, no one was in charge, the completed project was a moving target, you were aware of all that when you testified to the committee in april.

>> i asked for the mackenzie group to come in 6 months ahead of launch date and give an analysis of their best advice. i was briefed on it and we acted on their recommendations. >> you were the one that commissioned the mckenzie group report. >> we ask for them to come in. >> yourself. >> yes, sir. >> what did you do with that information to you were not being honest with us two weeks later when we were talking about it in committee. >> i would disagree. we wanted the report six months out to make sure that we had independent eyes and ears, look at the readiness, and look at the challenges and we took their advice very seriously in. i wouldn't tell you their primary advice focused on the reliability of the hubbub. they thought that would be where the large number of problems occurred. a lot of time and attention, we looked at -- >> they were actually accurate

and that assignment? >> the hub has worked beautifully start to finish. >> you testified this morning that there is, people cannot make their payment now when they go on heathcare.gov. >> that is not accurate. a lot of people haven't made their payment. the payment isn't due. >> i was unable to make my payment on heathcare.gov and the federal exchange from the state of texas and i was told you can't make that payment. >> you don't pay the federal government. the sino site, you make the payment directly to the insurer. >> december 23rd you said of someone worked through the process they're going to be covered, payment may not have been made. >> what i said is that you have to be enrolled by the twenty-third and make a payment by the end of the year in order to be fully insured. >> who is going to guarantee the doctor that sees that patient on january 4th is actually covered

for that visit? >> as they do today, you are enrolling in a private insurance plan. >> a premium payment, you said they're covered december 23rd but never write a check or make a payment. >> they are not covered. in every point along the way on the web site they are enrolled until they make the payment. >> i you going to make good for doctors to see the patients the first weeks and have their cash flow interrupted? you are practicing in a small practice you get your cash flow is interrupted two or tweak weeks that is big trouble. >> if an insurance company gives an enrollment to a customer they will make good with the provider. we tell people over and over again they are enrolled when they make a payment. we turned their name over to the insurance company. >> you said this morning -- >> the company deals with the new customer. >> if their robotic twenty-third they're covered. >> not until they pay. that is what every step along the way.

>> the and of how hard it is to make that payment? have you done that yourself? >> i have not. >> is almost impossible. i have never seen a business where you get to the point the fundamental business transaction make the payment and you can't do it. >> the gentleman's time is expired. chair recognizes the gentleman from georgia for five minutes for questions. >> thank you, mr. chairman and thank you, madam secretary for being with us today. i am glad there has been some progress since last time we met but i am concerned what will happen when the insurance mandated goes live at the first of the year. i voted against the health care bill because i thought bolting was unmanageable big to begin with and we have only seen the tip of the iceberg. i hope i am wrong about that. i want to ask about other approaches to the fundamental shortage enrolled in plans

required under the act. are there other insurance plans out there that are internet based? other folks selling health insurance on internet based exchanges? >> i think some of the company's have internet sites and i know that the health brokers have a variety of plans available. i can tell you how broadbased that is but i know a number of companies you can sign up in person with an agent or broker or sign up online. >> to what extent records made to reach out to such folks to learn from what they are doing argued lies the technology they are already utilizing to sell health insurance on the internet? >> there was a lot of outreach and conversation about what works and what doesn't. i would suggest that this is a unique integrated product

because not only is an individual identified and verified but can qualified than for tax credit and cost sharing based on his or her income, can be qualified not only for the federal marketplace but medicaid shipped services and in the federal website each plan, each state offers a different plan, each state has the consent of medicaid rules and the state has a different level of benefits so is basically an integrated system that tries to get you to the right place to make it choice. >> our private health insurance plans that are internet based health exchanges able to take advantage of the unique features of the law? the fact you get subsidies if your income eligible or there a specific package is not required? >> verify that through the hub, no one can have -- >> is that being done? >> yes it is. >> private insurance companies?

>> yes. they don't have direct access to the hub and. they come in through -- >> i understand that. >> blue cross blue shield are doing this enrollment all over the country now that the site is functioning. >> if there are other sites, other internet based exchanges already functioning it seems to me it would be a hopeful approach to have all hands on deck. >> to clarify, they are. the health insurance folks are now engaged and in fall, brokers involved in that, companies are directly involved as well as individuals navigating on their own. >> are you telling us that folks who would otherwise be able to get health insurance through health care -- heathcare.gov can get it through an internet based exchange? >> if they are subsidy eligibles they need to get that verified so that the subsidy goes

forward. >> 2 needs to do that? >> sitting in an office with a broker, they can do it with the e health-insurance folks, they can do on their own, with a navigator, on the call center. there are a variety of ways individuals can do that. is there not some the eligible, they make more than $46,000 as an individual or $92,000 as a family, they can go directly, and role in the marketplace plan -- >> back to the point you began with, rolled that heathcare.gov is supposed to provide is to match polk with subsidies and products out there. that can be done through private exchanges that exist right now. doesn't have to be done through heathcare.gov. >> the subsidy eligibility which involved verification of income, verification of citizenship, verification that you are to use a you are has to touch

heathcare.gov. other than that the enrollment process can be done. >> the front door provided by private internet based exchange can communicate with folks in the back room on the government end. >> they do not have access to the social security database, the irs data base, homeland security database. that is the peace that verify individual eligibility and can move them forward. that is being done by agents of brokers, the health folks, a variety of people along the way. >> madam secretary, the chair now recognizess the gentleman from kentucky for five minutes for question. i would like to ask the gentleman from pennsylvania to take the chair. >> thank you, mr. chairman and madame secretary, thank you for being with us. mr waxman admonishes us to treat you with respect and certainly we should do that and we want to

do that. i will tell you our first concern is with the constituents that we represent and some people have said we are simply trying to put obstacles up for the successful implementation of this act. i can tell you for myself and many others, we are here because our constituents are genuinely concerned and upset about what is going on and the lot of it begins with the way this bill was passed. when it came to the floor the most comprehensive change for healthcare in america that has ever been undertaken, no one could offer one amendment to the bill. so there are very deep feelings about this bill and many health care experts today say that we are going quickly to a new health care system. we will have one health care

system for wealthy americans and everyone else is going to be under the affordable care act. that is exactly what has happened in other countries that have gone down this path. when this legislation passed, your office was given immense powers, decisionmaking the authority. we know many regulations have been written. could you tell me how many pages of regulations have been written to implement this act? >> i can get you that number. i do not know. i do not know. >> the have a range? >> i'd like to get you accurate -- >> is a 100 pages? >> i will get you information. >> you don't know? >> just told you i don't know. >> the president talking about how this is going to save money, people will have lower premiums.

i can tell you those of us on the hill going on but d.c. health exchange discovered our premiums are much higher than they were and when we talk to our constituents going on the exchanges discovering the majority of their premiums are much higher, and my understanding is o m b said the subsidy would cost taxpayers over $1 trillion. we have been told -- i am sorry. the subsidy will cost the taxpayers $1 trillion because somebody has got to pay for it and i would also like to ask you up question because of what is perceived as a real inequity in the system. some people are being favored, other people are not being favored. when you go to the rotary club and speak and people ask you do

you have to go to the exchange does the president have to go to the exchange, the political appointees have to go to the exchange and you say no, do you think that is fair that the rest of the american people have to go to this exchange? but you and the people and the president and the executive branch do not have to go on the exchange? >> the vast majority of americans with insurance will not be on the exchange. 1 seventeen seven million people, it is as i said to this committee in october, illegal for me to go to the exchange. i miss spoke slightly because the reason it is illegal for me which i knew, i am an old lady, medicare eligible. it is illegal for a company to sell me a policy. >> you don't have to go on medicare. >> i am not allowed to be sold a

policy in the private market -- >> thank you for your comments but the bottom line is the executive branch of government does not have to go on the exchange but everyone else does have to go on the exchange. in addition to the $1 trillion taxpayers pick up on the subsidy they pick up another $710 billion because the president agreed the federal government would pay more state medicaid costs. >> that is from the paid for in the health care law and -- reduces the deficit. >> it is fleet paid for by taxpayer dollars by general fund dollars. >> this actually this bill was paid for. >> the president said everyone's premiums would be free. the president said people can keep their plan. the president said they would be able to keep their doctor. it is turning out that is simply not the case. there is a lot of frustration.

we are upset about it and my time is expired so thank you. >> you are recognized for five minutes. >> let me clarify something using the dingell yes or no strategy. is it not true that the congressional budget office said eight of ten americans who will go to the marketplace will qualify for assistance? >> i think that is true. >> yes or no, is the affordable care act paid for? i know you refer to that but if you could explain. >> it is paid for. again, the congressional budget office estimates that it will reduce the deficit in the first ten years by about $120 billion and over the next ten years

reduce it closer to $1 trillion. so defunding or delaying or repealing the affordable care act actually adds to the deficit. >> isn't it true that many of the people who have gotten these letters about the cancellations will be able to go to the market place and find something better or at least as good? >> again, in the individual insurance market which we are talking about, the plans change on a very rapid basis, constantly refresh so having a plan cease to exist is not a novel idea. significant percentage of people have the same plan they had in march, they don't change at all. for others they will have choices. many of them that they never had before both to get some

assistance, financial assistance if they don't have affordable coverage in the workplace, get financial assistance paying for health coverage but also be able to choose in a competitive marketplace and not be locked out because of a preexisting condition, not pay 50% more because they are a woman, not be worried about being dropped or kicked out if they get sick down the road. >> we have been going by anecdotes. i wanted to read you a letter said i got. i will contribute to the anecdote pile from janine and jeff. , affordable care act debate focused on anecdotes and many benefits such as not denying coverage for preexisting conditions and coverage for young adults under 26, we thought we would share our experience with the web site like many american families, young adult children ask for help reviewing the options and making the health insurance

decisions when they were visiting us over thanksgiving. we went to heathcare.gov and it worked. not only did the website work but it was easier to navigate and faster than the web sites of the private-sector health insurance companies. the other good news is our daughter erica is pregnant with a baby due in march of 2014. current health insurance policy is expiring on december 31st and were it not for the affordable care acted is unlikely one and 6 months pregnant would have been able to obtain health insurance at all. the aca is helping her just when she needs it from most. i ask two others i would like to submit for the record. positive stories that i am getting. we are getting more and more of those stories and i want to say to you, madam secretary, i am absolutely confident that the role that you played in bringing affordable health care to millions, tens of millions of

americans, will go down in history as one of the great achievements of our country, throughout its entire history and i want to thank you for that. i understand and full be agreed to rollout was, is unpleasant and as horrible as it could have been probably, but by the new year and into the new year we are going to find all these stories. my understanding is thirty-nine million people went either to state or federal websites in november. is that true? >> that is accurate. we had at least that the federal website five million visitors in the first six days of december. >> what do you think that indicates? >> would there is tremendous interest, there is now a very outdated and easy-to-use anonymous shopper that will give

people information before they go on and and roll and we see people coming back several times. this is an important decision important to them and their families and visiting the site, they are eager for information and desperate, many people, for affordable health coverage they never had before in their lives. >> recognize the gentleman from illinois. >> thank you, madame secretary. i will try to be nice and polite and kind. these are difficult because we want to get some of the truth out. last congress you testified and to me and this committee, that we double counted the $500 billion counted to preserve medicare, $500 billion went to was credited to pay for obamacare, you admitted that. you can't tell us that this is paid for when we double counted $500 billion. i want to put that on the record and for the amount of enrolled

in the plan, 1300, 20 times more have a role in medicaid and this medicaid explosion that are enrolled fraudulently or enrolled through woodworking or and rolled through the new expansion are going to kill the state's. when amazon.com recorded the books sold, they record a book sold based upon someone who has paid for it. not what is in their shopping cart and not what is on their wish list. our concern is 364,000 numbers fraudulent because it is not those who have purchased plans yet and so i would ask that when you return, that you give us actually to has purchased plans. do you understand our frustration with that? >> as you well know we did not take over the private insurance market. people -- >> you are telling us that those

-- >> i told you who is enrolled in. >> that is why we are frustrated. >> this is medicare. >> let me go to my next question. let me go to my next question. i had my phone on and when my phone rang on left on because i wanted to talk to democrats state senator from my state of illinois who was on the insurance commission and he said mandated preventive services are laid directly on premium prices. so you cannot say as you have numerous times that these preventative care services our, quote, free of charge, can you? >> they are free to the consumer. >> there is no free lunch, madam secretary! if the premiums increase because of the mandated coverage based upon state senator from the state of illinois, a democrat,

who is in oversight of the insurance of the state of illinois and he said when you mandate coverage it is ruled directly on premiums, premiums increase, that is paying, you cannot say these are free of charge! >> consumers will not have a co-pay or deductible and i think -- >> we would they have higher premiums? >> no i do not. ..

but you have to leave for the opportunity -- [talking over each other] >> we all agreed at that. [talking over each other] >> the gentleman will suspend. the gentleman will suspend. givget the secretary time to answer. >> last question, madam secretary chu. through the great work of congressman smith we know plans off of a congressional employees and members only nine offer -- nine policies include abortion coverage. i have a flat that was handed out. madam secretary, you promised the last time you here you would provide me a national list of those who cover and those who do not cover abortion and abortion services. we have yet to receive that list. now, folks are shopping now. and i'll tell you, when we went through this last time we received a call from my office from someone in the country who was pro-abortion thanking me for

the question because they want to know. we need that list, madam secretary, and if they are shopping today we need that list today. when will you provid provide th? >> serve, and relentless plan benefits. the one plan benefit they must list by law is abortion services. so as a shopper goes on i would highly recommend that they look in the plan benefit section -- >> last time i was here i held up a numerous policies that would not explain that. in essence, you promised to provide a list of those insurance plans. all we are asking is for you to keep your promise. >> the summary of benefits implants i guess we could -- >> will you provide us a list? >> i will ask -- >> you promised last time. >> sir, it is on the website -- >> if it's on a website can you provide -- can you provide is a list? >> can you answer the previous question so we have a -- were you able to completely answer

the question to the gentleman's question prior? >> i us in some. >> okay, thank you. mr. green in texas is like it is for five minutes. >> thank you, mr. chairman. madam secretary, thank you for being here and taking time to testify. first of all let me give a little history lesson, and i know my colleague are upset that this bill was passed at night, the affordable care act in 2010. i was here in 2003 and the prescription drug plan did also not allow a nimitz on the floor of the house. i would member walking out to the front of the capital and seeing the sunrise from the east that morning on prescription drug plan. so we were there all night. you can dislike the law but you can't say because it was passed at night or that there were no amendments on the floor and they did the same thing as majority and that's not uncommon for comprehensive bills that would have on the floor. >> would the gentleman yield? >> no. i won't yield to i only have five minutes. the other issues the reason the

administration is not covered under the exchanges, any employer or employee less employee-based insurance doesn't need to go to the exchange. members of congress are the exception of our own doing to as part of the bill that came from the senate. believe me, i disagree with a lot of the things the senate put in that bill. i know my ranking and and i both have some issues with the way the law is now and we would like to change it. but the house bill, we had hours and hours of amendments in this committee. i had 30 amendments on my own. a number of them were bipartisan. that were adopted by voice vote. so our two-minute play of time to debate this bill. we did that to the prescription drug plan because i was here in 2003. we have the lot of committee amendments but not one before. we didn't have one on the floor is the. let me get to my questions here first of all, -- problems with healthcare.gov website are

glaring and unacceptable and i know you took response along with the president. i'm pleased we see a great deal of progress made since then. i hope to see continued success in the area of the affordable care act and deliver on his promise to make coverage available and affordable to americans are stuck with unfair and unstable individual market health care, the insurance market. that market is still available even though in a lot of cases that's why the affordable care act is needed. it was broken. what fixes still need to be made to make the experience purchasing health care on healthcare.gov easier for consumers? is this on on word processor learning everyday i hope? because in business we learn everyday to serve our customers. >> we are learning every day, congressman. i would say since i was here last, the greatly improved anonymous shopper feature is on. we just added today the automated medicaid transfers, recognizing that some states are not able to accept them in an

automated fashion so we will do both. we have added the spanish version of the website experienced that rolled out last week. we are in the process, as i said, of building the financial management. but each and every day we learn something from consumer experience. it is a process where each week we are adding fixes and identifying problems and will continue to do that. this is the first of the conference and we're going to continue to make the experience more smooth for consumers. >> and it is important, the website to work. because in the middle of november we had anything in his where we at eight and people show up on a saturday morning and we use paper applications. that's my next question. the 400 or so people who filled out the paper applications in that for hours on a saturday morning, how are they being dealt with through the exchange

is? >> well, sir, we have a number of people who use paper applications early on or pdf applications, and we are we contacting each and everyone of those people, offering them either someone to help them walk through the web experience or inviting them to do it themselves. so that is very much underway on a casework bases. we want to make sure that anybody who filled out a paper out is actually welcomed into the system and gets through the process by the 23rd everyone coverage january 1. >> i think it's interesting though because my colleagues objected to the market place but the marketplace is a compromise in the senate. the house bill that passed did not -- we had an exchange but it was supper because we also at a public option on that exchange. so it's only market-based. when i went on to by our insurance, and i agree with my colleagues, my interest went up like you, i'm over 65, and you rate my wife and i, we are going

to pay higher premiums. we did have trouble even through the one for the members of congress, but most of the people in our country are not going to do with exchange because if their employer continues to provide the coverage they don't have to worry about this. and i can also say that i've had dozens and dozens of seniors because of all the misinformation out there who are concerned to have medicare and say, i'm concerned about my medicare. well, medicare has only been benefited by the affordable care act. and again, thank you for your time. thank you. >> the gentleman's time has expired. not recognize myself for five minutes. first of all, thank you for being here but i also want to thank you for giving -- there's more work we ought to do on mental health issues and would welcome an opportunity to meet with a number of us to talk about some things we need to help mental health america and i appreciate your dedication to the. i want to thank you for this analysis. it is helpful for us to see some

breakdowns of what's taking place with regard to the states in the market place. i want to ask some clarifying questions to cev no or you can find out on this. of those who have signed up you have a list of those who have signed up for medicaid and chip market place. do we know how many were previously palatable for medicaid? not those that were added on or previously eligible, do we know that number? >> i don't know that number and we're trying to get those numbers at the state level. again we know that a number of people even in non-expansion states have come forward and now our present themselves as medicaid eligible. but what's the old rules and what the new rules, we will be getting but that number. >> we had the previous level, now 133% of income or whatever it is interest states. it would be nice to know how many previously of approaches never sign up. thank you if you can get that information. also in terms of the data which is important, of those who have

speeded can i interrupt one second? there is a third category. we know that there are people who are currently enrolled in medicaid who are sort of reagan rolling. they are not native to either category but they actually are renewing. we will get that break them. >> renewals, previously eligible and newly out of children will. thank you. also, of those -- newly eligible. those of gone to the marketplace but not medicaid, how many were previously uninsured but are now covered? how many were ensured that had a plan and canceled it? do we have that kind of information? >> may be able to get some of that from the insurance companies. we would not collect that specific information. >> and people are talking of whether or not a policy cost less or more. it's critically important the facts. is there a way that your office

or is the indian building where we can find out how many people are paying more, less? >> again, we will relying companies because we talked about formally insured -- >> switch plans? >> switch plans, they may have paid something. but that's really going to be company data, not bad that we would have. no one newly insured would have that comparison. >> people of different opinions and a good be great if we facts on that so that would be helpful. of the demographics, when i talk to some people who are insurance brokers or agents, they are describing that many of those are some of our people who may that health problems with high-cost already and they're going to the mark place to find some way to low-cost. there's also groups who may be healthy and they're seeing some prices changes. if the affordable care act was designed to help a sign up the were not able to afford health insurance before, or who are having difficulty because they had illness, what we have breakdowns a stop on those

factors? >> again, we will be able to tell you hopefully in the not-too-distant future demographic breakdowns. because we don't collect personal health information from anyone, because there is no longer a preexisting condition. nobody is medically underwritten anymore, which everybody was in the individual market. we won't be able to tell you who of the population is six or not -- >> probably only item, the question on the questioner, disability or mental health problem or emotional problem. i guess we could look at that data and people check that box, that would tell us something. >> for medicaid eligibility there is i think a question on pregnancy and question on disability. those are the only two questions because that may qualify someone of a different income category for medicaid. those of it with you i think health information that is collected.

but we don't have personal health information. >> we will get those facts. >> usage as mckinsey -- to the white house encourage you to ask or was that a decision on your own? >> we made the decision going forward. >> why was that? >> i think it's prudent to invite people who have not been directly involved with building a product to take a look at, get their assessment of how things are going, what the problems are and do it enough and events that hopefully you can take their advice. >> i would love to know from you. let me ask this, the president said it people have suggestions to improve what's going on he would like to know. i'm wondering, is there some recommendations you have for congress what we need to do to take care of some the problems we are facing? >> well, i certainly think that we will know a lot as we

complete this first year of open enrollment. i would love the opportunity to come in and discuss those with this committee, and others. this is as you know the final phase of the three and half your implementation that has been underway, and i would say that we know a lot about the young adults that we didn't know them. we know a lot about some of the preventive care issues, if you say, mental health will be a part of this so i think we will have a list to actually share with you. and we would love to work in a bipartisan fashion to actually fix the bill. there's no question that a brand-new bill, you know, will take some and amendments and hopefully move forward, but i would welcome that opportunity. >> thank you. now recognize the gentlelady from florida for five minutes. >> thank you, mr. chairman. secretary sebelius, i'm very pleased to see all of the progress that's being made with

healthcare.gov. report from consumers and recent enrollment numbers suggest that individuals using the website to obtain quality, affordable health insurance are having a much smoother and more successful experience. thank goodness. weeding over the statistics from the new report -- reading over the new statistics i was surprised the state of florida is leading enrollment out of all of the state on the federally run exchange is. because we've had so many political roadblocks. there's been so much misinformation. this is good news for floridians and it makes me wonder what is the website have been working great right off the bat, these would probably be doubled. so i know families and individuals have more time. we really want to push over the next few weeks, but you said they have three and a half months? >> that's correct, congresswoman. and as you know because you've been a key part of this, i think the assistance of not only key

members of the congressional delegation throughout florida but mayors, civic leaders, health care providers, navigators, assisters, stepping up and really getting information to people who does billy needed. florida has one of the highest numbers of uninsured americans in the country. and clearly people are eager for information and welcome the opportunity to make some choices for themselves and their families that they've never had before. >> in fact i had one report yesterday that a local enrollment there at a church, they kind of -- i had this e-mail from a tampa family health center but two stories. one, rodriguez, a 63 old woman who has been without health insurance for three years stated, what a blessing to finally have insurance. she said this with a smile and replied hashes able to finally afford her medication for her preexisting conditions. her tax credit is $530, and she

purchased insurance for just $35 a month. and then robert welsh, a 29 year-old single young man who had no insurance for the past two years, he works for a small business and his employer was not able to afford private insurance. he was able to get a tax credit for $2200, and this premium is $28. he was extremely pleased and agreed to share his story, but he said he is too shy to speak in public. so, robert, we are sharing your story today. i want passionate i'm grateful now that we can replicate these good news stories. we have a long way to go. on his small business question, we are all a little disappointed that the shop, the small business website is not going to be up and running as early as we would've liked. but this that effective tax credits that are available for small business owners, the tax credits that encourage small

businesses to provide health insurance or to help make it more affordable for their employees to? >> no, congresswoman. it will not impact event. as you know, we had earlier suggested that at the federal level, and this is different in some of the states but at the federal level, year one we would not be able to aggregate premiums that give employees of businesses under 50 a choice. that will happen in 2014. the tax credits are very much in place. we have, again, a process where we are working with agents and brokers which is the way that small business owners have gotten coverage traditionally come and accounts. >> there are three or four employees, especially in a tourism field state, you know, a lot of restaurant owners. >> but the tax credit this you will go to a 50% tax credit for eligible employers. if the tax credits that did not

exist before the affordable care act. it's been a 35%. it rises to 50% and we will absolutely be enrolling. with thousands of applications for shops. we are working to get folks enrolled, and shop is different than the individual market, where business owners have a 12 month enrollment period because of the timing of plans. so shopowners or small business owners will be able to enroll each and every month as their employee insurance comes up for renewal. >> any file for the tax credit when they file for -- >> that's correct. in 2015 they would be eligible. >> so planning a very small business owner looking into that, because i don't think that many small businesses understand this very robust tax credit that's growing from 35% to 50% might make a huge difference. >> the sba has been a trip a partner in that effort. they're using their channels to do a lot of outreach and

education. >> thank you, madam secretary. now recognize mr. lance for five minutes of questioning. >> thank you very much, mr. chairman. good morning to you, madam madam secretary. >> good morning. >> my question will be in two parts. first regarding the rule of law, and second regarding the medicaid expansion. regarding the rule of law, i will be going into an exchange and that's how i read the statute, even though i didn't vote for it. i hope that it is replaced and those who work with me at our office will be going into the exchange. and i would urge other members, for example, senator reid, that as i read the statute, that is the rule of law. in answer to ranking member waxman, you indicated, and i certainly agree with this, that the president decided a

transition policy. even though the statute as i read it has requirements that began on january 1, 2014. from the perspective, madam secretary, what is the statutory authority for the president to have announced the transition policy? >> sir, i think the statutory authority is the enforcement discretion which is available under the law to us and the president has asked us to our enforcement discretion, to not pursue penalties against insurers who would voluntarily decide to allow a transition of individuals in the market plan to continue in that market plan. this the first to state regulators. they get the first call, because they regulate the marketplace,

and it ensures, there is no mandate to insurers. it's voluntary but it allows them to take up that option. >> from your perspective, the ability of the president to do that is based upon enforcement discretion. i respectfully disagree with that. thank you for answering the question. number two, and mr. barton did raise this. as i read the statute, the our subsidies for state exchanges but not subsidies for the federal exchange. and i presume that that was placed into the statute to encourage states to have their own exchanges. the carrot and stick approach. from your perspective, madam secretary, what is the statutory authority for permitting subsidies for the federal exchange? >> again, sir, i'm not a lawyer and i would defer to the department of justice for the statutory authority. i think the framework is that i am mandated by statute to pay

the subsidies, and that i think the interpretation is both by the omb which is worthy of procreation leader on this and the department of justice, that the authority is, consented you even though it's not explicitly spelled out, but again, i'm not a lawyer. i would defer to them. >> let me state it is my legal position the courts will rule against the administration in this regard, and, obviously, this is not before the courts. iin the three and half years since the ack's passage, as the president ever proposed a legislative change to any aspect of the law? >> sir, i'm trying to refresh my memory. i cannot answer that question but i will come back with an

answer. >> server. it's my understanding the president has never asked o for any statutory change whatever. he has made -- >> i can tell you one. that i do recall that i think has been in his proposals. we do have a provision involving state waivers of medicaid expansion and then into the marketplace. that is time to start at 2017. is suggested that he think it's part of our budget proposal that they would be accelerated so states would have full authority. there are other provisions i think in our budget plan, not necessary pieces of legislation not coming through the way that we could get you -- >> thank you. finally, regarding the medicaid matter. i have great concern that many who have signed regarding medicaid expansion, where eligible before, and i know you're not able to provide those figures today but i would like at an opportunity that is

convenient for you, madam secretary, to have those figures. because it's my belief that quite a few are, were already medicaid eligible and not based upon the new law. >> the gentleman's time has expired. now recognize the gentleman from maryland, mr. sarbanes, for five minutes. >> thank you, mr. chairman. thank you, madam secretary, for being here. you've been very stored in the face of a lot of adversity over the last few weeks. you've accepted responsibility for what you yourself characterize as a failure in the launch of the website, but have obviously been a crested in trying to improve the situation. the evidence you presented today suggests that things are on the mend and a lot more americans are being able to access the government website, which is the portal to affordable health care for them. i think if you step back, the bigger story here is, they were previously millions of americans

do were essentially trapped in a world where they could not access health care. there was literally no options available to them. if they had a preexisting condition, even the substandard plans that were offered in the individual market often did not provide any option for them. so they didn't have the opportunity to complain or face the challenges. now some of them are facing. but the fact that they are trying to access an option of affordable care, and yes, encountering some difficulties and having to push through those, et cetera. even that is progress, because before they didn't even have the chance. and i think it's important for us to keep that in perspective. and that's why you said earlier,

i heard someone say that -- maybe it was chairman waxman -- that one of the common emotional responses for people when they actually can enroll is a breakdown in tears. because their years of pent-up frustration and not be able to access to affordable care. >> august and, we know a game in the individual market, which is the market that the new marketplaces are addressing, a large number, national studies show that it could be as many as 25% of people who tried to buy a plan were turned down totally. no plan at no price. then you have people who were individually medically underwritten to virtually everyone in the marketplace. and that is very beneficial if you're healthy and don't have any likelihood of a pre-existing condition and typically if

you're a male. it's not very beneficial if you're not. and if you get sick along the way or if you're diagnosed, you could be again medically underwritten going for to eliminate the condition that you need the care for. the choices were somewhat limited to a lot of people. >> the promise of this is to create a new normal for the american people where the option of getting health care israel. and that wasn't the way it was before, for tens of millions of americans. >> depended on where they were. if you were at a company and the vast majority of large employers -- >> then you have the access speed and you were not medically underwritten and get work penalize based, as long as you were in employment. but if you work for yourself, if you're an entrepreneur, if you were a service worker and didn't have affordable coverage, your options were greatly -- >> but even that system will be

more rational going forward, because as you eliminate discrimination based on preexisting conditions, you address the problems, the portability that we saw before. when somebody leaves one input and goes to the next, those are all fixes that will again improve the employer based system as well. in terms of the challenges, obviously the launch of the website was much more difficult than was expected. but there were always going to be challenged. there's going to be new challenges. there are things, you look around the corner, there's going to be difficulties and challenges associated with some of the pain and issues that will happen down the line. these were always going to be there. they were always going to be difficulties. this is a major, major structural change to the health care system, which is going to improve it eventually, but we have to anticipate that there will be difficulties. we've got to soldier through those.

that's the american ethic, right? is you take challenges and you overcome them. and alas, i just want to make is i think one of the issues is that a lot of the people who are coming and finding new plans, and maybe they have to pay a little bit more, or maybe the deductible is higher in some instances, for example. but what they don't compare it against is the exposure they had under the old plan that maybe they never had the experience. so that's the apples to apples. >> the gentleman's time has expired. we have 15 minutes left. we have seven members still asked question. we will go to two minutes per member. chair recognizes dr. cassidy from louisiana for two minutes of questions. >> your answer to mr. shimkus, did you really mean to say the affordable care act has not resulted in increased premiums for the non-subsidized? >> sir, what i said was preventive care -- >> no, no. are premiums higher? >> premiums overall in terms of

-- >> you are describing it to the preventive health care aspect? >> that's what he asked me. that's what answered. >> jonathan gruber, the architect of this bill said that this bill is basically income redistribution. there's the taxes that are a trillion over 10 you but also the increased premium that people are paying. for the policy that did not subsidize. do you have an estimate of how much increased in what amounted increased taxes -- excuse me, increased premiums people are paying to subsidize others on the exchange of? >> no, sir. i don't. and i think you can only talk about increased premiums and i think dr. gruber would be one to suggest this. if you compare like benefits to like benefits. >> so let me go on. danny from baton rouge is losing his coverage. he says that -- this is my apocalypse now. the company i have, my family coverage one of 371%, monthly premiums for family of four on

two and $45 a month for 913. with a $4000 deductible. wow, i think danny would like to choose his benefits as opposed to the. many small businesses according to your office are going to lose their benefits. as many as 66% of employers according to your analysis will lose their grandfathered status. you think administration would support my employee health care protection act which would allow workers to keep their group health care plans they have not in 2014 and beyond? >> sir, as you know, the snapshot is not our office estimating anything. it was a description of the turnover that existed prior to 2010 in the individual and small group market. those statistics that you cited. and i think come again, the small group market there are lots of plans that are grandfathered. there are other plans that

offering transition and early renewals and we're watching that everyday. >> could i get an answer to my question? with the administration approved the same law given to the individual that is a small business wishes to keep the policy they would be allowed to do so? >> the president's suggestion about a transitional policy applies to both individual and the small -- >> beyond 2014? >> the gentleman's time has expired. the chair recognizes mr. and go from new york for two minutes of questions. >> thank you, mr. chairman. i just want to say that new york -- mr. dingell. a good example when the federal government has a willing and enthusiastic partner in aca implementation that we set up exchange, we have hospital participant in the first delivery system reform. our medicaid program is expanding. states that are thought to make the law work for the citizens like new york are finding success. madam secretary, i would like to know what your experience has

been in states that have obstructed efforts many republican governors to implement the aca compared to states that have adopted all its measures. are americans expensing easier times obtaining affordable health care coverage in states that have their own exchange? has the refusal of some ask states to expand medicaid affected the rollout? >> well, i think that what we are seeing every day is governors actually considering the medicaid expansion. some as you say in new york, california. others adopted very early on. we were please yesterday that the governor of iowa indicated an interest in moving it on medicaid expansion. that was not -- the governor of pennsylvania was recently also indicated his interest in doing the same. so we are working actively with states around the country. i think it is enormously difficult for consumers in states where there is no

medicaid expansion. they hear about the opportunity for affordable health coverage only to find out that they earn to less qualified for a tax credit in the marketplace and really they have no viable option at all. and that i'm told by our navigators on the ground, our ancestors, the people ingenuity health centers is one of the worst conversations that they can have in this period. >> we spoke with the governor of kentucky the other day, and he explained to his kentucky jelly a republican state where it's working really, really well. you have a governor who is a partner who wants to see it work. it can work and it should work. i hope that more governors would continue to do what is in the best interest of their constituents rather than playing political games. thank you spent the chair thanks the children. now recognize the gentleman from conducting. >> thank you. 80% of the people signing up on our exchanges our medicaid.

that's been a concern of mine. i was in state government before. medicaid as a national program has 72 million people and were expecting an increase of 25 million over the next 10 years. i do believe medicaid for low income, disabled and seniors. should it be a program of last resort where it just becomes its own engine program as it is no? >> first of all i think the enrollment numbers are about 51 million, not 72. but also medicaid has played i think a critical role for lower income americans, not only offering wide range of health benefits but at a lower cost per capita than private insurance -- >> i've only got -- they can to stand a couple of minutes. the question of what to get tht though, your department has estimated about 5 million americans have previously purchased interested of what

will lose medicaid. that's in the office of actuary, the number we got. are you familiar with that come that we're looking over the next four years estimate fight like americans have employer-based insurance will move to medicaid? >> i am not aware of that. the office of veterans with an independent -- i can check that out. i'm not the money without specific number is the the estimate is $20 billion in this group of people who present purchase health insurance through their employer but who will be moving to medicaid. the question that chairman upton at about income, there's a question with chairman upton about income verification and residency verification. i know that's up to the states be but the state to don't expand medicaid, the information right now is just like trust the federal government numbers, right? >> again, we don't enroll, we

don't enroll anyone in medicaid. what we do is look at income eligibility. and based on the state law, send that individuals name and information that has been collected to the state. the state actually is the connection between the individuals and medicaid. >> but by january 1 they will just have to accept that. >> that's going on right now. but we don't enroll in medicaid. we just -- >> right. >> the gentleman's time has expired. thank you, madam secretary. >> thank you, mr. chairman. secretary sebelius, let me just let you know that i agree with representative lances reasoning on the matters he brought up earlier in his testimony. i do find it interesting when we are listening to my college on the other side of the out and to talk about scare tactics. this is similar to what they said back in the summer and in september when we were holding hearings because we are hearing that the plane wouldn't be ready on october 1.

so i'm just concerned we will have some of that same kind of thing now that we are being attacked for asking questions. we're just trying to get the information. it's not that we are interested in scare tactics or witchhunts. it's a matter of we're trying to get to the bottom of a lot of these problems that we are concerned about. obviously, one of the tactics, this is all just political, but you certainly have accepted responsibility and you don't believe we cause the problems with the website, therefore making the public distrust it. isn't that correct? >> i do not believe caused the problem to the website. >> thank you. some of my colleagues have implied, maybe not that but somehow we are responsible for all the distrust out there and i don't think that's a good. also i don't believe that the federal employee health benefit plan is a skippy play. some of the folks said the reason that cars are going up is people that this can't be blamed. i was pretty does on the federal employee health benefit plan and my family is facing 117% increase out of our pockets. that's out of our pocket

increase to go onto the exchange here in d.c. and so you don't think the plan you have is skimpy, do you? >> no, sir. i don't. but as you know -- [talking over each other] >> have some adrian fenty federal employee health benefit program an did not so you will e younger employees paying a lot less an older -- >> i'm running out of time. let me say this with regard to medicaid. one of the problems is your send people to the states based on income alone and in virginia and no states they have an asset amount. in virginia it's only $2000. they may have sufficient income -- are they may not have enough income but they qualify for medicaid under income but they don't qualify because they own a house. have to choose whether they want their assets or medicaid. >> again, state law and state medicaid enrollment officials will make the determination of whether that individual will be

enrolled. when they present at the marketplace based on 133% or less. in virginia right now it would be based on a lot less because virginia has not raised their medicaid eligibility. we would make a determination and refer that name. >> dr. gingrey, two minutes. >> madam secretary, a question on the medicaid program. take the dealer george, i am sure all the other 49 governors would one inch. the americans -- affordable care act for states to retain the of the requirements for medicaid to the maintenance going back what, the 2009? with the expiration of these provisions states will finally have the flexibility -- tailored to the best addressed health care needs of their medicaid populations. this is the question. will the medicaid m.o.d., maintenance about to expire for all states beginning on january 12014? >> yes, sir.

>> thank you. madam secretary, real quickly, in regard to e-health plans, this company, california-based company i think 10 years old, we talked about earlier in the discussion, i think they spent about $109 developing the program allowing people to go onto the website and find place. and yet we spent seven times that much reinventing the wheel. can you tell me why we didn't just use that technology, or maybe some other silicon valley company, to have a public private partnership rather than starting over from scratch? and he made that decision? >> well, sir, i would tell you that while there are some comparisons with the e-health situation, there are a number of features very different in the federal website that were required. the health doesn't determine citizenship eligibility. it doesn't --

>> yes, but did you make that decision? or was not made by someone else? >> what decision? >> decision to start over from scratch. >> i don't think they did start over from scratch. actually i think along the way adopted a number of the known technologies that were in place. >> let me ask you. how many times did you actually visit with the president since 2009 or 2010 when he came on board, how many personal visits did you have with him at the white house regarding the affordable care act? >> a lot. >> can you verify that? >> i -- >> the gentleman's time has expired. the gentleman from florida for two minutes per question. >> thanks are holding the string. madam secretary, in november, a proposed rule in november, cms announced that they were considering increasing payments to insurance companies under

section 13 fortitude of the ac. this program is proposed, is supposed to be financed by insurance companies participating in the exchange, but the proposal appears to put taxpayers on the hook. specifically, the rule states that and i quote, this proposed adjustment may increase the total amount of risk payments that the federal government reduce the amount of risk quarter we see. did you, madam secretary, estimate how much more money taxpayers would have to pay to insurance companies under this proposed rule? >> sir, the risc core door has always been a part of the affordable care act and was anticipated for the first couple of years to be used for reinsurance and risk corridors for the new market place. so did put out a proposed rule. we talked about the fact that we would look carefully at what the immelman is at the end of -- >> i want you to answer the

question. did you estimate how much money? >> we won't know anything about what that risk quarter looks like until we get more involved. >> the rule says, ethical, we cannot estimate the magnitude of this impact on aggregate risk corridors, parents and charges at this time to like to get to the next version. do you think is responsible to put taxpayers on the hook for insurance companies losses in the exchange? do you think it is responsible to make these payments without estimating the cost of? >> again, sir, it will be based on what the risk pool looks like. we always knew in the first couple of years the market would be attracting some customers and not attracting others, and that ithere would be some risk. and what we are hopeful for as the affordable care act continues into maturity is that we have mature pools. we knew the first years -- >> the chair thanks it gently and not recognizes mr. omers for two questions -- ms. ellmers.

>> thank you, mr. chairman. thank you, madam secretary, for being with us. i have some specific questions to ask about some of them a sense of the promises that the president made to the american people as he was rolling out the idea of the affordable care act. one of those promises being if you like your doctor you can keep your doctor, carried. can you commit to the american people today that this is true and that they will be able to keep their doctor? >> congresswoman, i think that, as you well know in the private market, networks change on a constant basis. the president is not over taking the private health insurance market. there is -- >> you are correct. that was the promise, the promise that was made to the american people so that this piece of legislation which is now law was passed was that they would be able to keep their

doctor. yes or no? >> most consumers by the opportunity to pick and choose a network that continued their doctor. there's nothing in the law that has their doctor lost for them. >> there is nothing in the lot with our networks that are now very narrowed as result of the law, is that not true? >> insurance companies make network decisions day in and day out. [talking over each other] >> but that was not the promise the president made. did the president not make that promise of? >> private insurance market that changes networks basically -- >> why in the world, madam secretary, did the president make that promise to the american people? >> i think the president was trying to assure people that the law did not require them to lose their doctor. they have a networked -- >> no. i do believe that he was reassuring the american people that they would lose their doctor. i think he was reassuring the american people that if this law passed, they would be able to

keep their doctor. so, therefore, today you're basically saying no, this is not the case of? >> i am saying that there is, again, this is the private insurance market where insurance companies develop networks and change them on a -- >> and the american people will give the keep your doctor if they pay more according to ezekiel emanuel? >> they can choose the network whether doctor is available spent and play more? >> whether doctors not available based on the kind of premium, the kind of deductible, the kind of -- >> i see my time has expired so thank you, madam secretary,. >> the chair thanks the gentlelady. that concludes our questioning at the present. madam secretary, we'll have some follow-up questions were sent to you. we will ask that you please respond probably. we have a couple of unanimous consent request that i would like unanimous consent to submit to the record a letter from doctor julie welch, an emergency medicine physician and educator

from indianapolis. without objection, so ordered. dr. burgess? >> thank you, mr. chairman. dr. gingrey referenced an offer from the health to the president to provide a platform for the market exchange, and i would like to submit his letter for the record. and i will make this part of a question for the record that i would to a follow-up. >> without objection so ordered. ranking member? >> one is for my constituents in piscataway, anthony weill, that i referenced. another is the one that ms. schakowsky reference. you know, these are the different individuals impacted by the aca. >> without objection spent and then a third one from ms. schakowsky. >> without objection, so ordered. thank you, madam secretary, for your patience, for respond to all of our questions. i remind members they have 10 business days to submit

questions for the record, and that means they should submit the question by the close of business on tuesday, december 31. another important hearing. thank you, madam secretary, for your indulgence. with that, without objection the subcommittee is adjourned. [inaudible conversations] [inaudible conversations]

[inaudible conversations] >> kathleen sebelius testified on capitol hill today before the house energy and commerce subcommittee on health. you can watch this hearing tonight on the c-span networks, or anytime on our website, c-span.org. >> news this morning from capitol hill. according to politico, republican aides say that tomorrow the house will take up a bipartisan budget plan that was announced last night by senator patty murray and congressman paul ryan. that proposal would fund the government for two years and

restore some of the sequester cuts. house republican and democratic caucuses met this morning, and we got a couple of comments from party meters following their meeting. first we hear from republican paul ryan and then budget committee member democrat chris van hollen. >> we've got to find a way to make this work. we think it's her nations interest to do that. that's why we sought to reach a budget agreement that maintain our core principles and found common ground. we have found common ground with our colleagues on the other side of the aisle over in the senate. what this budget you can does is it helps produce more certainty. because it stops the shutdown in junior and it stops a potential government shutdown in october. we think that's good for the country. at the same time we wanted to make sure we're taking a step in the right direction for fiscal discipline. our budget we passed here in the house, republican budget,

represents our ultimate goal and our vision, balance the budget, pay off the debt. we understand in this divided government would not going to get everything we want. what we want to do is take a step towards that goal, a step in the direction toward that vision. and by having a budget agreement that does not raise taxes, that does reduce the deficit and produces uncertainty and prevents government shutdowns, we think is a good agreement. it's also an agreement that gives congress the power of the purse back. for three years we keep passing these continuing resolutions which basically of congress switching their authority. that is not right. that's not constitutional. so we reclaim the power of the purse. we make a statement on behalf of deficit reduction. we finally focus on a portion of the budget which has been on autopilot for years that is in need of attention. and we make divided government work. we feel very good at where we are with our members. we know that this budget

agreement doesn't come close to achieving what we want to achieve honor ultimate fiscal goals, but again if we can get a step in the right direction we're going to take that step and that's why we're doing this. >> this was a hard-fought negotiation, and i want to thank leader pelosi and my fellow conferees for making it clear as recently as 12 to 24 hours ago the way the agreement was taking shape was absolutely not acceptable to members of the democratic caucus. it's not in a former members of our caucus will have to decide for themselves. speaking individually, my view is that it is a small step in the right direction. because we're able to restore many of the cuts that would otherwise take place as a result of the sequester, very deep and immediate cuts. and it especially is good at restoring some of the cuts that would've taken place in

important domestic investments, in our kids education, insights and research, in places like the national institutes of health, law enforcement, and those kinds of areas. this will help restore almost two-thirds of the cuts that would otherwise have taken place in fiscal year 2014. and i believe the way those cuts are paid for it is not at all perfect but a lot more equitable than it was 48 hours ago. our caucus will have to look at the details as individuals, and, obviously, we will be doing that over the next couple of days. >> and more on the budget agreement. this from politico today. republican senator tom coburn of oklahoma saying he could not back the budget agreement that was reached. i am real disappointed in the deal, he said on msnbc. i'm sure it's the best paul could get but it's not anything i can support. he said the agreement failed to do in of to reduce government

waste, one of his pet causes. continuing the quote, senator coburn, you've taken to very well-meaning individuals and hammered out an agreement to get past a political event. there is so much waste, so much duplication, so much in competency in the federal government, and nobody wants to do the hard work of fixing it. senator tom coburn today, and again, that from politico. now to commerce secretary penny pritzker as she speaks with politico's white house correspondent mike allen on the administration's efforts to create jobs and economic growth. she also talks about the bipartisan budget plan announced last night. the second who was against this one at the groups labeled breakfast. >> thank you all for coming out on a semi-snow day. appreciate your being here. i'm mike allen, chief political

white house correspondent. that you for joining us for this breakfast. we are excited. we'll be hosting the commerce secretary penny pritzker, fasting let them have started countries, run companies and is now bringing companies here and growing companies here in the u.s. before we get started i would like to thank bank of america for this fantastic series of conversations. we've had an amazing year, different parts of the country, all, people from all across the spectrum talking about issues that matter most in washington. so we are grateful to the bank of america for making this great series possible. i brought along my twitter machine your. this will take your tweeted question. first of all, good morning to those of you in live stream plan. if you have a question for us please just tweak it to #playbookbreakfast and they will pop up and i'll ask it. without further delay, the commerce secretary, penny

pritzker. good morning. [applause] >> thank you. thank you for having me. spend so, a little bit of an extra friend, some of you know, i broke an ankle bone by working out. so working out will kill you. but i am getting no sympathy from the secretary because i found out that she twisted an ankle one time and ran an ironman. >> yes. >> how did you do that? >> well, you know, the alternative was i was halfway through the race, to stop and quit an and then i would have to drink again and do it again, or to persevere. i decided perseverance was going to be my objective. because i would have to spend another three months trying to train. >> very practical. after a lifetime in chicago, moved to chicago. officially in her northwest d.c.

house and we want me to washington with some news this morning, we always start with the news. last night's budget deal which people are saying may be a sign that the capital is freezing. top member of the economic team, somebody who is the lead face for business in the administration. how much hope is there that this is active start of something or does it look more like an anomaly? >> i'm an optimist so i think this is very positive news. regular order is something that's really important, and, frankly, it's very hard to run the government without a budget. aske..

looks like it going to come back in 2014. it's going to be different about the relations between the two ends in something avenue? >> well, i think we have a lot we want to get done and there's a lot of commonality of purpose. i do not die a little over five months. i've met with over 700 business leaders. but i don't want is they are