>> when do you anticipate that being reported to you by the insurance companies? >> that date it's reported to us by the insurance companies you know all on a regular basis as they are signing people up and then we will have to weed that together and come out with a report and we will do that. >> thank you mr. chairman. >> mr. tett din. ..

i expect it will happen. i continue think it's -- it's going to go down and. >> i think at the time it's more competition, you know, it's important to recognize that the health insurance market in many states has been extremely concentrated. and there's been one dominant carrier that has some as much as 75 or 80% of the market. i think we're beginning to see. it's not even the first year of the affordable care act in place. i think we are beginning to see fines in some places where increased competition has resulted in decreases in rate. >> and it's going make the claim they're going to ultimately lower rate for americans. we would like to hold you to it. it's really about fairness. it's that what you're trying to say? we want to have it fair for the american people.

fair for small business. is that right? >> yes. >> it is. then perhaps for you can explain for me. nfib. we spoke to the state of colorado. if you happen to live in rural colorado versus urban colorado, you are paid a premium under the president's so called affordable care act. explain to me how it's fair. >> congressman, i think you would find that -- >> no. -- >> no, no. i think you find that rates in all areas are higher than urban areas. >> it's very -- fair to punish people that live in rural america. access is lower, the administration is comfortable with that. >> i'm saying it's not because of the affordable care act. i'm saying it's because a number of other factors including the cost. >> providing -- the affordable care act coming out of rural colorado you can be paying anywhere from 65 to 100% premium just because you live in a rural area. that's where a lot of small

businesses in my area come from. how is the administration helping them with the policy? >> i think that with increased competition we're hoping there will be more issuers offering health coverage in both rural and urban areas. it will have -- what we've seen if you look at states where there's more competition. rates are lower. look at states where there's not a lot of competition. rates are higher. that was true before the affordable care act and that's something that, you know, we expect to change over time. but the discrepancies between medical costs, cost providing medical care or urban areas is not new or something that was cosby the aca. >> that's not when the president promised when we were talking about introducing this now law on the american people. they were going lower -- we are seeing rural americans suffer. in our areas our small businesses are seeing the cost

go go up. i have to tell you, it's disturbing come from a rural area with a lot of small businesses. the lack of compassion that this administration is showing for these small businesses. how much small businesses have canceled those policies now that the president made the decision to not -- small businesses he gave favor to big business earlier on. how many businesses canceled policy? >> i don't know. i think t important just in reference to what you said. the requirement that employers offer coverage -- from the affordable care act. it's only to large employers. there's no connection between those two things. it's always employers' choice whether to coverage to the employee. >> i'm running short on time. but you keep inserting the word we hope something is going to happen. we hope the westbound is going to. we hope we're able to lower

cost. it doesn't give a lot of comfort to many of us. you point to the credit. small business guys, who pays for the credit issued by the government? >> these are tax credits incentive. paid by treasury and the american people. >> so the american people. actually there's -- i think as with many things taxpayers pay for there would be a weft to society as a whole for making it possible for small businesses to provide health care donch their employers. we all benefit when people are healthy, more productive, and have good access to health care. >> federal government mandates if our people pay small business -- people in rural america perhaps -- my time is expired, mr. chairman. >> thank you, mr. shader. >> thought about. i appreciate the opportunity. thank you for being here.

is there a requirement for any small business under 50 employees to provide health care to the employees? >> no, there is no not. how many small businesses in america would you estimate are small businesses with under 50 employees? >> i actually don't have that figure. i'm sure it's available, but i don't have the figure. >> it's well over 95%. and most businesses push come to shove whether the westbound is not working or not totally unaffected by this website not working. and i guess that i would ask you personally a question. how many times has your computer worked perfectly. [laughter] >> i think it's, congressman, t we're familiar with circumstances where we go on -- it doesn't work. >> that's a fair question. i appreciate that. is there anything that prevents small businesses from getting health care because of the aca. can they still shop for health

care. >> absolutely. >> how many small businesses do you think ranking member alluded to this. how many small business men and women spend lot of time thinking about health care plan and which one to get for themselves and employees. they're trying to rather than business, sell a product, and try move economy. how many small businesses would really do it by thereses. call you up. that's right i want to get the plan. my impression is that while -- it's very concerned about the cost of health care and want to provide health care to the employees historically and today. they rely intennively on agency -- that's the intelligent thing to do. i urge all of my small business men and women and individuals to use the agent on a regular basis. you testified the cost of shk going down. can you emphasize the 2012 figure for us, please. and how much less it was going to be? >> so.

what in term of rate and the average premium increase for 2012 is only 4.7%. where before the aca rates have been increasing by 18% and more. >> as a small business i guy, i jumped down. i will a lot of different health care providers. i shopped around with agencies. my agent shopped around for us to find the best deal any given time. doesn't go up in double doesn'ts. i jumped ton. it was exciting to me. we're going see hopefully more of this going forward where premiums drop a little bit. i'll be -- i concur one aspect with my good friend of colorado -- min paradise valley. i can't get a car for the same price every year. i can't get the same price every year. everything goes up over time. health care cost prior to the aca have gone up in double digit

rate breaking the back of small business. the only game if town. the other team hasn't put thing on the table. is the aca. the pooling you referred to is critical. while i have a lot of folks in my area. i think i -- i don expect i'm going same rate. i know, with the pooling my rate is going to be familiar ated a little bit going forward. any comment? >> no. thank you. you remind me i should stress when we talk about what is happening with rate. i think we understand the predominant factor that causes insurance rate to go up. we need to work together to -- improve ak sets to eliminate --

tax on every single american. we all end of paying when people show up at the emergency room. we end up paying for are that. it goes to the rate the hospital and the doctors charge. and get put back in the rate that the insurance companies charge to us. that's not free. and so we need to focus on what we can do to attack increase in cost of delivering health care. as you have said, congressman, we need to tbhearmd those costs go up year over year. they have -- they have gone up by significantly lower amounts since the affordable care act passed. when we talk about rates being lower we have to be somewhat realistic there are certain costs health insurance rates that are due to you know what it costs to provide the actual underlying health care. >> it's working in my state the rates are less than people

thought they would be. i yield back. thank you. >> so the administrator is the -- has the rhetoric changed now. you are talking about we keep hear the talk about rates not increasing as much as they were. but then the rate said the rate were going down. ic we have seen some places rates actually going down. in new york, for example. they went down rather dramatically. >> really? >> yeah. but it varies a lot from state to state depending on the laws in effect in that state prior to the affordable care act. which considerably from state to state. and depending on the nature of the market in the state and how competitive it is. i think it's hard to make, you know, a general statement about what it's like everywhere for everyone. but i will -- i continue to believe that as

this law becomes fully implemented over time, and as we seek greater competition, it will have an effect on reducing rates overall. bearing in mind there are certain factors of inflation that are going to be part of the cost of providing health care, you know, salvation armies to insurance employees and et, et. >> i find fascinating it has changed. you are hoping for that now. we heard all of this talk about how rates were going go down for small businesses. now we talk about rates not just not increasing as much. you stated a few minutes ago. you said the aca was bringing predictability and stability to small business, those were your words. i have -- when you talk about predictability instability. how do you get predictability instability when you don't put these democracies off? administrator stated on october 29th in a hearing before the

ways & means committee the online enrollment was going occur -- going to occur at the end of november. and thicks were moving along nicely and ready to go. how do go from that to we need to delay for one year. how does it bring any stability in your words, again, stability predict to these small businesses out there that are trying to make decisions. >> well, i would just say, again, i don't believe that the availability or labeling of availability of the website and the ability to access the application, et, online is effecting the rate people are paying. the rates have already been timed. >> i'm talking about predictability, inability. >> taxable property my comment. there will be more predictability and stability for small business owner in term of the rates they were paying to provide hurricane for their employees. because they won't be subject to

dramatic changes in the event that an employee is diagnosed with a serious illnd and faced with the situation. there is no prability or stability in the whole process of trying to find out what your rate will be or getting enrolled in that process. bow hear from shoughses all the time about uncertainty. we use it all the time. uncertainty. this has been the e pit my of uncertainty to say the least.

thank you for being here. as we know, there's a lot of business information circulating much purposeful that is a lot of confusion within the small business community. i represent a district in defeats, new york city that has newer american, small business owners and entrepreneurs. one is being done to reduce a lot of misinformation and get the truth about the law out there. thank you. we're trying to do as much outreach as we can. as i mention a lot is done in connection with the small business administration. we have the national web theirs every week for small business where we provide information about the affordable care act and about the small business exchange. in addition, we have a e-mail we put information out. any small business who comes to

health care.gov can signed up to get e-mail information through us. we have been doing public service announcements as well as the radio to help provide additional informations. we have these significant networking in the states to the regional offices that have been holding a large number of educational and otherwise informative event forest fire small business. then we have a dedicated shop small employer call center that is available to any small business person who just wants to call and get information about the aca in general or more specifically about the options that might be available to him or her. and that shop call center, when you call in, there's a prompt on the line if you're an agent or broker you get directed to

somebody, you know, specifically trained to help answer questions for agents and brokers. to help them with their small employer clients to help them. finally, i would say particularly over the last several weeks, given the discussion that we made about not having the online capability available. we have been working very closely with the agent broker trade associations. the big i and the cia b and others. i have met with them myself. with my staff to make sure think can push out to their members information about how to access coverage using the sort of that dpitional channel of going

through an agent or broker. we have done quite a lot. i think. obviously we can comore. we want to make sure that everyone understandses as we've been talking about there's nothing about the fact that this online shopping experience is available that prevent any small employer from get coverage or tax credit they are eligible for. >> thank you. we know we saw in montana that many people didn't get coverage until closer to the deadline. do you anticipate the same to be true this time around? and how will year-long enrollment benefit? >> that's a great point. i think that it's important to recognize that first of all, [inaudible] can actually sign up throughout the year. at any point in time. and my understanding is that in fact small business policies do, you know, at my point throughout the year, four years, while

there may be somewhat larger number coming in january, it's actually, you know, throughout the year there's no particular magic. so january 1st as far as getting coverage for a small business and no particular magic even to march 31st which there is in the individual market. small business owners can apply for it and get coverage throughout the year. so i'm not -- i think on the individual market everyone is expecting that we'll see a spike in here december for january 1st and likely to see soot spike in march as we approach the end of open enrollment. i think for small businesses because the current policies will be ending at various point in time throughout the year. it's seems likely we might see more a steady, you know, rate. than in the individual market. >> thank you. i yield back.

i'm from new york. you said that in new york the premium for small business are going down, i think you said dramatically down. >> the question. i'm not sure it was specific to small business. i think we are talking about rate overall. i'm familiar with information that new york state insurance commissioner has put out ones the plans were announced and the rate were announced for new york. i actually in fairness -- we're here talking about small business. the one you're talking about, i believe, who were 100,000 individuals out of 20 million. the rates went down and the insurance commissioner quoted the statistics for those 100

individuals. the small business owner and in the midst of insurance renewal right now, the increases are staggering. and they're staggering because of the affordable care act. because of obamacare. again, you're right if you let 50 employees offering health insurance it's not mandatory. and my world, i don't know if you agree -- shouldn't be -- we had someone in here testify don't laugh the name of the company was -- and these were young, healthy adult males. i asked the question, do your employees need maternity

coverage? and after a few snickers the answer was no. they have to provide it now? they can't have a plan that doesn't have maternity coverage. >> i don't know whether new york state already requires maternity coverage. many states did. what i can tell you is the essential health benefit were based on what was the most prevalent plan in the market. if i was an employer and had a good plan that my employees liked and didn't have maternity care. i can't offer that plan. it doesn't meet the essential benefit. >> well, under the -- the president announced a few weeks ago, you could still sign up for the plan. you're right. >> you're incorrect sir. in new york, new york didn't offer that option. i'm from new york. you're correct. we conot have that option. my point is if i had 20 employees and they were healthy and didn't need or want to pay for prescription drug coverage.

i happen to know one of those companies. and the employees were satisfied with that coverage. it's basically a lot of drugs are generic, there was a company didn't have to provide coverage. didn't provide it. provided at an affordable rate. now they can't offer the coverage anymore. they will a good plan. worked for the company. worked for the employee. they can't offer the plan. one that meets the essential benefit is up 40%. now they get no plan. somehow that good for that family? the law provides that if people are had health insurance it should be hurricane that is actually going pay for the need they have. >> you would need them? >> they were young. -- they may need prescription drug

coverage, you know. washington knows that, sir. i don't believe washington does. now another thing you said, and i just take issue perhaps with some of your statement. are you telling me, i think you did. if i had six employees you have an experience rated plan one employee gets six and my premiums skyrocket? >> best of my knowledge, i have six employees. i'm in a community-rated plan. i'm not an experience-rated plan. >> not in every state. may be true in new york but not in every state. >> a statement but in new york i'm a community-rated plan. if i have less man 50 employees. i can assure you i'm in a community-related plan. i don't bear any risk. not one risk whatsoever if an employee has a serious illness. hundred and hundred of thousands of dollars in expenses. my premiums don't go up. i'm in the community-rated plan. yet you made a statement that made it sound like the aca was

the end all for employees that, you know, companies that offer ?urn. let talk about ?ie. it's not a true statement at all. we are trying to provide the exact same benefit that you were saying as a good thing to people across the country. employers as cro the country should be free from having skyrocketed health plan. the states vary. there's no question about it. we provide a level of -- >> my -- i would like to justice point out to clarify. new york you can't heap your health plan. in new york under 50 employees you are not experience-rated. there's nothing in the aca that is helping that employee which you use as a stark example. i can assure you that a lot of the employer and employees like the health care they had. they can't keep it anymore. there are things that are considered essential. they didn't think they were essential. now they're not going have insurance. they go home and explain to the wife and kids why they don't

have insurance because the government told their employer what think to to offer. now they can't have it. it was not a good day for the dinner table discussion for that family in five. >> schneider. >> thank you. an employer from 1997 to 2003. double digit increases. happy to make choices about how much we provide for the employees. what would be the best to serve them. it's a challenge we faced if are long time. it's a challenge our health care system is a challenge if we don't address if for the long-term a decision we make in business and the government for a long time to come. as you touch base on your comments, and you talked about

like i did with my partner a decade ago. what is the most important aspect. how do we make more people aware of the advantage or opportunities they have once we get through the challenges presently to use the affordable care act. the lay that stands to better provide health care for their employees? >> i think what i've heard from a number of small business owners. one of the things they point so the employee choice model, which is available now in the state-base marketplaces. it would be available in the federal marketplace for next year nap does provide something that has not been available to most employees in the past. where an employer can offer a number of different options. maybe an h many mo and one company. and employer employees can make a decision based on their individual need. what sort of coverage is best

for them. as companies try to weigh -- seeing in different state the states are ahead of others. small businesses -- many try to compete on national scale. what are you going say to companies who don't have the options today? what should they be doing to prepare for our make sure they can continue to provide their employees health insurance? >> well, i mean, i think they should definitely shop and look at all the options available either as we have talked through an agent or broker or, you know, mention again employers can go on health care.gov now on what we call the learn side. not the application side but the learn side. and see all of the plans that are available to them through the market place. you can get a premium estimate. and i think as with anything it's a complicated subject but

the more employers didn't educate themselves and learn about what options are available to them. obviously if they are a small employer and eligible for the tax credit. it's something they can pursue. it can pay 50% of the employer contribution. own behalf of the small employers who are anxious or concerned. i think it's critical we get the information out. they understand going forward that the systems systems are put in place. the stuff going forward. untheir needs and give them the option they need to slide their employer health care. my time is up. >> thank you, mr. chairman. >> a couple of thins to help me dig in to some of the information. i know, some of the frustration you are hearing from us as members is sort of based in information coming to the -- there were problems with the website and the mechanics and

those things, and yet have a lot of happens from our direction. you always wonder how much is professional staff. hiding behind politically appointed staff so often our relationship with the administration seems to be political not necessarily factual. i want to back up to where we were before. talk to me about some of the data you believe you have modeled. because obviously with the sanction like yours and what you do you model it. have you built the model? >> i'm going have to go back and look to see if we have. i'm happy to provide the information. i just don't have that.

something incredibly important to your organization, obviously, from a budget mechanic is also would you have paid attention to expectations of -- i knowen the individual side there have been, you know, enromment and the cbo published, you know, figures for what they expected enrollment to be and what the costs will be. i'm not able to call to mind what it was on the small business side. if we have that information, i'm happy -- >> it's -- well, and just plan we're going ask you for that. as we're seeing much of the data coming out of the dramatically mat rescuing in to individual side and medicate plans instead of individual purchases. maybe that changes. but just trying to get our head around, sure, what is the budgetary impact for all of us who will have policy making in to the future. you know, are we about to wake

up one day and blown up, you know, future entitlement spending and other spending in the lull so the unintended consequences has a bunch of mechanical issues. mr. chairman, are you familiar with the discussions around businessing a i are gracious rules? >> in terms of -- in terms of what actually makes up. oh. how you -- what how you -- to add to up 50? yes. >> yes. i'm familiar with the discussion. altogether that's a treasury rule. that's not -- >> a treasury rule. but don't you end up having to do part of the administration. part of the modeling for what that actually brings or does not bring in to participation? >> on the question of what modeling we've done.

i would need to go back and see what we have for you on that. >> okay. last week we actually had fascinating testimony here the gentleman sitting at the same table. we have a small business. we offer health insurance on a little business. i'm an investor in this one. i participate in this one. and i do this one. and oh my heaives, everything else i'm touching is getting pulled in under the businessing a dwraition rule. i'm better off not investing in my son and brother-in-law and daughter's businesses because they create a cascade effect and force everyone under the 50-employer rule.

mr. chairman, that i yield back. >> certainly i'll take whatever ask you have. and we'll work with you. he asked a lot of my questions. you did a great job as usual. i was trying to figure out the amount of the subty will be for the government. you asked the question. i thank you for that.

being able to go there for information. if there's a complaint with the policy regards to a company providing coverage or just participation period. is there away -- >> yeah. we do have part of our office that receives complaints from the public. >> what part of that? >> sometimes there are complaints about with a we're doing and sometime complaints about what they have experienced, you know, if they've had a problem with the health insurance or something like that. >> okay if i'm an insured and have a problem with the company. who do i contact? >> we have a phone line that people on our website. it. >> it's on your website? >> the number is on the website? >> type as a claims complaint. why? >> yeah.

and there's health care.gov call center focus now for most of the questions that are coming in. >> health care.gov. isn't that where people try to get signed up? >> well, no, but the call center is operating. we have, you know, literally thousand of people who are answering phone calls every day from the public. >> you're incorporated with that? that's troubling. i'm concerned that, you know, around a little bit of with regards to the increases and coverage and cost of coverage. and, you know, i have a little bit of insurance background and my history is such that prices

affordable and -- if it's unaffordability that will drop it. if they have, i mean, situation somewhere they can't get coverage you have an illness that is now as a preexisting condition, african, that can't get coverage someplace else. then they keep it. they wind up with a shrek which peens the people who have the most to gain are the ones who stay in the program. the ones who have the most to lose will get out. you don't think it's going to happen. that's the information i get. >> is the question whether it will happen in the small group market specifically? >> sure. why would it not occur? >> there's, a lot of written about what will happen to offer rates. of course offering to their

employees in the employer-sponsored market all together and the small group narcotic particular. and a lot of predicts about what is going to ha. i think that most, you know, as pointed out today most employers offer coverage to their employees because number one they think it's the right thing to do. they think it helps them recruit better employees. >> is there a likely scenario? you have 12 employees. one of them is a serious illness. and in order not wreck your rate. the person drops out. and now has to go on the individual plan. which obviously because l no preexisting condition with the new health care law they will be to be get coverage. then you have an adverse selection. then all the people who have problems will be in the pool.

within certain boin drink and location. and but not on health status. so this will make it easier for employers to man contain coverage from their employees because they won't have to worry about rates going up. >> so the individual will be retaining them in the health care group. the ability to provide care is going to be more coly; right? >> when people get sick they have more health care costs. what happens under the fracted now is we're creating a single risk pool so any particular insurers all of their employees -- all of their small business --

insurers are one risk pool. we have made the small group market look more like a large group market. the large group market health insurance has been less costly and has been more stable than the small group market. we create a larger risk pool to spread the risk. i see my sometime up. thank you. >> he has 93 loy employees. has 2014 is 655,000. they all increase 19.1%.

and the new taxes generated from obamacare was additional 44, 41. he is -- we don't want to be bankrupted by catastrophic. >> -- insurance for dental or vision sexual abuse never needed it.

can you lead me to one? >> that doesn't have -- the coverages i want to plain barebones medical pair process. what they need for the employees. where can they buy ones that doesn't cover introduction, mental health, those -- assuming the policy is not going to be extended pursuant to the policy the president announced two weeks ago. >> okay so then sexual abuse coverage, mental health coverage. are part of the essential health benefit that are included in what is required by the affordable care act.

by the most used small group plan. on general, the benefits that are required for small group plans going forward are very similar to the benefits that employers are choosing to buy up until now. >> well, i was an employer -- you said it was done on a state by state basis. they don't have to carry all of these outlining coverages. they have to provide the essential -- [inaudible conversations] it is a national requirement. it's not a national requirement. how they are offered in with a is in each plan within the essential health plan is benefit on a done state by state basis. the category -- [inaudible] are mandatory.

>> all right. your telling me that a little longer affiliated 15 employees. they're not on a plan that is offered because these are required federal benefits. is dental and vision. and maternity. and maternity. so 60-year-old law partner and his wife have maternity coverage. we are spreading the cost of women across the entire people -- >> that's --

that's how insurance works. it doesn't work. you pay for what you need. you spread the cost across everyone who is -- actually, no, you wrong. actually insurance is where you go. you choose to buy the coverage you need. and spread the coverage you need. as we doesed maternity and sexual abuse and mental health coverage are among the essential health benefits. >> yes. >> why would you they clearly don't need? explain that to me. what is the purpose of requiring a 70-year-old woman to buy maternity coverage. the purpose is to make sure that all americans have access to the health care they need.

>> and to spread the cost of -- [inaudible conversations] i would submit to you. i don't know whether they need mental health coverage or not. they have no idea -- i can promise you -- indian it. i'm over my time. thank you very much. >> mr. king. thank you, mr. chairman. i'm glad i'm not sitting in that seat. the unpopularity of this atrotion law surely has to reflect itself in the business committee. i thank the chairman for holding this hearing. i just think about some of the premise that have been made. i wonder if there isn't a

committee -- but i looked at my own policy and i haven't given any thought until october i spent the previous four years fighting on behalf of the american people against this. and so this when i finally had no choice except to be have subject myself to this law that going read through the policy that were available. and the teaching of the catholic church are this. the catholic church oppose con from acceptive in the birth control pill. and sterilization, abortion causing pills and abortion. and the legislation requires that at least a policy be

offered for purchase. so everyone in the country has an opportunity to purchase a policy that doesn't fund apportion. i find it's almost impossible to find out whether it is the case or not. and it was offered to members of congress according to representative chris smith whom i trust above all others. there are 112 policies offered to member of congress. nine don't cover abortion. of those nine eight are regional. those apply to me, at least. and there's only one available that doesn't fund abortion. that was my choice. i wonder if there were only one woman in the world marry her. that's essential only one available to me.

to buy a bolls that doesn't violate their conviction. with respect to the provision of contraception without cost sharing, there a part of the affordable care act that required a study to be done of

particularly preventive services for women. independent study was done which found that providing contraception to women without cost sharing has significant health benefits for women. pursuant to that study and the provision of the law. there are a number of different preventive services. mammograms, not to just women. but other vaccinations and others that have to provide without cost sharing. because there's a very robust literature that shows -- let me set up -- you have to deal with the law and the policy that is to the best you can to an this. let's take to the question. how does a faithful catholic come -- comply with the law? >> i can't speak to the convictions of a catholic.

>> i have. and the conviction of the catholic. they -- oppose the contraception, the sterilization, and the abortions. and the law says that a policy shall be offered to anyone at least one policy that doesn't fund abortion. how do i know that? >> the the mandate that buy the policy or have the irs come down on us and punish us with a thax is not a penalty. and how does a person comply with the law when the federal government is not complying with the law? i'm saying this. they have obligated under obamacare to make sure there's at least one policy available that does not fund apportion and important to the people on the panel and those listening to the committee know there are three other basic principles here that are mandated violated by this legislation. that's the contraceptive, the sterilization, and the -- they are mandated to be paid for

by everybody even the people mr. issa is talking about. it looks like it's a direct assault on people who are pro-life. >> with respect to the -- i know the fda has concluded those drugs are not. they did not cause abortion. their prevent pregnancy but don't cause abortion. we can debate that. it's the conclusion the fda reached. the contraceptive pills there may be an argument. i know, the catholic church wouldn't agree. even talking about that.

i'll yield in a moment. you can't be free to follow your religious conviction. because this law is enforce bid the administration violate the deepest qibs of at least 25% of the people in the country. i yield back. >> the time expired. >> i lost the -- [inaudible] what the hearing is all about. it is about shop exchange. but i would like to ask you if the viagra is prescribed by a doctor, is that covered? >> it depends on what particular insurance policy whether it's inquisitive to the drugs -- t not a decision. >> okay. viagra is not a preventive service mandated by the affordable care act. >> that's good to know.

let talk about the state that have children -- run their own exchanges. while they have declined. they -- in the state-based marketplace. especially in new york. in fact numbers where even here. and i know that the only numbers coming out from new york is ones that were provided the insurance commissioner from the state of new york who said that they had a -- operate for 2014 that are at least 50% lower outrage. but we have some numbers coming out of some states that are related to small businesses in the six states that have made information available in the small group market.

they are -- average 18% lower than the premium small employer will pay for similar coverage. without affordable care act. would you say that this is the type of trend that we will see coming out of other states? >> yes. i agree with that. again, i think it's important to bear in mind that the insurance markets vary dramatically from one state to the next. we can't generallyize from new york's experience to where there is a competitive market and lot of carriers offering coverage to some other states where there is maybe only one or two. so i think over time i would expect that the example of the states that have established their own market place and been successful will encourage and inspire other states to do the same. and what they will find is that

the affordable care act and the way we have implemented it gives state a tremendous amount of flexibility to operate the market place in a way best for the residence debit of their state and give them the opportunity retain control of regulation ever the insurance market which traditionally has been a state market. >> what role can you play to replicate this success we're seeing in new york where only 300,000 have -- on almost 100,000 hospital already enrolled. that's a great question. we actually all the state to help them if they are interested in moving forward becoming either a state partnership market place or they operate some of the functions including the outreach and review of plans to be offered on the marketplace

. receive and review issue grants to the state to help them establish state-base marketplace and work with them through the process of developing the marketplace just as an example, in mississippi, the state decided to operate the small business shop marketplace. not the individual marketplace, and we worked very closely with insurance commissioner with mississippi to help happen. and that state-based shop marketplace is going opening for business u very soon. >> here in this committee we always talk about importance of having stability uncertainty for small businesses. that is so because when they put together a business plan they need to know what they're confronting. and what triable resources will

they have available. my question to you is what effect the threat of -- have in the implementation of the provision of the affordable care act. i would say as with any government agency we dot best we can with with a we have. and while would always be helpful to have more resources and i think particularly the second jury has spoken very, you additional resourceshe benefitg do more outreach. to do be able to more education to be able to -- small business own nor the country knows that the law benefit of the law can provide to them. and knows how it take advantage of them. that has been difficult, you

know, given the funding level we have. >> thank you very much. >> absolutely. last question. documents served last week cms as far back as july 26. the federal shops were going function or at least the website wasn't going function.