>> i can assure you that at least the staff that is looking at these situations is very concerned that patients not be jeopardized by the care and try not to add administrative burden, but i would be happy come if you can give me some specifics, if the evidence back to you. >> thank you. again, i think these are

examples that i hope we can avoid of the federal government standing between a patient and his or her provider. thank you. i yield back. >> thank you. mr. buchanan. >> madam secretary, thanks for being here today. i want to touch on the biggest issue in the area, employer mandates. a lot of people are concerned. i'm looking at a "new york times" article about two weeks old, i'll be glad to give it to business cities, counties, public schools, community colleges around the country are reducing hours in terms of part-time employees to avoid pain health care insurance under the aca. this is coming from state and national leaders from around the country. are you aware of this? do you have any sense of the impact this is having on communities? in our community, and sarasota, brighton florida it's a gigantic issue. >> i have heard, congressman, certainly conversations about the 30 hour kind of cliff's that more than 30, people would be

required to provide health coverage for those employees. less than 30, they would not. again, i think there's a disputing evidence of what's happening with that, but we're watching it very closely. >> we need to clearly, because this is, i know we're trying to get more help there out there but everybody is taking innocent to 25% pay cut. the fact that it only affects 2% of the businesses. do you have any idea, one way to spin it or present, do you have any idea what the 2% mak makeupn terms of the number of jobs, the impact in the country? do you have any sense of that -- after one point in my area, they have over 1000 employees. most of their employees from 40 hours to 29. they are part of the 2% but i think you're looking at 20, 30% of the jobs across the country are going to be impacted by

these mandates. even though you are pushing the mandates off, people are making those adjustments in the public and private sector today. we are very concerned about that but i would like to get back to me on what the 2% makes out. one other thing i want to mention on terms of taxes and revenues. part of the reason we're having a record surplus this year, not a surplus but record revenues, because we did increase taxes 325%. we went from 35 to 44. that's what the pass-through entities are paying that create a lot of jobs in the country. if you look at the taxes for state and federal, the average across the country is 49.6. i don't know how much more burden we can put on our employers across the country, as you mentioned, we need additional revenues. i hope you're not consider going after more pass-through entities as the job creators of america. >> one thing i would point out is that the recently released rules by the treasury department

did look at the 30 hour employee, ma and particularly the kind of mixed workgroup where part-time and full-time, and indicated that employers, if they offer coverage to 70% of their employees, would meet the criteria. i would tell you that the 30 hour definition came out of the offerings in the private sector marketplace prior to the affordable care act. that's what employers chose to do, the people who were making, or working more than 30 hours were defined as full-time employees. people who are working less, so as congress looked across the country that's where that our rate came from. but we are watching, as i say, that's very closely. >> thank you. mr. doggett. >> thank you, mr. chairman. madam secretary, so much of the original promise of the affordable health care act has

been undermined by faulty implementation that has sometimes been in different to local concerns. last month cbo's you know concluded that faulty implementation of the health care law quote and peter tommy peoples enrolled in exchange is that 1 million fewer people will actually obtain, exchange coverage of this year than they previously projected. from your testimony this morning, it's clear we will not have 7 million or even 6 million. and, of course, the number that's really important is not the many people have enrolled, but how many people have paid their premiums are and are getting an exchange based coverage, a number we have never been given. as you are aware since last august, i've been voicing concerns to your office about implementation in texas. at best, less than 10% of the exchange global texans have selected a plan.

in other words, more than 90% of the people whom we wrote this long to get exchange coverage have not been covered. to meet your projections we would need to enroll and have premiums paid for as many people this month is have been enrolled since the beginning in october to yesterday, or last week. this is much more than a website problem. though i believe that the individual assistance programs there has been handled with about the efficacy of the original website rollout. i've been unable to get straight answers about even who is responsible for coordinating in person assistance in texas, a place where we have multiple assisters in some areas, and nine in many others.

-- nine. i have sought to get a dedicated line so that the certified counselor who yesterday had put in 10 hours trying to help one person would be able to call a line dedicated to assistance counselors to be able to get proper assistance and help people get enrolled in this. but there's been no response from hhs or cms about that. seems to me that we are to a point where, instead of just circling the wagons against all the political arrows that are shot against this plan, we need a little more accountability and we need to ensure that the next enrollment period is not handled as poorly as the last one. i'm very interested in answers to the questions that the chairman raised at the beginning of the searing. we haven't gotten them yet, and i hope that we do get them. we come at this from a different perspective. but taxpayers deserve to get their money's worth.

i think much of the focus as it relates to in person assistance needs to be defined, anderson, mr. chairman, some of these questions i've been racing since last fall can be submitted by you with your questions for prompt answers, such as how much it costs us are person who is actually insured through the exchange for some of these contractors have been providing these services. to washington beltway contractors have been paid $9 million for in person assistance in texas. i've been unable to find out what it calls per in raleigh for those persons. and so i think that while our goal should be to try to improve and strengthen this act, if it is to perform any better in the next enrollment period than it has in this one, we need answers to these questions to get the taxpayetaxpayers their money's h and to get the promise of this act fulfill. i yield back. >> at this time, dr. price.

>> thank you, mr. chairman. welcome, madam secretary, back to the committee. i think it sends a growing lack of trust that we reflect from our constituents. americans have a growing lack of trust in their own federal government. i think there's no doubt about that and i would suggest that obamacare is the poster child for one of the reasons that that exist, or that's increasing is because word isn't matching the. promises have been made and absolutely broken. and as a former matching position come is distressing because we're not talking of some nebulous program. we're talking about real people's lives. in so many ways real people are getting harmed. in spite of that you have harry reid taking to the floor of the senate saying any story that decries a problem with obamacare, all of them are lies. do you agree to all of these stories that have been read our lives? >> senate -- to me, congressman,

i did not hear what senator reid said. and, of course, there are lots of anecdotes of lots of people and lots of success stories. >> if you were to avert the senate majority leader say all thallthe stores about a see a sd is i really don't want to comment on his comments. i did knew that. >> again, that's the kind of trust that's lacking because it begs the -- >> i said clearly there are lots of people and lots of real -- i don't assume that people are lying. >> let me go to specific questions. you mention in your opening remarks for .2 million people have signed up on the exchange and want to get to some of the concerns others have. how many of those have signed up that have enrolled in the obamacare have paid their premiums. >> i can't say because i don't know that. >> how can it be that hhs in charge of this program cites a number, 4.2 million have signed up, has no damage people a big? >> because the consumers don't pay us.

they pay their insurance company. we can tell he who has enrolled the -- >> do you get -- >> we get information in aggregate form of the customers who qualify for a tax credit. not all their customers do. >> how many of those, of the 4.2, were previously in short? >> i do not know that. >> isn't too many members of congress are in the 4.2 million? >> i assume if you signed up on the exchange you're in that number. >> mckinsey did a recent survey that said 27% of those joining the exchange is were previously uninsured, and that's a low number compared to what you all projected. is that consistent with your information? >> again, we don't collect the previous insured -- i think these questions would be -- we would be happy to give them to you as soon as we have accurate information but in the meantime, insurers have this information about their customers because that's who's being paid and that's who is enrolling.

>> it begs the question that you don't know the answers to these -- >> these are private insurance plans and -- >> u. r. all -- >> from her private insurance plan. we qualified them. we get their tax information to make sure they qualify and then send them to the company. >> the american people -- you know what you're doing and you're not going to bill. >> this is not medicare or medicaid. it is a private plane. in the private market. it is not government insurance, in spite of the fact that it's been characterized that way. people are buying a product in the private market. assist with accurate information we will give it to you, but we did not currently have information about how may people have paid. >> sounds like last fall, mr. chairman. >> mr. gerlach. >> madam secretary, there's a section any aca on a reinsurance

tax, is that correct? >> yes. >> what's the purpose of that reinsurance tax likes the proceeds from the tax. >> there are three components of risk quarters, reinsurance tax, and risk adjustment. a three-year program that come again, is paid for by the insurance companies operating in the market, and it's to really balance the risk pool, exactly the same as the risk program in part d when part d started. >> i'm focusing on the reinsurance tax. are the revenues to be used to fund other portions of the act, including exchanges? >> the revenues will be used to balance the marketplace. >> how much is expected to be raised into reinsurance tax this year? >> i was just told the figure is a $10 billion for this year. >> okay. but there's also proposal out

there to provide waivers to some of those that are right now under law to pay that reinsurance tax, is that correct? in particular, unions? >> oh, yes. this is the -- i'm sorry. the rule that come if you're self administered and self budget plan he did not pay the tax, and that is not exclusive to unions. there are a lot of self funded plans. >> how much relief under this waiver will use it as a result of this will? >> i could get you the information. >> ballpark? >> i can't. >> i find it curious that the reinsurance attacks section of a seat is very clear as to who is to pay that tax. it's to be used to help fund aspects of the aca, including exchanges, and yet the president's requesting an additional $1.8 billion in his budget request for program

management to continue to build and operate exchanges. so what it seems to me is that you are providing a waiver to perhaps what would be termed political friends, not to pay what the law requires them to pay, but coming back to the taxpayers and asking them for more money to help fund the exchanges. >> the statutory language talks about issues -- issuers are those who operate plans to a third party administrators. is so funny, self administered plans which are a much broader category than you've just described are not in the statutory configuration of the law. in addition, the 1.8 -- >> to hear what you're saying, make sure i understand what you're saying, if it's your determination that those were granted this waiver are not covered by the language of the act and, therefore, -- >> they are not an issuer or do they operate with a third party administrator, yes.

self-funded, self-administered appliance. much broader than the category of unions. there are many who operate that way, are not specified in the statutory language. >> why were unions jumping up and down asking for this release if they weren't covered by the tax to begin with? >> i can just tell you that's what the statutory language does. that was our interpretation of the statutory language. that's the role we put up. the $1.8 billion that you suggest, 1.2 of that will be paid for by user fees. 600 million is the request for appropriations. >> mr. becerra. >> thank you, mr. chairman. madam secretary, good to have you with us. before i go to some of the questions about the affordable care act i wanted to check in with you regarding the financial alignment demonstration project being carried out in california called the dual eligible program for beneficiaries who receive both medicare and medicaid. we share the goal of ensuring

that everyone who transitions into this program will have uninterrupted quality health care that they can count on. i just wondered, will you and cms administrator tavenner keep us informed as you continue to roll out so we can make sure there is a successful implication? >> yes, sir, we will. >> i know that even today, if anyone is watching, there's a reason why folks should not be left with some sense of misunderstanding about what's going on. disinformation and scare tactics that have been used over and over again have been difficult to combat. but i wanted to just make sure about something. as i read the faqs, since the passage of the affordable care act, you mentioned that several million people have now become injured. in fact, i think you mention over 4 million people now have private health insurance. did you mentioned that three or so million young americans who have insurance as result of the

affordable care act have the consent of their parents insurance policy? >> i did not mention that. >> that is over 3 million or so? >> yes, sir. 3 million pray for the uninsured, far more young adults are on their parents plan but 3 million previously uninsured young adults. >> we have some 4 million or more individuals who now have health coverage as a result of medicaid. >> closer to 8.9 million in the medicaid. some of those are renewals. some of them are newly eligible in states that chose to expand their medicaid programs. >> so the 8 million plus number includes people who probably qualified before, or who just transition from current medicaid, what they had before to what they have not? >> some states require newly pashtun yearly renewals but there are close to 9 million people who have medicaid coverage, a number of those are newly insured. >> if i do the quick math,

9 million under medicaid, 4 million with the private insurance under the marketplace, 3 million young adults, that's about 60 million americans who have health security today that they might not have had before? >> that saturate. >> my understanding is looking at the jobs number since the affordable care act act passed more than 8 million jobs have been created in this country, not lost. and effect if you look, i look at just the health care sector and in the health care sector, since the passage of the affordable care act we've seen over 1 million jobs created just in the health care sector. we continued your folks talk about job loss that the affordable care act will result in job loss. just the opposite is occurring. we are also finding that we see a decrease in the rate of increase of the cost of health care. which i think would you would agree is a good sign. >> that is a good sign in the job front we also see a number of people working part-time

hours is decreasing the number of full-time workers is increasing. increasing. >> tragic if i could just add to the record, ask unanimous consent to submit in the record the cbo's estimate of numbers that deal with job loss and issues of employment and job creation. >> without objection. mr. roskam. >> thank you, mr. chairman. madam secretary, we just heard from mr. becerra who criticized critics, characterizing it as misinformation -- or disinformation and scare tactics. yet that wasn't what we heard from mr. doggett. mr. doggett was essentially admonishing the department for a lack of information and a lack of accountability. i want to associate myself with the spirit of mr. doggett, and also bring in one of the things that dr. price was trying to articulate, and that's this. wouldn't it be great, madam secretary, if dr. price and the question that he asked you able to say here's the answer. here is the answer, we made the

inquiry into see, i don't have that information, i'm just the secretary of health and human services. that is with a private insurance company. that was your answer. wouldn't be a great thing if you were to say here's the information and here is the answer? and the problem is, at least as far as the construction of the affordable care act as it is currently constructed, some of this information you may not know, some of it you may it's because of the limitations of the act itself. we've got an inspector general and your own inspector general, is only able to go and ask inquiries of health and human services. that inspector general reports to you cannot go and make any inquiries at the treasury, ma one of the earlier answers you cited tax credits. when it comes down to it, the hhs secretary house tour jurisdiction over tax credit. you don't know what happened in that other department. wouldn't it be a good thing if we were to amend the law and you have that information and the

word they special inspector general that have brought jurisdiction? >> i don't think that's necessary, and i think that's additional expenditure. i will give you information as soon as we have, and we will have it -- >> but you don't know what. so why is it that i did have a special inspector general for iraq reconstruction, why is it a good idea to have a special inspector general for afghanistan reconstruction? why is it a good idea to have a special inspector general for t.a.r.p. oversight, all of these have literally saved billions of dollars? the affordable care act according to the cbo is a $1.8 trillion expenditure? what is it that is sacrosanct that says they should not be subject to that brought jurisdiction? by your own admission, you don't know the answers to these questions, do you? >> i could not answer dr. price's question because i don't

have the information from the insurance companies yet. we will have it and -- >> right. >> this is not treasury. this is private insurance companies. 300 -- [talking over each other] >> your inspector general can't get to it. >> this is not an inspector general issued its private insurers who are selling plans to their customers. they can tell you how many -- >> its ongoing and you don't have the information and you don't have the capacity. >> i would just say, madam secretary, part of the frustration is you did have the answer to the number of injured children and that is also private sector insurance information but yet we were trying to get further information -- >> that can directly, mr. chairman, from the insurers and until you as soon as we have this information -- we don't collective. we didn't have it. they turned that into a. >> dr. boustany. >> thank you, mr. chairman. madam secretary, one of the glaring omissions in aca was

addressing the flawed physician payment formula under medicaid, the sustainable growth rate formula. a lot of work has been done to it's been a thorny problem facing congress. over the past few years we've gotten to an agreement on a policy. bicameral, bipartisan. so first question, does the administration agreed with this policy? will the administration support this policy? >> as you know, the president has supported a long-term fix of the sgr long before the affordable care act was signed into law. is included it in every budget and yes, we do support the bicameral position. >> the other issues going to be paying for this, and this will be a difficult fight obviously and it certainly can become a partisan fight. in interest of trying to get something done, will the administration come forward and work with congress, work with the senate to try to get to a solution on this?

>> we would be eager to do that. the first couple of budgets that the president put forward have specific pay-fors. those were rejected. he does assume that the sgr is fixed. fixed. we put that in our baseline for the next 10 years. we would be happy to work with congress. >> pursuant to the same question, the president in the past put on the table some medicare reforms that would help improve the outlook of medicare over the long haul. one being combining medicare part a and part b into a single structure, making it work more like a modern insurance type program your a second was limited means testing. does the president still support these? >> i think as you know, that was put on the table as part of a global package of both entitlement and structural spending reforms, and we would be eager to talk about those issues in that kind of global

package. >> but not within the context of reforming sgr, which is a pretty good piece. >> the sgr does impact certainly medicare physicians it is probably the single biggest threat to medicare's future in terms of beneficiary services, the looming -- >> it's a threat to -- >> so we are eager to talk about pay-fors, but i think having a more global discussion about entitlement reform, tax reform and revenues is also something we would be eager -- >> and finally is the administration went to put for the capital to try to solve this before the end of march so we can avoid another patch which would be expensive to? >> put forward, again will be happy to have a discussion with members of congress about what the pay-fors might look like. >> thank you, mr. chairman. >> mr. neal. >> thank you, mr. chairman. madam secretary, let me come back to your role for a few moments about the trustee of medicare and social security.

but just a reminder here that the democratic minority vigorously opposed the original part d prescription drug benefit plan offered by the bush administration because we did not think it had gone far enough. upon ascending to the majority right after, we took the role that not to undo what has been done but instead to work hard to improve it, and closing the doughnut hole was a pretty masterful piece of work. and now there's broad acceptance of the whole notion of the part d benefit. i wish it would've been the model we have adopted in congress for working with aca, but let me draw your attention specifically to a couple of issues. graduate medical education and the role of medicare financing our hospitals across the country

as you know in massachusetts, our hospitals would be the equivalent of what boeing perhaps means to that's pacific northwest. i think it's a reasonable description in terms of not only the success that they have but employment opportunities that they present. you i think by law have to sign every year a document certifying as to the longevity of medicare, correct? >> yes, sir. >> would you talk about what aca has done to that signing? >> yes. the first year i was a medicare trustee. in 2009 the anticipation was the actual aerials, projection was that medicare would begin to be insolvent, not that they wouldn't have any money that they would have about 70 cents on the dollar by 2070. so in 2009 it was a 2017 cliff.

the passage of the aca added years to that solvency, according to the actuary who looked at the law and the impact over time. and subsequent budgets have also added years, so we are now -- the 2015 budget, according to the actuarial projection, would add an additional five years to the solvency of the medicare trust fund. so during this administration i was a significant solvency years have been added. >> are the republican trustees of? >> yes. >> do they signed the document? >> yes, they do. >> and did a signing? >> yes. >> my point is, an example much like the one that secretary lew present about deficits in his appearance before the committee recently, and it's frequently underreported in terms of the good news because the emphasis remains on the conflict of the story as opposed to the substance of the store. so i would hope that you use the

opportunity medicare solvency, graduate medical education, to promote the notion that this is a widespread fix this story on that basis. >> thank you. >> all right, thank you. mr. reichert. >> thank you, mr. chairman. madam secretary, you in response to mr. reed's question regarding legislation, your answer was that there was no legislation that has passed congress. there's no legislation that has passed congress. are you aware there are actually eight pieces of legislation that the pass congress and have been signed by the president in regard to the affordable care act? there are eight pieces passed by congress and signed into law by the president, so there's another -- i think you ought to go back and redo the loss had been passed that affect the log you're trying to implement. i want to go back real quick. it's been four years since passage of the health care law. nearly six months since the exchange is open for business.

so let's look back at the four years in january 2010, the president spoke at the white house republic in retreat and acknowledged that some stray cats and dogs were added to the health care bill and that some of the provisions that got talked into law might have violated the pledge that if you like your health care you can keep it. if you like your doctor, might be able to keep your doctor. in february 2011 during your testimony and my questioning you said in response to whether or not you could keep your doctor or your health care, you said i don't think there's any language in the bill that interferes with the current system. again you were wrong. in figure 2012 when i raised these same concerns you said the notion, quote, the notion that some of companies and grandfather plans will not be able to keep your grandfather plan is really not accurate. again you were wrong. due to the loss many mandates and regulations put out by h. s. under your leadership, as many as 5 million americans have lost their existing health care plan. the law has created so many

disruptions that the president announced her apps illegally we think that states and ensures can begin to ignore the law. in fact, as mr. reed said, there are 37 changes to the law. september 24, september 26, october 23, november 14 there were seven more changes to the law. on november 22, november 21, 22nd, january 1, november 27, the 30th of november, december 12, december 19, december 23. and then, secretary sebelius, you were on fox news and assured the american people who are watching fox news at the time that they would be no more delays. yet on january 10 of this year another delay. genuine 14th another delay. then they portend another delay. are there any further delays? community promised to the american people today, another promise, madam secretary, that

there will be no more delays to the so-called affordable care act? >> we will continue to put out regulation -- >> can you make a promise -- >> as we go through this act, and i would like an opportunity to correct some of the i think the statements. we did -- >> will there be further delays? >> there are no planned delays in the law. >> you consult with a just when you, pardon me, do you consult with the treasury department before announcing any delays in changes? >> most -- >> do you consult with the department of treasury? >> most of the regulations that are [talking over each other] >> the regulations require three agencies participation. treasury, labor and hhs and there is broad consultation. >> thank you. i'll just quickly say to my friend from massachusetts he should look at the unprecedented

original appendix, the trustees report that talks about the double counting that occurred and putting part d on the credit card, the democratic proposal was more than double the credit card bill. here's what i want to ask, madam secretary, we keep this listed in the ways and means committee about all the delays. we have 23 so far. what i want to ask you about is ipad. the independen independent paymy board. your table in your budget last year, you claim in your budget you will save $4 billion. issue you couple that the $12.9 billion. this is above and beyond all the provider cuts that are in the aca to pay for the aca. so here's my question. where are we with ipab? if given us their last april report. i sent another one is forthcoming from the actuary.

where is ipab itself was when he going to cement the names? if you don't do that, as you know the law lets you, one person, submit the plan to save $12.9 billion. so what's happening with that? and if you're going to do, how do you come up with $12.9 billion? where is that savings coming from? >> the president has not yet sent to congress names for the nominees of ipab, but as you may know, the law is constructed in a way that ipab wouldn't trigger any recommendations unless there is a gap between what -- >> i realized that and you are claiming 12.9 billion. >> they would not have any recommendations to make in the foreseeable future. >> so how are we to ignore the fact that your clinic will .9 billion in savings from ipab?

>> i think the president intends to submit names to congress as we watch the cost trajectory, if the cost trajectory changes, and ipab will be in full effect. and those recommendations are presented to congress, as you know, not to me, they come to congress. and if congress doesn't change them and they go into effect. >> or you just recommend them if no ipab at the time. >> that's correct. >> said no answer to whether 12.9 is going to come from? >> we are optimistic that the current trajectory of medicare costs would actually negate any impact of ipab or me taking any kind of action in the foreseeable future. >> that's another way of saying it nor our budget because it's not real. >> i think the ipab recommendations are based on an actuary of -- >> i understand you go from gdb 12 gdp five. i get all that. you did that last year. he went to gdp five flash and you still had 4 billion here

negatively or savings to 12. the question is, where is it coming from? what are those justifications? which the assumption you using to claim the savings to show how your budget is put together? >> i think the actuarial projection is that out your medicare costs will rise again. so far they have been incorrect about those increases. we are hoping that they continue to be incorrect, and so if the ipab indeed gushing indeed does rise, i mean the trajectory rises, ipab the would kick into gear and we will make recommendations to the ipab to congress about those specifics. >> so you are saying, just so you know, in your own budget it's going to triple from this year to last year. that's coming. it's about projection. you got into budget but you were telling me give no idea where in medicare you're going to cut? >> it's based again on what the

actuary -- >> i understand spent in the pen actually says will happen in out years. currently we have not made specific recommendations about any cost cuts because none of that is actually happening right now. >> okay, i know time is out. when are we going to see the names? when will we see ipab -- >> i can't tell you, they come from the president. >> mr. davis. >> madam secretary, thank you very much for being here. but also i want to thank you for the medicaid waiver for cook county in the state of illinois. as a result of that action, the governors expansion of medicaid, and a lot of hard work on the part of a lot of people, illinois is doing much better in sign-ups for the affordable care act than many other states. and for that we are indeed grateful. i'm a big fan of home visiting programs and community health

centers, and i'm pleased to note that both are included in the budget. as a matter of fact, i get my personal-care at one of these centers in chicago at miles square. could you elaborate on the value and effectiveness of these two programs that relates to providing health care for especially low income people? >> well, congressman, i share your high regard for both programs. i think that there's no question the committee health centers are the backbone of primary care delivery in this country in rural and urban areas. they are proven time in and time again to deliver lower cost, high value, primary care. and thanks to both investments from the recovery act and ongoing investment through the affordable care act, the footprint of health centers is

spreading come increasing services and increasing clients. so we are now going to be able to serve about 31 million people, including yourself. and i think they are an incredibly important plant and an incredibly important role, particularly in underserved communities. in terms of the home visiting program, again lots of very strong scientific evidence that makes a huge difference to help give parents the tools to be the best parent they can be, that having a professional encounter with young parents is often extremely beneficial as the pathway to an early strong start in learning. so the president's budget, as you say, both increases the voluntary home visiting program as well as continuing to expand the footprint. both new sites and additional services sites for the national -- by me, for the committee health center program. >> thank you.

[inaudible] -- have not been automatic, but our experiences have come as a result of a large number of people believing in the program, believing that it will work, and then working to make sure that it does work. so i thank you very much. >> well, i don't think it comes as a surprise that in states where the governor is very much supportive, where the our delegation members, providers, others reaching out, there is a more positive experience and congressman doggett has mentioned texas, where they are not only barriers but significant loss that have been passed which make it difficult for a lot of the outreach people to even do the job they were contemplated do. >> mr. tiberi. >> madam secretary, mr. dent debated for the record this report, making inequality worse.

i'd like to read the conclusion which says for two years labor unions, employer partners have patiently explain to the obama administration and congress the potential damage that the aca poses to these unique and successful nonprofit plans. having made efforts to accommodate businesses, churches, congressional staff, it's up on the administration's highlighting issues of economic in the quality of the acting to preserve health plans in achieving the goals of aca for decades. without a smart fix, the ac will heighten the inequality that it administration seeks to reduce. we take seriously the promise that if you like your help plan you can keep it, period. you do not hear members like their health care plans can you do not hear members plan, plans are ready to compete with the corporate giants of health care industry. if washington will simply create a level playing field. there were three articles in local papers in my district. i would like to cement for the record, mr. chairman, that highlight this very issue.

>> without objection. >> the mansfield journal report on monday that only six of the obama to exchange plans in richmond county include the only hospital in the county, met central, in network. the marion star reported on monday only six of the 26 obamacare plans in marion county have marion general hospital. again, the only hospital in marion county in network. and, finally, the newark advocate report only six of the 26 obamacare exchange plans in lincoln county consider the only hospital in lincoln county, lincoln memorial, to be in network. that means that three quarters of the exchange insurance plans in these counties don't have access to county residents to the only hospital, and hundreds of doctors in network. because many of my constituents now are facing the choice of being in network and having to travel out of the county, maybe 100 miles to a hospital, and are now losing doctors if they had, these are people that insurance

and now have been forced to go into the exchanges, and an account in which which they reside they can't even go to the hospital but this is a problem just beginning. we spoke to a lady in the office yesterday, a central ohio when he wanted me to give your name. her name is calling. she had health care. she is one of the 4 million in the exchange and she has a plan that she is paying more for, that she doesn't like, that she actually lost for doctor. she liked what she had. she couldn't keep it. and now she can't even keep the doctor that she had. so the articles aren't misinformation or disinformation. the union report, not supportive of republicans by the way, is not disinformation. and yet there seems to be a disinformation campaign within the administration that this is all just make-believe. madam secretary, please help us

reassure our constituents that the administration is going to deal with the reality that is hitting the ground, and that's people are losing their doctor now they're losing the hospital. >> all right, thank you. mr. schock. >> thank you, mr. chairman. welcome, madam secretary. yesterday the house of representatives past a bill dealing with the affordable care act the clarified religious exemption clause for a small segment of the population who, the annual tax return will have to basically verify that their religious conscience inhibits them from participating in traditional health care here in our country. this is modeled after a lot of the state of massachusetts put into effect. in the state of massachusetts since 2006 only 6000 residents have taken advantage of it, primarily christian scientists and others. the bill passed out of the house yesterday unanimously. it's now headed to the senate where it enjoys bipartisan

support. senators ayotte, schatz, bernie sanders but i wonder if you did whether not you support this clarification in the religious exemption clause? >> i haven't read the language, but i will take a stroll look at it and they do know that it passed yesterday but i haven't read the built. built. >> will you get back to us with your opinion? thank you to the second question has to do with the administrations change in, or hhs is changing how you're handling the appeals process for medicare providers. the office of medicare hearings and appeals has recently taken the unprecedented and unorthodox step in no longer accepting medicare appeals for processing at the admission of law judge level. obviously, unconcerned about the current health care providers and current seniors who could be denied reimbursement, what effect that will have downstream, if you will, if they are not allowed their due

process. and, of course, if we press forward the implications of the affordable care act, if we set the precedent that they just said will not allow for due process for current medicare recipients, one would dennis and perhaps that would be a practice that the agency would do for the folks on the aca. are you working through that? do you see the administration standing firm and not allowing due process on the appeals? >> congressman, this is a major problem and issue, and i know that the head of the office of medicare appeals has been here on the hill briefing in the bipartisan nature of both the house and senate just on what has happened over the last couple of years. it's my understanding, and i don't want to his speech, but i would say what my understanding is and if it's incorrect i will correct it immediately, that their initial decision to suspend hearings was not for

beneficiaries but for hospitals and providers. said they were very concerned that beneficiaries not get caught in this huge queue and go to the back of the line. in the meantime they are looking at the whole array of systems which could alleviate the queue. the volume has about tripled over the last couple of years. we need to do some system changes. we need to work carefully with congress because the last thing we want to do is have anybody give up their due process rights. >> thank you. mr. rangel. >> thank you. madam secretary, i am convinced that when the final pages of history are written, that your name will be included among the courageous by news that improved health care to all americans. there seems to be some concern about the delay in the program. do you recall when last we have a program for the nation where all people would have access to help there? >> no, sir.

>> so that's since the beginning of the republican? >> yes. >> and so this is the first time. when we have social security, with their delays in legislation necessary to improve at? >> well, i would say both social security and medicare certainly has transformed over time since they had been a place. >> i understand and romans are going up, and that people, young and old, are applying? >> that's correct. we put out information yesterday that as of the end of february, about 4.2 million people have enrolled in the private market. another almost 9 million have qualified to be medicaid eligible, and 3 million young adults gather coverage earlier in the program thanks to the parents plan spent and that's young and healthier people to bring the balance that we need. >> yes, sir. >> is there any indication that

they are all democrats? >> we don't have that information currently. >> is there any reason to believe that republicans are not in need of health insurance, or they don't have preconditions or that they all are injured? is there any evidence that republicans will not receive the benefits of the affordable care act? >> no, sir. >> well, in the 50 attempts to derail or to repeal the affordable care act, which has passed the house, the senate and approved by the supreme court, is there any indication from the president if by some stretch of our imagination the repeal goes through the senate as to what the president would be inclined to do? >> i think is indicated he would veto a repeal of the act.

>> has there been any suggestions then from the republican leadership, since this is the law of the land and its universal and bipartisan as it relates to the beneficiary, have there been any suggestions from the republicans as to how we can improve upon this bill? that is, the provisions to provide health care for everyone? have a suggested to you anything that makes sense of? >> well, there have been a number of conversations, and i would say some productive conversations. unfortunately, i think the suggestions of how to improve are often tied to suggestions of how to repeal. >> time has expired. spent i wanted to just congratulate the chair, and i will insist on congratulating him as being a part of the republican party that has tried to be constructive on

legislation, and i think you. >> well, thank you. there's always time for that. we are just down to -- [laughter] we are just into mr. levin and myself and i just want to return to this issue about how many individuals have made the first month premiums. i realize you have repeatedly said under questioning that you don't have that information yet. but i just want to make up what we are two weeks away from the end of the six-month open enrollment. i know there's been, hhs has spent $2 billion building these exchanges and your own budget document states, ethical, cms administers the program on behalf of all marketplaces. this process involves receiving enrollment information from marketplaces including the level of selected t exactly and to get monthly aggregate payments to issuers. but given all the time and the critical need that you own department has for this basic information, i think it's just

absolutely critical that we find a way to get this information. and there are reports that up to 20% of individuals have selected plans have not actually paid their premiums. i don't know if this is in line with what you are saying. do you have any information on that line about, is the 20% in line with what you have been finding out? >> i think again, mr. chairman, the 20% number came from insurance companies. if i recall, about the first of the year, where they were heartened by the fact it was a deadline for payment of the first month premiums, and many people, if you will, enrolled for the first time in december, and with that kind of three months of strong enrollment, they were heartened effective in about an they had about an 80% payment rate. but again, that did not come from us. we will eventually them with a fully automated financial system is in place, have that information and be glad to share

it with the committee in real time basis. we just don't have it right now. >> but i think there's such an interest in this for one reason, is that we know at least one, and the gym at least one, you're about to make the second payment to ensures for the premium tax credit and cost sharing subsidies. so these reflect what injures or tell you about how many people have paid their premiums. >> they are aggregate number based on only those customers who would be qualified for either cost-sharing our a ptc, and that is not at all the entire look of the marketplace. so we don't even have any information at this point, even in active. we don't have individual information about the group that is premium tax credit and the insurance companies get paid much to just restate the first month as an indication that they did not have a full information. so we're getting aggregate data about a portion of the marketplace and not individual data about customers. >> they are not passionate

unless they paid the first month premiums they can't get agreement tax credit. so opposite that's in the jurisdiction of this committee. we are interested to make sure that is being used. >> we are, too, and we'll be chewing up with insurance companies a person at the time. we just don't have that at this particular time. >> had asked interest for this information? >> we are working, mr. chairman, on the automated system which at the end of the day, the 834 which is the process by which we sent to the insurance company from the website, chairman camp's name it wants to roll and blue cross in michigan, and will be a process where they will send back the confirmed 834 that chairman camp pages premium and that will be the end of the loop. currently that part of the process is not in place. >> is there a coordination between agencies on this? some of this is administered between irs and treasury. i know in answer to some of the

questions you mentioned that some of this is involving more than one agency. so are irs and treasury -- >> well, as in most bills, treasury basically pays the bills and the database on a system of our presenting them with information. much the way medicare bills are paid. >> mr. levin, and then we will conclude. >> thank you. well, welcome to i just want to ask that we enter into the record, mr. chairman, the three documents relating to the medicare advantage rates. one from the secretary to the speaker, one, an article from "the new york times," and one letter from beneficiaries. >> without objection they will be entered into the record. >> and also asked that the cbo table on 4015 that will be coming up in the next couple of days with your amendment showing about 13 million people would

become more with the uninsured. >> without objection as well. >> thank you spent thank you for your time this morning. appreciate that. with that, this hearing is now adjourned. [inaudible conversations] [inaudible conversations]

[inaudible conversations] >> while the u.s. does not officially support taiwan independence, it does conduct trade and maintain diplomatic ties to the asian island. that's off the coast of mainland china. a state department official will testify about u.s. relations with china. live coverage starts at 9:30 eastern here on c-span2. and on c-span3, agriculture department secretary tom vilsack will take questions about the usda's 2015 budget requests. our live coverage begins at 10 a.m. eastern from an appropriations subcommittee.

>> now senate finance committee chairman ron wyden talks about his bill to avoid cuts in medicare payments to doctors. he spoke on the senate floor for 15 minutes. >> mr. president, i am rising this afternoon to talk about the medicare program. which, of course, is a lifeline, a guarantee for 50 million older americans. and in particular what the senate wants to do is make sure that those older people have asked us for primary care doctors, nurse practitioners, specialists and other providers in their local communities because they provide critically needed care to our seniors day in and day out. mr. president, colleagues, many of those seniors have no idea

that by march 31, just a few weeks from now, congress has to act on their behalf to preserve access to the care that seniors depend on. and suffice it to say, those providers would much rather be delivering the care than waiting for this congress to act. now, fortunately, mr. president, there's a roadmap for getting this done. and getting good care to seniors not just for a short period of time, but colleagues once and for all. and i wanted to this afternoon to urge my colleagues to seize this opportunity. and in beginning my remarks, mr. president, i want to be clear, that i can take little credit for the opportunity that is before us. the path that got us here, that

got us started in the effort to make the needed reforms to protect our seniors is a direct result of the leadership of my friend and colleague, senator orrin hatch. .. senator hatch was key to forging a bipartisan solution to a challenging, long-standing problem. so what i'd like to do, mr. president, in beginning is recognize that effort by senators hatch, my predecessor as chairman of the finance committee, senator baucus, house ways and means chair dave camp, house ways and means ranking member senator levin, house energy and commerce chair fred upton and house energy and commerce ranking member henry waxman. waxman. >> the work that they have been doing over th