ought to engage in to help countries build up the kind of technological and capital requirements to build up the systems and while we do that, to some extent we don't, for example, at the department of homeland security have capacity buildinbuilding fund and fundine sector funding in which to do that. so when we go out to do that they grant from the state department or the defense department we have to do that so-called aldehyde which we regularly do. >> that you have no budget line items that would allow you to dip into the funds and be engaged in that kind of capacity building? >> that's correct. >> when the secretary went to visit with countries dealing with tsa responsibilities in foreign countries, what outreach

was that? >> with regard to tsa because of the responsibilities for the screening and airport security has a limited separate line budget with regards to providing technical assistance on airport security no other component to my knowledge has a separate line item that would permit the kind of capacity building. >> let me quickly pursue this very briefly. you said that despite the fact they work to incorporate recommendations on response times and the standard operating procedure they do not require member countries to implement them. do you have recommendations on this? >> as i said in response to the

chairs question requiring other countries to screen the database is an issue we need to debate but populating it has a direct and immediate impact on our security so if we go down that route and mandates or capacity building efforts i would focus on getting data into the database that we could screen. whether we could cooperate with interpol and other organizations such as the civil aviation organization is one we also need to explore as we move forward. >> but there is a question with mr. wagner.

cbp has screamed arriving passengers. you haven't screamed departing pax to the passengers i think you started after malaysia 370. mr. bersin said he doesn't believe any other agency have capacity building. i need a yes or no on that and then whether this indicates our ability in the human trafficking issue because i would imagine that that is also a possibility for individuals being smuggled todathey may be on a fraudulent passport as well but the question is you just started giving the exiting passengers. why haven't you done it and then what about the impact getting our hands around the passports on human smuggling?

>> we've recently added to the lost and stolen documents to the outbound manifest screening that we do. we will focus primarily on the terrorist screening database is and other types of national security. but we will call out some of the administrative heads. >> we will be working to come up with a better -- >> do you believe in issues dealing with human smuggling and trafficking? >> and assuring people that are properly credentialed. as far as the capacity building i don't think we have a line item for it but we do put a lot of resources into doing that and work with the department of state to fund those activities and like i mentioned before helping the governments build these advanced passenger information systems to get the

manifests, to do the targeting and analysis and helping ex- change that information is critical to a lot of our priorities. i have questions i will put in the record and ask for a response from the committee and i will ask about how you discern the possible hits but do you do if a possible hit is discerned. now the chair recognizes the gentleman from mississippi. >> in an effort to share information to the passports as a criteria in the visa waiver program countries must sign agreements with united states regarding the sharing of lost and stolen passports. through participation in the

program that nations have agreed to share the lost and stolen passport information. doctor bersin, do the countries routinely share information on lost and stolen passports in interpol backs >> yesterday due into there was regular checking that we do to see that that requirement is met that would be a preview of how many entries have been made by the countries and if th that problem arises we will remedy that. >> are there any countries that are noncompliant? >> at this time no and asked several of us noteasseveral of e testimony of the 40 million records 96% of them come from the visa waiver countries or aspiring in which the requirement to populate the database is set.

>> if the country becomes noncompliant what actions would you take? >> first would be the communication between the program office working with the components on hsi to point out the deficit and overtime we haven't met the situation yet but there would be the authority of the secretary's office with secretary johnson to take steps to see that that effort was enforced in the law. >> we haven't had this instance happened yet. what would be a realistic amount of time, three months or six months quick >> because of the importance to the security vetting we wouldn't want that to be an extended period of time.

i know everybody seems to be in compliance right now but is there a hurdle to providing the information you hear from the partner nations? >> with regards to the visa as the chair pointed out at the outset of these are the closest allies in the country with whom we share the most experienced that have developed sophisticated information systems operating through, so with regard to the countries we have the infrastructure in place. >> as a result of the requirement to you think the sharing has been increased into the program has been successful?

>> i appreciate you can be named this hearing and exploring the legislative options so soon after the vulnerabilities have been exposed and appreciate the testimony that we've heard from the experts today and want to thank mr. wagner and mr. bersin for the response and the outbound passengers from the u.s. in light of the flight 370 tragedy and everything else that you described but to build upon something the ranking member has asked about the capacity building with other countries around the world you responded that there is not a line item currently but can you talk a little bit more starting with mr. bersin and continue with mr. wagner about funding the

capacity and efforts into the second question you may also want to address in the same way that we are exploring the legislative options in the fixes you've already put in place maybe talk about what other countries have done over the last three weeks so if you would start. >> starting with the second question in the aftermath of the interpol statements come of secretary general ronald noble has been publicizing the issue and countries around have taken note of the problem and while it's too soon to say that it's

resulted in changes it has created an awareness that didn't exist before and i think we will be seeing different countries within the constraints of the systems and cultures into the wall taking action and we should continue to encourage the populating database and also the screening. with regards to capacity building there are instances in which they have received state department grants through programs to help countries build the capacity. my point is it's always on a grand basis and there is no long-term capacity building line item to say we are going to do this and encourage all of the countries in north america from colombia or pinnacle to build a system so that any time someone comes into the north american aerospace or port we would have

insight who is on those planes. to do that would take a large budget. mr. wagner is in a better position to give the experience and can allow anin panama all ad others but the larger vision is that over the next ten years while we cannot build the measures we built here we can put a minimally required satisfactory system in place from ten of all to the arctic but that would take it budget appropriation and i was us. >> i would think every country and every person in the world that gets on an airplane has a shared interest so we have the allies we've already described. the uk is already pursuing this but we also have countries like

iran who have safety concerns. is there any way we can provide resources or encourage others especially wealthy countries to share the burden to make sure everyone is participating? i would love to find from you or mr. wagner what the cost is so we know what we are talking about. do you have a thought on this? >> we did work with mexico and panama on and the caribbean to help these countries with their authorities into the internal laws and regulations to complex of the manifest information to help fund them in the systems to actually go through and screamed that information and we have our personnel with this to share

what we can so there's work to do with other developing develog countries and then there's also the developed world getting our allies to take like approaches to how we do this and you will find very degrees of capacities and authorities and privacy issues that it's a consistent message that all of our allies should be doing it in a similar fashion. >> as a follow-up to today's hearing what you be able to come up with a ballpark figure and share that with the committee so we understand and maybe on the past experiences with other countries what it would take to fund the necessary capacity locally, not that the united states needs to bear that burden on its own, but just so we know what that number is it so that is the basis for engaging other countries that might give to

fund that's because it's in everyone's interest. >> she described this in finer detail. there is an infrastructure background. there is one single that connects the 190 countries have interpol and it's the beginning of the kind of system that you're talking about but perhaps he can explain what the system is and why it is a potential link in the area that you're exploring. >> we have notes in about five minutes. >> it is the backbone that connects the countries to not only interpol and resource databases to each other and the ability otothe ability of the co utilize this is centered upon its bureaus of the national central bureau becomes the cornerstone for making sure that

the utilities tools are available. >> with that said the u.s. has been supportive of the interpol membership in the community specifically in central america. we helped install sites at specialized police units but also border control points as well. we are continue to work prior to the airline disaster we've been working with counterparts in mexico and other countries in the caribbean as well to determine how we can better and most effectively assist them in fully realizing how the utilities and tools may be better serviced in their countries. and we will obviously work with interpol to determine how we can best come up with a global strategy for engaging countries sharing best practices and lessons learned from this process. it's been a process for the united states, one that's taken time to develop and we need other countries to ramp up as

quickly as possible. >> recognize the gentleman from california. first the ranking member has a comment. >> i want to put on the record thank you for your leadership on this issue and a lighter that you joined on into this isn't taking your time but i hope you will submit -- i would like to submit the letter for the record. again thank you for your leadership. >> thinthank you madam chair for allowing me to participate and the ranking member for supporting that request. and as others have stated, my prayers and wishes go out to the families of malaysia flight 370. but as we have often learned from aviation disasters, if there is any hope that has come out of it it is that we learn a lot about our own security and

how to make passenger safety much better and i also want to note int if the chair miller submitted a letter to the department of homeland security and we appreciate the response that we received. and with senator schumer to create this s. ltd database if they don't we simply won't issue than these us and i hope i can work with the chair and the ranking member on such legislation. mr. bersin from you we would've to north america's concern as well because i believe the country we should principally be tracking our ones who have

airports near our borders. for example, and my colleagues district she has mexico which has a large international airport and in san diego you have to yell on a just to the south and washington state you have vancouver and of course new york montréal and toronto are not far. my question is what degree are the bordering countries to the north and south, canada and mexico and of course in the hemisphere and a law and other countries, what percentage of passengers are being screened against the database traveling in and out of those countries? >> with regards to mexico, the figure mr. wagner can confirm what the 100% in terms of people entering mexico and could cross the border and come into the

united states. with regard to canada, the canadians are fully cooperative with us and they screamed. we are in discussion with them about the full screening debut for their own citizens and as a result of this incident we will see a complete screening from the neighbors to the north. >> does that mean a flight originated in venezuela and landed in mexico 100% of the passengers with a check? >> that's great with regards to the stolen and lost travel document database. >> suppose a flight originating from germany and coming to vancouver, 1100% be checked? >> with regards to against the canadian database, yes and against the s. ltd when there is a secondary inspection there

would be a check and as i say we are engaged in canada is engaged in to see what it could do to complete the cycle. with regard to the point on north america the reason i focus is that it's not just the neighboring airports such as far as and el paso, san diego, but it's people coming from outside the atmosphere into central america for example and traveling overland to the border so it's important for us to actually look at this as a continental problem, not a national one and i think president obama in the own the border action plan with the prime minister and canada recognizing perimeter security as a critical issue and our colleagues and partners share this notion.

>> we are beginning to learn about check it whic such as a purchase program with interpol. what is the participation of u.s. airlines and hotels and other tourism companies right now as far as checking passports against the database as a point of purchase rather than 72 hours before the flight? and i'm just talking about the united states. >> i believe that all passports are being screened not by the airlines necessarily at the plaintiff purchased but by cbp and domestic purchases is what we are referring to. >> but i check a program intended to have cooperation with the vendors, right?

the airlines and hotels. >> right. the relationship, the public-private relationship exists in the u.s. for some time and has a better fact it's a model for the world. it's one that we have taken to interpol and the ie check if working group is in a developmental stage. interpol is beginning to look at how to balance requirements into the concerns of 190 companies with a public-private partnership. having said that, the models that have been rolled out have been with hotels and they have seen success. they are now looking specifically at following the malaysian airline disaster at the transportation sector. >> is every purchase in the united states to travel outside or every purchase out of the united states to travel in the united states checked against

the database at the point of purchase or closer to the departure or arrival? >> this will be the final question. >> when the tickets are purchased and checked out the counter. >> 100%? >> inbound flights to the u.s. yes. >> i want to thank the witnesses for being here. i think all of us have additional questions, so i would invite you all to separate those for the witnesses and we will ask for a written response to the questions and again i appreciate you coming on short notice. we convened this hearing i had an idea and convened it pretty quickly particularly for helping us move on capitol hill. so we appreciate the witnesses coming this morning and in person went to the role that record will be open for seven days and without objection the committee stands adjourned.

thanks again. [inaudible conversations]

[inaudible conversations] [inaudible conversations]

the unemployment rate remains the same. same. of the labor department said employers added 192,000 jobs below february's total. the unemployment rate was unchanged at 6.7% of americans started looking for work and that mosmost of them have found. it matches last year's average monthly total. john boehner released a statement in response to the numbers. i'm glad more americans found fd work that the economy still butt creating jobs for the american people. he goe goes goes on to say theyd what the they called they calles senate hasn't considered them.

>> at this moment and across afghanistan with people to get a car with 21 or 22 million voter cards floating around in a country with 11 to 12 million individual borders. they want you to have access which is an indication of the building of enthusiasm. they joined -- judge of their own elections. if this does produce a credible

result it would be off the power in afghanistan street. we want to be careful not to rush to judgment ahead of the afghan people. it's their judgment to make us whether it is legitimate and credible i don't think we want to be second guessing that issue every step of the way. >> the absence of the international observers were the drawdown in the numbers that would be present will have a psychological effect, it will have an impact on how the international community views it so the reduction in the number is unfortunate that the truth is it's not going to make a difference there are enough observers to do their job and the story is this is an afghan

election being undertaken.

>> we are a nonprofit organization and our mission is to advance through it making. it can be books that are unbound or bound. all different structures from a court he ends to tumble but to traditional round that lay flat when it's open. so it is a book and art and it's all handmade so it's more than just the word that are in the book. it's also the structure of the book is part of the art whether there is text or no text. and it is an unending world to

discover and create. >> 86 prints binding studio is one of the places we would visit as booktv in history tv to get the literary life of bend oregon saturday on c-span2 and sunday at two on c-span three. >> not only did the healthcare website after a slow start with severabutseveral exchanges are o having a tough time house committee held a hearing yesterday to learn about the issues in the witnesses included officials from hawaii massachusetts, maryland, minnesota and oregon. this hearing comes three days after open enrollment ended. >> '

>> the committee will come to order. the oversight commission statements exists to secure two fundamental principles first at the right tofthe right to know n takes from them as well spend and they serve an efficient government that works for them. the government reform us to commit these rights. the responsibility as the government to taxpayers because they have the right to know what they will get from the government had worked tirelessly with watchdogs to deliberate the fact to bring reform to the bureaucracy this is the mission of the government reform committee. good morning everyone this is the conversation today about the affordable care act and the

state exchanges. the law was passed to promise people they would keep the coverage they like into the premiums for the family in four years later the reality sank in and receive notices from their insurance companies. they found out the doctors theyy liked were no longer covered by the plan rather it is going down for family coverage has increased in the years. we are also told that obamacare would be good for the nation's economy. the truth is to minimize the exposure to the costly mandates and taxes they were forced to lay off some workers and reduce him to part-time. congressional budget office estimated they would reduce employment activities by 2.5 million full-time job equivalents.

they dramatically increased federal government spending at the time the federal government continues to run the massive deficit according they spend nearly $2 trillion from the next decade. there are 20 new taxes and significant cuts to the medicare advantage program despite spending all this money more than 80% of those that are uninsured before it took effect are still uninsured today. in addition to the negative on greatcoat affects the law has implemented extra legal protection, 21 different parts of the law changes. for example in response to the broken promise about health care they unilaterally allowed insurance to renew non- grandfathered policies for an additional year into the ministry should extended the policy until after the 2016 e. election and it's part of a pattern of actions aimed at insulating the wall from inconvenience parts at the expense of taxpayers to read while i welcome the changes that reduce the cost of the mandates

and to give consumers a greater choice they set a precedent by going around congress to write parts of the law that are troubling. it is even greater uncertainty in the market and mainly to higher premiums 2016 and beyond. one of the largest insurance participants in the exchange predicted double-digit increases in 2015. just this week and analysis predicted h they would continueo increase because of the way they carry out the law. there are issues we can and will explore in the days ahead the topics in today's hearing or state exchanges. representatives from the state are here today and residents in thresidence inthe state are fora website many people who thought they had successfully enrolled found out the plan they chose could now receive the information from the exchange. state residents are working

through the same issues and while states worked incredibly hard and were grateful for the service to the people in the state you represent you are also struggling with federal regulations into the delays that are coming down as well. how is it possible after three and a half years and spending hundreds of millions of dollars so many different exchanges had incredibly difficult time putting together a website. what was the effect of changing guidance in the administration on the construction of the exchanges and third where was federal oversight of the project and how could so many state exchanges have such a difficulty at the same time? finally how many dollars will be requested to bailout the troubled exchanges in the years ahead? the congress has an important role to ensure the funds are spent wisely and effectively.

i welcome the witnesses and i appreciate you coming to be part of the conversation. you have things to contribute to the conversation we cannot know until we get a chance to hear from you. i now recognize the ranking member from california for an opening statement. >> to the witnesses who traveled on distances to meet with us today now that we have surpassed the goal established for enrollment with more than 7 billion americans enrolled in the aca, republicans are as wers determined today as ever to try to rip it apart. 7 million americans must be wrong. the reality is the latest numbers prove there is a genuine demand among the american people for affordable healthcare. this is a million doesn't even include the enrollment including california running their own exchanges.

republicans today won't be focusing on the successes or even conceding the predictions this far have been as reliable as a fortune teller at a carnival. many have voiced their certainty that the aca would fail and they said the 7 million goal was impossible. several months ago chairman isa said it was time for the president to finally acknowledge obamacare isn't working and to delay the law and fairness of families and individuals. today is the 26th hearing on the aca and this week on the floor we voted for the 52nd time to repeal it. like all historic and transformative pieces of legislation, the rollout has been challenging. but republicans have contended from the beginning there is no meaningful role for the government and healthcare. let's remember how the market has handled health-care in the past. the market out loud in church to

rescind your coverage if you got sick and the night coverage if you had a pre-existing condition. the unregulated market allowed insurers to charge women more just for being women. let's remember how they determined premiums before the aca with the exception of the reception premiums grew by double digits year after year's. since it has gone into effect we have seen dramatic declines in the rise of the premiums. this is the real story and the impact of the aca and i ask you to look at this chart. this is profound and if anything speaks to the importance it is that premiums have declined dramatically as a result of this effort. i agree with colleagues on the other side that it should be the subject of scrutiny by congress and the oversight of the committee but the partisan

one-sided approach has been all about carrying the program down and not fixing it. the preparation we provided the latest example how the committee seeks to undermine the efforts of the states and administrations to implement the law. today we will hear testimony from the executive director of the massachusetts health insurance exchange. massachusetts has experienced its own website issues and requested to send the highly qualified colleague to the hearing so that she could stay in massachusetts and continue her work in fixing the website. however upon hearing about the change in the witnesses the chairman of the full committee threatened to issue a subpoena. i would like to apologize on behalf of the committee and to the people of massachusetts for the actions to bully you into testifying today. what the committee should be focusing in the lead co. on his

the cost and how we can share the best practices by the successful states are california, connecticut and kentucky and new york's. a balanced hearing would have looked out the story of state-based success. if someone had been invited to testify i'm sure they would have wanted to tol told a committee t do them in every analysis found approximately 75% of their enrollees were previously uninsured before signing up through the exchange and that 49% of the enrollees are under the age of 35 or that by the end of the enrollment period over 370,000 kentucky citizens now have health insurance that didn't have a sure. i'm so glad to have peter, the executive director of the california exchange to testify as a minority witness and bring some good news and balance to

this discussion. at the end of march 31 over 1.2 million signed up for private health insurance is. this surpassed the baseline projection of 580,000 the end hands projection of 830,000 for the entire open enrollment period. the medicaid program enrolled approximately 1.93 million an additional 800,000 were found likely eligible. this brings the total of all enrolled in the dx change to almost 4 million people. and insurance companies in california reporting 85% have paid their first month's premium. they refused to accept the ex- change current success with continually updating policies with efforts to increase enrollment in the community. i look forward to hearing more from you today about the improvement is california plans

to make. as you know i value our relationship we have a common interest we have discussed many times and i know we can put our heads together and come up with new topics that conduct oversight and requesting the committee to investigate the alleged medicare medicaid and try care fraud perpetrated by the host management associates the hospital chain that allegedly ripped off the taxpayers for more than $6 million. that should be the work of the committee. i look forward to hearing the testimony. thank you for being here i ask consent that colleague be able to participate in today's hearing. our economic growth for the opening statement. >> thank you mr. chairman. if i could ask unanimous consent we have several witnesses. i want to thank you for having this hearing and let's remember

all the false claims that have been made about the affordable care act sometimes it's good to put some context on this if you like your plan you can keep it, false. if you like your doctor you can keep them, false. premiums will go down. false. premiums will go down an average of $2,500, false. the website will work. false. the website is secure. false. we have had hearings on these claims. now today we are going to hear about the performance of the state exchanges again, underscoring how poorly this has operated and how bad it is and why we need to change it. i want to thank you for putting this hearing together and i look forward from hearing from the witnesses and asking questions about these state exchanges into the overall impact it's had on

the american people and they would yield back. >> thank you chairman and chairman jordan as well. this marks the 26th hearing we have held on the aca over the course of 25 hearings he would think every member on the committee on both sides of the aisle would have been working tirelessly to guarantee each and every one of their constituents have access to affordable healthcare and you would also think that they would have consisted of a bipartisan effort to find ways to fix healthcare.gov. this is the oversight committee. it saddens me to say none of these things have happened and today isn't going to be any different. in this committee and approve of congress health care has become a divisive partisan issue.

instead of offering but they have access to universal health care and has held 53 votes to repeal the affordable care act some of my colleagues have run misleading and often times .-full-stop her ties with from signing on the exchanges as opposed to educating them on the realities. the democrats have held more than 400 events in the districts at home in an effort to educate constituencies on the healthcare.gov i've had five of them myself and i would also like to commend my fellow democrats for ensuring that their constituents are afforded the same kind of information. this hearing has been called to examine the state health insurance exchanges under the aca. california has one of the most

successful exchanges with more than a million individuals signing up for insurance plans through its exchange. other states such as new york, rhode island, connecticut have experienced success with implementing their state exchanges and are very grateful that mr. peter lee is here with us today regarding california's state exchange and provide much-needed balance to this hearing today. i do wish that new york rhode island and connecticut were included so we could hear about their best practices. i also wish that pennsylvania had its own state exchange so that my constituents could have had the same access that these states have an wireless wish the governor in pennsylvania had originally accepted the generous offer for medicaid expansion it is my hope that the two sides can still agree on a plan and expand medicaid for the more than 520,000 that would benefit

from that expansion. the high demand for the quality and affordable health care available under the affordable care act is real and evident that to the enrollment figures showed 7.1 million people sign up for the health insurance plans using both federal and state exchanges meeting both the administration's goal and popular expectations. if the market demand isn't enough, the health care bill is more popular than ever. about half of all americans now support the law despite the misinformation over the last four years and i want to say i'm glad that many more people in places like oregon, maryland, california, massachusetts, hawaii and minnesota have health insurance than they did prior to 2013 and i'm interested in hearing about how the states

database despite glitches in the rollout in each of the state and i look forward to hearing about the best practices from the state of california from which i think we can all learn a lot. i welcome the witnesses and things had for taking the time to be with us today and i yield back. >> the chairman of the full committee for his opening statement or any statement he would like to make. >> i want to thank you for the work you've done on the details in the healthcare .gov and the overall legislation. i ask consent by statement be placed in the record without objection. >> i welcome you here. it's welcoming as a californian to have california represented here because both the best of the worst will be seen in looking at the largest state in the union.

we often turned divisive partisan legislation into divisive partisan oversight. mr. cartwright, mr. speaker has made that clear by talking about republicans this and republicans backed. i've called or authorized every one of those hearings they either did too and i'm proud we did it and i'm sorry we didn't do more sooner. ultimately, about half of america's federal spending will be related to healthcare, medicare, medicaid, medicaid dual eligibles, and obviously the growth related to subsidizing the affordable care act representing the largest single bulk of the budget today and that over a trillion dollars is the area in which we have no real control over the rise of the costs unless we implement changes that drive the cost of

delivery down. long before president obama became senator, we had problems with healthcare. i think republicans and democrats need to recognize that medicare and medicaid have been part of the problem not just part of the solution. just a few days ago by voice vote, almost a cowardly act in many ways we did what was called the dot fix. the doc fixes based on a decade 1997 i guess old mandates we were going to lower costs through some congressional magic. every year we rack ignites that it doesn't work and that if we don't suddenly come up with billions of dollars of new money to doctor it will be underpaid by and about 25% of what apparently we delete this fair. and i use that as an example of the clinton era republican house

and the senate attempt to fix health care and i do it because this committee has a solemn responsibility to deal with the costs and savings. that hasn't been the case for people on both sides of the aisle for decades. the affordable care act is well intended i believe. but it has had many flaws one of them we will see today is fairly straightforward. instead of doing a single website in which everyone fed hiinto spending 700 million come 800 million, billion, 1.5 billion, 2 billion, some enormous amount of money to create a network but we did is issued large grants in the case of california the number i have in front of me is $106,521,270,950 in grants.

in the case of hawaii i'm told it's 200 million to establish the website. let's understand something here today. whether you voted for the affordable care act or you didn't, redundant programs throughout most of the 50 states that issued hundreds of millions of dollars per state to do the same thing again and again sometimes with success were in the case of maryland i believe today some would say failure in the website, that alone was billions of dollars of unreasonable unnecessary in the plan. it took him together with common sense. to divide it into contracts which each state may or may not have chosen the same vendor or some cases the bad vendor the affordable care act federally used is self-evident.

let's get past to be arguing about who voted for or against, whether we voted to repeal or change. republicans and democratic members are in fact today regularly talking about necessary change. i know the 7 million figure is big as of yesterday and i know as a republican i told to say very clearly that figure represents a great many people who lost their plan and in fact simply picked up and got the 7 million. mr. lee will have to tell us because california mandated to get on to the exchange that you get off of programs that was necessary and deliberate cancellation of all kind of programs in california because vendors had to choose whether to keep their own program or participate in the exchange. i am not holding anyone accountable.

it probably seemed like a good idea at the time, but the fact is we have not driven down the cost of health care to the individual except for the tax payer picks up the tab. so all of us today should begin looking at not just the state is like 30 some different websites paid for with federal dollars essentially asking many of the same vendors to simply duplicate the software but the bill was for reinventing it abou you do e should also look at the question since we haven't succeeded in the past in driving down the cost of healthcare through the cms efforts but rather we will pay less and cost shift into the act is implemented and more people are under a federally subsidized program where do we cost shift to clicks by definition, everything we do

will have to be something we pay for. mr. chairman, this was long and i apologize for going over. but like you i am passionate about efficiency and not just the affordable care act but all of the federal spending has to be looked at. i received your letter and i've taken note of the fact that correction is rampant and we do need to go after it and i look forward to holding the hearing that we look at both sides. vendors that sought to enrich themselves and government oversight agencies that let it happen. i want to thank you for something you did that you may have forgotten. you votehave you voted on a bipn basis for the change in how we

procure it. and the senator has a companion bill. when that becomes past we will become more efficient as a result of our oversight and legislation on a bipartisan basis of the committee. i know we started off on a partisan basis. hopefully we can switch the tone to realize that we are all living with increasing healthcare costs whether we voted for affordable care or not we have a major role to try to drive down the future increases in healthcare if we are going to be competitive around the world in commerce so i think you for your indulgence and yield back and recognize the ranking member of the full committee for his opening statement and if you would please take the time to introduce mr. lee of california as well -- i'm sorry, but maryland. >> you just moved me across the country. >> sorrcountry.

>> sorry that is quite a shift of time zone. >> thank you mr. chairman. today is april 3. just three days after the deadline for the americans that sign up fotosign up for health e under the affordable care act and a lot has happened in the past six months since federal exchanges opened up for business. it's not always been pretty but we should take a moment to reflect on what we have a comp pushed. 7 million residents of the state have signed up for affordable healthcare, millions of people who could not afford health insurance and 41 accident or whe accident or illness away from financial ruin now have health insurance. ..

so they can stay well. we all know that it's cheaper to keep somebody who is well and to treat them when they're sick. if you want to talk about driving down the cost of health care. millions of kids can stay on the parents plan until they are 26. and billions of dollars in rebate checks have been sent to consumers across the country. that happened, and it's happening now. ladies and gentlemen, put simply, the affordable health

care act saves lives. and it prevents people from going through pain. and it allows people to live longer, like the gentleman who is probably watching us right now with colon cancer, knowing that he has a way to be treated and he will be able to walk his daughter down the aisle. or the person who just wants to survive long enough to see their child graduate from high school. that's what the affordable care act is all about. sometimes i think we get so caught up in the things, the problems we are going through we forget the big picture. emerson said it does. he said do not be pushed around by your fears and your problems. be led by your hopes and your dreams. that's what this is all about. hopes and dreams. and so do the witnesses here

today, and to the state and federal employees who are working tirelessly to implement the law, i want to say thank you. i look at dr. sharfstein of maryland, the head of our health department. this is a man who's given his blood, his sweat and his tears trying to make life better for people when he was the commission in baltimore and now of our state. i can probably say that if i knew all the people there, i know that you all are doing the same thing. and you don't do this for the money. you do it because it feeds your soul's. you do because you want to make a difference. you do it because you want to affect generations yet unborn. and that's what we are all about. we should be about. making a difference so that people can live the best allies that they can. the road we took a duty today was rocky for the federal

government. it has also been challenging for some states, including my home state of maryland. i cannot fully express how frustrated i was in the troubled rollout of the maryland health connection. in my state, as in many of yours, people have a desperate need of quality, affordable health care. we needed a system to work. let me say it again. we needed the system to work. life depended upon it. when it did not, unnecessary obstacles were put in the way which completely were unacceptable. now, let me say this. sometimes you have contractors that advertise more than they can produce. and so they sell you a bill of goods. maybe those are the folks we need to be looking at, but let's be clear. this is not just about a

website. it's not just about a website. this is about making a difference for people so that they can be the best they can become and be all that god meant for them to be. the answer to the problem is not to decimate the affordable care act. solution is not eliminating health care for millions of people, to get the budget for the aca, or to return to the days when insurance companies could discriminate against us based on our medical conditions. i've said it before and i'll say it again. we are better than that. to let insurance companies do that to us. the remedy certainly is not to scare people away from enrolling in health care they have a right to under the law. it's not to scare them away from enrolling communist scare them away from having health care.

for having insurance, for being able to take care of their child when the child gets sick, or prevents a child from getting sick. we are better than that. unfortunately our republican friends have voted for the 50th time to repeal, design and undermined the affordable care act. and my friend, mr. issa, chairman of the committee, i agree with him, we need to move not, not, not too common ground but to higher ground. what this nation is all about, higher ground. where we come together to try to get what is wrong and correct it and move forward. so when the history is written, when that man is able to walk down the aisle with his daughter, when the mother is able to see her child graduate from college, when that person

lives long enough to see their first grandchild born, they are not going to be worried about whether a website failed. they're not even going to be talking about that. they may not even know that it was the affordable care act that saved them and gave them a life. all that will matter to them is they had an opportunity to live, and live in dignity, and to have a moment of happiness. and so i'm hoping that as we move forward, that this is the law by the way, that we move forward to make the law better and not try to destroy it. the only reason i mentioned these past efforts with regard to the numerous hearings is because i have not seen in these hearings one effort to improve the law. not one. and if we could improve that, then we could move to higher ground. without i yield back.

>> like to recognize our panel. sender would like to increase his guest from maryland as well. >> joshua sharfstein is the head of our health department in maryland but as i said before, he has been come either way, he was staff number on this committee, mr. chairman, some years back and he came to baltimore and he was are commissioner of health care where he had all kinds of innovative products with all of our -- nevius ahead of the head of our health department of state american i'm very pleased to have him. >> ms. speier can would you like to introduce someone? >> i'm delighted to introduce peter lee, executive director of coverage california who's had a storied career in health care

both in the private and public sector and formally was the deputy director of the center for medicare and medicaid innovation at cms, among many other places. welcome. very glad you're here. >> mr. matsui can get the longest time change. we're glad you're here. is jean yang as executor at the massachusetts health insurance exchange. mr. scott leitz is in and chief executive officer of minnesota health insurance exchange. mr. greg van pelt is the visor to the governor of the organ health insurance exchange. % to committee rules all witnesses are sworn in before the testified, please stand and racial right hand. [witnesses were sworn in] thank you. nadc the let the record reflect all witnesses and informative.

ascii don't you just want to five minutes. your entire written statement which i'll be submitted will be a part of the comment record as well. mr. matsuda become your batting off the beginning here. a little spring baseball conversation. push to talk button. >> thank you, mr. chairman, ranking members, and members of the subcommittee to my name is tom matsuda made and accepted director of the hawaii health connector speaking on behalf of the connector and its board of directors its board of directors. hawaii has long been the leader to ensure that our residents have access to quality, affordable health insurance. in 1974, hawaii enacted a groundbreaking state law, the hawaii prepaid health care act. this law requires that most employers into why provide health care coverage to employees who work more than 20 hours per week for at least four consecutive weeks. hawaii's prepaid health act requirements are generally stricter than those of the

federal affordable care act. as a result, hawaii has a little uninsured rate estimated at about 8%, or 100,000 individuals. because the state's law is a strong supporter by the people of hawaii, the aloha state authorized the establishment of a state based marketplace to harmonize the aca with the hawaii be paid health care act. my written to me provide you details about the connector and i would like to focus on some specific issues. first of all enrollment. as of march 31, 2014, we have 7596 individuals enrolled in commercial plans to the individual marketplace. 265 people enrolled through the shop small employer marketplace, and 24,641 completed applications in our system. the connector doesn't handle medicaid eligibility or

enrollment for the medicaid population there that is handled through the department of human services, or dhs. dhs had over 20,008 a medicaid enrollments from last october through february this year, for a total of over 36,660 went enrollments across the entire wide marketplace. we launched our online market place on october 15, and accepted initial application forms between october 1 and 15th. the system has been operating since then, but it was very difficult to use at first. as of now we have made significant improvements. the system is better today than it was back in october. our system is working for an end to end, but more improvements can be made. sustainability. as a state marketplace we must be self-sustaining by january 1, 2015. last year the connector board approved a premium assessment of

2% premium assessment for plans sold on the connected to our board is now engaged in a sustainability planning process. the key is to reduce operating expenses while supplementing enrollment, especially in the shop exchange. the federal and state decisions to give small employers the option to remain with their existing insurance plans through 2015 have reduced the bottom of participants in shop. hawaii has received for federal grant awards. wawa is a small state, we are subject to the same federal requirements that all other states, to establish the infrastructure to operate these state based marketplace is. the establishment costs will be comparable from state to state to ensure that the structural components of the marketplace are complied and secure. our small population as well uninsured rate means that a wide has a smaller market to support our operating costs. as of december 31, 2013, the

connector has spent about 57 million of the total 204 million in federal grant money awarded to us, and we have an operating system. for our priorities going forward, we have roughly 11,000 incomplete applications. these individual enrollments, not yet complete. we have increased staff to complete this process. we are also working on extending our outreach into island kennedys that are underserved to help educate these populations about the services available to them. on behalf of the hawaii health connector i appreciate the opportunity to discuss these issues with you today. we have much left to accomplish but we believe in the mission of the connector and a fully committed to contributing our part in a wise long history of providing access to affordable, quality health care coverage to our residents. thank you.

>> thank you, chairman lankford, ranking member speier, other members of the committee but i appreciate the opportunity to testify today. it's to the i used to be one of the people sitting along the back wall. i think, i can say every staffer wonders what it would be like to sit on this side of the microphone, and after the hearing out be able to tell them. as has been widely reported, maryland has faced considerable it challenges in establishing our state based exchange. on october 1, the system barely work at all. for weeks we struggle with a range of software and hardware problems. but we did not give up. we now expect that our enrollment goal. in fact we expect to see by tempers a number. would expect the number of enrollments and corporate health plans to come within 10% of was was predicted by into the experts and to exceed expectations or medicaid

enrollment. by the time the dust settles we could enrollments more than 300,000 in maryland. maryland store it includes decision we wish we could make again, failures by multiple vendors, and to many it frustrations to count. but maryland store is also about an exchange that is a lot more than a website. it's about a state that is battling back and is looking forward to the future. i submit a detailed written testimony so i'll just make some key points. first the exchange is a lot more than a website. it includes our close partnership with more than 2000 brokers. includes a very competitive market with four carriers offered 45 plans. we have some of those competitive insurance rates in the country including dental plan. we have a website that has a physician network for each carrier, and the kennedy-based navigator program that includes more than 30 organizations. second, we did face various website problems.

we made a major misjudgment of russia's potential in adopting a stretch of trying to buy commercial off the shelf software that could be configured for the purpose of the affordable care act instead of building something specifically for this purpose. products that were advertised as being ready actually were defective and efficient. this caused immense frustration for consumers, and at certain points made us wonder whether anyone would be able to enroll. third, rather than get up in the face of the it challenges, maryland tackled the problem head on. changes included new leadership, including when the governor asked the secretary from it to step aside from her job and be the single leader for all it development. hiring a general contractor, this income to help fix the federal healthcare.gov. it fixes, clapboard and closely with carriers to allow for special types of enroll for

people who have trouble on the website, manual workaround which allowed us to process certain types of the building i can't. elbow greece by the galvin with incredible tough work of hundreds of consumer workers, and finally a strong finish with as much enrollment in the last two days as in the first 10 weeks or so. as i said before, we expect not only to meet but to exceed our enrollment goal. quality and affordable health coverage is providing peace of mind and access to lifesaving care to families across maryland and is also going to reduce a hidden tax that all of us pay for poorly managed and uncompensated care under our unique system in maryland of ratesetting for hospitals, which not only i think to chairman issa's point, is going to reduce the care within assessment also reusing across all players with

no cost to address the fun of shots of costs in health care. let me finally say that talking next step. in addition to the significant work and the hundreds of fixes that it took to get as to the point where we could exceed our enrollment goals, our secretary of information technology as a process of figuring out the future for the website. and after an extensive analysis, the board this week voted to leverage the connecticut it solution in order to upgrade our website. this is a model that has proven very effective and allows us to use something that works very well in time for the second open enrollment period. as the chair of the port of the maryland health benefit exchange, i did regret the frustration that many builders have experienced. i am proud of the effort that so

many to overcome the it challenges and help their friends, neighbors and fellow citizens can access to affordable and quality health coverage to thank for the opportunity testified and i look forward to your questions. >> thank you, mr. lankford. chairman jordan, ranking member carrack, ranking member speier and members of the subcommittee, good morning. thank you for the opportunity to testify about our experience in limiting the affordable care act in massachusetts. as you know, massachusetts is very for my with a framework of the aca. in 2006, former governor mitt romney worked with our state legislature to fashion an approach to expanding health coverage the two ideas from both ends of the political spectrum. once he took office in 2007, governors -- other deval patrick work to bring the framework to light in close collaboration with our state legislature, our

health care providers, our business and labor leaders, our insurers, our consumer advocates and countless others. we are extraordinarily proud of the results we have achieved together over the past eight years. virtually all of the commonwealth's residents are now insured at 97%. 91% of our residents report having access to a primary care physician, and 88% having seen a physician in the previous 12 months. on a whole host of measures we are healthier. at the same time more employers are offering coverage and our budgets have been consistently balanced. one of the most important lessons we've learned in the year since 2007 was that health care reform takes time. we refined our plan as we learned of new medicines in collaboration with our partners, including the bush and obama administrations. it has not always been easy, but we kept our eye on the goal of

getting people adequately covered. as governor patrick has remarked, we learned early that health care is not a website. we support the affordable care act because it embodies the principles of our massachusetts reform, and because it gives our state new tools to sustain and expand on our success. we know that it is already helping support affordable coverage and to enhance of americans across the country. in massachusetts, since the aca took full effect in january, over 200,000 more people have signed up for subsidized coverage. almost 30,000 people have purchased unsubsidized aca compliance points to our health connector. health connector is also offering dental policies for the first time with over 2300 plans purchased to date by individual shoppers. even so, while implement the aca we've experienced website challenges.

these are mainly due to failures of our system integrator. but with a new team in place, we on the path to go live with a functional, reliable exchange website for the next open enrollment period. challenges with our system integrator and project management shortcomings indeed our progress in achieving our full vision for the website by october 1 of last year. on that account we decided to deploy only parts of the new system on that date. given these constraints and with many people encountering errors and wait times even with the parts that were deployed, we have developed alternative pathways to support enrollment. these mechanisms have enabled us to protect and expand coverage with stronger cooperation from our health insurers, providers and consumer advocates. many residents of the commonwealth have experienced difficulty with some of these processes, and we fully share their frustration. but we are not allowed website problems to prevent us from

meeting the ultimate goal of the aca, getting people covered so that they can enjoy health and economic security. of the website challenges are mainly the result of an underperforming it vendor, we are holding ourselves accountable for fixing them. and we are making progress. we have stabilized our system, eliminated the backlog of paper applications, and substantially reduced call-center wait times. we continue to maintain strong data security protocols that meet federal standards and have kept personal information of applicants safe from data breach. and we have a detailed plan to open up new parts of the website only when they know they are ready for users. in the meantime, th through the creativity and flex builder of our team, people are getting covered. we have an unwavering commitment to ensuring quality of florida health care for the people of

massachusetts. the commitment that kept us moving forward to both the peaks and valleys, a commitment that keeps us before today as we strive to realize the aca's full potential for improving care and improving lives. thank you for your time. i look forward to your questions. >> thank you. mr. lee. >> good morning and thank you to chairman issa, jordan and lankford and ranking member spear, carbide incomes but i appreciate also the other members of the committee having is here. peter lee from california. i'm going to share with you our early implantation lessons in california and launching this affordable care act. i think it is important that we're excited in california to across a whole range of constituents, whether they be insurance agent, county workers, health care providers of a range

of clinical position of come together in california to launch this expense coverage. we're seeing the fruits of that effort today. california is one of 15 state-based exchanges. and when we started we looked at the data and said somewhere around 4 million californians could benefit from federal support to either subsidies to cover california. in a very few short years we've gone from being a 10 person or session to over 1000 people. we are very, very fast startup that is working to change history. so how is it going so far? well, you for some of the numbers. 1.2 million californians now have coverage directly through cover california. additional 1.9 have coverage through medicare. today and over 800,000 are signed up for pending eligibility is as close to 4 million californians. every single one of them went to coverage -- our website dignity

of them were touched by humans in the info process and we can't agree to strong but we heard again and again exchanges are but more than websites. i want to double but about what they are about. i also want to underscore when you think about state-based exchanges can verify the exchange iexchanges out there ta month ago have already covered more than 30% of those eligible. though states included california, rhode island, vermont, washington and connecticut. other states have been a very good job as well. texas, new york. as of three days ago california have brought coverage to more than 50% of those subsidy eligible in the exchange because remarkable number when you build a brand-new industry program. let me talk briefly about what it takes to make a state-based exchange work. and i would note that when we say work we do not mean perfect but it's been rocky, bumpy and you will continue to be rocky and bumpy.

this is a story. this is a very big change to the health care system but all in all we feel good about the progress we are making. it takes in our mind three things when exchange to work. it takes having affordable health plan delivering quality care. it takes effective marketing and outreach, and it takes effective enrollment. in the area of affordable care, cover california has been an active purchaser. 33 health plans originally expressed interest effort is being in a market place. we expected -- accepted 11. covered taliban with the process of standardizing our benefits designed to give consumers the tools to make choices as to what they were choosing between the plans. we ended up getting very competitive rates and we're optimistic those rates will stay competitive and affordable. right out of the gate we've been giving consumers information to choose to that's how they can use information to make the right choice for them. secretary donovan of success,

covered california has been reaching out to californians across languages, the whole range of marketing channels, through tv, radio, newspapers. but as more importantly through over 250 groups anchored and local committees and outreach to educate people about the importance and opportunity that enrolling in covered california. finally, effective enrollment. it is more than about an it system and it is a complex it system. enrollment system we have like the other people at is fine with me here come has to connect with more than 11 different major databases including the federal government and also the state system to provide system up and running. it has been up 91% of the time. it encircled and 12 million unique visitors. it's working well, but more importantly, when it's working well, over 25,000 californians,

county workers, license engines agents can certified enrollment counselors in every committee in the state have been helping literally millions of californians get enrolled. that's what we think is largely worth it in california because californians have stepped up to they stepped up to talk to their neighbors, members of the churches, schools to get them covered. we do have lessons learned we can share but those are i in my written test and a ford responding to questions. thank you very much. >> thank you, mr. lee. >> chairman jordan, chairman mica, ranking member speier, recommended cartwright, ranking the comings and members of the oversight reform committee, good morning. thank you for inviting me to commit today to talk about minnesota's experience in establishing our online health exchange but i want to start by telling you about two who live in minneapolis record is a teacher. reduce the, have health insurance through his job but over time the families out of pocket costs grew.

after welcoming their third son into the family, they had to choose between paying their mortgage or paying their health bills. fastball her three was qualified for medical assistance with no premiums or deductibles inches able to purchase a plan for herself that is less than $200 a month. without tax credits. in her words, i was thrilled. of those women were going to be able to be cared for and when i going to lose our house. today i am proud to say mnsure is stable, secure and successful but because of our efforts, they are a few of the ones that if a thousand people in minnesota who have access to coverage because of mnsure. about 170,000, nearly, over 88,000 have enrolled in medicaid. over 34,000 have enrolled in minnesota care, our state's basic health plan for people

between 133-200% of the federal poverty line. and other states these individuals or invoice would be in private plans with tax credits. the remaining over 47,000 have enrolled in private qualified health plans. it's also worth noting in minnesota 95% of people enrolled in health coverage have paid for it. as we continue to process applications, we expect our numbers to grow even higher. it isn't used to this committee that mnsure rollout was rocky to our initial launch in october was flagged by software and technical glitches that i was appointed interim chief executive officer on december 18 after the resignation of mnsure first executive director but in recognition that more must be done to ensure minnesotans have access to function website and conference of affordable health coverage, i took immediate action to continue i commissioned an end-to-end review of our exchange. director would make a number of enhancements to customer experience to help boost enrollment and to improve

customer satisfaction. working in close partnership with the vendors were able to stabilize their system. our eligible software is operating with over 99% success rate compared to 70% in december. our online marketplace has been stable enough to process more than 2000 enrollments a day. december's software problems caused our call center wait times declined over an hour and up to 70% of consumers were simply getting up before they could be helped. held. we resolved this issue by more than doubling the size of our call center and to bring stability to our software system. in which we times for the month of march were dramatically less. moving forward, we are planning our budgets for 2015. i am happy to say that next to scalia budget is balanced and does not seek additional state or federal funds to operate mnsure. in the longer-term we are in the process of selecting a lead vendor that will help mnsure ss the larger architectural

software issues that were identified in the optimum report. the goal is to not just make the 20 can open a moment predicted the experience for consumers, but of the conference of roadmap for continues improving mnsure and enhancing the exchange for consumers and every open and woman trade to come. i had the opportunity to meet kate needleman anderson recently. she told me that having affordable insurance has opened the door for her family. health reform is needed more of the website. it's the getting real people and families in to affordable comprehensive health coverage. this is something we're doing well in minnesota. thank you for the opportunity to testify and i look forward to your questions. >> mr. van pelt commute been patiently waiting. thank you very much. >> mr. chairman, ranking member and other members, the government reform committee, thank you for allowing me to speak before today about oregon's health reform efforts. my name is greg van pelt but i recently got as chief executive officer of providence health

insurance is in the oregon region. throughout my graphic direct expenses with the challenges of expanding access to all the health care while mass managing costs. last year governor kingsolver asked me to step in and help navigate the chose it wrong -- currently i service present of the oregon health leadership council and voluntary adviser to the governor and dr. bruce goldberg, acting director of corporate work and for whom i'm appointed because the results suffered a broken leg. while the launch of the aca in oregon has been different than we hoped, over 300,000 individuals have enrolled in health insurance plan since october 1. governor kitzhaber released an independent assessment of cover organ produced by the company first day. the report which also request the including today's record was based on 67 images of stakeholders and cover organ and oregon's health employs to the

governor and legislators from both sides of the aisle. and review of more than 3200 documents. members of the committee i want you to know that in response to first data signing, the governor and its numerous steps he has taken a will take to improve performance, accountability and oversight. these tips are detailed in my written testimony which also has been shared with you. we do know that some things have worked very well. would use our technology investment to enroll more than 300,000 oregonians in health care coverage since october thanks to cover oregon and the oregon health authority they would continue to be proud of the work we've done to improve oregonians lives and we know that that will endure. i welcome your questions and the opportunity to discuss with you oregon's ongoing health care transmission work as was the progress we've made to ensure the public trust to make good on cover oregon's promise to enroll

more oregonians in affordable, high quality health insurance. thank you very much. >> thank you, mr. van pelt the now turn to question. start with mr. kosar. >> thank you very, very much. i want to start off with you. to talk about the rocky start for your exchange earlier. so my first question is in the three mostly up to the botched website wrote, receive bonuses for working within exchange because accurate? [inaudible] >> congressman, it is. >> why would the state a people a total of $27,000 for a botched website? usually bonuses go to exceptional work. botched doesn't seem to meet exception. >> congressman, those bonuses were approved by the executive director -- >> i'm glad you said that because have you done anything

to claw back of those bonuses? >> congressman, not to date, no. >> interesting. now, in january unite help optimum division released a report stating that the exchanges current program management structure and process is nonexistent. management of leadership decision-making is occurring via crisis mode. that report also concluded that the exchange might be so badly flawed that the insurer might have to scrap all the. in the same article you were quoted as saying we do intend to take action to effect i thought i heard you speak about this in your comments. we need to take actions as result of the report. have you fired anyone in the state government for the bungled launch and a massive loss of taxpayer dollars? >> congressman, we have made changes within the -- >> i asked you a question but have you fired anybody, so? >> congressman, personnel actions have been taken.

>> persons have been fired? >> congress and -- >> how they just been reassigned like in the federal government's because individuals are no longer with the opposition spent are they still in the state government? >> congressman, no. >> so you did make some changes the? >> yes, congressman. >> the "los angeles times" report on how governor dean referred to the minnesota exchange as the black hole. where he was referencing consumer applications that were frozen or advantage to get a find out where those applications went? >> congressman, yes, we did. >> you have a total accounting? >> yes, we are able to identify in applications that up really been in the system that we weren't able to track during the fall rollouts. >> will you provide that? a lot of folks back in minnesota don't know that story. >> i be happy to provide accounting of those individuals. >> thank you for much. i'm going to go to everybody so we will try to go fairly quickly. how many people did have to hard to process paper application because of the problems with

your exchange website? start with you, mr. matsuda spent in our contact center, recently we increased staffing to handle the backlog that he mentioned in my remarks by a total of 80 people. >> how much did that cost? >> i'll have to supplement out to the record i can get the exact number for your. >> we would like to know how it was paid for two. let's go to the dr. sharfstein spent about two and a more people in a call center. about $6 million. >> how was it paid for? >> through our grants under the affordable -- state and federal government. >> we have leveraged workforce of about 300 individuals through an extended work appeared in the past four weeks, and we're happy to report that the paper application backlog the longer continues to i do not know the precise number for that period.

we can get back to you on that. >> and how it was paid for. mr. lee. >> we have a customer service staff the that were expanded by about 250 people to do both phone and mail and we shared paper processing work with countcounty partners throughoute state of california. and additionally it extra contracting of vendors to help us get to the paperback law. i'm not sure of exact number. i will happily follow up with you on that number that it was paid for out of our federal establishment grant. >> mr. leitz. >> approximate 50 individuals were added for that purpose. we also paid for the out of the establishment grant. >> mr. van pelt. >> thank you. oregon also leveraged sources from different state agency but i will have to get back to you on precise number and payment source. >> i'm going to come right back to you quickly, mr. van pelt, because when did the state first alert seen as the exchange is not going to be operational?

>> that's all in the first data assessment and i have to defer to that report. >> secant address the oversight -- >> my particular role was such that i was called in shortly after the governor and cover oregon determined this was not working or going to work and that being the case my time focused on setting up paper application process and that was going forward. >> and my point was seen as a very, very poor oversight. affect your predecessors were talking in regards to their lackluster questions than how they impressed cms with unimpressive answers but i'd like to have a report on that. that. >> be happy to do that. >> i yield back. >> thank you again for your outstanding testimony. it's really a tribute to you as executive in each of the

programs that you've turned what was lemonade -- turned lemons into lemonade. i'd like to start by quoting the speaker, when he referenced the rollout as horrendous, and the launch was anything but smooth. representative barton called it a huge undertaking, and it's going to be glitches. those were comments made by the speaker and by congressman barton on the rollout of part d, medicare part d, which was seen as full of problems with the initial rollout and yet republicans at that time were all about fixing it. because it was in president bush's administration. i would like to see the same kind of frankness and willingness to fix the system

now that it's in president obama's administration, and we are undertaking a much, much larger effort. now, what's good but everything i've heard to this point is that you have fixed the initial problems. you are all optimistic about the success of the program. and i just had each of you indicate whether or not you believe that you have met your goal or will meet your goal? >> thank you, ms. speier. we believe we will reach our goals. our system is working as i testified earlier and really our goal now for the short-term is to improve the functionality and the usability of our system. >> maryland has exceeded its enrollment goals. >> ms. yang. >> congresswoman, as you have heard in my testimony, we are proud of the fact that we are achieving a fundamental of the aca which is to expand coverage on top of an already very solid

ground in massachusetts. our work is not done but we on a very solid path. >> mr. leitz freshman mr. leitz spent we have not had specific goals but with exit poll projections. all goals are to ensure everything california's we still have work to do. >> congresswoman, minnesota is solidly on track and we feel very good about the future of what's ahead of us. >> mr. van pelt. >> thank you. oregon estimate on its way to achieving its enrollment goals and feel confident in the steps we've taken to improve our technology. >> mr. lee, california is a great sunshine story here, and we are proud of that. would you tell us what some of the reasons for the success were? >> congresswoman, i'd be happy to, and some of these are highlighted in my testimony and i highlight this very briefly, five things.

one, leadership across the state focus on consumer. we put politics aside and said let's make this work for consumers. we had very effective collaboration both between state agencies, the medi-cal agency which a partner with but also with regular agency, department of insurance to this has changed entire insurance market. it's not just about exchanges. it's about changing the marketplace. that coordination is critical. partnership, this has worked because its work on the ground in communities with committee clinics, counties, insurance agents that partnership collaboration has been vital. and, finally, that we've had a culture of both transparency and learning. we've had bumps along the way and we've adjusted our courts continually and we will continue to do that. this is the beginning of a very long road. we look forward to learning and improving as we go forward. >> dr. sharfstein from your going to intimate the connecticut it solution. i don't have many other states

are but they seem to have made it work very well. what do you think the key is to the connecticut system? >> thank you, congresswoman. several things that are attractive about the connecticut solution to personal it's a very simple and elegant design both for consumers and the consumer assistance worker. it also has very good functionality for insurance brokers and met a lot of insurance brokers that we are working with in maryland. that was very good but it also uses some of the same software, not the specific software for the trend for some of the general software pieces we have licenses to and runs on the same kind of computers we've already purchased. there's a lot of overlap and allows us to reuse some of the initial investment. those are some of the reasons. and, you know, we are able to demonstrate it at our board meeting recently. we've got a lot of positive feedback around maryland for

that. >> thank you all. >> we will now go to the gentleman from michigan. >> thank you, mr. lankford. and thank you for holding this hearing, looking at a program that is being pinned as just an exceptional opportunity to i guess carry on approach that takes away freedom, competition and opportunity and i think great health care continuation for our country, simply because we were unwilling to deal with costs and increase that competition. but let me ask a question of mr. lee, and thank you for being here. july 2013 state auditors report that called covered california's plant in a high risk entity, and that was the auditors statement. the report stated that under all scenarios, covered california will not have sufficient revenue, to cover its operating

costs in this coal year 2015, 2016. specifically it said it would be losing $73 million. you told state finance officials in december that, and i quote, the long-term sustainability of the organization, end quote is its greatest weakness. what did you mean by that? >> a couple things. we are very appreciative of the federal funding to get going. in california after we are going, we will be running 100% on our own steam, supported by premium dollars. by state law cannot go to the state of california the general fund. the making sure we are well managed is a critical come important factor for being an ongoing organization. the auditors report also noted, i believe, in our budgeting is always planned to have a couple years of what are called deficit spending. in 2016-17 we planned to be

operating in the black -- >> you still believe you will be? >> absolutely. we are action in the process of developing our next year, our budget, revised budget now based on our current heroic figures that we'll be taking to draft to report this next month and will be able to adjust every year our operations both on the revenue and expense side to the fiscal well managed per california. >> let me fall up comic in the state auditors report noted that premiums and both individual and shop markets, and i quote generally would provide the revenue required operating exchange. but you shut down the shop market earlier this year. >> no, we did not. spink you didn't shut it down? >> absolute nut. we have more than 6000 individuals enrolled in over 600 businesses. we turned off the online enrollment functionality which is generally not used -- >> of the shop market.

>> that's generally not how small this world anyway. but we are enrolling people today. >> you don't plan any taxpayer bailout? >> absolute nut. by state law in california, want to be clear, we cannot be depend on general fund money and we expect that we're going to be converting to -- >> federal taxpayer bailout as we'll? >> we been supported by the federal support to get launched. >> but you don't expect any more federal support or bailout? >> i do not expect -- >> we will hold you to that. i hope that is the case. >> me, to. >> we both do. let me move on to ask several of the questions. in total, let me start with dr. sharfstein. in total how much has been paid your state to develop an operating is exchanged? [inaudible] >> your microphone, please.

>> so far out exchange has spent for all calls, including the website, about $129 million. >> that's what's been paid in total, your state to operate the exchanged? >> our federal grants i think in total, if i'm correct, are about $180 million. but no, i'm sorry. let me get the exact number for you. >> ms. yang, you can get prepared for that same question. >> it's about $180 million in grants. >> that's what's been paid to you thus far? >> those are the federal grants we've been awarded. >> who are the contractors and how much have they been paid? >> there's a long list of contractors so i could submit that for the record. >> would they did competitively or sole-source? >> for the major it procurement we did a competitive procurement spent any of the contracts, sole-source?

>> for a couple of much smaller contracts spent appreciate that on the record as well. how would you rate the contractor performance under contract? >> well, we let go our prime contractor. we do not think that they performed well. we were declared is by without some of the software worked as i mentioned before. it was both us out of the box to be able to do a lot of things but, in fact, did not get out of the box and we wound up with some of the same problems as minnesota had. >> mr. chairman, if i could ask for the record if i could get also information to us that would clearly state whether he will seek for the federal funds. with that my time has expired. >> mr. carper it is recognized. >> thank you, mr. lankford. and thank you to all the witnesses who have joined us here today. and thank you for your tireless efforts to get people signed up for affordable health care. unfortunately, i come from a

state that did not start its own exchange. pennsylvania. which i think the failure to do that intensifying was in abdication of the responsive really of governor corbin on behalf of pennsylvania's citizens. in the last five years we've seen 12 hospitals in pennsylvania close. and i see the ack and in rome as a way to strengthen america's hospital system, that includes pennsylvania. governor corbin's decision back in 20 told to decline to establish an exchange was announced in a peculiar way. it was first celebrated in a press release by americans for prosperity. the koch brothers funded enterprise. 20 minutes later the commonwealth of pennsylvania itself made the same announcement in a press release. the timing of that announcement to me certainly raise questions

as to how the koch brothers influenced that decision in the first place. even more disappointing, i want to say it was governor corporate edition not commit expand medicaid for the more than five and 20,000 pennsylvanians who could be covered under this but it would've been 100% of those costs for the first three is facing it down to 90% by 2020. you know, i had a health care ceo in my district in northeastern pennsylvania confided to me and that if they pennsylvania doesn't accept the medicaid expansion, he's going to have to close one of his two hospitals. that's how important this is. instead of accepting federal funding to expand a highly successful medicaid program, governor corbett submitted a waiver proposal that would impose premiums, work search standards and limits the benefits to medicaid recipients.

according to the kaiser family foundation, the covers below cost pennsylvania hundreds of millions if not billions and medicaid dollars this year and will leave hundreds of thousands of low-income residents without health care coverage in 2014 in pennsylvania. it's unconscionable to me. it's time to quit playing politics as ranking member cummings has put out with people's lives, with peoplesoft. it urged governor corbett to reconsider his wrong candidate decision that without i'd like to turn to the panel today at the citizenship represent, ladies and gentlemen, are fortunate that all other states have made the decision to accept the medicaid expansion. mr. lee i want to start with you. california has enrolled more than 1.5 million new applicants into medicaid since october 1, am i correct? >> that's correct. >> could you tell the committee

about what the medicaid expansion means for those california residents and for the state as a whole? >> absolute. i appreciate the question. we have in california been in close partnership with our traveling seven colleagues. -- medi-cal. we the people break down in tears that they have affordable coverage. that's both for medi-cal coverage of for the subsidized coverage of covered california. i've talked to many myself and people on the front lines with the insurance agent, customer service people relate these stories constantly. it's touching many lives. >> what about you, mr. lee? and you describe the impact of the medicaid expansion on your residence and your state's? >> congressman, we know in minnesota about 60% of our uninsured population is eligible for the medicaid program and so as our numbers have grown through mnsure we know they're reaching uninsured by into

medicaid. what that is been able to allow them to do is to access services many to oftentimes for the first time to get preventive screenings, to care for issues that they might have had not cared for in the past but it's been a very important thing both for them as well as the caregivers that they seek. >> thank you. mr. lee, what about you -- dr. sharfstein, same question. >> the medicaid expansion is extreme and. in maryland we've done an analysis that there are well over $159 in uncompensated care reductions we expect as a result of the expansion. it matters a great deal. i met pediatrician. i met one mom who said that her daughter got them was telling a story about a very sick baby who need a heart surgery, that the medicaid paid for and then out came the daughter to give me a hug. there are real people in maryland to my patients would see them in clinic that the medicaid expansion changes their lives. >> i thank you, sir, and i yield

back. >> thank the gentleman. ranking member of the subcommittee, from florida is recognized. >> thank you, mr. chairman. recommend, i'm on your team. >> that's all right. spin not a bad thought. thanks to the chairman. i appreciate this hearing. i've got to tell you, when i hear things like that this law is causing premiums to decline sharply, for americans, i don't know what to say after having dealt with so many disappointed constituents, just. the question is who are you going to believe, those who are defending this law or your own lying eyes. i think the american people will make that determination. some of the things that are set are just factually not true. we keep hearing that this has led expansion of coverage for 3 million young adults but the people that looked at that most recently have debunked that number and said it's probably less than 1 million. and all, by way, that's imposing

the costs cost on families between one and 60 -- $480 per policy. some of the numbers back and forth are fine but the central promise of this law was that if you like your arrangement, and this law would not negatively affect you and, indeed, it would benefit you at lower cost and that central pols clearly has been broken. people like your plan, they may not be able to keep it. people are losing access to their preferred doctors are i don't have any constituent has come to me and said their policy that they had has declined in premium by 200 -- $2500 as was promised and also we don't talk about the increase in deductibles. people are paying higher premiums and seem to deductibles go up so they're spending way more out of pocket than they used to. can we put the slides up on the board about -- and so you all of those things which we were told were not going to happen but then we see a lot of people have seen their existing arrangement undermined or changed in the way

they would not have chosen to do it. .. the amount of money that has gone into creating these exchanges and people that lost access to their doctors and medicare advantage, so it hasn't even produced what they said in terms of expanding coverage and i think that