should accept it and the west should continue a policy of nonrecognition until such time if and when the ukrainian decide use something other was the second issue perhaps put down the road. the other piece here might put together a basis for a confirmation that would help mend the divisions within ukraine, and the thing could be an acceptable way forward. i think the big question here is the end of the day is a still acceptable to russia? i'm not sure that the russians are happy just with ukraine saying no nato. i think the russians double, are happy with the idea that ukraine was to draw and this is not just the president but it's also the parliament and i think budget of ukraine people hav that they wao draw closer to european union. when you look at the association agreement and without agreement does, if ukrainians were to implement it, if ukraine and puts the eu association agreement, it is a retrievable out of moscow's jew political orbit. i think that still remains a

sticking point for the russians. spent thank you very much, ambassador. i think we want to quickly get to your questions and comments so get ready. before we do that i'd like to give ambassador issued your an opportunity to respond to dr. brzezinski's remarks. >> first, in the way, and i mean this half cynical, we can say thank you to vladimir putin for reminding us that at least a good reason for having nato. nato was in the process of getting off the radar screen a little bit of the major european and transatlantic debate. now it's back on the radar

screen. that's good. second, president putin has also, by doing what he did, reminded europeans that there is an overwhelmingly good reason for trying to get our act together in terms of speaking with one voice for the eu to be a political actor that can exercise a significant role, as it should, from dissenting 500 million people. and third, i think the events are in the process, are already re- energizing the debate about how best european country, including my own, then unburden itself from too great a dependency on the energy imports from russia. so that's actually all figured. second point, when you discuss

delivery of support, extension of support including weaponry to ukrainians, the one problem i believe we would run into is that the ukrainian military is in terrible shape. and that is not the fault of the russians or anybody else but it's simply the fact they have been understaffed, under finance, underequipped. and it's not going to be very easy over the short period to make of this rather sorry state of the ukraine military, something that can work efficiently as a military. next point, deploying nato forces to eastern neighbor countries like poland or the baltic states. we will have here at the wilson

center come if i can make a little advertisement, in a couple of days, the new german defense minister, and i'm sure somebody will ask her the question whether germany should or could join those who have already taken some steps. the one word of caution i would add is that we should think twice before we violate the promise we made in the context of the nato-russia founding act almost 20 years ago when we said that we would not permanently deploy major combat troops in, among the new nato members. now, i think this can be handled. major combat groups is something they can be interpreted, but sending a smaller force, sending a few airplanes is probably not

a major combat force and i think even symbolic acts would be helpful in the sense that dr. brzezinski has suggested. finally, last point, one point that has not been mentioned i believe, president putin has not only, has not only challenged the european security architecture, as dr. brzezinski described it, he has also presented a challenge to the very idea of european integration, to the idea of europe. is it not amazing that not only the post-communist leaders of west european parties, including in my own country, is traveling to moscow to conduct discussions

with russian leadership, that's normal, but it is very surprising, certainly to me and i'm sure to many in my country, that many of the right wing leaders in europe have discovered that vladimir putin is their hero, the hero of something that rejects overcoming the nationstate, that looks for nationalistic leadership. there is a strange, these are strange bedfellows, the european right wing and president putin. and in my view this is a rather fundamental challenge to the very concept of europe. i'll stop here. thank you very much. >> thank you so much. let's go to your questions and answers but if you could please wait for the microphone. it's coming right there and we will start with president harmon. >> thank you all.

and zbig, i remember you talking in the cabinet meetings of the carter white house, and i think it was a warm-up act. this was just magnificent. thank you very much for coming here. my question is about an organization that got very little mention but wolfgang ries i spent a lot of time connected to it, and that is the osce. the osce secretary-general was here about a month ago and it was the roundtables in ukraine that will gain shared that are credited to some extent with really encouraging ukrainians to participate in election. it is true as ambassador pifer said, that unfortunately someone eastern part of ukraine couldn't participate but the turnout was substantial, about 60%. better in our election. so my question is, could the osce, which is a security organization which includes russia, but which operates by consensus play a bigger role in

negotiating an outcome here that would be satisfactory both to the west and to russia and benefit ukraine? >> thank you. >> i suppose it could, but probably at this stage on the sub rosa. in other words, the discussions were informal and basically not open to the press and conducted in private. because right now we are not at the stage in which it is likely that they could lead to something very positive, but certainly they would be open to the. so i think it's desirable. could i make a few comments on what also i said earlier? very briefly on the arms, the arms -- the ones i'm talking about our defensive, urban warfare. they cannot use against defense i can stretch. those reasons is that this is provocative to russia.

it doesn't require a lot of military sophistication to use them which means that if the military is as organized as you say they are, civilians can take part in it and the really works. i become i could regale you with some stories with what happens when the russians tried to storm -- and how surprised they were and certainly during world war ii the are examples of urban warfare that endured. so it's a very useful way of saying to the russians, don't expect an easy walk in because it's going to be painful, costly, prolonged. on the, one more aspect and this pertains to live up to what you asked, jane. right now the russians are really in a phase in which they are trying to modernize global support of western reaction, and that's what you referred to. and the interesting thing about the western reaction is that they liked the content of what the russians described as the

russian global civilization. that is to say, anti-modernist anti-modernistic, and it's socially, sexually, reactionary, it's kind of drawn inward but very self-righteous. and this is what makes a new western right wingers all of a sudden equivalent of the old western left-wingers who lost russian communism. so we are seeing a flip around here. but my guess is that the change in character of russian society over time, particularly changing characters of the middle-class, is going to spell the doom of that wants to things happen. putin is not successful in militarily asserting itself, and at some .1 way or another is no longer a central player. >> thank you. >> i just think it remains to be seen whether osce to play a role in the actual negotiation of the settlement. i think a lot of it doesn't have the russians approach this.

certainly if you have a settlement it seems osce mechanisms are mantras could be hugely important getting ground troops, building conference on the of the ukrainian population at whatever accord will work out will hold. >> if anyone brief word on that. we had on the 17th of april a meeting in geneva between john kerry, sergey lavrov european union, and the ukrainian government. that was so far unfortunately only a one-time event. and in my view it is highly desirable that a second geneva, geneva to as we attended to call it, should take place and osce i think is a good organization to support and implement and help government the kinds of decisions that were taken already in geneva. and are still not fully unlimited unfortunately, and so

i do agree that osce has a potentially important and continuing role to play in supporting what at a different level needs to be hammered out between the u.s., european union, the ukrainians themselves and, of course, the russian government. >> thank you. yes? please state your name and affiliation. >> steve, rand corporation. quick comment -- >> speak up, please. >> quick comment to wolfgang and the question for dr. brzezinski. wolfgang, that statement that you mentioned regarding troops and so forth. that was criticizecriticize d at the beginning of it since as very important because as long as the current security situation does not change. well, it's certainly changed

when one country invades another and tries to annex it. i think the situation has radically changed and, therefore, policies no longer obligated by that statement. the zbig i would say, i wanted to get your reaction to china. how do you think china looks at this? because they certainly were not very happy with the annexation of crania. and -- crimea. what applications do you think this might have for u.s. relations with china? >> i have to say that, regrettably in my view, neither china nor russia, neither china nor america have handled the relationship all that well in the last couple of years.

i'm not thinking just of the american press. i think, i'm thinking of some american official pronouncements and action, which unfortunately i think was not well worded. because it's intent was not to give the impression that the united states is committed to the physical military containment of china, but the emphasis on pivoting, on the pivot, on the reallocation of troops, on the deployment of troops in australia which as far as i know is not under the imminent threat of an attack from pop under guinea pigs would have to be china, engage the chinese the impression that we are really sliding into position of siding with whatever neighbor of china has a territorial conflict with china. that's an exaggeration but that's the way the interpreted it. and secondly on the chinese side

in the last year or so, there has been a dramatic increase. i follow this very closely. a dramatic increase in public pronouncements in the officially controlled and censored press. ..

>> more than anything else. and incidentally, not much noticed in the american press by israel who is, of course, thal beneficiary of our military assistance, political assistance and so forth, and they took this mutual position for their own reasons and interest. so one shouldn't be too surprised that the chinese did it too. in the russian-chinese relationship, i think what we are seeing is a gradually increasing russian dependence on china. that 30 years' treaty, by and large, is more advantageous to china than to russia even though the chinese squeezed the russians into some price concessions. because the fact remains that the major financial investments in order to make this treaty operative are going to be made by the russians in communications, facilities,

pipelines and so forth. and the chinese are going to have alternatives in terms of price as soon as iran opens up, as soon as they reach out to deal with saudi arabia and so forth. and, therefore, at some point the chinese will be able to go to the russians and say, well, it's very nice, we value this treaty, but you really have the lower the price because the world price is going down, and we have these options. and the russians will have no choice, they'll have to accommodate. which means that the benefits of the treaty will be increasingly favorable to the chi niece who are at the same time -- chinese who are at the same time moving into central asia quite visibly and openly. >> thank you. yes, the center. >> thank you. i'm with the rs office for cooperation, tread and investment. -- trade and investment. i have two questions, one pertaining to trust. one of the common elements i picked up on is there's a definite lack of trust of the

russians, and my question is what makes you think that we can build trust with russians, because it's on the basis of our actions over the previous years in terms of invading countries, in terms of spying on our own citizens, in terms of illegal detentions, in terms of our own disregard of international law? what makes you think that we can somehow convince the russians to sit at a table and trust us if we don't trust them? with good reason, given what you have all described. how do we get back to building trust? and the second question pertains to the cost of doing what you have said. it's clear in terms of the cost you've laid out for the russians, but what's the cost in supporting ukraine for europe and for the u.s.? how much is that going to cost, and that be borne, the burden, by the recovering economies of europe in particular? >> thank you. who'd like to take that on?

>> i can answer the second question. ukraine has struck a deal with the international monetary fund, and the imf has agreed to provide ukraine $17 billion over two years provided -- and this is a very important provided -- provided that ukraine does the necessary reform steps that are required in the program. and so the way the imf doles out the money is every several months there's a review if ukraine has met the conditionalities it's agreed to in terms of reform steps, then they get the next dollop of money. it was interesting, there have been a lot of imf missions to the ukraine over the last 20 years, and usually the mission would sit down with the crew crane januaries -- ukrainians and say here's what you need to do. what i understand is in march when the imf went to meet with the new acting government, for the first time the acting government said here's our to-do list, and it was the right to-do

list. i think people like acting prime minister yatsenyuk, they understand the economic reforms that ukraine has to take. there's been discussions with ukrainian governments for 20 years. the real question will be can they sustain the political support for these steps which are going on, in some cases, very pain beful. so, for example, to get access to the program, start the program on may 1st, ukraine raised the price of heating to every household. may 1st is a great time to raise the price of heating because nobody needs it. but in november, december, when the temperature's down in the 20s and the teens, people are going to notice that their heating bills are way, way up. at that point politically is the government going to be able to say to the lick we need to do this, we -- to the public, we need to do this, we need to get through the next couple of years. and it momentum stop with the i many, f -- doesn't stop with the imf. and so ukraine has potentially

access to $25-$35 billion over the next couple of years, primarily in the form of low interest loans. and that should help ukraine get through this period if they do the right things. >> who would like to take on the trust question, the first part of the question? >> yeah. i'll be very brief. i mean, i don't think it is fair to compare russian behavior on ukraine and especially crimea with western behavior going -- that's, that's a very popular thing for russians to claim, that we are at fault. because as russians say, we -- the west -- we adepressed the former yugoslavia, we did what we did in libya and, of course, in iraq and etc. i believe that it is important

to note that, for example, in the case of libya we, the west, certainly the united states, went to the security council of the united nations and obtained, actually, with russian abstention at the time a resolution endorsing activities directed at libya. the same is true in a number of other activities. we went to the security council i don't know how many times trying to find a way forward on syria, trying to find a way forward on kosovo and on bosnia, etc. i am not aware that the russian federation even tried not even once to seize the security council to authorize russian action on crimea. so i think it's, the comparison is not fair.

i would grant you one point. the european security architecture as it exists with institutions like nato, the nato russia council, osce, etc., is not working the way it should. we do not have a sufficiently functioning body of institutions and rules. that's, that's my take from what we are witnessing. so that needs to be improved and repaired. but in order to do it, you need to have a minimum of trust that all actors are, you know, singing from the same page. and that's very hard now that we have had such a terrible loss of trust in the predictability of russian policy as it happened over the last few months. >> thank you. david can ignatius, what will probably be our final question.

>> thank you. i want to ask ambassadorrishinger for his assessment of whether germany -- meaning both the government o chancellor merkel and the german people, whether germany is prepared to support the policies of deterring this chauvinist russia that dr. brzezinski described even though germany will pay significant costs in doing so? >> yeah. david, i think, yes. but the question is, how? how exactly? if you take the majority view among the german public, you find a lot of skepticism regarding our jointly-adopted decision on sanctions. you will find a lot of skepticism regarding the question of weapons delivery. you will find a lot of skepticism regarding deployment

of military force to eastern nato countries. in other words, there are obstacles to overcome in terms of public opinion. and, quite frankly, as much as i personally agree with the point that our eastern nato members need to be reassured, should be reassured by certain types of activity including symbolic or not so symbolic military deployments, i think that our priority number one needs to be to stabilize ukraine. and, quite frankly, by sending a few airplanes to estonia or to poland, we are not directly doing anything to help these poor ukrainians to handle their

problems. so i think the first objective, the first priority needs to be things that will help ukraine directly. i know having been involved in these discussions over how to deal with the ukrainian crisis over the last month or so, i know of no leader, certainly no leader in europe who has spent more time trying to explain to president putin that he's making a mistake, a big one. and i think chancellor merkel has also been quite successful, surprisingly successful, in convincing the german business community which has a much larger stake in the russian business than the u.s. business community that the german business community should not to pose sanctions -- oppose

sanctions against russia. in fact, just over this past weekend the leadership of the german business community, the bdi, issued a statement supporting with pain, as they said. you know, first, this is painful. but we accept that this has to be the prerogative of political decision making among transatlantic partners. and if they believe that sanctions are needed and maybe more sanctions are needed, then so be it. that's a painful this thing for somebody to say who actually represents many hundreds if not thousands of large and small businesses who have been doing a lot of business russia and with their subsidiaries in russia. so it's not a small thing. >> i very much agree with what wolfgang just said about the problems and especially the problem problems the europeans and germans face when it comes

to subsidies. not subsidies, sanctions. i just want to add a little bit to it; namely, it's true that their difficulties in that regard are greater than our difficulties. but we also have expenses. for example, the president just committed $1 billion for the reinforcement of central european security. that will come out of the pockets of the voters. but it is a step in the same derek so that we assume -- direction so that we assume certain obligations and difficulties, costs as well. i also think that, in any case, solidarity is what is essential. and solidarity need not be only tangible. it can be symbolic. and anything that our european allies can do to show that the issue of european security is of common concern and a common responsibility is to thed good. and it's not -- to the good.

it's not an anti-russian step, it is a stabilizing step. in the last several year, the russians have held several exercises, military exercises in its person territories. in fact, in large measure on belarus soil which brings them much closer to baltic states. and these are enormous exercises by our standards. large army formations, repelling an alleged attack and then moving forward. and the last one ended with a simulated nuclear attack on the central european capital. nuclear attack. no one has used nuclear weapons since 1945. i mean, these are things that we haven't paid much attention to but are part of this equation. and building security has to be very much a reciprocal responsibility in addition to solidarity in the face of challenge. >> thank you so much. this was a terrific round table. let me just congratulate the

ambassador again on the volume, highly recommend it the all of you. thank you, dr. brzezinski, for your extraordinary keynote, your very thoughtful comments, ambassador pifer and all of you for joining us. we're adjourned, thank you so much. [applause] [inaudible conversations] >> and live now to remarks there former health and human services secretary kathleen sebelius. she'll be sharing her reflections on the challenges in implementing the nation's health care law and best practices learned from the initial open enrollment period which ended on march 31st. the next enrollment period will start in november. enroll america is hosting this speech here during their national conference23ç in washington. this is kathleen sebelius' first public appearance since stepping down as health secretary, relaced by sylvia burwell who

this should get under way in just a moment. live coverage on c-span2. [inaudible conversations] >> good morning, state of enrollment 2014 national conference participants. leads welcome -- please welcome president of enroll america. [applause] >> hello. good morning, everyone. good morning. >> morning. >> and welcome to the first national enroll america conference. state of enrollment: getting america covered. very excited to have you all here today. [applause]

you know, when we first started planning this conference months and months ago, our hope was to bring together enrollment leaders from across the country to reflect back on the historic first open enrollment period and share best practices for the future. we thought, you know, maybe a few, couple of hundred of our friends would come to d.c. for this. but we never expected that more than 900 attendees would join us from communities in 48 states -- [applause] yes, incredible. and not just that. including the district of columbia and as far away as guam. pretty amazing. so thank you all for being here. and thanks to our generous sponsors, many who are in the room here today and make our work possible. but especially those that helped make this conference possible; the robert wood johnson foundation, get insured, go health for helping us all gather

here today. the fact that there are so many here in this room shows just how strong and passionate this coalition is. you represent a cross-section of the many industries who work together to make this first enrollment period a success. you are in-person assisters, government officials, health literacy educators, insurance industry leaders, outreach specialists and organizers. everyone here understands the importance of our work to engage consumers and spread the word about how they can benefit from coverage under the affordable care act. and for those of us who have been working on expanding health care access and awareness for years, we know we've reached an incredibly important milestone. thanks to the exceptional work of the people in this room, more than 14 million americans and counting have received health coverage through the marketplace, medicaid and chip.

give yourselves a round of applause. pretty ahazing. [applause] and despite an unexpectedly rocky start, you all made history by powering through a few negative news cycles and keeping your eye on the ball. you stayed focused on educating consumers because they were hungry for the facts about how the law could benefit them and their families. you connected consumers with free in-person help from experts in their communities. you made sure they knew about the opportunities for financial assistance which finally made health insurance a reality for millions who couldn't afford it in the past. and you stood ready to handle the surge in sign-ups as the deadline approached. here at enroll america we reached more than five million consumers across the country with information about enrolling and coverage, but we didn't do

that alope. our -- alone. our over 230 employees worked hand in hand with over 2,000 partner organizations and tens of thousands of volunteers who shared our commitment to connecting consumers to the information and resources they need to get covered. through empowering public officials and local leaders to be messengers on health care in their communities, we preached thousands more -- we reached thousands more and encouraged them to learn about the options available to them. we met consumers where they were online and on social media and shared coordinated enrollment messages with our partners to increase our reach even further. we worked with community colleges, health care advocates, providers, faith groups, in-person assisters, government officials and key local organizations just like all of you to reach as many consumers as we could. and one of my favorite parking lots of this first -- parts of this first enrollment period was

when i had the chance to travel from texas through ohio, and i saw the true scope of work and how unique it is from community to community. in dallas i stood with 17 pastors on stage who pledged to educate their congregations about their new options. in mcallen on the border in texas, i stopped by a local library where enrollment assisters set up shop every single day to serve their community. in cleveland i saw an overflowing enrollment event hosted by cuyahoga community college. and in cincinnati i stopped by a health center with deep roots in the latino community. even city looked different, and the effort in each city looked different. but in every city there were local organizations and leaders with a vision to see the need and the willingness to fill it. and in every city that local knowledge and personalized outreach was crucial to success. and that is why it is so

exciting, really a true pleasure, to be here with all of you today so i can thank you in person for the work that you've done, and we can celebrate together. there's also someone else who wanted to thank all of you as well, but he's a very busy man, and he couldn't be here today. he's someone who needs very little introduction and who has played, oh, a pretty big role in expanding coverage to millions of americans. so without further ado, i'd like to play for you a message that he recorded for all of you. >> hi, everybody. thanks for being a part of our effort to enroll america. we've always said that change doesn't come from washington, change comes to washington. change happens when ordinary americans stand up and make it happen, and that's what enroll america has been doing from the very beginning. today eight million americans have signed up for private health insurance plans through the marketplaces, some getting

covered for the very first time. what does that mean? it means peace of mind for working families, it means freedom for young people who want to change jobs or entrepreneurs who want to chase new ideas. it means justice for every woman who can no longer be charged more just because she's a woman. that's why many of you joined this fight in the first place, from community organizers and hospital leaders to navigators and faith leaders and elected officials. i could not be more grateful to you for all you're doing to help americans get covered. but we cannot let up now. as we look towards 2015, we need you to keep telling your stories, keep spreading the word, keep standing up for folks trying to get covered. because the other side has billionaires funding campaigns to scare the very people the affordable care act would help. but we've got something better with, we've got you. and i'll take you any day of the week. so thanks for all your hard work. together we're going to make sure this law works for everybody and keep fighting to

restore opportunity for all. [applause] >> we are very grateful that president obama took the time to record that message. and we're also grateful to his administration for their ongoing commitment to providing opportunities for americans to find the health coverage they and their families need. as you heard the president say, now that millions across the country are experiencing the peace of mind and financial security that comes with a quality affordable health insurance -- some for the first time ever -- now is not the time to slow down our efforts or to rest on our heels. which is why we are all here. you all know that very well. everyone in this room brings a unique perspective from his or her experience which presents us with a valuable opportunity to learn from each other and reflect on our accomplishments, identify areas we can improve and strengthen our partnerships

so that we can continue to build on this important work for years to come. to kick off that process, we wanted to bring together experts from across the different industries who played a critical role in the historic developments of the last year and take a look back on what we all just experienced. so i'm very excited, really thrilled by the lineup of prominent health care leaders from the insurance industry, the policy world and state and federal governments who have all agreed to join us today. and i am particularly honored that kathleen sebelius -- who as secretary of health and human services -- shepherded the affordable care act from an idea into the law of the land and then to a reality for millions of american families has chosen to be here with us, with all of us in her first public appearance since leaving hhs. we'll hear, first, from each of our panelists about their different perspectives on the first enrollment period, and then we'll have some time for a

panel discussion to reflect on what worked well and the obstacles we faced. so to start us off, i'd like to welcome to the stage one of america's leading health policy experts, the president and ceo of the kaiser family foundation, dr. drew altman. [applause] >> good morning, and thank you very much, anne. you know, when i was in state government, i was described in a major newspaper as a nice guy trapped in a deadly serious face. [laughter] so i'm really very happy to be here, there's just no way in the world you would ever know that. [laughter] i wanted very much to be here today because millions of uninsured people got coverage in this first aca open enrollment season, and no one did more to headache that happen -- to make

that happen than the people in this room. and, you know, while the partisan debate about the aca continues and we all know we still have a lot more work to do with anotherren rollment season coming, and our surveys show more than half of the uninsured trying to figure out what the aca means for them. on behalf of many of us in this room and in the country who have spent our entire lives working on the issue of the uninsured and the millions of americans who got coverage because of you, thank you for what you did this year. the enrollment success in year one is also the result of leadership and i think when you ask who are the leaders that you think of when it comes to expanding coverage, number one, two, three, four, five and six on the list are secretary sebelius and governor beshear, and i would add anne to that list even though she likes to stay in the background. she can't hide any longer. she's no longer in the

background. so it's just a pleasure for me personally to be here with everyone who will be on the stage in just a minute. now, as ceo of the kaiser family foundation, i'm sure you're expecting a lot of data from me. [laughter] here this morning, because that's kind of the organization. yeah, you know that i've established. but i'm actually throwing out my own script. i want the tell you three quick stories and just make a few very basic points. the first is a story from my time in state government as new jersey human services commissioner under a great governor named tom cain who you may just remember. it was a while ago, chair of the 9/11 commission. i made my name this state government -- in state government doing welfare reform, but one thing i put great effort into was developing a school-based program for youth. we even kept the bridges to new york open in new jersey. [laughter] you know, in case we had to

escape from new jersey. [laughter] anyway, i was in cumberland county which was in south jersey, and at the time it was the poorest part of the state, it had worse statistics than camden and newark. i was meeting with young people, and i was asking them which services are most important in this program, which medical services, what about behavioral health, do you want midnight basketball? should the clinic be in the schools or near the schools? you know, they were a technocratic commissioners, me, programmed to ask questions. and there was this one young guy, and he was very small, is and i remember he was sitting in the back of the room, and he just looked up at me, and he said, you know, commissioner, you're just an idiot. it's not this or that service. what we really need is somebody be we can talk to who we trust. from that day on, whether it was organizing services for at-risk youth or hiv prevention programs in squatter communities and big

cities across south africa or health care for the homeless programs in the u.s. and big cities or outreach for the uninsured here in the states, community-based outreach has been a cornerstone of really every successful program that i've been involved with. our surveys show that about half of the uninsured have been uninsured -- okay, some data. half of the uninsured have been uninsured for two years or more or have never had insurance. about 20% do not have access to the internet. the national debate that we had this year focused on the web site problems, it folked on what i call the aca's actuarial mission, making sure there were enough young and healthy people in the risk pool that it is a2mr healthy risk pool, and that's a very, very, you know, we have to have -- that's a very important thing. but there is a social mission too. what really is the point of all

of this if it's not also to reach the long-term uninsured, the folks who need the coverage the most, and that will not happen without community-based outreach anden rollment services -- and enrollment services. and that's not just in the survey data for me. it's a lifelong lesson i first learned when the young gentleman in new jersey called me an idiot. by the way, on the unfortunately politicized question of whether any of the folks who you helped get coverage were previously uninsured, well, i can't release numbers yet. we have, i think, a very important study of the nongroup market coming out on thursday of this week which will show that a very large percentage of those who got coverage in the exchanges were, in fact, previously uninsured. so so much for that. my second story is about a guy named duffy who clears timber in the mountains, and i helped him get coverage.

he works like a dog when he gets work which is not that often from early in the morning until it gets dark, and he has all kinds of health problems that i won't go into. when i asked duffy why he doesn't have coverage, he said, of course, that he couldn't afford it. i showed him the tax credits, i also showed him the deductibles. duffy had no idea what a premium was, what a deductible was. you've all dealt with a lot of duffys because with, of course, he didn't have insurance, he had no computer, he doesn't know how to use one, he had absolutely no idea where to go for help. he said he had heard about obamacare, but he had read that it was broken, so he didn't pursue it. that was during the web site problems. ultimately, duffy went to the local county social services agent by where they walked him through the process, and it turned out duffy qualified for medicare which he was absolutely thrilled about. health coverage had always within unaffordable -- been unaffordable for duffy, so knowing about the credit and

then knowing about the medicare coverage, that made all the difference in the world for duffy x. this should be no surprise to anybody in this room because since the beginning, i think, of recorded time every study we have dope of the uninsured has shown that the main reason the uninsured don't have coverage is they can't afford it. it also mattered that duffy now was required to buy insurance. there was a penalty, it would grow. there was a deadline. duffy didn't know that. it mattered to him. so for duffy and millions more according to the research, the financial assistance and affordability really matters. it's a central message. it may be the central message. and the mandate matters too. there are a lot of other stories about family and friends helping assisters, about the national media as a source of information, but let me just close with my last story. this is a story i tell occasionally, it's one of my favorite stories. it's the story of my first day

on the job as human services commissioner in new jersey, and the problem i had was i couldn't find the job. there's no reason to go to trenton, new jersey, if you don't have to go to trenton, new jersey. and so i went, and i wandered around, and i couldn't find the building. there was a big building, i thought it was the place, but it didn't have a sign in front of it, and there was a guard, and i was very young at the time. he said, it's in there, kid, just go in there. i had my big idea, this was how i was going to take control of this large agency. i went up to the ninth floor and then i said hi big idea -- my big idea, what's wrong with all of us? we are the largest organization -- we were then in new jersey bigger than the drug companies in the state of new jersey. we should be proud of what we do. there will be a sign in front of this building. well, nine months later after the job was stopped because the wrong procurement jobs were used and then stopped again because the wrong union team worked on

the job and then stopped a third time -- wonderful, i love this letter from the state department of treasury which said this job should not go forward because it is too small to do. [laughter] they called me out to the front of the building. the press was there by the thousands, people were there. it was my birth day. there were stories, will commissioner altman get his sign? >> there was a giant sheet in front of the building, and they pulled the sheet back, and there it was: the new jersey state department of hunan services. [laughter] they spelled it wrong. [laughter] i wanted to keep the sign and change the services. [laughter] it took me nine months to get a sign. big changes like the aca take time, and that's -- [laughter] especially true for a law like the aca which is going to play out differently in every state and differently for people

depending on their income and their employment circumstances and where they live. in the national debate about the aca, it's east good or bad -- either good or bad. that's the debate we're having, a binary debate depending on your partisan politics. but if you somehow force people to take off the partisan glasses, i think the defining characteristic of the aca is its variability. i wish we had a congress which could learn from that variation from this great national experiment. we don't. but states do watch other states, and they can learn. as we look ahead, maybe the politics of the aca will change after 2016. maybe it will no longer even be called obamacare. finish maybe, right. but one thing i do know is that more than any other factor, it will be your efforts, the efforts of the people in this room, that determine success

reaching people who need coverage the most. so on behalf of the kid in new mexico who called me an idiot -- in new jersey who called me an idiot and duffy and the new jersey department of hunan services, thank you very much. [laughter] [applause] >> thank you so much, drew. next up we have one of the most experienced and insightful leaders in the health insurance industry today, the president and ceo of independent blue cross, dan hoferty. [applause] >> thanks, anne. well done. good morning. >> morning. >> anne, well done. and thank you so much to enroll america for including me in this very important discussion. i just have to echo something that drew said. one of the heroes in getting

well over eight million people enrolled across the country is anne filipic and the work that enroll america has done, so i think she deserves a round of applause. [applause] it's an honor for me to be here with governor beshear, the great commonwealth of kentucky. although i'm a pennsylvanian, i have a fondness for kentucky. and even in the dark days of the rollout, governor beshear was one of the folks that stood up in front of the national media and talked about how things were working in kentucky. and although many of us weren't so sure at the time, he was steadfast in his belief that this was the right way to go. also secretary sebelius, whether she was the insurance commissioner or governor of kansas or in her latest role as secretary of health and human services, regardless of one's politics, it's amazing that an implementation of this magnitude, of this complicated nature could be dope in such a short period of time -- could be

done in such a short period of time. so i am thrilled to be here with them and, of course, with drew who you've heard from. before i get started though, i'd like to acknowledge another group of people, and that's you in this room. if you think about the grassroots effort, if you think about educating people on the need for enrolling in some plan to cover themselves and cover their families, you were there day in and day out, so congratulations to you as well. i know you're from all over the country, as anne mentioned, so i'd like to just give you a quick, brief understanding of who independence blue cross is. we are headquartered in philadelphia, we are the blue plan for five county philadelphia, southeastern part of pennsylvania. but through how companies affiliate, we're in 24 states and the district of columbia, and we touch the lives of about nine million people in all those security dictions. jurisdictions. as a leader of a major health

insurer, people say, wow, you must really have been busy over the past year with reform. and it's true. and i'd just like to give you a quick, a quick thought on how things change. i can remember with the rollout and the problems with the web site, i could not walk around the neighborhood, i could not walk my kids to school or an event without somebody stopping me and asking me about it. well, just past weekend you may be able to tell from my hoarse voice, my oldest daughter was married. and, certainly, there were a couple hundred of their friends in their mid to late 20s who really is one of the key targets of this incredible reform initiative. and there was a lot of dancing, a lot of fun. i tried to be one of the younger people. [laughter] not successfully. but not one question about reform. and that's not because they're

disinterested, and that's not because they don't worry about it. it's because they're finally getting it. therethey're finally being educ. they're finally understanding the importance of taking their own, being accountable if or their own care and their own coverage. that's a positive thing. so i just wanted to give you that piece. but it is true. the fact of the heart at independence blue cross, we've been preparing for reform for years. i know i speak for all the blues across the country. we believe that reform was needed. so since the law was enacted in march of 2010, we've been an active participant. have we voiced our concerns about several areas? yes. secretary sebelius and her team were always there to listen. they didn't always agree, they didn't always support our position, but they were there to listen. in the insurance industry, there was a lot of concern about reform. some insurance companies decided, well, we're going to wait it out. we're going to see how this plays out. but the blues, for the most

part, jumped in. and at independence blue cross, i'm happy to say we led the charge. here's why. regardless of one's politics, regardless of where you stand on the affordable care act, regardless of who you support in your local elections, in your state elections, in your federal elections, the health care system was andsome in some ways continues to be broken. we needed to change it. when health care spending accounts for nearly a fifth of america's gross domestic product and when more than half of american adults go without recommended health care, when we spend more on health care than any other nation in the world and yet americans are no healthier, when 50-60 million americans have no coverage, something's wrong. something's broken. the affordable care act is not going to solve all the challenges facing america's

health care system, but it's a start. and through your efforts and the efforts of organizations like ours, it's a very good start. reform has been a big shift for our health insurance business. traditionally, independence's main customers have been small employers who provide health care for their employees. we had a small customer base in the individual consumer market. but we know that all this was about to change and has changed. as we move forward, individuals become the key part of our efforts. it's now not only a consider of business to business business, a consumer to business business. the affordable care act has led to what some have called the amazonification -- i like it -- of health insurance. consumers can now go online to a

public exchange, and in a few clicks see a whole range of coverage options and sort them by price. in our markets we have 13 different products, 0 variations. -- 30 variations. i'm happy to say the lowest priced. people could shop and find what they needed. this is as great an opportunity for an individual to get coverage in our nation's history. at independent we found that consumers were drawn to our competitive pricing and unparalleled network of physicians, hospitals and ore health care professionals in our market. i am very proud to tell you that in the first open enrollment period we gained more than 285,000 enrollees. now, you might say, well, okay, that's a lot when well over eight million enrolled. that doesn't include in the various states where we do medicaid managed care where we picked up several hundred thousand because folks now have

access to coverage. but we budgeted. remember? 285,000. we budgeted well under 900,000. -- 100,000. so that should speak to the success that you have fostered during this enrollment period. this vastly exceeded our expectations. i believe that there are a number of reasons we were successful in signing up so many individual consumers. for starters, we've gone the extra mile to make it simple and easy for consumers to sign up for coverage and get the care they need. also we particularly want young people to enroll with us. as i said earlier, we've used digital media to reach out to them where and how they want to be reached. íçld

in those churches, in those schools, whatever it might be. our mobile education retail center, the independent expressed, is a perfect example. this is a truck, you might've seen a picture of in "the new york times" at the beginning of rollout. it's a truck. we like to think of it as the apple store of enrollment. people came off the street and there was an ipab there where there was one of our representatives. they were educated, showing how to get onto the website. at the time of the were problems were able to help them understand what the coverage possibilities were. we also found that while

traditional means of advertising are important, the key to reaching this new consumer group is the personal touch. that's why people like you here in this room are so critically important. community and religious leaders, people in the medical community, friends and neighbors, all of you, encouraging citizens throughout the country in your communities to get covered, to understand the coverage. it's very important and it's made a huge difference. so what's next? now that we have new members, and part of our business, we were determined to help them understand the value of what they have purchased. so that they take advantage of all the programs available, for them to stay well our get well. so here we are continuing to reach out and to educate thousands of people, and this is going to be an important part of your role going forward, to understand that the health insurance is just not about caring cards. it's taking responsibility and reaching for the points of care where and when you can get them.

so as i said, and in closing, reform is just underway. it was a great first year. regardless of one's politics, this is not a perfect law. this law will change over time because each of us will have input. but what will not change is the fact that 8 million americans, plus those in the medicaid arena, now have access to care. they won't go back. they won't allow us to go back. and it's our job now not just to educate them about having the card, but how to use the card. and how to get healthy, how to stay healthy, and how to continue to live a life of -- a fulfilled life. because they have coverage. regardless of the carrier, regardless of the network that figures, they have the courage that they need. so i'm very excited, ma and all of you, to be here today.

we as an industry are proud. we as blue cross blue shield plans are proud that we have been the leaders in and ruling people across the country. i look forward to this discussion to hear how we can do it better, how we can help you do it better. and next year when we convene, millions of more americans will be part of this great effort. so thank you very much. [applause] >> thank you. thank you, dan, for your leadership and for being with us this morning. now it is a real treat to introduce the man who led one of our nation's most successful state-based marketplaces. the governor of kentucky, the honorable steve bashir. [applause] >> thank you.

kentucky -- [laughter] you know, about nine or 10 months ago, most of you in this room who are not from kentucky to although we have some kentucky into. where are you? there we go. but the rest of you, about nine or 10 months ago, when you heard kentucky, if you thought anything, you may have thought, oh, kentucky derby. thoroughbred horses. kentucky fried chicken. [laughter] isn't that where a brown liquid called kentucky bourbon is made? let me tell you how important kentucky bourbon is to kentucky. [laughter] we have 4.3 million people in kentucky. we have 4.9 million barrels of bourbon aging in kentucky.

[applause] so i'd like to say that each of us kentuckians have one, and we will share the rest with you all. [laughter] but i'm sure that nine or 10 months ago when you heard kentucky, you didn't think, for instance, education reform, although kentucky was the first state in the union to adopt the common core standards. [applause] we were the second state in the union to adopt the next generation science standards. we just raise our dropout age from 16 to 18, so we've got some great things going on in education reform. [applause] >> economic development, we are doing some great things. we've set export records where bringing foreign direct investment into the state and diversifying our economy, lots

of great things going on. but you also wouldn't have thought nine or 10 months ago when i mentioned kentucky one of the most successful health benefit exchanges in the country implementing the affordable care act, but that's what we are. and we are here today to give you kentucky's perspective as the operator of the highly successful state-based health benefits exchange. now, by now i know that our story is familiar to most of you. on the federal level, we are called a red state, although honestly on a state level five out of our six statewide officeholders are democrats. as you know, our two u.s. senators are among president obama's most vehement critics. and quite honestly voters in kentucky don't support the

president very strongly. but nevertheless, kentucky -- kentucky's federal reform has been passionate and public. last fall "the new york times" published an op-ed that i wrote admonishing critics to get out of the way, get over it so that we can get health care for our people. [applause] >> and president obama himself gave kentucky accolades with me sitting in the first lady's box during his state of the union address. he referred to me as a man possessed when it comes to finding health care coverage for my people. now, that was both humbling and quite honestly thrilling. but let me tell you, kentucky's success isn't because of stephen

beshear. it was a team effort and it's because of people like you sitting right there and here in kentucky. [applause] >> in the days after the first enrollment period ended, we had signed up 421,000 people for coverage through what we call connect am kentucky's health care connection. and about 75% of those 421,000 people have never had coverage in their lifetimes. folks, that's a life-changing experience for them. it's transformative for our state, because 421,000 represents about 10% of kentucky's population. that's an impressive number in anybody's book. and it's do not only to my aggressive approach but also to people like you and kentucky who did the hard work, building a

website, creating an application process and working with families face-to-face to help them enroll. last october, about a month into our enrollment period, steven brill from "time" magazine came to kentucky. i took him over to the office of our health benefits exchange, and quite honestly he was shocked and somewhat abused. -- and used. you look at me and said this looks like a warehouse. well, he was right. he was right. our exchange started an office building that looked exactly like a warehouse. we built it with surplus furniture, rows of folding chairs, cheap tables and some computers and telephones. but here's the thing. it didn't look like much, but people noticed that it's open

air strip down at mr. created the feeling of a startup -- a new country -- company where creativity abounded, collaboration was expected and determination to succeed prevails. and that sense of mission was contagious. when providers, insurance officials, i.t. people and sign up agents we call connectors came in for meetings, everybody felt the excitement. this or of provided the context for decisions that we made that contributed to our success. and let me talk about a few of those. we kept the website simple. we knew we didn't have much time so i left off the bells and whistles. but an important feature of the site is that it allowed you to browse and plug-in numbers without actually signing up. this gay people a no risk way to

get an estimate of their premium, or to find out -- gave people. or whether they qualify for medicaid. i told people and you don't have to like me. you don't have to like president obama, because this is not about me, and it's not about the president. it's about you. it's about your family. [applause] and i said, i said you owe it to your families to go see what you might be able to get. well, they went and they found out, and they were sold, so to speak. and yes, many of them still don't like the president or still don't like me, but that's okay. we also built a single system to determine eligibility for both the exchanges private insurance subsidies and medicaid. to institutionalize collaboration and eliminating barriers, we put the exchange in

our cabinet for health and family services, which also houses medicaid and the community based services. under the same roof than were both i.t. experts a new how to build complex systems in the health care universe, and people who knew how to determine eligibility. we also tested our system early and often. we worked closely with all of our partners, hhs, local health care experts, insurance companies, to be ready to test, connect at the earliest available time. three months out we tested the whole system top to bottom. so day one, despite overwhelming activity, our site remains available throughout the day for browsing in preliminary screening for eligibility. and when i said overwhelming, i mean that by 7 p.m. on the first

day we had over 70,000 free screenings, almost 47 and applications, and some 940,000 unique page views. i also picked strong leaders. i agree case haynes, my secretary for health and family services is a former deputy assistant to president clinton, and chief of staff to tipper gore. carrie dann and, executive director of our exchange has extensive experience in medicaid, health policy and it insurance regulation. we also had an open door policy that encouraged communication. some of the governors around the country were caught by surprise by events surrounding their exchanges. but secretary haynes kept me a price of the challenges come and we may decisions together every step of the way. we also built a huge network of

people that publicized connect and to identify and enroll the uninsured. we formally engaged all of the sister agencies within the cabinet to educate their clients about connect. and were hired local health departments, community based agencies to act as connectors. these people were already on the front lines, many of them were, especially in our impoverished communities. you know, a lot of people don't trust state government. so we went out and found the people that they do trust. our connectors were available everywhere. and i mean everywhere. kentucky has a lot of small towns. they host a lot of festivals. the connect mobile tour visited them all. the bourbon festival -- [laughter] the woolly worm festival, the

apple festival, the world fast, september fast, and on and on. not a member of college football games, ironman competitions and minor league baseball games. at every place connect result of the benefits of the exchange while passing out those colorful and reusable connect tote bags. we have handed out over 64,000 tote bags, and people love them. we also had an accessible ad campaign with a catchy tune that featured cartoon figures with which any demographic group in kentucky could identify, black, white, male, female, someone in a wheelchair, a single mom, a two-parent family, a young professional. another thing we did was carefully separate the politics of the affordable care act from health care impact of connect.

that was a very fine line to walk, and i'm still walking it. nationally, i've become the face of obamacare for many, calling out senator mitch mcconnell and others who continue to try to dismantle the affordable care act for being disingenuous now when they talk about it. [applause] you know, not over 421,000 potential voters in kentucky signed up -- now that we have over 400,000 potential voters in kentucky for health care, our senators and others seem to be looking at it a little differently and try to talk about it a little differently. at home in kentucky though, my emphasis is not on politics. it's on people. look, i had the authority under

kentucky law, thank goodness, to expand medicaid and to create our exchange. so i didn't ask anybody's permission. i just did it. i -- [applause] and i was sued, and i one. know, let me rephrase that. i didn't win. the people of kentucky one. [applause] before the aca was implemented we had 640,000 uninsured people in kentucky. that's almost one in seven kentuckians. helping them is morally the right thing to do. and we all know that. but economically it's also the smart thing to do for the future of kentucky. as increased access to health care slowly reins in cost and improves health, all of us in

kentucky, state government, providers, policy experts and families, are taking a more holistic, long range view. we are using that ready access to health care as the foundation for a larger initiative called kentucky health now. folks, kentucky historically suffers from some of the worst health statistics in the country. kentucky health now is taking aim at the problems that are really holding us back, such as our tobacco use, obesity, heart disease, cancer, and behavior and oral health. the affordable care act is an enormous opportunity to change the lives of the next generation of kentuckians. and through kentucky health now, we are going to be more economically competitive as a place to do business, and more attractive as a place to settle and raise a family. in the end, people across the

political spectrum want the same thing, a better life for themselves and for their children. now, we have a lot of work ahead to make kynect as successful as it can be. to improve our performance on the next enrollment period, we've been holding weeklong workshops with stakeholder groups. we need to better reach populations that are illiterate, or who don't speak in which. we also need to improve our small business portal, but having finished the first enrollment period on such a high note, we are excited and looking forward to the next one. i've had dozens of folks come up to me on the street with tears in their eyes, thanking us and saying for the first time in their lives they can take their kids to the doctor. i get letters and e-mails every

week from grateful families describing how obtaining health insurance has given them, given them better health, and a real hope for the first time in their life. obviously, that's rewarding, and i know that you feel the same way. so to you i say, keep it up. we are going to change the world. thank you. [applause] >> thank you so much, governor. >> thank you. >> thank you, governor, for being here and for your leadership i think you have taught all of us a lot about successful and limitation of the aca. now it is a real honor to introduce our next guest.

she is the leader who presided over one of the largest expansions of health insurance coverage in our nation's history, and i'm going to ask all of you to help me get a very warm, thank are not on for being here with us this morning, but all she did to help get over 14 million americans covered. so secretary kathleen sebelius. [applause] >> good morning. thank you. thank you. well, it's great to see all of you here in washington, and i want to start as my colleagues did, with thanking anne filipic and also thanking all of you. enroll america did an amazing job. i've seen a lot of political campaigns in my day, and efforts

to find and educate people, and turn them out. this was one of the most amazing efforts built from scratch that it ever seen in my life. and i think anyone has ever seen in the country. so again give anne and yourselves a big round of applause. [applause] >> and i'm so glad to be here with great partners, drew altman and the kaiser family fund have been terrific in this effort from decades ago, moving the country toward comprehensive health care. dan hilferty and the blues that he represents, but really the blue cross blue shield plans across the country, and lots and lots of insurance partners did an amazing job, coordinating and collaborating on how to best reach out to potential customers, how to educate people

about the benefits of health insurance and how to work side-by-side with all of you. and isn't steve beshear pretty swell? [applause] i had a great opportunity when i was chairman of the democratic governors association, steve was one of our candidates that year, and a big win in kentucky. so i have known steve for a long time, and i wasn't surprised, but thrilled with his incredible leadership and promotion of health care in his state, knowing, having grown up in cincinnati, knowing a lot about the health status in kentucky. i can tell you that he has done a lot of wonderful things, but the best legacy project that he will leave behind is a far healthier and more financially secure infrastructure for hundreds of thousands of people in kentucky. and that's something that will

go down in the history books. now, i saw a lot of you around the country, as i traveled. we went back and i was in, about 47 cities just during open enrollment. and enrolled america was always there. you always were part of these amazing coalitions. and what i know is you didn't have the easiest jobs. the work that you did was very tough. it was perhaps easier in a state like kentucky which pashtun with supportive governors and coalitions being pushed in a constant message. it was harder in states where you were facing unbelievable odds, political environment where people were working not only to push back on the law but really intimidate you, push back on you, make it more difficult for you to do these very important jobs of getting information to people who

desperately needed it. as we approached open enrollme enrollment, the opponents of the affordable care act had already outspent what was our small federal outreach budget for to one. they had already spent directly, it is isn't all the at the political campaigns, it isn't all the writer, its direct expenditures against the affordable care act, $400 million has been spent. with a total of 70 million in the entire federal budget for outreach and education across the country. before people shut down the government, trying to stop this law from ever happening. it's before our well known issues with the website, which made it very difficult for people who are eager to sign up to actually get enrolled in those first eight weeks. and it's before we had this

amazing opportunity. so we knew we were facing very daunting odds. we had right wing media, leadership in congress who was determined on the house side to stop this law at any cost, shadow political or positions, hostile governors, hostile legislators, all working to make sure you couldn't do the job that was so important. but the people who needed health care and the people who have been waiting for years, actually decades some of them, for this opportunity needed you. and you absolutely stepped up to the plate. let me just give you a little snapshot of what we were watching at the federal level. just before christmas, and these are national numbers, not just the 34 states and the federal marketplace, but just before christmas and most of this came in december because i december 1 the website was fully

functioning, just before christmas there about a million people who signed up. on january 24 we announced that we jumped to 3 million people. so another 2 million in that second month of good operation. february 25, 4 million. march 16, 5 million. march 27, only 11 days later, an additional 1 million people had come into the system to get to 6 million people. you can feel this momentum building, deadlines really do matter and you all were doing these amazing rallies and work and outreach across the country. april 1, 5 days after that, 7 million people had enrolled, and then we allowed for an additional two weeks for people actually in the system, an additional 1 million folks signed up by the end. so 8 million people across this country now have financial

security and health security because of the work that you did in the marketplace. and at the same time, that effort also in states that expanded medicaid, like kentucky, brought in an additional 6 million people into the medicaid system over the enrollment pre-october 1. that's an amazing number of folks. and again, a lot of the medicaid outreach was based on the kinds of outreach efforts that you all were doing. i know it was heartbreaking because it was heartbreaking for me to be in states where governors are still playing politics with medicaid. and having to tell someone actually you don't have enough resources to have affordable health care. there's something so fundamentally wrong with that message, and that's something that has to be worked on as we move forward. that is unacceptable. [applause]

>> and the coalition i think is there to do that. so the original cbo projection was seven when people would sign up him and the way they predicted this would happen was 4 million people would come in into the federal marketplace, an additional 3 million would come through the state based marketplace. in the end, about 5.4 million of the enrollees came in through the fm space, and i can tell you, and you know this, any of you who worked in some of these states know just how difficult that was. ..

much unless with the deductible was or had to figure out who should be in your network. if you never had the doctor how in the world do you figure out a network? how do you go through that process? that is where you all came in. what we know and dance at a bit of this, this will change the country. we have a snapshot in the united states of america of spending two-1/2 times what any country honors spends on health care and having very mediocre health results. would be one thing if we are spending a lot more money and

have these dazzling, healthy populations but that is not the case. we have one of the largest blocks of uninsured in any developed country. combination of more money, lousy health results and a big lack of running short was a recipe for disaster not for individuals and their families, not for communities but for this country. that is a look of a country that has some serious economic challenges. what the president said on the campaign trail, if you don't fix health care you can't fix the economy. he is absolutely right and that is what is underway right now. i was across the country and i was always so incredibly moved by people who would come up to me. steve beshear talks about people with tears in their eyes. i had somebody with me, was

found and scripted and signed up for health care and were willing to tell their story and come forward and that was impressive, but what was more impressive to me was getting off an airplane and having somebody stop me as i walked down the quarter of an airport and tammy on the shoulder and tell me about their grandson or their mom with themselves. stuart s.es gave me now adkins and handed them to me saying can you help me? can you help my child? i live in texas. what can you do for us? we would follow up with those individuals one at a time. the guy and a seat in front of me on a tiny regional plane who handed me his cellphone, and passengers were boarding, i said ok, and she said my husband told

me on the plane, i need to tell you you saved my best friend's life. she knew something was wrong, she has gone to the doctor, discovered a tumor, had successful surgery but the doctor said she had four months. if she had not identified this, she said i had to face a thank you and kneeling on the back of his seats. i am not sorry. i am not sorry at all. [applause] >> i look forward to watching your great work as we continue forward. i can tell you you have a terrific partner in the new hhs secretary, sylvia matthews bu e burwe burwell. she is committed to making sure our effort continues in the

strongest way possible but i am always reminded as i think about this effort of dr. king's famous words, it bends toward justice. you all have done an amazing job bending that arc much further than it has ever been before in the history of this country. you have done something no one has had a chance to do before, you have not only worked to pass comprehensive health coverage but you have now connected people with comprehensive health coverage and financial security. you are on the frontlines of history and making a huge difference for individuals, communities and this country and for that, thank you very, very

much. [applause] [applause] >> thank you all for being here. let's get the entire panel. [applause] >> a group of leaders, so much to make this moment possible. we have 25 minutes to have a conversation which i am looking forward to. i want to start with you, secretary. people often talk about two distinct moments. the dark days of october, november when the website wasn't working, bright sunshiney days at the end when we saw this incredible surge. i am a real be leaders that the surge at the end was made possible by work and decisions that were made last summer and in october and november when we were dealing with those the

issues and a great example is the work folks in this room did. they didn't sit back to wait for the web site to be fixed but did education and outreach. very curious from your perspective. when you look back what was something you did last summer or in october or november to facilitate that surged in march and something you might have done differently looking back? >> no question, having first of all six months open enrollment period and that was a decision that we made early on. volos that benefits started on january 1st and i was to choose a date for open enrollment. we knew it was a brand-new program and a lot of the people were uninsured would need a lot of education, a lot of health and intentionally look at a long period, that was an important

strategic decision, and what we heard from you not only and roll that navigators on the ground but lot of people going to need four, five, six touches because they were not ready at all to sign up, as they needed information to bring family members, somebody to come with them and talk to neighbors so having that long period and deadlines in the period about coverage starting, that combination was a very good strategic move which also gave you all an opportunity. the second thing that was a critical part of the ground game was working with our partners throughout the federal government and throughout the campaign effort and they were certainly part of this but putting specific targets down looking at the number of uninsured, trying to target

relatively limited resources to where there were big opportunities for enrollment, large numbers of uninsured in states that we were actually running the federal marketplace and having that communication with folks on the ground so they have some idea about the campaign, what actually was going on, who was coming in the door, how that was working, sharing information about success. certainly, better would have been a website that was full the functional. i would trade those eight weeks in october and november in a heartbeat except as somebody said to me would you like this move website, 4 million enrollees, or a black website? i will take the 8 million any day. [applause] >> ironically, there is

something to be said about we said to people we will get it fixed, we did a lot of analytics, said it would be fixed by december, it would be a different experience. probably the most terrifying couple of days in that process were november 30th and november 29th and thinking i really hope this is going to work and on december 1st when millions of people came back to the site knowing how smoothly operating, great validation and we saw people really take advantage. we had to go back and invite people and partners back, we did a pretty good job. nan -- dan knows this, other partners, we were able to reach out to people individually and say steve beshear, you came in in october and had a frustrating experience somewhere along the way. come on back, you have plenty of

time. here is how long open enrollment lasts. try to process again. >> i hope you can bring us behind the scenes a little bit of the insurance industry. you had something of a majority of folks in his room do not have which is a real-time view of how many folks were enrolling in your plan. i am curious if you think of a few moments along the way. last summer on october 1st prickly coming in, in october and november, the final surge. and will far exceed what you are expecting. tell us about the experience you were having and hearing from your colleagues and how you approach these. >> panic. the insurance industry as a whole, we did have ongoing conversations with the secretary

and h h s, we felt very good about the tools we were developing as the company, as and industries to meet individuals where they were and we have all reference to it whether it was churches or community centers, humankind in kentucky. we felt very good about that. what we were most concerned about frankly, this was before the glitches with the web site, we were concerned about the cases of the members. speaking to you as this person, we were concerned about the case mix and folks coming in. if we weren't able collectively to get the young invincibles into the program, we were fearful it would break the bank on the program and the federal government did a terrific job. we referred to the three ares, risk, adjusters, reinsurance, they were in place. we weren't sure they would be

enough to sustain the program. i would say that we were less panicked when all the outcry over the problems with the website because we were in constant dialogue and we knew over a period of time any program of this magnitude was going to run into problems and we knew that if we were successful, we keep our heads down working in cooperation with you and government, that we would be able to enroll numbers of people we needed to but the fear was the young people. we uped our efforts in social media, our efforts in going out to ball games, professional teams, college teams, schools, to educate educate educate. i would say it went from we feel like we are ready to are we sure we are ready? are we going to get the types that we need to make this work financially?

and ultimately feeling real good about our collective efforts and our efforts as individual entity to bring people in. just in closing, the other speakers referenced medicaid. i have to say medicaid managed care works. in every state where it has been implemented the significant reduction in the growth of expenditure is powerful. number 2, people move from accessing care in emergency rooms and in clinics to have enough primary-care physician. beginning to understand they have a vested interest and there is a pride in knowing you have access to care. here is my fear. the effort to expand medicaid was the right effort. the issue is this. at some point of the money runs out. states will be left holding the bag. the reason i say this is not a political statement. i don't care what your political persuasion is. what it is is incumbent that the

next step of health care reform is making sure we focus on the individual, individuals, to get them access to the lowest possible cost care, the highest quality care possible so once we attack the cost curve and show real outcomes using fine data in the hands of clinicians and health systems and other professionals to drive down costs it is all for naught. >> the only thing i would say i don't disagree with anything man has said but the other piece of information that is so important to get into people's hands as this dialogue goes forward is the untold story of what has happened since the affordable care act was passed. we are on the lowest cost increase in the history of this country on overall health

problems. and medicare costs have been cut in half. the trend line is cut in half. medicare would be solvent for a long time. medicaid costs last year actually went down across decrease never seen before and private insurance costs are down. we have had not one but four straight years of the lowest cost trends in health care ever in the history of the united states of america and we are now below overall inflation costs which never happened. it is an important piece of the puzzle, it is a start and a lot of tools in the affordable care act with major delivery system reform focusing on keeping people happy as opposed to

getting more stocks, healthy populations, help lower those costs, but that all gets tied in with having people have access to medical homes and primary care doctor, with sunoco pays thornberry ears so that trend can continue again. these are very linked together. >> an interesting purge, you are an expert in your own right and had access to incredible data, the monthly polls that kaiser family foundation does that we found very valuable. i am interested, you are looking at all of that, what were the things that most surprise you and what were most important about the ultimate success? >> the secretary didn't always

love the polls. the most amazing thing about the polls was they never changed. from when the law passed until after passage until today, and that is because of opinion on the rise and randomly distributed is distributed almost perfectly along partisan lines. at this point i think we could ask the american people the affordable care act, and the energy crisis in america and turn the season around from my beloved boston red sox and we did get a perfect partisan split. that is because we are not really having a political debate, not really a debate about the substance of the aca. it has become the poster child for a larger debate between left and right about government and other things in our country.

what that means, it may not remain a lightning rod and poster child for that larger political debate. we will see how that plays out over the next several years. the big question in my mind is as more people get coverage, as this becomes more real for the american people and no logger just a political symbol, those judgments about the discussion of the law focus more on the reality and less on the loss of a political symbol and that is what we will find out. >> great transition to you, governor. your remarks about the experience of implementing this and washington d.c. consider the recipe n u captured national attention for many reasons for your leadership but not the least of which is this experience of the highly

politicized issue and implementing in away a lot of people think about is red state versus blue state and you have proven something, that it goes beyond that. she touched on is this a bit but what do you think about public opinion, public perception on, quote, obamacare? what role did that play or didn't play in kentucky? >> obviously the phrase obamacare has been demonized to put it bluntly. when you say obamacare it creates the automatic partisan reaction one way or the other. what we did in kentucky, we sort of anticipated that. when the affordable care act passed and when it was in front of the supreme court we very quietly accepted every dollar secretary would give us to plan and get ready. we were very quiet about it.

we did all of our planning and as soon as the supreme court said it was constitutional, we announced that we were going to expand medicaid's and create our own exchange. what i did leading up to that was number one, i went to all of our stakeholders, ky chamber of commerce hospital association, doctors, all of these folks and everyone of them said we are going to have an exchange one way or another, let's have our own exchange and that gave me a great political foundation to be able to say we are going to do our own exchange. we know how to devise something for kentuckyands that takes a cookie cutter approach from a national standpoint is the tougher decision was the medicaid decision because it is money. eventually it is money for the states, you know the details. i won't go into that but i asked

price waterhouse coopers. i said tell me what this is going to do for us or to us? can we afford to do this? i knew that would be the question. in six months, looked me in the eye and said you can't afford not to do that. [applause] >> this will infuse $15 billion into your economy over eight years, 17,000 new jobs, you have a positive impact on your operating budget over the next years and obviously up until then, this is a great business decision. and i had to make sure i had an answer for the economics horse so once we did that, whose renown in the summer after we got our web site kind of all together and we really started

an education campaign. i will just use one story to illustrate what we started with on obamacare. we are at our state fair, thousands of people from across the state come to our state fair every august leading up to october. we had a big boost and we are educating people and we decided to call hours kinect, ky as health care connection. there was a fellow standing there being briefed by one of our connectors and she goes through the whole spiel and he looked at her and said man oh man that sounds great. that sounds a lot better than that obamacare. [applause] >> one of you as connectors talked as she did. do i tell him? she only took a moment and said no.

and we just kept pushing and getting ready and really, what we ended up doing was convincing kentuckyands is we don't like the president but i got to find out what this is about. we separated that as much as we could and they did. they ended up deciding i am going to find out for myself. when i went on and found out, quite honestly it wasn't the website so much. it was you. we really pushed personal connectors all over the state because most of these people, the reason the website worked pretty well, no bells and whistles, we have to look at who we are dealing with and a lot of those folks didn't really know much about computers, what they knew wasn't very complicated. had to make it something. these are folks who never had

insurance in their lives. you start talking as we mentioned about co-pays and these things, i had insurance all my life and don't understand all that stuff. i do -- i knew what we were facing. you folks were the most important link to making it successful in kentucky because they sat down across the table from me. we got insurance agents qualified and they trusted their insurance agents. people they developed a trust in that sat down and explained what is going on and that ended up making its successful and taking it out of the political realm. it has been interesting. last november i was asked to come up and meet with house democratic caucus. they were all moaning and groaning about what was happening and they were getting hammered. i came up and said this is a process.

i guarantee you that next november the discussion will be a lot different than it is this november and that is what you are seeing now. you are seeing that transition, you are seeing some of the worst critics, all at once they are trying to still be against obamacare but be for kinekt. i want to tell you something. this lady is the hero. [applause] >> she is. i never saw anybody take more abuse, undeserved abuse and she stood there, took it and make this thing work. [applause] >> i would like to say that is what governors are all about. she was a governor. >> really read state. >> they get things done.

you make things happen and don't have a lot of time to argue about ideology, you have thousands of people depending on you every day. when things didn't go exactly right, she could have pointed fingers, she and the president said we're going to fix this and they went and fixed it. i am so proud of this lady. [applause] >> one of your comments, the next question, talk about your conversation with price waterhouse coopers, you all are the leaders that implemented that and we'll turn to for advice. i am curious if you were undertaking this enormous implementation project and this is a jump off question for anyone to jump in. what did you turn to for advice? what past experience or efforts did you look at to inform the decisions that you made in your

planning stages but also normally when things didn't go according to plan? >> i will jump in on that. it starts with we as an organization have had a great deal experience in medicare managed care working closely with government. we are in several states in medicaid managed care so we looked at our experiences in developing programs for special needs populations or different populations, not traditional commercial populations in building our products and building our out reach. we look closely at our actuarial team to make sure we left no stone unturned in understanding the makeup of the population but we started from a point where a great number of people across the country signed up it was only about five or 6% of our business so we felt that we could air on the side of prices and our products to attract people, on the side of putting

programs in place, proactive programs in place in collaboration with provider community to make people understand there are ways to stay healthy, there are ways to access high-quality care at lower costs so we felt good about that. it was really banking on our experience we had in the past, really high quality effective government programs. understanding the potential actuarial risks, partnering with government and the provider community, set of products and programs that educate and help people access care. >> governor, secretary, and when you turn to ford vice? >> i turned to everybody. i mean that seriously because the affordable care act is first of all much more comprehensive. >> we will leave this to discussion. you can see it in its entire be in the c-span video library, go to c-span.org.

the senate is about to gavel in at 10:00 eastern, at 11:00 members will vote on the confirmation of three more of president obama's nominees to serve on federal district court and whether to let fans nomination of peter joseph ka i kadzik to be assistant attorney general. @consider the federal spending bills including funding for the department of transportation, commerce, housing and agriculture. now to live coverage of the senate. the chaplain dr. barry black will lead the senate in prayer. the chaplain: let us pray. eternal god, because of your power, monarchs reign and rulers decree justice. radiate your light and peace on capitol hill today.