but the market is really not the price because there are rebates and other discounts applied, so we do not have a view of the actual price, which i think is to a certain degree false advertising. you agreed that the thieves are distorting market price? >> tom, i agree with what jeff said. he is my boss, after all. >> he is not listening. [laughter] >> do you believe that fees are distorting market prices? >> if i can, if i could address the comment "that was made, it is a matter of fact that posted prices on exchanges and posted prices that go out through our raw data feeds or public feeds

do not include the fees associated with them. so that is accurate that they do not include all prices. to the extent someone is using that data and assuming that it does include the various fees, from their perspective it would be distorted. if someone understands it is not excluded they are receiving a different date is set. >> have you heard him say that, change your view that this scheme, as you put it, creates an inherent conflict? >> no. >> he also said the following, mr. thomas farley, it creates a false liquidity. >> i suppose i have a slightly

different perspective. so, again, i come from a career mostly spent in the futures market, and that type of liquidity and market making the most value comes from participants who will show up and buy from sellers and sell from buyers and engage in risk transference will their will hold a position for an amount of time. barely knew the equity market, what i see is a whole swathe of market making that is easily switching back the 50-plus of the news you mentioned earlier this morning and has many examples of participants who are buying and selling at the exact same price at the exact same time on different venues in part to capture maker taker rebates. that is a different form of liquidity. i would choose different words and jeff did, false liquidity, but it is not as a value as the type of liquidity that we have always valued at market -- ice in building markets if.

>> a different kind of liquidity that is not as valuable as a kind of liquidity where there is created where they're is a real shifting of quest. >> no question, and they're is a blanket of cost switching back those 50 conservative number and the 50 venues. >> i think we have all heard about a recent survey of equity market participants that suggested the majority of those surveyed the of the equity markets would not be fair for all participants. is there a lack of confidence, as you agree, mr. thomas farley, and in the conflict of interest fuel that lack of confidence? >> i look at statistics such as the one that i believe you cited , senator, that two-thirds

of americans head equities in their account not too long ago and maybe a decade ago. now is half. participation the equities markets is that a 16 year low. i look at that empirical data and the anecdotal data. i am sure you, like i, have conversations about the equity markets with your friends and family. i grew up down the road, and when i go back home inevitably people ask me what is going on. tell me about these high-frequency traders, and they're is a sense, you know, unfortunate but they're is a sense that, boy, we do not have as much confidence in the markets as we once had which is why we as the new york stock exchange from the moment ice agreed to acquire the new york stock exchange has been standing for what we can do to increase confidence, simplify the markets because as simple as you can make the market, to inspire confidence you want to make the

market as simple as you possibly can and as transparent as you possibly can. >> free of conflict of interest as you possibly can. >> yes. >> mr. joseph brennan, your main business is investment management, and you offer mutual funds and other investment opportunities for real customers do you believe that the maker taker pricing creates a conflict of interest between a broker's duty to seek best execution and the money that can be made by pursuing rebates? >> yes, we think that the maker taker pricing model creates an appearance of a conflict of interest and its judicial complexity to the market. we are in favor, as restated, of looking at maker taker as part of a comprehensive review of our market structure. >> do you think they should be eliminated? >> i think that we should test any changes of the pilots.

i am not sure elimination is the answer. i think pirates and data driven analysis of the best way to really make decisions on changes to market structure. >> and a pilot would lead to an area to relieve maker taker? >> sure. >> what area would be suggesting to eliminate on a pilot basis? how would you describe or define the pilot area? >> i think experts at the s -- sec should work with industry practice of is to define the pilot. market participants should be involved in the definition of the pilot. >> the reason you want to move in that direction is because you believe in your company believes there is an appearance of a conflict? >> maker taker does create an appearance of conflict. i think we are all in an agreement. >> now, mr. joseph brennan, as some other consequences of the

things we've discussed today -- [silence] -- why does it matter that a conflict, an appearance of a conflict be removed for a few pennies per transaction? >> well, we generally stand for what is in the best interest of our clients. and we are for transparency and a fair market and it conflicts -- the eliminating conflicts and reducing conflicts of interest with benefit to our clients. >> has also created a problem for you to check and explanation

>> it does not create a problem for us. >> with that result by less time ? >> our approach to our counterparties is four or five parties first. >> he said counterparties. >> brokers, the use of brokers, our source of brokers. we have a lot of brokers that we transact with. we scour the marketplace looking for the best place to execute our transactions. we have highly skilled traders to manage our portfolio on behalf of our clients, and we have a choice to eliminate a broker for not living and to our needs. along with that skill and expertise we also have a trust but verify mod of operation where post trade analytics are

pursued to make sure that there are living up. >> and i think your company told our staff that not having brokers to ensure best execution is a significant effort and that they would rather not have to do so in a conflicted environment. is that true? >> we think it would be a significant effort weather maker taker existed or not. a lot of trading. billions of dollars a day, 6 million per year. we all ensure execution is top notch. >> even though the amount of money per transaction may be $0.30 or whenever it is, is that still true? do you worry about that being added to a transaction? >> that cap? >> yes. >> so that is pricing model and a cap on the pricing model. what actually happens with our transaction is not necessarily

30. we have a lot of control over trades. we do not just handed over to a broker. >> but you spend time reviewing this. >> spend time in the actual trading in review. >> and the review. >> yes. >> and there were less conflicts in environment which you have less need to review? >> i think we will still review, to be honest. >> would you rather be in a non-competitive environment? >> it might make that process easier in a dead comes back. >> would you rather review the trading in a non conflicting environment? >> sure. >> a retail broker, this man guard accept payments from

wholesale brokers? >> vanguard has a retail broker that is not there at the company >> do you know whether or not they accept payments from wholesale brokers? >> vanguard in its retail brokerage does not accept payments for equity. >> do you know why? >> we need to talk to that area of our company. i am quite separate from our retail broker. >> all right. the persons in that area told our staff, tell me whether or not you disagree with this, that they could make money by selling their retail order so that they believe accepting payments would create a conflict, so they do not do so. do you have any reason to not believe that? >> i have not talked to the person that runs that area of our company, so i cannot confirm

>> would you take back to your company that request? >> yes. >> solicit an answer for the record as to whether or not staff at vanguard folks told us that they believe accepting payments would create a conflict so you do not do so. for the record is that, in fact, is the case. >> yes, sir. >> a great -- okay. >> mr. clark -- [silence] -- i understand that your company, td ameritrade sans market of zero orders which

would encourage fee in excess of exchange to a wholesale broker-dealer. is that correct? >> that is correct. >> and that the broker-dealer palin's -- pays ameritrade furthers orders. >> that's correct. >> and that you send non american orders, the ones that are eligible for make rebates -- for rebate to exchange, is that correct? >> that is correct. >> and is it correct that td ameritrade receives payment either from a wholesale broker as payment for order flow or from an exchange as a rebate on nearly every trade completed? >> i would not say on every trade. >> nearly every trade. >> nearly every trade, yes. >> all right.

so on nearly every trade t d ameritrade receives to payments. one is the commission paid by the customer, and another is from a venue where trade as executed . who decides whether an exchange or a wholesaler is provided? is it td ameritrade? >> we would have committees that would make that decision. >> best execution. >> we do have a best execution committee. >> can different brokers reach different conclusions about which a venue offers the best execution? >> i think the answer to the question is yes, but i think what is going to drive the decision as to what the best

execution is the client. if a retail client puts in a market order to my they are telling as they want a quick, timely execution. >> if they're is a market order. >> yes. >> other than that. >> if they're is a limit order they're telling you they want the order to be visible. they update the price determined whether they're interested in purchasing the stock in wanted to be visible. >> the question is still the same. could different brokers reached different conclusions about which menu offers the best execution? >> yes, but determinative factor would be what the best interest of the client or the client is looking for. hours are not going to look like, for example, your clients. we will have different needs with respect to execution. >> the answer the question is different brokers with the same clients can reach different

conclusions about the best venue >> yes. >> would you agree with that cunaxa? are you shaking your head yes? different conclusions as to which menu offers the best execution. >> back in 2009, that td ameritrade managing director ordered writing strategy said the following. with maker taker, there is a higher costs to retail investors . now, that is not your position today. is that correct? >> i don't know what that is in

reference to. >> that is not your position. >> now. >> that was end boards magazine september 10th 2009, and he was dead of managing director and said the following. we felt it would become deleterious. is that your position? >> no. >> do you know what changed? >> i do not know what his position was. i was not involved for. >> were you there? >> not in this capacity. >> abcaeight. >> the some trading menus offer

higher rates than others? >> yes. >> is the size of the rebate, is the size of the rebate offer by an exchange a factor in determining where you route non marketable customer orders? >> away at our committee and the people responsible for a to approach this is they start with the best execution and go through a list of variables that we should consider as hurdles. in order to get to a point where revenue sharing is even considered those hurdles must be cleared. >> and the revenue sharing you're talking about is the rebate. >> correct. >> my question is, is -- when you get to that point. >> yes. >> after you say you have looked at the other factors and then you look at the rebate issue, my question is, is the size of the rebate offered by an exchange of factor in determining where you route those non marketable

customer orders? >> yes, it would be the last factor. all things being equal, that would be a factor. >> the greater the rebate that would be where you would go if it is otherwise -- >> yes. >> how many trades does the ameritrade route to exchanges in a typical quarter? >> we round about 37 percent of our flow to an exchange on a daily basis. i'm exhuming -- assuming 40% of 400,000 trades per day, talking about -- >> 150,000 trades per day. >> 150,000 trades a day times, you know -- you said a quarter, right? so that is going to be about, let's see -- >> rounded off. say half a million a week.

>> yes. >> so maybe in a month that would be about 2 million. in a quarter that would be about 8 million. >> that sounds good. we did about 90 million last year. >> okay. why would it be only 8 million. exchanges. >> and you asked per quarter. >> okay. that is about 8 million, to exchanges in a typical quarter. we looked at form 606 quarterly order routing disclosures for the quarter that was covered in the paper. and i am going to have to go vote. i apologize. we have to reassess year for what 15 minutes and give you all a chance to do something else you might need to do. what time is it? it is exactly -- we will reconvene at 1215.

thank you all. [inaudible conversations] [inaudible conversations] >> we think our witnesses for their patience and understanding . it let me pick up where we left off. i guess we were talking about how many trades ameritrade routes to exchanges in a particular quarter, and that think we rounded off to about 8 million. >> that's correct. >> now, we looked at your form

606 quarterly order routing disclosures, a quarter covered in the robert battalio paper. according to those disclosures for the quarter covered in that paper, the fourth quarter of 2012, td ameritrade directed all non marketable customer orders to one venue in that quarter, direct dates. is that correct? >> that is correct. >> now, among all of the exchange's director h. paid the highest rebate during the fourth quarter of 2012 which is, again, that time covered by the paper. you say the orders, your policy directed first and foremost on the basis of best execution. but, as we learned today, best execution is subjective judgment your subjective judgment is with -- which market provided best execution for tens of millions

of customer orders per year, 8 million per quarter which allowed you to route all of the orders to the market that pay you the most. i find that to be, frankly, a pretty incredible coincidence now, you directed all your orders for that quarter to direct age because what you said is that that exchange offered your company the best execution. the disclosure did not show a single order being directed to the new york stock exchange, for instance. so, the new york stock exchange just consistently worse than direct aid in getting best

execution in retail orders? >> no. >> and mr. steven quirk, how much did t d ameritrade received in rebates from exchanges last year for routing orders to venues that paid maker rebates? do you know how much you may just from payments for order flow and rebates? >> i can estimate based upon what was discussed would be about $80 million. >> about 80? >> yes. >> and that is just the part that goes to the venues that pacemaker rebates. >> maker taker. >> maker taker how much did td ameritrade pay in exchanges last year for routing orders to venues that charged ticker fees? >> i do not know the answer to that question, but i can get it. >> the ticket is closed to zero. >> no, it is not close to zero, but i do not know what the

answer is. it would not be significant. >> get the answer for the record >> okay. >> anyway, for virtually every trade your customers, you say, were better off routing their orders to the exchange that save you a rebate rather than a venue that td ameritrade would have had to pay a fee. is that true? >> in the subsequent 24 months you will note that we have routed to a number of exchanges in one quarter. and some of those exchanges would not be the exchanges which we are paying. >> go into that, and the first -- in your 606 disclosure, for the first quarter of 2014 td ameritrade routed all this close

non marketable orders either direct -- direct edge or a leveraged slow. the exchanges that appear from our review of your disclosure to roughly the highest the rates available in the market. is that true? >> that would be true. >> again, your subjective judgment is to which market provided best execution for tens of millions of customer orders, virtually always leading you to route orders to markets that paid you the most. >> it would not have always led as. >> asset virtually always. >> virtually, yes. >> senator mccain. >> i want to think the witnesses for coming. what affect would maker taker payments have upon your stock exchanges? >> thank you, senator mccain.

the effect would have us, as in commercial operation, change the way in which we charge our customers to access market. as we mentioned earlier today, we take on the order of $0.2 for every 100 shares traded as revenue for conducting services of an exchange. if you take away the maker taker rebate we will simply reconfigure the pricing mechanism we have so that we can continue to operate our business. it is not fundamental to the way we do business. to answer your question, we would simply adjust our pricing to whatever framework that the law allowed. >> we would have your order types which would reduce complexity in the market. we would like to have fewer venues. as well, we have three separate equities trading venues. we would not need all three of those in a world where we did not have maker taker, and i

suspect our competitors would reduce the number of vendors. however, if we dan maker taker and isolation that is also probable that more business would move away from fully regulated exchanges and art markets and therefore we would need to couple it with what is called a trade up provision which would establish the primacy of public quotes. >> i guess i have a question for all four of you. in your business an hours perception is reality and reality is perception. i think that you would agree that we would not be having this hearing if it was not for significant questions out there about whether you do business fairly or unfairly with favoritism, even as was charged and michael lewis's book, there is corruption. i think you would agree it there

is problem. would you agree with that? do you not think that there is problem with public perception? >> first of all, i guess beginning with you and going down the line here, do you believe there is a public perception problem, and if there is, what do you think that we ought to do? what measures ought to be taken? if you think that there is no pr problem out there and just say, i don't think there is problem. if you think there is problem, what do you think we ought to do ? >> markets are built on confidence and perception. as you point out, i think the perception could be a lot better we are talking a lot about trading businesses. the new york stock exchange, the most important part of our business is the listing business, the part of our business where entrepreneurs come to market to raise capital to help create jobs, and that is built entirely upon perception. we want to do whatever we can to

improve the perception of equities market. we proffered several suggestions , coupling with a trade out law would improve perception because of some of the after effects, reducing complexity, the news. when you bring that sort of complicity to the market it breeds confidence because people can understand. it is more tangible. >> would echolocation be part of the reform? i think we all agree that transparency -- would call location, elimination of that also be a positive affect or no effect? >> eliminating the location would go and the other direction bringing more transparency to the location is a great idea to whatever extent that we can. >> there is no question that these questions about market structure have entered into the mainstream and that people are

wondering how markets work. i think that to address that, maybe a few things. first, there are probably areas of a media transparency that can be brought to market and we are seeing market forces to some extent start to do that. ies and goldman are three operators that have released as an example. prior to recent months those reforms that were not made available to the public. we are seeing a trend in the direction of transparency, and testimony we have talked about areas of success, section 605 in other areas of operation or transparency could yield a lot of insights and potentially additional confidence in the market. that is the immediate response to be the medium term responses to let the sec do the holistic

review that chairman wide as articulated to the industry. this holistic review would be fully comprehensive covering every tentative market structure as we understand it, put everything on the table, and some things will undoubtedly change. they will find ways to optimize with good attributes for today's market but also even things that we do not change whether regulators will have said, look at this. we got data. we concluded that this is a good tentative market structure. i think every element of our structure will be addressed and nothing will be left out, and i think that process will be healthy for our markets. >> senator mccain, as to whether the market, there is perception problem and a confidence issue, the only thing i can judge that on is generally our business and customers and clients.

we have seen record interest of the last few years and products, the majority has been into our equity market as product. 138 billion client asset come in the door last year. 76 billion in the first five months of this year. again, the vast majority of those belong to equity products. >> i think it is like the old story of a guy in this small town is said to the other guy what are you going to do on saturday night? i am going to the poker game. why? you know the game is corrected. it is the only game in town. i do not accept your allegation that everything is fine. but if that is your view are respected, but i do not agree with it. >> i would probably have a closer view to mr. brennan. when i discuss the u.s. will

discuss the view of our 6 million clients and tell you, and the behavior as they have exhibited in the last couple of years they would be consistent. we have seen trading accounts increased 31% and have a proprietary index which recreated a couple of years ago which indicates how much exposure people are taking in the market. they are participating in a rally that is happening of the course of the last couple of years, and a significant portion have. that being said, i agree that there is perception problem in this segment of these clients. those would be the clans that are probably closest to this. most of the mom-and-pop, these terms do not mean anything to them. they are just terms to them. the problem for us is in that segment trying to make sure that, you know, as i think senator johnson pointed out, we do not spooked them. we do not want them, you know, to think they're being treated

unfairly. >> thank you. i think the witnesses. thank you, mr. chairman. >> thank you. earlier this year you said that some high-frequency traders played a role in getting back together a fragmented market structure and other high-frequency traders may be unfairly taxing the system through their behavior's. now, when you mentioned that some high-frequency traders unfairly taxed the system, were you talking about firms that engage in practices like rebate arbitrage with a try to capture rebates without actually providing liquidity? >> that would be one example. yes. >> so, there are folks there which -- and therefore the maker

taker system contributes to that problem. >> i think the market's structure as a whole has improved dramatically over the past 20 years. >> i am talking about the part that has not improved. what you just said. some high-frequency traders unfairly taxed the system. you agreed you are referring to those firms engage in rebate our charge. i just asked you whether or not the maker taker system is obviously by definition contributing to that problem. >> i think the maker taker in combination with the lack of trade out in combination with differential date is beach contributes to potential issues. >> can you have rebate arbitrage without rebates? >> no.

>> so there for rebates contribute to the problem. is contributes to the problem. >> yes. >> i think you were critical of that testimony. one way you will be willing to provide with the order routing dated so that he could analyze. >> yes. we were actually asked by a professor after the publishing of the draft of that paper free would be willing to share data. we would be willing to share data. we would have to ensure at was not going anywhere. >> what was your answer? >> to be honest i am not entirely sure. i believe that we were being

told it was being considered, but i am not certain. [silence] >> let me conclude by very briefly saying the following. a very constructive hearing, eliminating hearing.

we heard a consistent message. they're is a lack of confidence in the market. the conflict of interest that we discussed contribute to that lack of confidence. both the actual conflict as well as the appearance of conflict contribute to that lack of confidence. and they may lead also to regular investors, average investors being worse off. that is what professor robert battalio told us today, what is study showed. both of these problems, all of these problems should be and can be addressed. one of the ways that we have got to do it is to remove the conflict of interest. the subcommittee has looked at other conflicts, some of which have been very erratic at earlier hearings and our market of conflict of interest to the extent humanly possible if we are going to restore confidence

in our markets, and it is important that we do. and so hopefully the regulatory agencies are going to take action. as a number of you have mentioned, they will look and structural issues long overdue. hopefully -- sometimes the regulatory agency. so there may also be a role for congress. it sometimes happens. hopefully more often than not the operations of a free-market. some of them just to not happen the way governments say you have to change your ways. we may disagree to what those

steps are, but there are steps that must be taken either by regulators are congress to deal with conflicts and to deal with the other kinds of problems which exist in the current market because it is clear there can be improvements. we very much appreciate your testimony. sorry that it was interrupted by two votes in the senate, that is the way that life works around here. i wish we could pass laws without interruptions. i would have a regulatory agency figure out a way we can avoid these. that is not yet in the cards. thank you and we stand adjourned . [inaudible conversations]

>> tonight on c-span2 former health and human services secretary talks about implementing the affordable care act.

>> the idea is that instead of trying to tell the entire history of st. louis through a time line or era by era we would absolutely mess vital things. instead of trying to do that and failing we decided what if we just gave snapshots of history that would give people a glimpse of all of the diverse things that have happened here and they can use their imagination to fill in the rest. beaches 50 people, places, moments, images, and don jackson tried to choose the

most diverse selection we possibly could we are standing right now. this was where the object is right in front of them. such a huge part of the history. it is an amazing story with lots of different stories and, of course, anheuser-busch, the largest in the world. and then the era of anheuser-busch talking about millions of barrels produced each year, so much beer from an era when things were a little bit more simple. kind of gauge their response. in the days before they had cans or bottle caps somebody had to sit on this thing and do it by hand. you can see, it has foot pedals on the bottom where the operator would push down to get the court

enough force to go into the bottle. it has three holes for three different size bottles. >> this weekend that history of literary life of san louis, they gave way to the west on c-span2 book tv and american history tv. >> good morning. in 2014 national conference participants. please welcome president of an

all-america. [applause] >> hello. good morning, everyone. morning and welcome. the first national in rural america conference. giving america it coverage. excited to have you 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 time and share best practices for the future. we thought maybe a few couple hundred of our friends would come to d.c. for this, but we never expected that more than 900 attendees would join as from communities in 48 states -- [applause] yes, and credible. not just that, including the

district of columbia and as far away as qualm. pretty amazing. so thank you all for being here and a thank-you for our generous sponsors, many of whom are in the room today. especially those that help make this conference possible. the robert wood johnson foundation, 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 to work together to make the first enrollment a success. government officials cannot help with trustee educators, insurance industry leaders, out of reach 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. for those of us who have been working on expanding health care access and awareness we know that we have reached an incredibly important milestone. saying to the exceptional work of the people in this room more than 14 million americans and counting have received health coverage the marketplace medicaid. give yourselves a round of applause. pretty amazing. [applause] and despite an unexpectedly rocky start you all made history by pouring through a few negative news cycles and keeping your eye on the ball. he stayed focused on educating consumers because they were hungry for the facts about how the law was presented to them and their families. you connected consumers with free in-person help.

he made sure that they knew about the opportunities for financial assistance. finally making health insurance a reality for millions to could not afford it. and you stood ready to handle a third sign up as the deadline approached. here at in rural america we reach to more than 5 billion consumers across the country with information about enrolling in coverage. they did not do that alone. over 230 employees worked hand-in-hand with over 200 partner organizations and tens of thousands of volunteers who share our commitment to connect consumers with the information and resources they need to get covered. through in powering public officials and local leaders to be messengers on health care in that community we reached thousands more and encourage them to live out the options available. we met consumers were they were on line and social media and

shared coordinated enrollment messages with our partners to increase our reach. we worked with community colleges, health care advocates, providers, groups, government officials, and keep local organizations, just like all of you, to reach as many consumers as we could. one of my favorites was when i had the chance to travel through texas and ohio. i saw the true scope of this work and how unique id is from community to community. in dallas i stood with 17 pastors on stage to placed to educate their congregations about their new options. in mcallen on the border in texas i stop by local library where enrollment assistance set up shop every day to serve their community. in cleveland i saw an overflowing in rome that event hosted by kaj of a community

college, and in cincinnati i stopped by a health center with deep roots in the latino community. each city was different, and the effort in each city was different, but in every city there were local organizations and leaders with the vision to see the need and a willingness to philip. in every city that local knowledge and personalized average was crucial to success, and that is why a is so exciting to be here with all of you today so that i can think you in person for the work they you have done and we can celebrate together. there is also someone else who wanted to thank all of you as well. a very busy man who could not be here today. someone who needs very little interaction and has played a big role in expanding coverage to millions of americans. without further ado alec like to play in message recorder frothy.

>> thank you for being a part of our effort to enroll america. we have always said that change does not come from washington back to washington. ordinary americans stand up and make it happen. that is what in rural america has been doing from the beginning. 8 million americans have signed at. some being covered for the first time. what does that mean? peace of mind for working families, freedom for young people who want to change jobs are entrepreneurs who want to change ideas, and justice for every woman who can no longer be charged more. that is why many of you joined this fight in the first place from community organizers and hospital leaders to navigators and officials. i could not be more grateful to you for all of your doing to help americans get covers.

we need you to keep telling your stories. [applause] >> we are grateful that president obama took the time to record that message end to the administration for their ongoing commitment for providing a virginities for americans to find the health coverage they and their families need. ..

and strengthen our partnerships with 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 development of the last year and take a look back on what we all experienced. we are very excited and thrilled by the lineup of the prominent healthcare leaders from the experience industry and policy world into state and federal government who have all agreed to join us today and i am particularly honored that

kathleen sebelius, who as the secretary of health and human services shepherded the affordable care act from an idea into the law of the land and then to the reality for millions of american families has chosen to be here with all of us at her first public appearance since leaving hhs. we will hear first from the panelists about their different perspectives on the first enrollment period and then we will have some time for the panel discussion stoop reflect on what worked well in on the obstacles we faced. so to start off i would like to welcome to the stage when of america's leading health policy experts president and ceo of the kaiser family foundation, doctor drew altman. [applause] the >> good morning and thank you very much. you know, when i was in the state government i was described in a major newspaper as a nice

guy trapped in space. [laughter] so, i am really very happy to be here. there is just no way in the world that you would ever know that. i wanted very much to be here today because millions of uninsured people got coverage in this first open enrollment season and no one did more to make that happen then the people in this room and while scheuer the partisan debate about the aca continues and we all know that we have a lot of work to do with another open enrollment season coming in our surveys show that still more than half of the uninsured are trying to figure out what the aca means for them on behalf of any of us in this room who come into the country who spent our entire livespend our entirelives workif the uninsured and the millions of americans who got coverage because of you, thank you for what you did this year.

the enrollment success is also the result of leadership and i think that when you ask who are the leaders that you think of and it comes to expanding coverage number one, two, three, four, five, six for secretary sebelius and i would and to that list even if she likes to stay in the background she can't hide any longer. she's no longer in the background as it is a pleasure for me personally to be here with everyone who will be on the stage and just a minute. now as the ceo of the family foundation i'm sure that you are expecting a lot of data from me here this morning because that is kind of the organization that you know that i have established. but i'm actually throwing out my own script. i want to tell you three quick stories and just make a few very basic point. the first is a story from my time in the state government as the new jersey human services commissioner under the great

governor named tom came to you y just remember was a while ago as the chair of the 9/11 commission. i made my name in the state government doing welfare reform, but one thing i put a great effort into is developing a school-based program for the youth all across the state of new jersey. we actually did a lot of good things in new jersey we even kept the bridges to new york over. [laughter] drove them in case we had to escape from new jersey. anyway, i was in cumberland county, which is in south jersey and at the time it was the poorest state that had worse statistics than new art and if you don't know it's actually below the mason dixon line and i was meeting with young people and i was asking them which services are most important, what about behavioral health, do you want clinics in the schools were here in the schools, you know, they were a technocratic commissioners program designed question and there was this one

younger guy that was very small environment version 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 that 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 a squatter communities in big cities across south africa were programs for the usa and outreach for the uninsured, here in the states to community-based outreach has been a cornerstone of really every successful program that i've been involved in. our surveys show that about half of the uninsured have been insured -- okay, half of the uninsured have been insured for two years or more or have never had insurance. about 20 percent do not have

access to the internet. the national debate that we have this year focused on the website problems and focus on what i call the aca's actuarial mission making sure that there are enough people in the risk pool that is a healthy risk pool coming it if it is a very, very -- you know, we have to have that. it's a very, very important thing. what is the point of all of this if it isn't also to reach the long-term uninsured, the folks who made the coverage the most and that will not happen without the community-based outreach and enrollment services and that isn't just in the survey data for me, it is a lifelong lesson that i first learned when the young gentleman in new jersey called me an idiot. idiot. i'd be oidiot. either they all be unfortunately politicized question of whether any of the folks who helped get coverage were previously uninsured while i can't release

the numbers get we have a very important study of the nongroup market coming out on thursday of this week which would show a large percentage that got coverage in the exchanges that were previously uninsured so so much for that may 2 story is about a guy named duffey that clears the timber in the mountains not far from where kaiser is based. he works like a dog when he gets work which is in fact -- he has all kind of health problems i won't go into but when you ask him why he doesn't have coverage committees is of course that he can't afford it. so i show him the tax credits and i also showed him the deductibles. duffey had no idea what a premium was or what a deductible was. you were all dealt with a lot of duffy's because he didn't have any computers or how to use one and he had absolutely no idea where to go for health. he said that he had heard about

obamacare and that he had read that obamacare was broken so she didn't pursue it. that was during the website problems. ultimately he went to the local counties and services agency where they walked him through the process and it turned out that he qualified for medicare but she was absolutely thrilled about. health coverage had always been on affordable for duffy comes to knowing about this independent medicare coverage, that made all of the difference in the world for duffy. this should be no surprise to anybody in this room because since the beginning i think of the recorded time any study that we have done of the uninsured have shown that the main reason for ththat the uninsured don't e coverage of the can't afford it. it also mattered that duffy was required to buy insurance as a penalty at the grove. there was a deadline. duffy didn't know that. it didn't matter to him. so for duffy and millions more,

according to research, financial assistance into the afford ability really matters. it's a central message. it may be the central message and demand these matters, too. there are a lot of other stories in the duffy story about families and friends helping the sisters of the national media association, but let me just close with my last story. this is a story that i'd have occasionally that is one of my favorite stories of my first day on the job of the human services commissioner of new jersey. the problem i have is i couldn't find the job. to go to trenton new jersey if you don't have to go to trenton new jersey. jersey. and so, i went and i wandered around i and i couldn't find the building. there was a big building. i thought that it was a place but it didn't have a sign in front of it and it was a guard and i was very young at the time and he said just go in there. so i went in there and i had my big idea. this is how i was going to take control of this very large agency. i went to the ninth floor and

said hello to everybody and then i said my big idea. what is wrong with all of us? we are the largest organization. we were then in new jersey bigger than the drug companies in new jersey. we should be proud of what we do and we will be a sign in front of this building. welcome to ninwell, nine monthsr the job because of the procurement rules were used and then stopped again because the team worked on the job had been stopped a third time in the wonderful -- and i love this letter from the state department of treasury that said that this job shouldn't go forward because it is too small to do. [laughter] they called me out to the front of the building. the press was there, about a thousand people were there. it was my birthday. there were stories. will commissioner altman at his sign back 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] i wanted to keep the sign in to change the services. [laughter] it took me nine months to get a sign. big changes like the aca take time -- [laughter] and that is especially true for the law like the aca which is going to play out differently in different states and people depending on their income and employment circumstances and where they live. in a national debate about aca, it's either good or bad. that's the debate we are having come 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 very issue from this great national experiment. we don't. but states do watch other states

and they can learn. as we look ahead may be the politics of the aca will change after 2016. maybe it will no longer even be called obamacare -- 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 the success reaching people who need coverage the most. so, on behalf of the kid of new jersey that called me an idiot and a duffy and the new jersey department of hunan services, whoever it is, thank you very much. [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 hilferty. [applause] >> good morning. well done and thank you so much to enroll america for including me in this very important discussion. one of the heroes in getting well over 8 million people enrolled across the country is the work that she has done so she deserves a round of applause. [applause] >> is an honor for me to be here with the governor beshear, the great commonwealth of kentucky. although i'm from pennsylvania i have a fondness for kentucky, and even in the dark days of the rollout, the governor beshear is 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 were not so sure at the time, he was steadfast in his belief that this was the right way to go. also, secretary said elliott, whether she was the insurance commissioner of the governor of kansas were her latest role as the secretary of health and human services, regardless of one's politics, it is amazing that an implementation of this magnitude of this complicated nature could be done in such a short period of time so i'm thrilled to be here with them and of course with drew, who you heard from. i would like to acknowledge another group of people 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 in to cover their families, you are there day in and day out so congratulations to you as well. i know you're from all over the country as ann mentioned, so i

would like to give a brief independence of who blue cross is. we are headquartered in philadelphia if we are to plan for five philadelphia counties, but through our health company affiliate, we are in 24 states and the district of columbia and we touch the lives of about 9 million people in all of those two restrictions -- jurisdictions. as the leader of a major health insurer, people say to me you must have really been busy over the past year with reform, and it's true. and i would like to give you a quick thought on how things change. i can remember with the rollout and the problems in the website i couldn't walk around the neighborhood. i couldn't walk my kids to a school or an events without somebody stopping me and asking me about it. just this past weekend to -- inc. you may be able to tell from my voice -- my oldest

daughter was married and 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 and 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 are disinterested, and that's not because they don't worry about it. it's because they are finally getting it. they are finally being educated. they are finally understanding the importance of taking their own and being accountable for their own care and their own coverage. that is a positive thing so i just wanted to give you that piece. but it is true. the fact of the matter at independence blue cross, we have been preparing for the reform for years. i know i speak for all of the blues across the country. we belief that reform was needed

assistance the law was enacted in march of 2010, we've been an active participant. had we voiced our concerns about several areas? yes. secretary sebelius and her team were always there to listen. they didn't always agree or support our position, but they were there to listen. and in the insurance industry, there was a lot of concern about reform. some insurance companies decided well, we are going to wait it out. we are good to see how this plays out. but the blues understood and i'm happy to see that we lead 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 and state elections and federal elections, the health care system was and in some ways continues to be broken and we needed to change it. when health care spending accounts for nearly one fifth of america's gross domestic product

and when half of american adults go without recommended health care, when we spend more on healthcare than any other nation in the world, and yet americans are no healthier, when 50 to 60 million americans have no coverage, something is wrong. something is broken. the affordable care act is not going to solve all of the challenges facing america's health care system. but it's a start. and through your efforts it is for the big shift of the health insurance business into traditionally the independents paying customers or the main business is. there are large employers to provide health care for their employees. we have a small customer based on the individual consumer market. we know that all of this was about to change in has changed.

as we move forward the individuals become the key part of our efforts. it's now not only a consumer of a business to business, but it is a business to consumer business. the affordable care act has led to what some have called the amazonification. they can now go online to the public exchange and in a few clicks see the range of coverage options and sorts them by price. in our markets, we had 13 different products, 30 variations i'm happy to see the lowest price people could shop and find what they needed. this is as great an opportunity for an individual to get coverage in our nations history. we found that consumers were joined to the competitive pricing and develop physicians, hospitals and other healthcare professionals in our market.

i am very proud to tell you that in the first open enrollment-we gained more than 285,000 285,000 enrollees. that is well over 8 million. that does not 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 285,000 we budgeted well over 100,000. so that should speak to the success that you have fostered during this enrollment period. this exceeded our expectations. iab leave that there are a number of reasons we were successful in signing up so many individual consumers. for starters, we have 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 so we use digital media to reach out to them where and how they want to be reached. we were pretty successful and although we didn't expect it, 30% of the sign-ups in pennsylvania are individuals between 18 to 34-years-old. that's promising. overall we didn't wait for people to come to us. we went out into the community to meet our future members where they live and work and play and referenced all the places she visited from texas to ohio, we were there too in some cases working closely with you in the community centers and in those churches into those schools, wherever it might be. our mobile education retail centecenter of the independentss is a perfect example. this is a truck. you might have seen a picture of

it at the beginning times of the rollout. we like to think of it as the apple store event will have. people came off the street and there was an ipaq there where there was one of our representatives. they were educated and they were shown how to get onto the website. at the time that there were problems, we were able to help them understand what the coverage possibilities were. we also found that while the traditional means of advertising were important, the key to reaching the new consumer group is a personal touch. that's why people like you you e in the room are so critically important. the community and religious leaders and people in the medical community, friends and neighbors, all of you encouraging the citizens throughout the country come in your communities to get coverage to understand their coverage it's very important and it has made a huge difference. so what's next? now that we have the new members and a part of our business, we are determined to help them understand the value of what they purchase.

so that they take advantage of all of the programs available for them to stay while organic while. so here we are continuing to reach out and to educate thousands of people into this is going to be an important part of your role going forward to understand it isn't just about carrying the card but it's about taking the responsibility and reaching for the points of care when and where you can get them. so, as i said and in closing, the reform is just underway. it was a great first year. regardless of one's politics, this is not a perfect law. this will change over time because each of us will have input. 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 is our job now not just to educate about having the card

of how to use the card and how to get healthy, how to stay healthy and how to continue to live a life, a fulfilled life because they have the security of the coverage regardless of the carrier, regardless of the network that they use they have the courage that they need. so i'm very excited, ann, and a lucky to be here today. we as an industry are proud. we as blue cross blue shield are proud of enrolling people across the country and i look forward to the discussion on how we can do it better. how we can help you do it better. and next year when we convened, millions more will be part of this effort so thank you very much. [applause] >> thank you. [applause] >> thank you for your leadership and for being with us this morning. now it is a treat to introduce

the man that led one of the nations most successful state-based marketplaces, the governor of kentucky, the honorable steve beshear. [applause] >> thank you. kentucky. [laughter] you know, about nine or ten months ago, most of you in this room who are not from kentucky -- although we have some kentuckians here' here -- but tt of you, nine or ten months ago when you heard kentucky, if you thought anything, you may have thought kentucky derby. [laughter] thoroughbred horses, kentucky

fried chicken. [laughter] isn't that where a brown liquid called kentucky bourbon is made? but because you how important it is to kentucky. [laughter] we have 4.3 million people in kentucky. we have 4.9 million barrels of bourbon aging in kentucky. [laughter] [applause] so i like to say that each of us have one and we will share the rest with you all. but i ensure that nine or ten months ago when you heard kentucky to me you didn't think for instance education reform. also kentucky was the first state in the union to adopt the common core standards. we were the second state in the union to adopt the next-generation science

standards. we just raised the dropout from 16 to 18, so we've got some great things going on in education reform. [applause] economic development we are doing great things. we have set export records where we are bringing the four indirect investment into the the state and diversifying our economy. there are lots of great things going on. but you also wouldn't have thought that when i mentioned kentucky that 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 a 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 fight out of the six statewide officeholders are democrats. as you know, the u.s. senators are among president obama most vehement critics and quite honestly the voters of kentucky don't support the president very strongly. but nevertheless, kentucky's embrace of federal health care reform has been passionate and public. last fall "the new york times" published an op-ed i wrote admonishing critics to get out of the way, get over it so that we could get health care for our people. [applause] and president obama himself gave the kentucky accolades with me

sitting in the first lady's box during the 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, it isn't because of steve beshear. it's a team effort and because of people like you sitting down here in kentucky. [applause] in the days after the first enrollment period ended, we have signed a 421,000 people per coverage through what we call connect, kentucky's health-care connection. and about 75% of the 421,000 people had never had coverage in their lifetimes. folks, that is a life-changing

experience for them. it's transformative for the state because 421,000 represent about 10% of kentucky's population. that is an impressive number than anybody's. and it is due not only to my aggressive approach, but also to people like you in 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 the enrollment perio period comt events from "time" magazine came to kentucky. i took him over to the office of our pulpit of exchange and quite honestly, he was shocked and somewhat abused. he looked at me and said this looks like a warehouse.

while, he was right. our exchange started in an office building that looked exactly like a warehouse. we filled it with surplus furniture, 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 open air strip down atmosphere created a feeling of a startup. a new company where creativity abounded. collaboration was expected, and determination to succeed prevailed. and that sense of mission was contagious. when providers and insurance officials and it people have signed up agents we call connectors came in for the meetings, everybody felt the excitement. this 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 we left off the bells and whistles. but an important feature of the site is that it allowed you to browse and plug in the numbers without actually signing up. this gave people a way to get an estimate of their premium or to find out whether they qualify for medicaid. i told people you don't have to like me or like president obama because this is not about me and it is not about the president. it's about you and it's about your family. [applause] and i said you owe it to your families to go see what you might be able to get. 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 don't like me but that's okay. we also built a single system to determine eligibility for both vx changes private insurance subsidies and medicaid. to institutionalize the collaboration and eliminate the barriers, we put the exchange in the cabinet for health and family services which also houses medicaid and the community-based services. under the same roof for both it experts who knew how to build complex systems in the healthcare universe and people who knethepeople who knew how te eligibility. we also tested our system early and often. we work closely with all of our partners, hhs, local health care experts and insurance companies to be ready to test connect at

the earliest available time. three months out, we tested the whole system top to bottom. sold on the number one despite overwhelming activities. our site remained available throughout the day for browsing into pulmonary screenings for eligibility. and when i say overwhelming, i mean that i 7 p.m. on the first day we had over 70,000 pre- screenings. almost 4700 applications and some 940,000 unique page views. i also fixed wrong leaders. my secretary for health and family services is a former deputy assistant to president clinton and chief of staff to tipper gore. kerry then i had has extensive experience in medicaid, health policy and insurance regulation.

we also had an open door policy that encouraged communication. some other governors around the country were caught by surprise, by events surrounding their exchanges. but the secretary kept me advised of the challenges and we made decisions together every step of the way. we also built a huge network of people to publicize 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 we hire local health departments, community-based agencies to access connectors. these people were already on the front lines, many of them, especially in our impoverished communities. we went out and we found that

the people that they do trust. our connectors were available everywhere. and i need everywhere. kentucky has a lot of small towns. they host of other festivals. the kynect mobile tour connected them all the bourbon festival. [laughter] the festivalsof september fast and on and on, not to mention college football games, the competitions and minor league baseball games. at every place they sold the benefits of the exchange while passing out the colorful bags we have handed over 64,000 bags, and people love them. we also had an accessible 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 mother, too. family, young professional. another thing we did is carefully separate the politics of the affordable care act from the healthcare impact of kynect. that was a very fine line to walk. and i'm still walking it. naturally, i've become the face of obamacare too 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] we know now that we have 421,000 potential voters in kentucky

signed up for health care, our senators and others seem to be looking at it a little bit differently and trying to talk about it a little bit differently. at home in kentucky though, my emphasis is not on politics. it is on people. look, i have the authority under the kentucky law to expand medicaid and to create our exchange. i acted. [applause] let me rephrase that. i didn't win, the people of kentucky one. before they were implemented we have 640,000 uninsured people in

kentucky. that's almost one in seven. holding them is the right thing to do. and we all know that. but economically, it is also the smart thing to do for the future of kentucky. as increased access to health care slowly rain reins in the ct and improves health, all of us in kentucky, the 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 is directly 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 behavioral and oral health.

the affordable care act is an enormous opportunity to change the lives of the next generation of kentucky. 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 wants 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 have been holding weeklong workshops with sql server groups -- stakeholder groups. we need those that are illiterate or don't speak english and we also need to improve the small-business portal. having finished the first enrollment period on such a high

note, we are excited and looking forward to the next one. i have had dozens of folks come up to me on the street with tears in their eyes thinking us and saying for the first time in their lives they can take their kids to the doctor's. i get letters and e-mails every week from grateful families describing how obtaining health insurance has given them a better -- has given them better health and a real hope for the first time in their lives. obviously that is 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 governor. [applause]

thank you, governor for being here and for your leadership i think that you have taught all of us a lot about successful implementation in the aca. now it i is a non- honor to introduce the next guest. she is the leader that presided over the largest expansion of health insurance coverage in the nations history. and i'm going to ask all of you to help me get a very warm welcome and thank her out only for being here with us this morning that all she did to help get over 14 million americans covered. so, secretary kathleen sebelius. [applause] >> good morning.

it's great to see all of you here in washington. and i want to start as my colleagues did with thanking all of you. and all america did an amazing job. i have 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 effort to build from scratch but i've ever seen in my life and i don't think that anybody has ever seen and the countries of again gave anne and yours holds a big round of applause. [applause] and i am s so glad to be here wh drew altman and the kaiser family fund has been terrific in this effort from decades ago

moving the country towards comprehensive healthcare. daniel hilferty and the blues to kiefer presents but really the blue cross and blue shield planeplansacross the country ane partners did an amazing job coordinating and collaborating on how to best reach out to potential customers and how to educate people about the benefits of health insurance and health work side-by-side with all of you. and isn't steve beshear pretty swell? [applause] i had an opportunity when i was the chairman of the democratic governors association he was one of our candidates that year and a big win in kentucky. so i have no 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

and 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 the open enrollment period. and all of 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 was tough. it was perhaps easier in a state like kentucky with support of governors anofgovernors and

governors and statewide officeholders in coalitions being pushed in a constant message. it was harder in the states where you were facing on the reasonable odds, political environment where people were working not only to push back on the law but intimidate you. you make it difficult for getting information to people who desperately need it. as we approach open and all that, the opponents of the act had already outspent what was our small federal outreach budget for-1. they have already spent directly and this isn't all of the ads in political campaigns but it's in the rhetoric that has earned the media and its direct expenditures against the affordable care act. $400 million had been spent and we had a total of 70 million in the entire federal budget for outreach and education across the country.

i had people shu have people she government trying to stop this from ever happening. it's before our well-known issues with the website which made it very difficult for people who were eager to sign up and to get an role i enrolled ie first eight weeks and it's before we had this amazing opportunity. so, we knew that we were facing very daunting odds. we had right-wing media, leadership in congress who was determined on the health side to stop this at any cost shadow, political organization hostile legislators all working to make sure you could do the job that was so important. but the people who needed health care and the people who had been waiting for years and decades, some of them for this opportunity needed you and you

absolutely stepped up to the plate. let me give you a little snapshot of what we were watching at the federal level. just before christmas come and these are natural numbers not just of th to the states and the federal marketplace but just before christmas and most of this came in december because by december 1 the website was fully functioning but there were about a million people who have signed up. on january 24, we announced that we jumped to 3 million people so another 2 million in the second month of good operations. february 25 of a 4 million. march 16, 5 million. arch 27th, only 11 days later an additional million people had come into the system to get to 6 million people. you can feel the momentum building. headlines really do matter and you all for 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, and an additional million folks signed up by the end. it's becomso, 8 million people e 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 the streets that expanded medicaid like kentucky brought 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 kind of outreach efforts that you'll were doing. i know that it was heartbreaking because it was heartbreaking for me to be in the states where the

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 is something so fundamentally wrong with that message and that's something that has to be worked on as we move forward. that is unacceptable. and the coalition i think it's fair to do that. so the original was 7 million people would sign up and the way that they predicted that this would happen was 4 million people would come into the federal marketplace and an additional 3 million would come through that state-based architect is. in the end come out 5.45 million of the enrollees came in through the states and i can tell you, and you know this, any of you

that worked in some of the states know just how difficult that was. and thanks to your efforts on the ground, which really combated relentless not only misinformation, but relentless obstruction, people who were told they couldn't come onto the city or the county property to do your job and people who were forced with getting fingerprints and paying a fee in order to help people access health insurance, answering questions in multiple languages, trying to figure out how to get information to people who as the governor beshear said never had health insurance because they didn't even know how to start the process, twice what a deductible was or how to figure out who should be in your network. if you've never had a doctor, how in the world do you figure out a network, how did you go through that process? and that's where you all came in. and what we know is this will

change the country. we have had a snapshot in the united states of america spending two and a half times what any country on earth spends per capita on healthcare and frankly having very mediocre health results. it would be one thing if we were spending a lot more money and have these dazzling coffee populations, but that is not the case. we also have one of the largest blocks of uninsured in any developed country. so the combination of more money, loans lousy health results into the uninsured was a recipe for disaster not only for individuals and their families, not for the communities, but for this country. that is the look of a country that has some serious economic challenges. so when the president said early on on the campaign trail if you don't fix healthcare, you can't fix the economy cut he's absolutely right and that is

what we are -- that's underway right now. i was across the country and i just was always so incredibly moved by people who would come up to me. governor beshear talk about people with tears in their eyes and i always had somebody with me at the average events i would do that but found in the script and they signed up for health care and they were willing to tell their story and come forward and that was always impressive. but with more impressive to me was getting off the airplane and having somebody stop me as i walked down the airport and copy on the shoulder and tell me about their grandson or their mom for himself. the stewardess is on the airplanes that gave me notes on cocktail napkins and handed them to me saying can you help me come it can you help my child? i live in texas. what can you do for us? and we would follow up with those individuals one at a time.

the guy that felt on the seat in front of me in a tiny regional plane who handed me his cell phone and said i hate to bother you but what you talk to my wife as the passengers were boarding -- [laughter] i said okay. [laughter] she said my husband just told me about on the plane and i need to tell you saved my best friends wife. she got health insurance for the first time, she knew something was wrong and she's gone to the doctor and discovered a tumor. she has had successful surgery to the doctor said she had about four months. if she had not identified this, she said i just had to say thank you. meanwhile, still on the back of his seat saying i'm really sorry. [laughter] while i am not sorry. i'm not sorry at all. [laughter]

so, i look forward to watching your great work as we continue forward. i can't argue you have a terrific partner in the new secretarsecretary sylvia mathews burwell. she is totally committed to making sure our efforts continue on in the strongest way possible. but i'm always reminded as i think about this effort of the famous words that the art of the moral universe is long but it bends towards justice. and you all have done an amazing job bending that much further than it has been before ever in the history of this country. you have done something that no one has had a chance to do before. you have not only worked to pass the confidence of health coverage come of it you have now connected to people with complaints of health coverage and financial security.

you are on the front lines of history and you are making a huge difference for individuals and for communities and for this country, and for that, thank you very, very much. [applause] >> thank you all for being here. and let's give the entire panel a round of applause. [applause] they are an incredible group of leaders to do so muc that do soe this moment possible. we have about 25 minutes to have a conversation, which i'm really looking forward to and i want to start with you, secretary. people often talk about the first enrollment period into two distinct moments.

the dark days of october and november when the website wasn't working and the bright sunshine days of the end when we saw this incredible search that you described. but im a belief or that the search but we saw was made possible by working and decisions that were made last summer and in october and november when we were dealing with those issues and i think a great example is the folks didn't sit back and wait for the websites to be fixed. they continue to do education and outreach. really curious from your perspective as you look back what is something that you did last summer or in october and november that you think helped facilitate that in march and what's something you might have done differently looking back? >> i think there is no question having first of all a six-month open only period command that was a decision that we made early on.

it said that the benefits started on january 1 and that i was to choose the date for the open enrollment. so, we knew that it is a brand-new program and we knew that a lot of the people who were uninsured would need a lot obitof education and health and intentionally looked at him long period. i think that was an important and strategic decision and what we heard from not only you all that the navigators on the ground is that a lot of people were going to need four, five, six because they were not ready at all to sign up at the first. they needed information. they needed to bring their family members back. they needed to talk to neighbors and friends. so having i think that long period and the deadlines i think started that combination and i think it was a very good strategic move which also gave

you all an opportunity. i said to the second thing that was critical as a part of the ground game was working with our partners throughout the federal government and throughout the campaign efforts and they were certainly part of this but putting some specific targets down the king of the member kine uninsured, trying to target our relatively limited resources to where there were big opportunities for the at-home and into the large numbers of the uninsured in the state that we were actually running the federal marketplace and then having that communicated to the folks on the ground so they had some idea what a campaign what actually was going on and who was coming in the door and how that was working. you could measure the sharing information about success. certainly i think better would have been a website that was fully functional on the number one.

i would trade those eight weeks in october and november in a heartbeat except somebody said to me what you like a smooth website and 4 million enrollees or iraqi website and 8 million? i will take the 8 million a day. [laughter] and ironically, i think that there is something to be said about we set it to people we will get it fixed and we did a lot of analytics greatly set would be fixed by december 1 and there would be a different experience. i think probably the most terrifying couple of days in the process for november 30 and november 29 and thinking you know, i really hope that this is going to work. and on december 1 when the millions of people came back to the site knowing that it was operating it was a great validation, and then we saw people really taking advantage.

we had to go back and invite people and partners. and i know that daniel knows this as well as other insurance partners. we were able to reach out to people individually and to say i know that you came in october and i know you had a frustrating experience, stop somewhere along the way and come on back. you have plenty of time. here's how long the open enrollment lasts and try the process again. i'm hoping that you can bring us behind the scenes a little bit of the insurance industry. you have something that the majority of the folks in the room do not have which is the sort of real-time view of how many folks were enrolling in your plan. i'm curious if we can think of a few different moments along away. last summer as we were gearing up with october 1 quickly coming into the period in october and november and then a final surge coming at you described that the

numbers did at the end of the day far exceed what you were expecting. tell us a little bit about the experience that you were having and what you were hearing from your colleagues and how to approach these different kinds. >> panic. [laughter] no, actually from our perspective, and i think the insurance industry as a whole we did have ongoing conversations with the secretary and with the hhs and cms. we felt very good about the tools that we were developing as a company as and as an industry to make the individuals as they were and we referenced it whether it was the communities where the churches that were best known to humankind in kentucky. we felt very good about that. what we were the most concerned about frankly, and this was before the glitches in the website, we were concerned about the next of the members and i'm speaking to you as a business person i have to be honest we were concerned about the mix of

folks coming in. if we were not able collectively to get the young and invincible since the program, we were fearful that it woul they wouldk the bank on the program and the federal government at a traffic job. we referred to the risk adjustments and the reinsurance. they were in place. we were not sure that they would be enough to sustain the progr program. i would say that we were less panicked when all of the outcry over the problems in the website because we were in constant dialogue and we knew that over a period of time that any program of this magnitude was going to run into problems. and we knew that if we are successful but we kept our heads down working in collaboration with you and working in collaboration with government, that we would be able to enroll the numbers of people that we needed to. again, the fear was that young people, so we asked our efforts

in the social media. we re- upped our efforts and going out to ball games, the professional teams, the college teams into the schools to educate. are we sure that we are ready and are we going to get the types of mix that we need to make this work financially, and then ultimately feeling good about our collective efforts and efforts as an individual entity to bring people in. just in closing, and the other speakers are referencing medicaid, i have to say folks, medicaid managed care works. in every state where it has been implemented, the significant reduction in the growth of expenditures are palatable, number one. number two, people move from accessing care in emergency rooms and in clinics to having a primary care physician. and beginning to understand that

they have a vested interested that there is a pride in knowing that you can access care. here is my fear. the effort to expand medicaid was the right effort. the issue is this. after some point, the money runs out and states will be left holding the bag and the reason i say this, it is not a political statement. i don't care what your political persuasion is and what it is that the incumbent is the next step of hope kerry form is making sure that we focus on the individual and that we focus on the populations of individuals to get them access at the lowest possible cost care and the highest quality of care possible to cause unless we attack this and showed real outcomes using the time data in the hands of clinicians and other professionals to drive down cost it is all for not. >> secretary committed you have something to sa say? >> the only thing that i would

say, i don't disagree with anything that daniel has said, that the other piece of information that i think it's so important to get into people's hands as this dialogue goes forward is the untold story of what has happened to the cost since the affordable care act was passed. we are on the lowest cost increase ever in the history of this country on the overall health costs. ..