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. ..

>> and we also have access to this incredible data, the monthly polls that kaiser family foundation does that i know we all found a very viable. i am interested in, as you were looking at all of that, what were the things that most surprised you about the trends in enrollment and the things that you think are most important to the ultimate success as we saw? >> first of all, the secretary did not always like the polls.

[laughter] >> the most amazing thing about the polls really was that they never changed. from passage until today. that is because randomly distributed almost perfectly along partisan lines. at this point i think we could ask the american people, will be affordable care at take customers are solve the energy crisis in america were turned the cs for our beloved boston red sox. [laughter] that is because we are not really having a political debate it is not really a debate about the aca. it is because in the political debate the hca has become the poster child for a larger debate between left and right about government and other things in

our country. and what that means, and it may or may not remain the poster child for that larger political debate. we will see how that plays out over the next seven years. the big question in my mind is as more people get coverage and this becomes more real for the american people and no longer just a political symbol, does that judgment about the loss discussed focus more on the reality which is what we will find out. >> that is a great tennis -- transition to you, governor. you spoke in your remarks about the experience of implementing what washington d.c. considered the space and wanted to capture the national attention for many reasons, not the least of which is this experience that you're describing this highly politicized issue and

implementing it in a space that a lot of folks have started thinking of as red verses blue. i think you have proven that it goes beyond that. i am curious. what role do you think that public opinion aligns public perception that "and "obamacare, what role do you think that plato did not play in kentucky? >> well, obviously the phrase obamacare has been demonized to put it bluntly. when you say obamacare it creates the automatic reaction one way or the other. what we did in kentucky, we sort of anticipated that and then the affordable care act passed. we quietly accepted every dollar that the secretary would give us [laughter] to plan and get ready.

we were quiet about. we did our planning, and as soon as the supreme court said it was constitutional we announced that we were going to expand medicaid and create our own exchange. leading into that was i went to all of our stakeholders. the kentucky chamber of commerce, hospital association, all of these folks and every one of them said we will have been exchanged warm with the other that gave me a political foundation to say we will do our own exchange. we will take these cookie cutter approach from a national standpoint. the coverage decision was the medicaid decision because it is money. eventually money for the states, and you all know the details.

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 because i knew that would be the question. they came back in six months and said, you cannot afford not to do this. [applause] they said this is going to and use about 15 billion into your economy over eight years. you will create 17,000 new jobs. you will have a positive impact on your operating budget of the next eight years, and obviously i took that and announced, you know, this is a great business decision. it was also a moral decision. it was the right thing to do, and i had to make sure i had an answer. once we did that we started out in the summer after we got our website altogether and really

started an education campaign. i will use one story to illustrate what we started with. we are at our state fair. thousands of people from across the state come to our state fair every august leading to october. we have a booth and are educating people and have decided to call hours connect. there was a fellow standing there being briefed by one of our connectors. she goes through the whole spiel. he looked at her and said, that sounds great. that is better than that obamacare. [applause] and one of you, as connectors, as she did, do i tell him? [laughter] she took a moment and said, no.

[laughter] you know, we just kept pushing and getting ready. what we ended up doing was convincing kentucky hands, look, i don't like the president, but i have to find out what this is about. we separated debt of as much as we could. they did not hot. they ended up deciding there would find out for themselves. when they found out, and quite honestly it was not the website so much. it was you. we've really pushed personal connectors all over the state that caused what most of these people, the reason our website worked well, no bells and whistles. we have to look at who we were going to be dealing with. a lot of those folks did not know much about computers. what they knew was not complicated, so you had to make it simple. we knew that these are folks

that had never had insurance and their lives, most of them produced are talking about copays and these kinds of things i have had insurance all of my life and still don't understand all that stuff. i knew what we were facing, and so you folks word the most important link to making it successful because they set out across the table. we got insurance agents qualified. it was people that they developed a trust and that set out and explained what was going on. that ended up really not making its successful. taking it out of the political realm, and it has been interesting. last november i was asked to company with a house democratic caucus moaning and groaning about what was happening. getting hammered. look, this is a process.

i guarantee next november the discussion will be better than it is this november. you are seeing that transition, some of the worst critics, at once trying to still be against obamacare. it has been interesting. i want to say something, this lady is a hero. [applause] i never saw anybody take more undeserved abuse. she took it and made this darn thing work. [applause] and quite honestly i like to say that is what governors are all about. she was a governor.

they get things done. you don't have a lot of time to argue about ideology. you have thousands of people depending upon your everyday. when things did not go exactly right she could have pointed fingers. they said, look, we are going to fix this. you know, i am so proud of his lady. [applause] >> one of your comments sets up the next question. you talk to rot your conversation. i am curious. you all are believers. as you were undertaking this enormous implementation project, and this is really a jump of question. who did you turn to for advice? what past experience and efforts to do like to inform the

decisions you make of in your planning stages but also has fixed income. >> i will jump in on that. it starts with we as an organization have had a great deal of experience in medicare and working closely with government. we are in several states in medicaid managed care. we looked at our experiences in developing programs for special needs populations are different populations, not traditional commercial populations and building products. frankly, we looked closely at our actuarial team to make sure we left no stone unturned in understanding the makeup of the population. we started from a point that even though a great number of people across the country signed up it was only about five to 6 percent of our business. we thought that we could price our products to attract people

to mantaro on this side of putting programs in place, proactive programs in place in collaboration with the provider community to make people understand that for out reached to stay healthy there are ways to access high-quality care at lower cost. we felt good about that, but it was really thinking on our experience that we had and high-quality government programs , understanding the potential actuarial risk in partnering with government and the provider community to set up products and programs that will educate and help people access care needed. >> anyone for advice? >> i will basically turn to everybody, and i mean that seriously. see affordable care act is, first of all, much more comprehensive than the

marketplace enrollment. it is a very comprehensive health bill, standing community health centers, work force issues, electronic medical records, lot of delivery system possibilities, the first-ever innovation center, centers for medicare and medicaid, our own are in the applications to look at what works and change protocol says that leaders look at the health care system. providers are a key part of those discussions. what were the best hospital systems doing, how can we drive that further? i did have the experience of being the elected insurance commissioner in kansas for eight years. my former colleagues were critical in putting together the framework for the new plans that were going to come into the marketplace. i spend a lot of time with

governors that we knew were going to be hugely important, and i have one of my former lives as a governor. members of congress, both advocates and adversaries were important to stay in touch with. some had a little too much, but that was an important constituency. but trying to look across the spectrum of who at the state and local level because at the end of the day the effort would really be about personal out reached, personal touches, personal connections. again, i cannot underestimate this amazing role that america has because we are building an organization specifically designed. you have the kind of go to

church groups, house leaders and others saying, could you add to your mission this piece of the puzzle? will you spend time and energy. in rural america did this across the country which became an amazing has said. and what you were learning, they did a great job so that we could make strategic decisions out in the field about what worked in did not work, what you were learning to matthew operated. i would say it was really everyone in an ongoing fashion. listening to what the critics said, trying to make improvements, we also, the rules and regulations are substantial. we had to write them. the way the framework is, it was three departments. hhs, department of labor, the department of treasury. the fact that we got some out

the door in a timely fashion is somewhat remarkable. as you know about regulations, government time. there were a lot of pieces of the puzzle, but i would say it was an all hands on deck approach. at the end of the day reaching across the cabinet which the president did very effectively in saying to a lot of our colleagues, when you travel to the states, when you have an opportunity, you do not lose that opportunity to also look at ways that you can help spread the word. it became a nation that people adopted happily to participate in work well. >> i mentioned secretary haynes. behind them were hundreds of folks. i went over to our warehouse on

the first day. they had been up all night. they all had smiles on their faces. we approach to midnight and took a deep breath, cross our fingers, and said a prayer. it worked. and these people were invested. they are believers. we are all believers. we were going to make it work. >> that will be the last word. again, i want to ask all of you to join me in thanking our incredible panel for being here tonight. [speaking in native tongue] [applause] [applause]

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