i can't remember what but the preventive services are listed. they are defined. so, and in terms of the prescription drugs, posturing requirement, out-of-pocket spending for drugs, as you recall in my presentation i noted that prescription drugs is increasing a lot faster than medical spending. so i think insurers are going to be looking at ways to better manage, and she does cost the they have a couple of different ways they can do that. one is to change the cost sharing requirements for particular prescription drug tears, and they can also change where on the tears particular drugs go and they can also just changing the formulary. so they have different ways to

do that. i can make any particular specific comments about plans are actually think i think those are the things to look out to better understand what's going on. >> what i can say, in 2015, employer-based insurance and marketplace insurance were very different when it came to apply the deductible to prescription drugs benefits. employer-based insurance, less than 10% applied. marketplace insurance, i think the majority of plans may be as much as 70% you have to meet a deductible. for some of the tiers at least before you received prescription drug benefits. >> and so post-aca all of you know there's a requirement that you can't discriminate in benefits, and we jointly with sister agencies including the

insurance regulators and folks from the health department looked at the tiers on the formulary and with help of outside researchers there was a pattern that evolved that certain hiv drugs are classified in the highest out of pocket tiers, and based on that we thought it was discriminatory benefit design. in that case the carrier solve the problem and voluntarily fixed it, moving certain hiv drugs to lower cost. said would make that kind of discrimination against people who need hiv medication. the opportunity to look at how formularies structured for discrimination patterns whoever mentioned there would have to be a law change come to change things are considered whether or not they are considered, that

would require a law change. >> thank you. so we run out of time. if you would kindly take one moment to fill out the blue evaluation form in your pocket, we would be grateful. also we the question earlier about consolidation and i wanted to mention that we would get back to comp the lines in the commonwealth together to bring you another briefing on the subject of consolidation on the from the 20th so please watch your inbox for that. please join me in thanking our panel for a very interesting conversation today. [applause] [inaudible conversations]

>> a required if you missed any of this event from capitol hill you find it anytime in our video library c-span.org. we will return to the hill today at 4 p.m. eastern when the senate gavels in to consider the nomination of u.s. district judge for the eastern district of california. confirmation vote to fall at 5:30 p.m. the senate will likely consider moving forward on a bill authorizing 2016 defense programs. the house returns tuesday at noon eastern would like to say this is at 2:00. later the house agenda includes a number of energy bills including one that would lift the four year old ban on crude oil exports. on thursday house republicans are expected to meet off the florida leadership elections. paul vallas live on c-span innocent of course life here on c-span2. reaction from the hill on the announcement of a deal reached in the negotiations for the trans-pacific partnership, or tpp. this from hill.com.

mcconnell called the tpp quote potential what of the most significant trade deals in history and added lawmakers will have to ensure it quote meets high standards for congress and the american people have demanded. that's from the hill.com ever care more about that when the senate gavels in later today for being eastern. >> as the supreme court starts this new term c-span debuts its new series, "landmark cases." on the series premiere we take a look at the real story behind the famous marbury v. madison case delving into the heated political battles between

outgoing president jon adams, the new president thomas jefferson and the newly appointed chief justice jon marshall. >> he established the court as the interpreter of the constitution into same as to say she wrote of marbury v. madison spent marbury v. madison is probably the most famous case is court ever decided. >> join the discussion. "landmark cases" printers live tonight at 9 p.m. eastern on c-span, c-span3 and c-span radio. for background on each case while you watch order your copy right of the book available for $8.95 plus shipping at c-span.org/landmarkcases.

>> up the next remarks in president obama at the 34th annual national fallen firefighters memorial service held just at the national fire academy in emmitsburg maryland honor at the 84 firefighters who died on duty in 2014. [applause] >> thank you. craig, thanks for that introduction, but more importantly, thank you for the outstanding work that you and your team do all across the country every single day. for those of you who know craig, you know that he is cool under pressure, no doubt because he got his start, started his career as a firefighter. i want to thank congressman steny hoyer, fire administrator

ernest mitchell, chief dennis compton, and everybody at the national fallen firefighters foundation for bringing us together here today. and most especially, i want to say how honored i am to be with the families of the fallen, and express the gratitude of the nation for the sacrifices that you and your families have made on behalf of others. scripture tells us, as each one has received a special gift, employ it in serving one another as good stewards of the manifold grace of god. employ it in serving one another. every single day, across our country, men and women leave

their homes and their families so they might save the lives of people that they've never met. they are good stewards, serving their neighbors, their communities, our nation with courage, and fortitude and strength. we can never repay them fully for their sacrifices. but today, we gather to honor 87 brave firefighters who gave their lives in service to us all. our prayers are with their families, many of whom honor us with their presence today. you remember them as moms and dads, siblings and spouses, friends and neighbors.

today, we remember them and salute them as the heroes that they were. it's hard to think of a more selfless profession than firefighting. there's a reason why firefighting occupies a special place in our imaginations, why little boys and increasingly little girls say, i want to be a fireman, i want to a firefighter. they understand instinctually that there's something special about it. imagine what it takes to put on that heavy coat, and that helmet, and override the natural human instinct for self-preservation, and run into danger as others are running away, to literally walk through fire knowing that you might never make it out because you're

trying to save people that are strangers. and yet, the fallen that we honor today would probably have said that they were just ordinary americans who were doing work they believed in, carrying on a tradition as old as america itself. there's a humility that seems to be part of being a firefighter. from rural communities to inner cities, those we honor today lived a fundamental principle that binds us all as americans, that i am my brother's keeper, i am my sister's keeper, that we look out for one another, that

there's something bigger than each of us individually that we have to be true to. we honor men like michael garrett of west virginia. mikey, as he was known, started out as a junior firefighter at the age of 16, became an emt by 18, was on his way to graduating with an associate degree in emergency services. his mom, faith, says mikey was always smiling, always a practical joker, if you turned around, your cell phone would be in the pool. and he was always the guy you could call on in a pinch. no matter how busy he was, between school and work and being an emt instructor himself, he'd be there to help. and in february of last year, mikey was pulling a seriously injured utility worker out of harm's way when a cell tower came crashing down. and he was only 28 years old, 28 years old. he's survived by faith, his dad

dale, his four siblings. and he will always be remembered by his community as a good man devoted to helping others, that's who he was. and he typifies what it means to be a firefighter and to serve others. that's who kevin bell was, too. kevin was that rare combination of full-time firefighter and part-time dj. his wife, wayette, says that the day he graduated from the fire academy in connecticut was one of the happiest days of his life. and he truly loved his work, and his kindness and generosity were widely known. and like so many firefighters, he never talked about his heroic actions. his daughter, raquel, says that she would later hear from those he had helped, above and beyond the call of duty.

the friend he had assisted after a car accident. the classmate he drove to the hospital after an epileptic seizure. last october, kevin gave his life battling a house fire. he is survived by wayette, and raquel, his parents, and his siblings. because of the role model kevin was, there are african-american kids in his hartford neighborhood who want to be firefighters just like him. and one day, they'll be able to go to work in the kevin lamont bell fire station. we honor heroes like malcolm jenkins of louisville, kentucky. malcolm was the go-to-guy in the firehouse, no task was too big or too small. he was the guy who could fix anything, which his wife sharon says taught his three daughters an important lesson, marry a man who can fix everything that you can break.

[laughter] malcolm was a farmer when, many years ago, the county put out the call for volunteer firefighters. he rose to become a major, and helped develop the kentucky regional fire training academy, which has trained hundreds of firefighters to serve their communities. last october, malcolm succumbed to a heart attack. and today, in malcolm jenkins, we remember not just a great firefighter, but a loving son, husband, father, grandfather, and friend. these are the kinds of individuals we honor today. and even as we honor these 87 heroes, we know that their work is carried on by firefighters all across our nation, by so many of you, with that same bravery, and that same

dedication, that same sense of duty, that same humility, that same love of country. in recent years, you've battled some of the most severe wildfire seasons in american history. so far this year, nearly 50,000 wildfires have burned more than 9 million acres, an area larger than the entire state of maryland. at the season's peak, 32,000 firefighters were battling blazes from california to north carolina. thirteen have lost their lives. and today, we honor them as well. and we reaffirm that, as a nation, we must work to prevent fires, and we must give firefighters the equipment and the support that they need to get the job done and to come home safe. that's what we owe every one of you. [applause] and finally, this memorial also pays tribute to names that do

not appear on this wall. it's a testament to you, the families of these individuals. the families who stand alongside every firefighter across this nation. because the brotherhood of firefighting doesn't stop at the firehouse door. it extends to every community across our country, to every mom and dad, every spouse, every child who waits for their loved one to come home at the end of a shift. all of you are united by an unbreakable bond of strength and sacrifice. this is your family, too. for the families of the fallen, we know that words alone can't ease the pain of your loss. but perhaps it helps a little

bit to know that the american people stand with you in honoring your loved ones. we admire them. we cherish the work that they do. we hold you in our hearts, today and always. we offer you our deepest condolences, and our prayers, and our eternal gratitude. these are extraordinary people that we honor here today. they're extraordinary americans. they set an example for us all. may god bless these fallen heroes. may he watch over their families and all who protect us. may their shining example inspire us all in our own lives as each one has received a special gift, employ it in serving one another as good stewards of the manifold grace of god. thank you.

[applause] [inaudible conversations] >> be seated, please. thank you, mr. president. we appreciate your kind words and we thank you for being with us this morning to help our our firefighters and comfort their families. the president will not unveiled the plaque with the 87 names of

the fallen. this plaque will be added to the national fallen firefighters memorial in the coming days. mr. president, please unveil a plaque. [applause] >> the u.s. senate returns this afternoon gabbling in at 4:00 eastern to consider the nomination of u.s. district judge. confirmation vote will fall at 5:30 p.m. later the senate likely will consider moving forward with a bill authorizing 2016 defense

programs. house passed that lastly. meanwhile, the house returns on tuesday at noon future with legislative business. later in the week the house agenda includes a number of energy bills including one that would lift the 40 year old ban on crude oil exports. off the floor on thursday house republicans are expected to be told the leadership election. we are just getting word and house speaker john boehner has announced that a floor vote for speak will be held on thursday. october tonight. follow the house live on c-span and the senate here and c-span2. until the senate gavels in house energy and commerce subcommittee on oversight heard from state health insurance marketplace officials talking about the ongoing management and implication of the affordable care act. the officials describe challenges in their state in implementation. summon measures that they can to improve the moment process and participation in their states.

>> [inaudible conversations] >> good morning. the subcommittee on oversight and a vacation in means this hearing today to examine the state health insurance market places established under the affordable care act. we seek to understand the sustainability challenges these state exchanges continue to face. the centers for medicaid and medicare services has awarded $5.51 billion dollars to the states to help them establish their exchanges. let me repeat that. the states received $5.51 billion in federal taxpayer

dollars to set up their own exchanges. yet, the aca had no specific definition of what a state exchange was supposed to do, or more importantly, what it was not supposed to do. this is compensation without limitation. since the funding for these exchanges came from the entitlement side of the budget, there was no oversight through the appropriations process. there was no budget for state exchanges, rather grant money flowed freely and rewarded bureaucratic innovation. of course, no one bothered to ensure that more money and more innovation didn't wind up creating more government bloat. in fact, the states represented on our panel today, california, connecticut, hawaii, massachusetts, minnesota, and oregon were awarded over $2 billion of federal grant dollars. notably, oregon has already pulled the plug on its state exchange and hawaii is in the process of doing so. the faucet of establishment grant money finally turned off at the end of 2014, when the

states' exchanges were supposed to be self-sustaining. despite this enormous taxpayer investment, state exchanges are still struggling. they continue to face i.t. problems, lower than expected enrollment numbers, and growing maintenance costs. here are just a few more recent headlines from news articles on the state exchanges, obamacare exchanges are a model of failure, nearly half of obamacare exchanges face financial woes, and obamacare's failed state exchanges. the alarm bells are not only being sounded in the media. earlier this year, the department of health and human services office of inspector general alerted cms acting administrator andy slavitt that the state exchanges may be using federal establishment grant funds for operational expenses, which is prohibited by law. hhs oig urged administrator slavitt to develop and issue clear guidance to the state exchanges on the appropriate use of establishment grant funds. the guidance that followed,

however, was still vague, permissive and lacked real-world examples. in fact, cms has seemed more focused on doling out taxpayer dollars rather than overseeing how those dollars are spent. the u.s. government accountability office just issued a report demanding cms conduct more oversight over states' health insurance marketplace i.t. projects. gao found that cms did not clearly document, define, or communicate its oversight roles and responsibilities to the states. further, cms often did not involve relevant senior executives to approve federal funding for states i.t. marketplace projects. and although cms established a process for testing state marketplace systems, these systems were not always fully tested. we have a panel of witnesses today representing state exchanges, each with its own set of challenges and circumstances. the state of hawaii was awarded $205 million, but this past

june, the governor announced that its hawaii health connector does not generate sufficient revenues to sustain operations and will shut down. the commonwealth of massachusetts accepted $234 million for its health connector, but enrolled only 13% of its goal the first year, temporarily placed individuals in medicaid because it couldn't determine eligibility, and cost massachusetts an estimated $1 billion in additional funds. the state of minnesota initially received $155 million to launch its state exchange. its exchange received an additional $34 million from cms, in part to fund ongoing fixes to the i.t. system. despite this infusion of funds, minnesota has announced that it would revert to an old system next year for minnesotacare premiums because of the continued exchange problems. the state of california received over $1 billion in federal grant

dollars to establish its exchange, covered california, the most of any state. despite call center and website woes, california had the highest enrollment in 2014, but only retained 65% of its 2014 enrollees. this year, california's enrollment numbers reached 1.4 million, falling 300,000 short of expectations. cms awarded the state of connecticut approximately $176 million in federal establishment grants, and as of september 2015, approximately 96,000 individuals were enrolled in a plan. only 50% of enrollees were previously uninsured. the state of oregon received $305 million in federal grant dollars exchange, cover oregon. despite this heavy investment, cover oregon was dissolved early this year and transferred its responsibilities to the department of consumer and business services. the state is currently operating as a federally supported state-based marketplace and

relies on healthcare.gov. we are here today to understand the challenges these state exchanges face. why are they struggling to become self-sustaining, especially given the extraordinary taxpayer investment? is it a lack of accountability or oversight? where has cms been during this whole process? is cms encouraging fiscal restraint, or instead, taking a hands-off approach, which has allowed money to be spent uncontrollably? and where an exchange has decided to shut down, has cms tried to recoup any of the federal grant dollars? lastly, are the exchanges doomed to fail? hopefully, we will get answers to these important questions today. so i think all the witnesses participated economic in a the ranking member for five minutes. >> thank you, mr. chairman. i think we can all stipulate that some states have struggled with the technological hurdles of setting up their own marketplace. we all knew that the affordable

care act with these challenges in some aspects of implementation, and i've been saying for a long time that it is this committee's role to conduct oversight and to improve that process, and so i'm glad we're having this rented and hope we have a goal in mind. i hope we are not hoping that the state exchanges failed to cope we are hoping to we can improve it and we can make it better. i think that despite the fact that we had a rough start in many places, the aca is working and does great improve access to affordable, high quality health insurance coverage. in the last five years we've made tremendous progress in helping millions of americans throughout the country can access to quality health care. first some notable statistic. since passage of the law more than five years ago, 17 points 6 million previously uninsured individuals have gained health coverage to the aca's various

provisions. nearly 10 million consumers have enrolled in date federal facilitate exchanges. about 2.7 million of those individuals use state exchanges to select private plans. according to newly released data, the uninsured rate fell from 13.3% to 10.4% and 2013-2014, which represents the largest single your reduction of the uninsured rate since 1987. in 2014, hospital uncompensated care cost for $7.4 billion more than 2013 levels as a result of exchange coverage and medicaid expansion. the aca also good health care delivery systems, hospital revisions are down and indicators of patient safety at hospital-acquired conditions have improved significantly. all of the states before us today have taken significant steps to improve health coverage

for the residents. their uninsured rates have plummeted due to the efforts to implement the affordable care act. despite the technical and financial challenges that confront us, hawaii's exchange, for example, it's uninsured rate has fallen and now stands at only 5.2%. in just a few years since 2013, minnesota has reduced the number of people without health insurance by more than 50%. they are and insurance rate is now one of the nation's lowest at 4.6% of massachusetts which award had one of the nation's lowest uninsured rates in the country is down to just 3% in 2015 which is a 38% decrease since 2013. connecticut which now has a robust state pays workplace cut its insurance rate by passionate and connecticut the uninsured rate is 5%, and california which

also had one of the lowest, i spend insurance rates in the countries, it was 21 points 6% from is also managed to drop its rate by 45% since 2013. now the uninsured rate in california is 11.8%. and, finally, or can which is one of the nation's highest and insurance rates of 20% and 2013 also reduces the insurance rate by 55% to 8.8% today. how did this all happened? how did statesmen is to ensure so many millions of people? the affordable care act has provided these tools. so as we discuss call centers, web-based portals and all these other things, let's not forget that the affordable care act usually working to achieve its goals and let's work together to try to make it better. i want to thank you for having this hearing. i want to thank our californians for joining us, mr. chairman, and want to yield the balance of my time to ms. matsui from

california. >> thank you very much for yielding. peter lee, thank you for coming here to testify today. let me reiterate, the affordable care act is working. california is an early adopter in so many areas, not the least of which is health care. we've embraced opportunities provided by the ac can our system from painful volume to think about you. and to reform our system to ensure that everyone has access to quality, affordable health care. copper telephone has an integral part of it and i'm happy to say that as of the most recently released census data over 41,000 in my district of sacramento and nearly 2 million californians are -- that's an average of 5% reduction in the rate of uninsured. in sacramento and 2012, 18% of the population was uninsured. in 2014 it was down to 12%. that rate is likely to be lower in 2015. we need to continue to work to

bring those numbers of uninsured down. by supporting defense that made by covered california and exchanges, not by moving backward. inc. and i yield back. >> i know on our side if there's any members want to speak. i know mr. walden who is not a member of this committee want to sit in and has right to do so. t. want to be recognized for two minutes? >> i was a practicing physician before i want to talk about the focus on insurance rates, people getting insured. coverage does that guarantee access to health care. deductibles are up, premiums are up, the cost is being shifted to the people. the uninsured rate may be dumb but the access i would argue does not improve dramatically. if you're a schoolteacher, factory worker or other middle-class avoid them together $5000 family deductible, maybe a

size 10,000, do you have affordable health insurance? i would argue you do not. in many states physicians are not taking new medicaid patients. i know this because i'm a physician at the top two positions all the time. in fact, many physicians are not taking new medicare patients, let alone medicaid. i wanted to clarify focusing only on an insurance rates is not the only parameter to look at when you're looking at the ability of our citizens to access quality, affordable health care and i yield to mr. walden. >> thank the gentleman and thank the committee for letting me participate. when i was in the state legislature, the oregon health plan itself was passed. when i became majority we realized it had a lot of work left to do adequate together a select committee that the that and i cheered. i concur with those who think we need to do more to reform political health care and access to a. i have a pretty good record on doing both. trent lowe to thank you for holding this hearing on this

issue though. mr. allen, thank you for coming out from oregon to attend. agenda oregon received $305 million in federal grants to build cover oregon. only california and new york, states with about nine and four times the population respectively received more. we've got a lot of money out the exchange was launched with much fanfare. i heard the kitchen long live organ jingle to encourage oregonians to sign up. the problem was when the lights came on, when the curtain went up, it failed to sign up a single person online in one sitting. not one person was able to sign up that way. oregonians were forced to sign up using paper applications. the state decided to abandon a statement exchange i.t. platform and move on to healthcare.gov, the federal exchange. eventually the legislator votes to shut down entire program which it did on june 30.

hundreds of millions of taxpayer dollars apparently down the drain. last degree chairman upton, chairman pitt, chairman murphy and i request an independent federal investigation into the failure of cover oregon. while the gao did good work, generally, me questions about organ remain unanswered. how did this happen? who was in charge? what could be done to make sure this never happens again anywhere in the country? we are still waiting the answers. going forward the movie felt a change poses a whole new set of questions. i understand you are not the running this thing, so we are not here to point fingers but we are here to get answers. so how this happened and what we do now and how we're going to fund the next phase of this. i still have a clear understanding what happened to 305 million in grants. dcms even tried to recoup this? what was the role of cms to observe how this money, taxpayer money was spent? did they do their due diligence?

in spite of the repeated assurances, i think there are still questions of how the state will pay the federal government for using healthcare.gov when it's required to do so in 2017. they are are concerned with significant insurance rate increases. i know in your test understate the rate increase our result of market rebalancing itself. whether or not it's rebalanced or indicative of future rate hikes i think remains to be seen. the collapse of cover oregon is cleared an epic disaster for oregonians and for taxpayers across the united states. frankly, the aftermath has inspired additional confidence in our state government or cms. i am deeply disturbed about the role of the former governor who is had to resign and the role it is campaign consultants in calling the shots. i hope you will help us learn more about what happened, why it happened and what steps to be taken to make sure that this sort of debacle never happens again. thank you, mr. chairman.

i yield back the balance of my time. >> not recognize the ranking member, mr. pallone, for five minutes. >> i want to over five ago we passed the affordable care act and finally changed the health care system in this country. we expanded access to health care for millions of americans and ensure that no individual could be denied coverage for arbitrary or discriminatory reasons. we guaranteed insurance coverage when the business of making our citizens healthier, not just making a profit. we strengthen medicare put the program on sounder financial footing to preserve and protect it for generations of americans to come. today my republican colleagues will tell a different store to put a lot of technical glitches, inefficiency, rogue i.t. systems. of which is listen to republican side we are led to believe report money down the drain and casino benefit of the reforms of the affordable care act are a complex undertaking and about their lessons to learn from its importation and we should learn those lessons and use them to

improve going forward. that doesn't mean we should lose sight of the bigger picture to make no mistake the affordable care act is working. we are seeing it successes to ththe couch and that is there to prove the recent census data shows the insurance rate has declined to get 17 by six-point america to did not coverage before the law went into effect now adventures. states that just embrace the full measure of the law and extend the medicaid program is testablish state-based markup assisting the greatest game for their citizens. this is true for the six states that we have joining us here today despite our technological challenges in some of these days, everyone here today has expanded access to care and significantly lower their numbers of uninsured. it's also important we look at how state pays workplaces could be run more efficiently and effectively and how we can continue to enhance the health care delivery system in this country. let's do this with an eye for improvement the site uses finger as an opportunity to score

political points. let's have a discussion about how to reach the remaining uninsured, how to continue to improve the consumer experience in year three of exchange moment and how to best address the challenges that remain. with that i would like to yield the remaining time to split between congressman kennedy and representative capps, initially yield to mr. kennedy. >> i want to thank the ranking member for yielding. it is always nice to see a then they face amongst our witnesses at hearings and at least have a chance to welcome mr. gutierrez this way. point. mr. gutierrez throughout his career has championed technology, top government do its job better, smarter and more efficiently. whether it's as our commonwealth chief information officer, and spoke of the exit group were not as executive director of the massachusetts health connector he has pursued a strategy to improve the delivery of critical services to people who need the most. particularly when it comes to health care. in his latest role is for kelly

to ensure that massachusetts maintains its proud status as a state with one of the lowest uninsured rates in the country. after nation's uninsurance rate continues to fall, nearing single digits thanks to the affordable care act. i believe it's critical we replicate the successes we've seen in our commonwealth across the country i'm looking for to hearing more about your efforts to make our system or effective and more efficient as well as any best practices you've encountered that could be applied across this country. thanks very much for being here. yield back. >> with remaining time to ms. capps. >> thank you, ranking member, for yielding, and let me also, also in the be here today for i know together important discussion. i wanted to come in person welcome mr. lee, an eccentric record of cover california which is my states health insurance marketplace which has helped to make some of my constituents

with health insurance. california made a conscious decision to be an active player with the affordable care act implementation. when there are problems they have been responsive, holding insurance companies accountable and focus on making cover california a national leader. thanks to their efforts we have cut our state's uninsurance rate by 28%. pretty remarkable in my opinion. california shows what a state is invested and buys into the goals of the affordable care act, prices can be held under control, quality plans can be made available for purchase at. i look forward to hearing more about how cover california could perhaps serve as a role model for other states looking to get the best value for the residents while promoting high quality care. and i will yield back to the ranking member. >> i yield back. >> i not ask that in them is consent the rain opening statements of members of the

subcommittee be introduced into the record i know mr. upton was something. we will leave it open for other members if you wish to do so. so without objection the documents will be entered into the record. to our witnesses were where the committee is holding an investigative hearing and by doing so has the practice of taking tests when under oath. do any of you have any objection to testifying under oath? all the witnesses say no. they cheer advisee under the rules of the house and the rules of the committee you are entitled to be advised by counsel. to any of the witness desire to be advised by counsel today? all the witnesses declined. in that case we are pleased rise, raise your right hand and i will swear you in. [witnesses were sworn in] >> thank you. all the witnesses have answered in the affirmative. you now are under oath and subject to the penalties set forth in title 18 section 1001 of the united states code. will have to each get a one minute dash back five minutes,

five minutes some effort statement of we are not trying to russia. again with mr. allen. please make sure your microphone is on. pulled a very close polar bear close to you so we can hear you. thank you. >> chairman murphy -- >> make sure the microphone is on. is the light on? >> there we go. thank you, chairman murphy, ranking member degette, mims of the subcommittee. my name is patrick allen on the direct of the oregon department of consumer and business services. with the states largest consumer protection and business records or agency to our mission is to serve the protect consumers and workers in poor, supporting a positive business climate in the state. my agency responsible for regulating the financial service industry including banks, credit unions, mortgage lenders, all aspects of insurance including life, health, property and casually. ..

>> >> healthy, competitive, and

sustainable. 11 companies will offer play of the various coverage levels. or a given individual insurance market is one of the zero lowest a nation we're in the process to major there's long-term sustainability of the rates have been significant the results is comparable to those available in neighboring markets in california and washington and remain very affordable. third, the marketplace is deficient and financially sustainable and subject to ongoing oversight. we as a state agency is able to operate the marketplace 60% fewer staff and the previous organization and. completely financed by participating insurers with no federal grant funding involved.

it will be adequate financial capacity to pay reasonable technology cost with the relationship should that be necessary. i'll be happy to answer questions. >> the interim chief executive officer from the state of minnesota you are recognized for five minutes. >> good morning chairman murphy and ranking member and distinguished members of the subcommittee. in the interim ceo of venture minnesota is online health insurance marketplace. i am honored to have this chance to share the success we're seeing in minnesota. let me begin with an update how injure its impact the minnesota ince.

we have made to read when dutchman this progress by providing affordable comprehensive coverage i went to provide a full picture of where we are today. since october 1st, october 1st, 2013, more than 500,000 minnesotans have shot compare and unrolled for their quality affordable coverage. as a result minnesota has the lowest rate in state history and in the first year the uninsured rate dropped by 40 percent in into now nearly 90 percent of minnesotans are covered. within $31 million of premium payments of tax credits in 2014 alone and i am pleased to report ensure is financially sustainable with the conservative still budget based on real numbers and real experience.

we have come along way the last 18 months have brought measurable progress along with a deep commitment for transparency and accountability. in making a difference in their lives and health of minnesotans. a cattle farmer in minnesota went to the doctor for the first time in years discovers he has cancer and consensus that - - successfully treated now he is cancer free. minnesotans like take sanders a small business owners with three small children with a pre-existing condition since birth and minsure allowed him to find a lower cost policy now he knows his son will be covered. covering minnesotans is bin the foundational goal in the performance has improved

dramatically since then. there is the night and day difference between the first and second open and roll period. minnesotans could complete the enrollment process with ease and that continues today. no one should struggle to find a health-insurance plan it is also to make sure that minnesotans can live their life to focus on the important thing is like going to work instead of worrying about how they'll pay for big men -- big medical bills. there is plenty of work ahead adding functionality with web site performance to ensure a positive consumer experience also a strong functionality for medical

assistance with minnesota care. one final point in minnesota the state recently created bipartisan health care task force that will help address questions like access to care and financing i am thankful to these people for their thoughtful approach to address the tough questions that remain for the health care program. as minsure interim ceo my eyes are focused on preparing for the third open enrollment period, improving the consumer experience, is setting and implementing a smart budget to make sure as many people as possible take advantage that minsure has to offer. we want to see families get the care that they need and deserve.

i look forward to your questions. >> now the executive director of massachusetts health connector. you're recognized for five minutes remain chairman, rating member and distinguished members of the subcommittee good morning. thank you for the opportunity to do testified with our state based marketplace. i have served as the executive director of the health connector since federated share following the election of massachusetts governor baker progress the new state administration took office massachusetts was partly to a second attempt to implement eligibility enrollment system for the eligibility front end and functions remain under development.

this is to stabilizing operations to support massachusetts state based marketplace. upon taking office the baker administration had several changes with an approach to the connector authority. first altered the government's structure placing the secretary as chair of the health connecter board of directors the secretary for health and human services receive the state medicaid organization this reflex successful coordination between the exchange in the state medicaid agencies. and also replace executive management hiring for experience of some - - implementation and systems with a new chief operating officer a woman distinguished in pare operations.

and with a greater eligibility system and the implication -- implementation never. because of their eligible ability initiative is shared to reestablish a formal governance structure led by the state medicaid agency and the technology division to undertake a six week examination to assess the state of health connector operations to have a path of existing problems and finally to complete the process for temporary coverage with a replaced and 2014 to appropriate placement with qualified health plans or medicaid. and is better to use

scituate to get the needs of residents. 83 qualified plans are on the connector across by issuers of the dental plans. over 175,000 enrollees and massachusetts is one of five states with less than 5% uninsured. we have significantly expanded customer service components with 200 additional customer service hours with saturdays and sundays and for additional access to self-service so they can update to their account without having to call the call center. massachusetts believes it needs flexibility to meet

local needs. we cannot provide those benefits without the flexibility of the state market place for example, our connector program for individuals earning less than 300% we desire the ability to recognize local market conditions and going forward there are more seamless ways to integrate the eligibility and subsidies. it is important states offer that chance to make it work better for everyone. massachusetts remains committed to make sure those who need health insurance can obtain at now and into the future with the state based marketplace as one component of the strategy. thank you. >>.

>> good morning. chairman murphy and the ranking member of the oversight and investigations subcommittee it is a pleasure to report on the activities of the exchange before doing so well by to explain the of health care environment in hawaii to understand the context of my remarks. yes as a renegade lois insurance rates in the nation but this is because of the passage of the hawaii prepaid health care act of 1974. think the state undertook as policy the responsibility for providing access to health care and from its resources virtually every employee resident ever staged for both democratic and republican administrations in hawaii have not only supported those provisions but develops a spit -- substantial resources to aid the health care industry to deliver these services to an

increasing percentage of population. why is not ranked among those of lowest rate of infant mortality, obesity and diabetes and other critical metrics the population enjoys a longer life span and by any measure healthier outcomes from diseases and other health issues from diverse and a cultural mix i believe this is a direct result of the community's ability to develop excellent health care access to secure the of viability through their prepaid health care act with the employer mandate. in this context it was widely viewed as an opportunity to expand access to even more of the white population. taken together the expanded medicaid program in the

affordable health care act insurance policy have reduced the insured rate by half. unfortunately a lack of planning, and with today's to deliver the important services to the people that most needed it in our state. we have come a very long way to achieving the goal of harmonizing the benefits of their prepaid health care act with the provisions of the affordable care act. to support a well-trained out reach team of workers as they assist with the and will the process. this change converted our computer systems to resource rather than a barrier to entry. we produced a cop