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 comprehensive

10 your strategic business plan to report with the condition and sustainability required with the state enabling legislation also of the advantages and challenges with the second of all your of operation and we explain how we would meet sustainability and other requirements of the affordable care acted recommended a financial approach to generate revenue from about 70,000 and royalties that the rate of $12 million per year. i am pleased to say it increased by more than 400% to be expanded to the medicaid program with the

uncompensated costs and other community. even overcoming the technology changes with the potential to exceed the initial cost of the federal government funded the initial cost the people of hawaii are responsible for the ongoing cost after consulting, and we decided to migrate to healthcare.gov as a supported state days to exchange to ensure continued access for our residents. i fully understand the basis as the risk by the assistance of technology as we work of the affordable care act with outstanding access to health care aromas' resources for every

resident and any of the millions of visitors we welcome to our state if necessary. with 84 years' time to address the issue before the people of united states. >> the governor of california. >> of running chairman murphy from the members of california at. it is an honor to be here in front of you to implement the affordable care act. but also by putting in place to benefit all americans. but we consider to be the key to success how we're

actively working to improve and we're doing in california. to embrace the affordable care act on the number one the first-aid to establish legislation with a state based exchange win legislation was passed with the democratic legislature and republican governor. since then to be an active purchaser to negotiate their quality and networks provide the best value to consumers. we provide a standard benefit design. in the individual market you will not see consumers surprised not getting access to primary care. that is the standard of primary care access is not subject to deductibles for any californians we have to will's the means the health

plan is competing on an apples to apples basis. under governor jerry brown decided to expand medicaid has meant that millions of californians have the benefit of coverage they would not otherwise have. in california the affordable care act is working. 68% of the voters recognize that to say they have seen the affordable care act working in our state. first and foremost, is a strong in moment with 1.3 million californians covered by cover california but additional five budget thousand that have had coverage our coverage today not because they are uninsured but with employer based coverage or medicare coverage but the exchanges are providing a safety net to move in to the employer base coverage with other options they did not have before.

to have one-third of the population turnover every year. we're the glue from the employer based programs in california insurance rates are under control. in 2016 the average rate increase will be 4% and in 2015 the average rate increase was 4.2% we have proven them wrong after double-digit rate increases in the individual market. in california those and not just from cover california but the entire individual market. 1 million that buy insurance that benefit from our negotiating on behalf of consumers. a young mix a diverse mix to

the tune of $200 million the premium savings that they have demonstrated that in the rates before california. coming forward we will be expanding from the plans that we have today with oscar and united healthcare that virtually they will have delhi's three health plans in the vast majority will have six plans to choose but we don't think that more is always better. we make sure they're delivering value and building on the platform to make sure we change the delivery system over the long term. that is what we need to be looking for to put patients

first and that for it to taking your questions with a path for word judah future. -- look forward to the future. >> now the chief executive officer for access health care connecticut. you're recognized for five minutes. >> today chairman and ranking member and members of the subcommittee thank you for this opportunity to offer testimony as to offer this date based insurance markets one of the best and healthiest state marketplace. access telekinetic it established 2012 with lieutenant governor and the kinetic kill general assembly to expand access the of leadership in the board of directors is critical to our recess so is the access connecticut team since they launched the

marketplace we work together to meet the unique needs of our citizens rousting focused on innovation and collaboration and expanded coverage today i am pleased to report they have used the exchange to enroll unqualified health plans in medicaid we have exceeded federal and moment goals to cut to less than 4% those sitter more likely to go to a doctor. ready to keep costs down and rates for the most affordable plans have remained flat for the last two years we are a self sustaining exchange well ahead of next year's deadline we no longer use state or federal funding for operating costs. how do you achieve this cost an ounce of prevention is worth a pound of cure. from the very beginning we

kept things simple ever changes are considered a national model because of the straight forward design and ease of use over a 60 percent say they are satisfied to be overseen by the executive leadership team for passion of health care and decades of experience in that industry to establish clear business requirements to reduce the number of residents we have extensive research to partner with community-based organizations to help us better understand to reach those most did indeed with the award winning tactics in addition to putting feet on the street one of two brick and mortar store fronts to take a page from the

playbook we provide free professional guidance and a personal touch to help navigate the complexity of the insurance and the success has exceeded expectations that even the blizzard of 2015 that dumped snow across the state could keep people away. year over year for a traffic more than doubled it is the first date basic change to implement a mobile platform that integrates closely with the back and system this allows customers to create accounts and comparison shop to submit documentation all from the palm of their hand to streamline the moment process is also recognized by our peers and last year access health and a ticket were ordered for creating a multi channel no wrong door

experience committed to exceptional customer service makes access help the model for other states connecticut is unjust and its own stable and another one entirely. we will continue to collaborate with other exchanges to share expertise and business practices in technology we will continue to innovate to expand access to health care to promote health and wellness with health disparities we will explore new opportunities to safeguard stability and to keep premiums low for all consumers will never lose sight my review this were hard-working people who operates a small dry cleaning shop in connecticut to develop a chronic health issue it began raising rates on a regular basis.

month after month you feared of using his coverage he found a cheaper plan to keep his doctor and afford his prescription but at age 60 he is living the american dream with the peace of mind he cannot be dropped because of age your pre-existing condition. i welcome the opportunity to answer any questions that you may have. >> please answer the questions correctly if you could. does your state have any dollars this year? >> we do not believe so. >> know. >> we have not spent outside of nt written authority from cms. >> we have one item we are

trying to reconcile before engaging in spending it is in a segregated account. >> we are spending establishment funs with the establishment but no operational funds. >> no. >> what did your operational cost this year? >> for the current fiscal year that began july 1st operational cost is $12 million. >> we are about the same i am happy to provide the committee with the full balance sheet. >> we are still in our were billed the year with operations in the expenses within the connector of 65 million. >> a little over

8.5 million. >> the current fiscal year is 330 million but segregated operational to establishment i don't have that. >> our total budget for the year the team is dedicated to operational cost. >> i would appreciate it if we got more detail on what your costs are but i am curious what is the cost per enrollee? >> yes exchanges funded. >> and how many enrollees? >> right now 107,000. >> how much have you spent so far? >> referring since the

beginning of the program? >> that is $305 million. >> you add the state to that as well? please get that information for us. >> i am happy to provide a balance sheet to submit to the committee ready ways to make you know, what you have. >> not offhand. >> it is of very large number but i want 2.0 with respect to the chairman it is like saying the first year use of the freeway is only for the people that use it. >> i got it.

>> we have not done that cost but i do note to me have managed to over $10 billion of premiums in the first year and a half and 1 billion from the federal government. >> with your cost do you know that number of hand? >> no i do not. >> by industry and the different costs are up front but now who keeps it and who turns it over to this data exchange federally? >> we're operating of marketplace using a federal platform. >> we take a massachusetts. >> california is managing our system. >> and edited is keeping our system. >> overtime that will mean

more and more. you are critical of project management can you be specific? >> when i joiada health connector i examined had a miserable track record. and the tracking tools were virtually nonexistent. it didn't have hours tracked order to define the end game and the goals because i command of the infrastructure business rebuilt wrote it -- roads and bridges and bases with the department of defense.

>> and from some of the testimony of rainbows and unicorns and i appreciate your honesty. that is what we want to hear. to cost taxpayers big horn dash billions of dollars i will tell you how we address it. >> mr. allen, are you deny your change had problems? >> no. >> space in back -- no i am not. >> no. >> certainly not you. what about your change? >> absolutely not. >> it may be rainbows and unicorns but have you had

problems? >> yes. >> everybody has had problems but how do you recognize those and move forward? i guess i start with you since you are the model student if you want to do talk about to access telekinetic it very briefly what problems you saw i think it will be very instructive for us. >> as we look at the challenges from the onset of this very large project we saw some of the challenges being management of scope could be delivered everything we needed to deliver in a 10 month period? no.

soviet-backed to the drawing board a number of times for the october 1st time frame to refer functionality to the later months that we knew would not impact our customers and ultimately that came back around with the key decisions made. >> argue trying to improve these deficiencies in your system? >> every day. >> all they have two minutes 57 seconds. >> very briefly. when we address. >> the timeline is the big issues. >> was it for everybody else? >> yes. >> i was not there but my understanding is yes. >> consumer misinformation

with the affordable subsidies is a huge challenge this is an educational message working with 12,000 agents without reach challenges we address. you have been there one year now? what did you do before that? >> i was in the infrastructure business with the gas utility in hawaii. >> did you see this had not had to be addressed? >> absolutely dog if you take back to the ticket and california model to rule that out gradually refer started to make airline reservations you cannot even

get a seat assignment how we can order everything. >> and it cost extra for those umbrella drinks. [laughter] yours state had a lot of issues watercolor do lehigh. >> we have made tremendous progress and they have been rolled with relative these we have a strong third governance process and procedure in place. >> as i mentioned earlier

hoped to have direct responsibility for the exchange functions of 90 days. >> q would fix a whole thing? >> yes. >> that design transferring to raise state agency was the most significant step to put this on the different paths we're now laser focused in a functional way. >> i yield back. >> your recognize for five minutes. we're talking about the state exchanges today we were arguing of the federal system was ready to be enrolled and noticed with your written testimony i am pleased to say as of june

june 2015 our independent verification and contractor river the only state pays to change to have the blue print testing scenario providing third-party validation with the working i t system may be stiff they can pass the same type of test it is interesting that hawaii passed it that not withstanding a 10 year plan to give finances in order in june, the governor decided to shut down the connector with $205 million of the federal establishment rand dollars. that is the money to get started. >> there is only for

140 million we don't have plans to spend all of that. >> where does the of money go? >>. >> dan touche shutdown the system. for the fiscal year policy 2016. >> given the of reach as we use healthcare.gov. >> how much? >> i will provide the exact amount but it is about $7 billion. >> to have tens of millions is that the state of hawaii? >> it is not drawn from the federal government. i appreciate that. is a white undergoing a rate

increase? and with the rate increase of the plans of 46% and kaiser has increased by 8%. >> which one is dominant? >> blue cross blue schaede -- blue shield as 85% market share and a cover the state. does kaiser? >> virtually some of the rural areas they do not. >> any other players? >> they're just not that many players. medicare advantage is there but the health plan for the average working person. >> you know, any states people have higher than the

46% increase? >> i do not but there is no well-balanced insurance community 50 years in the making. when the affordable care act policies were introduced insurance companies experienced negative selection of a tiny state with a fragile economy we don't have national players we need that extra protection to provide us a tonight -- as a net. with a small economy like ours. >> you have indicated their rates for our most affordable plans it in my mind a former practicing

attorney don't tell me about the others today get an increase? >> all of the plans on and off of the exchange have to have the same rates. a the benefit or the state pays marketplace has allowed for the exchange plans to be more competitive as well. >> the plans are flat and other plans are not? >> is that the way i read that? image there will always be plan of when you get into the platinum group. >> my time is up but i will note you're not claiming that claims went down to to

$500. >> eight you mr. chairman into the witnesses i will not talk about rainbows if unicorns we prefer to talk about thoroughbreds in the kentucky. because kentucky has had one of the truly successful and mostly problem free experiences with the affordable care act and his team deserves a lot of credit. with the first morning of the exchange we have been problem free. we have injured more than 500,000 people under the affordable care act through our exchange and expansion of medicaid is the two years of operation. the state of 4.4 million. to reduce the rate statewide

in my district by 81%. they're only slightly less citizens that are uninsured that was all will less than 3%. how that happened was because of the of reach to connect people to the county fair and the help center where people gathered there for their. and has been so successful that one senator suggested we try to expand the exchange to other states so we may be coming after your business pretty soon. additionally, this year we do have insurance companies

budget of sixers seven bin thousand tauruses sold of market is expanding and most importantly, earlier this year the governor commissioned a firm to do an assessment of the economic impact of the affordable care act would be over the next five years and deloitte said it would create 40,000 new jobs with additional economic activity to have a positive impact but the connect operation has been very positive an incredible increase for breast cancer increased by 111% and

colorectal cancer screenings and physical exams are up 187% but this is not as important as the human impact of a light to read a letter from one of my constituents. she wrote my daughter is one of several young adults on our insurance policy and tell she was 26 years old is still unemployed and looking for employment. january 9, 2011 the aca saved her life one of the kidneys shut down and almost went septic if not on our insurance schumer avoided are not have gone to the hospital doctor said she would have waited one hour she would have lost a kidney or died. that is with this is all about to provide quality affordable care to our citizens.

and i am very proud once again of kentucky and the progress we have made and we thank you for the work you we're doing in your respective states as well. ultimately to be a true success story of congress and a new way to insure americans thank you for your work and your testimony i yield back. >> thank you first of all, for doing when you can on behalf of citizens in this state that you represent to have access to quality care is not a question i also agree the state's should have more flexibility indiana used in the and the plan using a combination of federal funds as well as state funds from hospitals that agreed to kick bin to do have state coverage with

a state based program that is working. this data for again was awarded federal tax dollars and did they spend all the money? >> a little bit less than the full amount but there was some unused grant funding. >> battle led to cover or again? >> was all used to establish a health insurance exchange that the grants were to partially cover. >> so it wasn't spent on anything else other than to establish cover organ? >> correct. >> could you give us an itemized accounting of the $305 million? is that possible? he has agreed to provide the committee with expenditures

to mexico the we get one page with four things but we would like to have the detailed ionization of where the money went would be great. also there are a lot of good things happening out there and a lot of things that need to be changed what percentage of your people are on silver plants or above approximately? >> 75%. >> so then they have no deductible for primary-care. >> even with the bronze plan in california even with bronze they get three visits to primary or specialty care not subject to a deductible in addition to do preventative care. >> 84 that clarification because you said silver and above and your testimony. i am understand the private sector plans are still there

but federal subsidy should -- subsidization compete with private sector makes a hard for the private sector to compete is part of the issue. approving a 22 percent hike is that correct? >> yes. so is it true mr. gutierrez is that at some point massachusetts had to put 300,000 people into medicaid are they still there? when you were working to establish the exchange with the template of your web site has had issues i assume that has ben resolved and i assume they are out? >> all temporary medicaid members have been predetermined to qualified health plans or to medicaid.

>> great. >> do you still have a backlog of 180,000 renewals and the system? >> we do not. that has been resolved. >> despite additional funds minsure continues to struggle. the goal is to figure out to make of blood dash improvements but minnesota and ausable river to the old system for minnesota care because of minsure problems? >> it is true for a short period of time we have prioritize that functionality for the beginning of 2016. >> and n y you are totally turned over to the federal exchange i have you extended it october 2016 but it was shut down due to insufficient funds but now it is extended?

>> the of reach will extend through open enrollment than the corporate affairs will wrap up and it will take through october to do the accounting. >> i yield back. >> let me thank though witnesses for joining us today to present good information. i know that some state based marketplaces have challenges to manage their platforms their well-publicized but what is less well-known perhaps is the efforts that the state based marketplace has to tailor that aca to its own citizens. what is the state pays marketplace doing to ensure that consumers culturally

with appropriate reach as well as health care? >> that is the question that landed with us with the rate of uninsured to be relative lease of a harder to reach. we have made the decision to move from a wide media broadcast advertising from what is community partners and organizations and communities of color to be more technology that work hard to those demographic populations that are the hardest.

>> what we learned in minnesota the injured are harder to reach that are remaining. those who work in every community to reach out to the population to enroll them and we are proud of that. we compare them with enrollment centers around the state and we have learned it isn't an easy decision to refocus resources. >> the three principal items the media strategy is focused on the ethnic media dealing with the hispanic portuguese communities around the state better underinsured and second our

selection of navigators to target to the under dash served communities that there is the programmer massachusetts has the state insurance mandate the department of revenue knows who does not have insurance but they would not share with us but they are on our behalf to begin the state based marketplace. >> we changed that outreach model to a personal model to speak the 5920 languages over dialects and to call from my personal of reach in

those that lost their homes were then half with water to working members we help them to enroll in coverage. in to move forward with that social security model with depending on the needs of the individual. >> if you are sophisticated you can ogle onto the computer but the personal information is on the web site. >> with the of wide range of language but also it is unjust our reach budget cater that is culturally appropriate and contractor requirements in our negotiators to hold them to

account those are among nine nationally recognized to provide culturally appropriate care. >> we have been focusing all of the aldrich -- shot region to communities that we know that reside within the than the zip codes so we can go straight into those communities to work with those residents. >> i wish we invited us d.c. a stage because it still shows i am not eligible for coverage. states continue to opt out as they set up the state exchanges they migrate to the federal exchange but we need to try to understand the impact on that and to

know how sustainable the state exchanges are that are an existence so what can and taxpayers expect of its fiber 10 years and is that sustainable during that time period? >> we are financially sustainable at this point. the budget is balanced and based on real numbers in a real experience the board of directors passed a three year financial plan that looks out. so we keep a close eye on this. so our board and team is committed to living within our means so to make hard decisions we will. also in my testimony we have the bipartisan task force that is looking into some of

these issues to have a more "in-depth" conversation and we continue. >> the expense profile is high we will have to reduce that making hard choices but massachusetts is fortunate that the connector authority initially had the reserve fund also a dedicated revenue sources from our cigarette tax and the state insurance mandate penalties as well as the administrator fees. we have a set of funding sources and bipartisan commitment to the effort. >> from day number one putting money in the bank with $200 million with a strong balance sheet and

dave will be sustainable model. >> but compared to what health plans were enrolling previously, it is about 3.5% of the premium but it is very expensive them prior to the exchange coming along plans for spending 12% with commission is an acquisition. >> we have a fully balanced budget and within our budget as well. >> what is the impact on premiums interstate? >> the impact related to the assessment is similar to california we feel it has allowed the marketplace to level off.

. . >> i'm happy to do so. >> given the short amount of time and time for another question so i yield back. thank you, mr. chairman. >> recognize ms. castor for five minutes.

>> thank you, mr. chairman for calling this hearing on the substantial reductions in the rate of uninsured americans under the affordable care act. and thank you to all the witnesses here today in what you doing for families across the country. when i think of the affordable care act i often think, i think it's helpful to break it up into its pieces. first you had the consumer protections, the affordable care act brought. you have a piece on medicare. we strengthen medicare. and then you have the policies and strategies to reduce the rates of uninsured all across the country. so for consumer protections, the aca is working. we no longer have discrimination based upon a preexisting condition like a cancer diagnosis or diabetes. that has been a godsend to families. the consumer protections that allow young adults just a other pairs policy. i've heard directly from many friends back home what a benefit

that has been. and then insurance companies can no longer cancel you if you get sick. and there are others but that's an important piece. then under medicare, medicare is a stronger. we invested savings into lengthening the life of the medicare trust fund. we also are closing the donut hole, put money back in the pockets of our parents and grandparents through less costly prescription drugs. and then medicare is undergoing reform so that care is provided in a smarter way. but then it comes to the rates of uninsured, and it's pretty remarkable. this is important is willing to think about it for people thought we have insurance. because what the affordable care act has done is help people take personal responsibility for themselves and make insurance more affordable. that way you don't have this cost shifting to people that do have insurance. so the reason, recent census

bureau report said that since the passage of the affordable care act five years ago, 17.6 million americans have gained coverage, and the from 2013 to 2014 we've had the largest reduction in the uninsured rate in america in 25 years. and it's important to note that at the same time, the rate of employer-sponsored health insurance has remained constant because that was kind of, that was a question mark going in. so so far so good. i would like to thank you all for i heard today a little healthy competition among the states, how proud you are of some of the things you've been able to do. i heard my colleague mr. yarmuth from kentucky what they've done a fantastic job. mr. lee, congratulations since opening exchanges. california has provided a lifeline to so many families in

california to cover california, medicare. 170 uninsured rate in california and? >> the uninsured rate company on census figures, has dropped about 12% in future direction. one of the largest reduction nation but it's also a for me, you know it's also for people that have insurance or sing the benefit of lower rates to 1 million californians individual market that don't lie to us benefit from our two years holding rates down. your note on those benefits are not just for the uninsured but it's also for insured people that are in jobs that have insurance that have rates kept in check spent i'm glad ms. capps came in at this point so she turned directly after she worked so hard on the affordable care act and passage. how are you working to ensure that coverage remains affordable from this point forward? and meaningful for families spent one of the things we're doing is we're working with our 12 health plans to say how do you actually affect your rates delivered?

the end of portability is about delivering the right there at the right time every time. the movement we've seen in congress, a common movement, moving from blogging to value to something we're working with all of her health plans to change payment to promote primary care to make sure people with chronic illnesses if the writer at the right time and that needs to be the focus. one of the other congresspeople noted it's not just for getting people and insurance card is making sure people get the right care and the writers delivered at the right time to that's going to be the key for all of us reducing costs over the long term. >> mr. watley, we have a access health can here on behalf of access health, congratulations and thank you for what you've done in the when the rate of uninsured. tell us what happened to the uninsured rate in connecticut and but this is meant for your citizens. >> thank you, congresswoman. the uninsured rate in connecticut has been cut in half just in the last two years.

we see that will continue to go lower. so that has been very exciting. what i put also said it is our next come it's what our next step, similar to what mr. lee has said. it comes down to how do we start working to help despairs kent wells complexity primary care physicians. those are some of the goals we're working on right now as working with the residents of connecticut. >> thank you very much, and i yield back. >> we have an agreement to mr. walden will be able to go next in order. without objection. thank you. >> i thank my colleagues for that. i know ms. degette as each of you if those of which are exchanges and all wisely and you just because it's never easy to will one of these out. i just got to go to an organ specific issue. i'm going to ask each of you to put a highlight o on this. did the governors in your states use their paid campaign political visors to craft official to mitigation and management strategies for the

rollout or determination of your exchange, yes or no, mr. wadleigh? >> i don't know the answer if our coveted that are not. >> mr. leahy? >> i have no information about on the governor uses his staff. >> now to my knowledge by the governor is very courageously taken on the burden of this exchange embedding it in all of the departments. >> mr. gutierrez? >> not under the current administration. >> ms. o'toole? >> i have no information about that. >> i think mr. allen the potential of the to this question in oregon. >> i was not directly involved in the management or operation of exchange at the department of health direct experience with that kind of involvement. >> kodansha on your part. i want to introduce, to into a series of newspaper articles that were acquired, investigative reporting that was done that could indicate that our governor at the time used it

outside political campaign staff to manage and coordinate messaging on covert work in. it may be worse than that based on e-mails made available from for you. i think it's important for the e committee to know as we investigate what happened to this money, what happened behind the scenes, apparently, in our state of oregon. and so, mr. chairman, without objection of like of those entered in. >> without objection. >> mr. allen, due to how close to completion cover oregon was when they pulled the plug on it? >> i don't have direct knowledge of how close it was to completion. i do know as there is on the record technology assessment report provide to the cover oregon court at the time that the decision was made whether to move forward with that infrastructure i moved to the federal marketplace that indicated where they could choose to maintain the existing infrastructure it was already failing to meet benchmarks

necessary to be available for open enrollment in 2015. >> my understanding is it's about 90%. >> i would have no -- >> you didn't ask, okay. how did oregon inform to migrate, give any knowledge? >> i don't have direct knowledge. >> i know we've only been on it 90 days but is what some point. do you know who oregon worked with or scholarly working with at cms either during this transition? >> assure. we've been in most close, most closely working with myra alvarez who just recently departed. semester i've had close contact with kevin as we dealt with this transition issues updating them on transition as well as dealing witwith site visits and those ks of things. >> wicked cms require oregon before allowing it to migrate to healthcare.gov, tw the units

because i don't have an edge on the. >> was there any forensic analysis on the cover oregon or are they now? did they conduct an audit of their own? >> we did recently have an audit on the ground by cms about three months ago, and i should make a comment i did not, i simply did not use pashtun 2015 operations. there are two minor elements that were identified in the audit. we're working to resolve within a. i would not get addicted to anything i'm aware of as forensic. >> will that audit be made public by the state when it's completed or by cms? >> i believe by cms. >> i'm sure the committee wouldd like to access private data from data from cms or oregon. you know if cms require oregon to return any of the $305 million originally awarded for the establishment of the speech other than the potential couple of minor items, no, i'm

not aware of it. >> did oregon enter any additional cost when it migrated to healthcare.gov, do you know that? >> i can get back to you. >> i realize equipment at this conflict is have been going on for a long time and as you know it's dominated certainly the minds of oregon's out there. now that oregon is elected as to the georgia the federal exchange will it be an attempt to recoup any of the money that was granted to the state to establish a state exchanged? are you in any discussions about that? >> to recoup from whom i am? >> well, the 305 million. will cms comeback on the state? >> what i'm in a position to do so we been able to review the grand documents can $300 went for the entire operation setting up the health insurance exchange. technology is peace of the. i think of the gao report that identifies 70 million of the 300 for that function is my

understand where in compliance with and have delivered the deliverables required under the terms of the credit for the $305 million. i don't think there's discussion about return because we have complied with the terms of the grant. >> well, even though the exchange was never functioning? >> technology didn't launch but were able to cover 70,000 people in the first year despite the. 100,000 people -- >> did use the exchange behind the curtain with paper input? >> it was a hybrid paper automated process spent sorry, mr. chairman, of conover. >> in terms of an audit you said, hhs our cms require an audit into how you spent the money, mr. alan? >> we are required -- >> to report. are in a few required by the federal plans to give an audit of how you spent the money? >> is my understanding that we are required in massachusetts.

we've had three straight years of clean third party audit. >> i'm just curious, is required by the state or the federal government? is a federal government, ms. o'toole? >> we are subject to comprehensive oversight both in minnesota by our state and -- >> yes or no? >> yes, federal government. >> mr. gutierrez, yes? mr. kissel? >> that's a guess, but there's a detailed self reporting and certification and auditing, but it relies on our records. so they don't go to the next love and look at our contractors records to be sure that what we say has actually been done. >> mr. leahy? >> yes, there is reduce both by cms as well as by state level of our spending. >> mr. wadley? >> same thing. >> ms. capps, you're recognized for five minutes. >> turn one.

states created and run their own state based market places are testing new models for enrollment come insurance market oversight and consumer protection. serving as hubs of innovation. the work being done can serve as a model for other states and the federal government as the ac continues to be implemented. mr. lilly, telephone has been a leader in the quote active purchaser model. can you explain what this is and how does this help california, cover california usher access? >> thank you very much, and thankfully leadership. three things that underscore by being an active purchaser. we don't take everything that wants to knock on our doors and be a part. we do think critically and make sure that the networks an in ple a system to deliver called it care. second and will close at the rate to make sure that the rates aligned with the quality of care we expect of him. and, finally, we pulled into account for delivering quality care. that's all in the context of what we have which we think is

critical and so my colleagues have similar things which is stand to benefit designs where right now in may parts of the nation consumers may buy the lowest cost plant and then find out they need to spend $3000 deductible before they get too. that doesn't happen in california baker standard benefit designs for both on and off exchange in the individual market we are reshaping the market to benefit designs are designed for consumers, not for health plan. >> does access connecticut have a standardized benefit package? how does it help consumers? consumer? >> we do. thank you for the question. we have a standard plan designed for all of our individual gears and what we found is that it makes it easy for our residents to compare apples to apples for as prior to this there was much more difficult to compare plans. >> one of the focuses of the ac is to confirm delivery system and improve quality care. as a nurse i find this goal to

be incredibly important. bottom line really. a special as we reach the goal of transitioning from a fixed care system to one that promotes wellness. what efforts have cover california taken to improve the quality of care through better coordination, payment reform or other initiatives? >> take you very much for the question. when we released our rates which are only a 4% increase we didn't just release the rates. we released background on how our 12 plans are doing better coordinate care using telehealth come addressing wellness and prevention, addressing health disparities in health equities. these are requirements in our contract with her health plan. they're not just putting products on the south. they need to t deliver on the promise of care we think that something off exchange the look at to make sure it's not just a car in the pocket of people are getting access to get that is being improved speed and let me put it to each of you briefly. if you have something to add come chiseling get it on the record about initiatives going on in your individual states if you want to add.

go ahead, ms. o'toole. >> thank you. a lot of this, several experts but one thing we're going to go in minnesota is where adding a comparison tool. someone mentioned earlier about premiums are just one part of the cost of care and so we're trying to get consumers more robust picture of like out of pocket costs and other costs that go into the care so they make better choices for themselves. so to be a new feature on our website for open enrollment. >> any other examples of initiatives? >> i would adequate make you a 120 different plant options for consumers to 11 companies in the market is relatively small as oregon, that's an incredible range of choice which becomes a problem for consumers actually. action. we are relying on pages and assessors to people through that decision-making process so that they don't go to the lowest price plan when, in fact, their own circumstances they really dictate that higher monthly premium but lower deductibles or

co-pays would be a better option for them. >> are individuals opting to use those ancestors speak with yes. >> anything else? >> i was a connecticut similar to the rest of my peers. we're doing something you this year working with all of our church equipment with them to start collaborating on how we can help improve health leaders to with all of our new customers that pre-visit the uninsured. and similarly we have found that when you a comparison tool to help our customers get the right. versus the lowest price. >> and 17 seconds, mr. lee, what, if anything, is cover california done to encourage the right there at the right time? that such an important area. >> the one thing is what a partnership with our plans to promote was called choosing wisely and each of which is led by the clinician community to make sure patients don't get unnecessary care but i'll get the right care.

that's the one i highlight. >> thank you. you back. >> now recognize mr. collins. >> i want to thank the witnesses. it's been very educational. i think we all know everything we're all working on is a work in progress with differing results and nothing from any other states, it's interesting to hear what you are saying. i'm from new york. we received 575 million to set up our state exchange. but somewhat disappointingly, quite, the inspector general of hhs last week revealed that other randomly selected number of applicants on our state exchange, that it investigated 62% were either improperly granted subsidies or the application was deficient in some of the meaningful way. the most prevalent problems work inconsistencies in reporting their eligibility data and their income.

the website didn't seem to question if those and applicants receive subsidies that frankly they were not entitled to. so before i get back to some questions about we also just last week and ensure called health republic of new york which is a new york city-based insurance cooperative endeavor significant player in our state exchange the special up in western europe were to represent was directed by state and federal officials to stop writing health plans effectively shut down because they were not solvent. which means over 12,000 people in western new york which i represent are going to lose their health plan. here is the problem with health republic of new york. as an insured under the ac that company received government assistance to cover startup costs in return for providing more competition in the marketplace. but as you might suspect their policies were not with the market could sustain. they cost little and gave away

too many benefits. these plans sucking unsuspecting new yorkers by wasting taxpayer money and distorting the health insurance marketplaces. these new yorkers now have to find a new plan with staggering price increases that reflect the real rate of coverage with the ac mandated benefits. and while i know know the represent new york, i'd like to know have your state exchange is been audited like new york does was by hhs where we found is 62% error rate? and again subsidies being given that were not based on eligibility of income, and if so what did your state, i know mr. allen who may not -- >> we used the federal platform. >> just skip you. ms. o'toole? >> and two congressmen. not to my knowledge. i did see that report so i'm generally familiar with what you talk about. not to my knowledge. i just want to note that we

obviously take compliance very specific we have a robust team has worked on that, and making sure that only eligible minnesotans are controlled through mnsure with a focus. >> that's a we would hope for. [inaudiblmr. gutierrez? >> not to my knowledge but we have a validation program for elderly system. >> mr. kissel? >> we have not been audited a we have come with a small community and since everybody has by phone number we are self audited in that respect. the inquiries did was went from the thousands in 2014 down to a few dozen and 2015. we did have a problem, and i think it is largely been resolved. the 295 irs reporting process for us went very smoothly with fewer than 100 overall issues and to than two dozen financial

issues. >> mr. lilly? >> cover california has been the subject of a range of both oig, gao, hhs audit images of an album practices. we must all of them will find opportunities for improvement but by large that we been complying with the rules and setting been in place better and better each year. >> glad you're california is doing better than new york in debt. mr. wadleigh? >> thank you for the question. we have had multiple objects from the g8 oh and we also take all those opportunities to improve our system. >> thank you giunta pickup time from of the question, mr. chairman, so i get about. >> recognize for five minutes. >> thank you, mr. chairman to apologize i was at another hearing. mr. allen and mr. kissel, i guess the question for both of you. do you know whether cms permits

the establishment grant dollars to be spent on the transitional costs to healthcare.gov? if you can what transitional costs are, mr. allen speak with i do not know the answer to that. >> mr. kissel? >> yes. we have submitted a transition budget, and i've got to check on the status. i believe it has been approved. these are for the enrollment of new members in healthcare.gov. it is for the decommissioning and archiving of our existing technology, and certain other items including approximate $225,000 for the program management organization that the state has retained to manage the transition of our function into old healthcare.gov ended to the state departments, the operative department. >> was this a written policy if you know that hawaii is using

come you are using the money, correct, from establishment to transition. >> correct. >> was this a written policy or something be negotiated? >> i don't know whether it is written but i do know that we've agreed on it with cms. >> do you know what was the basis for that agreement? why did cms say that you could use the establishment of dollars to transition and what was the rationale? >> i can't speak for all of their decision because it covered technology, cover a large number of issues. into force outreach it is only to enroll new members in healthcare.gov. we are bearing the cost of re- enrolling our 38,000 existing members into healthcare.gov. that's coming from internal state funds. >> and deeply deficient be permitted on this is beneficial to why, correct?

>> let me answer the question by saying in hindsight we are learning an awful lot. had the regulations way too small business health options in place, hawaii never would've had to undertake to build exchange to support the pre-health care act and harmonize it with the affordable care act. this is the kind of issue i think this transition will be later. >> and i apologize if these questions were asked, but why did your government choose to shut down the hawaii health connector? >> he worked extensively with cms, administrator slavitt, and they came to the conclusion jointly that because we were an independent reliable agency relying solely on issue of these are revenue, we couldn't get to critical mass to be self-sustaining. together decided to embed -- >> we believe the last few minutes of this hearing come and

take a bite to the floor of the senate where members will be debating a judicial nomination for the easter district of california. tomorrow the senate plans to work on the compromise bill with the house on defense authorization which that' that e programs and policy for 2016. live now on the floor of the senate here on c-span2. to orde. the chaplain, dr. barry black, will lead the senate in prayer. the chaplain: let us pray. eternal god, ruler of all creation, each day seems to bring more bad news than good. we hear about floods, bombs, murders, disunity, pestilence, and anguish. in spite of bad news, we continue to look to