doctor murphy five minutes for an opening statement. >> the committee began its investigation of the faith-based exchanges in 2015 and we aimed to understand why they correctly and effectively utilized billions in federal grant funding. the committee requested and received documents from the original state exchanges and over the course of two hearings we heard testimony from leaders and federal officials. our investigation found the centers for medicaid and medicare services cms wasted $4.6 billion in grants due to excessively careless management and oversight. disappointingly and despite the fact that four out of the 17 exchanges have closed down a very small and very inconsequential amount of improperly spend federal dollars have been recouped by cms. we were told a state exchanges would be self-sustaining by january 1, 2015 and afterwards from any continuous use would be

illegal, yet today every state exchanges still using federal money. moreover, some state exchanges went so far as to violate federal rules and use medicaid dollars to pay for an allowable extension. the details and findings are outlined in the report released yesterday september 2016. in addition to the work we've done the stat on the state exche subcommittee held a hearing on the co-ops and their costly failures. we examine the factors that contributed to the collapse of now 17 out of 23, with oversight mechanisms were used to monitor and the likelihood of the federal government would recoup any of the loans awarded. since the hearing in november, five more have closed leaving only six of the original 23 remaining and these have caused the taxpayers a quick total of

$1.8 billion. similar to the state exchanges committee investigation into the co-ops found they were disadvantaged from the start. restrictions to obtain outside capital and fall the premium stabilization programs need of financial stability near impossible. what ultimately contributed was the mismanagement and ineffective oversight as they failed on numerous occasions to assist when needed. recently hhs released a report that found the majority were nearing bankruptcy making it highly unlikely the remaining six were to pay back any of their loans. this will result in the loss of even more taxpayer money and leaving hundreds of thousands of americans displaced with insurance coverage. the details and findings from the investigation are outlined in the report released yesterday. the productive dialogue with the witnesses today i want to note on behalf of this committee

appeared deeply troubled by the findings of this investigation. ultimately, what we are seeing is the affordable care act feeling the american people. the object was to provide health insurance to those who could not afford it yet these findings proved that they are accomplishing just the opposite. hundreds of americans have been uprooted from their plans and left without any insurance coverage. both of the reports suggest recommendations for the legislative and administrative changes to address the concerns highlighted in the report. it is my hope that we are able to have an honest and open conversation about the reality of the legislation and discuss solutions rather than continue to identify its well-known problems. i think you for being here today and with that i yield back. >> of the chair recognizes the ranking member of the oversight investigation. five minutes for an opening

statement. >> thank you so much mr. chairman. i've been wondering about the affordable care act. do you know if it covers treatment for déjà vu? because there seems to be a mass outbreak when it comes to the aca. here are some of the symptoms. one, between the house subcommittee and the oversight subcommittee come as you heard that i'm the ranking member of, we had over 40 hearings on the aca since it became law in 2010. number two, we've been through six years of efforts to repeal and undermine the law. three, we have seen any number of administration officials, some of whom are sitting here today interrogated by hostile members of congress about their work to implement the law. at the same officials have been the target of countless letters requesting briefings and documentation of every single aspect of their work. but despite the hours and hours spent on these efforts, house

republicans have nothing to show for it. mr. murphy, my chair man on the oversight subcommittee just mentioned the recent oversight investigation hearings that we have had in our committee. instead of conducting good-faith review of these issues followed up by targeted bipartisan legislation to improve the law as congress did on other major pieces of healthcare legislation like the medicare part d. program that was passed by the republican congress some years ago. this congress has used its oversight powers to highlight failures over and over again while offering no solution. as we just heard from mr. murphy, we have had two hearings this congress on the state insurance marketplaces but again, we are going to hear today about how some states have struggled to set up exchanges and make them work as efficiently as possible.

as you heard, we had a hearing earlier about the co-ops and i'm sure we are going to hear today again about the fact that many including my state and colorado failed to the facing challenges. this isn't news. what would be news is that the majority would actually sit down with us and try to work out some solutions to help more and more americans get affordable and expansive health-care insurance. i am not saying that these issues are not worth congressional intention but what i am saying is it's time to stop having this dance over and over again, and it's time to start figuring out how we can fix the affordable care act. highlighting solutions are making important corrections and requires a willing congress and at this point my colleagues on the other side of the aisle don't seem to be willing to admit to the public about the

law has actually helped millions of people and it simply needs fixing rather than being repealed. now in conversations privately with me many of my colleagues on the other side of the aisle offered thoughts that perhaps we could work on this together in the next congress did in the meantime, all we are doing is having hearing after hearing and wasting a lot of time and money that could be spent getting more insurance to more people in these hearings. let me just briefly in the final remaining seconds that i have remind people of what the aca has done even with the fraud that it has. we have had historic reductions in the country. the cdc reported last week that the uninsured rate is at a historic low. the lowest that we have had in four decades. that's an accomplishment. since the passage of the aca, 20 million previously uninsured

americans now have coverage. this includes millions of young adults who cannot stay on their parents plans and age 26. i want to interject a personal note. my daughter francesca who everybody on the committee knows she just graduated from college. she's 22-years-old and is also a diabetic. she just left to teach in madrid to teach english for a year and she's on my insurance, and because of the affordable care act, she can't get thrown off of my insurance because she has a pre-existing condition or because she's over 21 and furthermore, we were able to get her a years worth of diabetic supplies before she left. there are thousands of families in the united states who are benefiting in the way my family has and i'm going to fight until the end to make sure they can keep these benefits and we can keep expanding it so that every american has high quality health insurance. i yield back.

>> the chair thanks the gentle lady and recognizes the chairman of the full committee mr. upton for an opening statement. >> thank you mr. chairman. so in 2009, the american people were promised a new health-care system, one that would give a one-stop shop to choose a plan that would be affordable, and of course at that time we remember the president saying you will have your choice of a number of plans that offer a few different packages that every plan would offer an affordable basic package. so six years later, the fact i thinisi think tele different st. major health insurers like humana united are leaving as many as one third of counties and seven entire states with only one carrier. with new jersey's collapse, 17 have now closed their doors costing taxpayers nearly $2 billion resulting in tens of thousands of americans without a plan. and today just 12 states are

running their own exchange. premiums are off the charts. competition is dramatically declined at all and al in all ae everyday patient is left paying for fewer choices. but every member has a name and each one of these patients indeed have a story to tell. caring for a michigan tells us she paid $700 for insurance, she and her kids are in the process of choosing between having a home or having health insurance and moving back with her folks. she said because of the affordable care act, my entrance is doubled. please, you have to do something to help the hard-working middle class in this country. she's paying $744 a month for a plan with a 3,000-dollar deductible. before the aca she paid less than $300 a month for her family's health care. my bet is she wishes she had the plan she had before. greg lives with his wife of 40

years and feeling the pain. he says it is a disaster and has been from the start. i think he's right. when this was sold, patients across the country were promised as many as 21 million individuals would get coverage through exchanges by the end of 2016. sadly even with the individual mandates the number is set to come in at about half. simply one reason why house republicans offered a better way to help patients get and keep health insurance. our solution puts patients first improves the quality of care, lowers healthcare costs, restores freedom and flexibility and also keeps patients on their parents insurance until they are 26-years-old and will not deny coverage based on pre-existing conditions. we want to leave the world and cures and treatments in our plan builds upon this work outlined in the 21st century act to help deliver cures now. recent nonpartisan analysis found that the solutions would

in fact lower premiums by ten to 35%, increase access to doctors and boost medical productivity all while cutting the deficit by nearly half a trillion dollars over the next decade. this ambitious plan one where nobody would be priced out of health care, everyone in michigan, and across america deserve access to quality and affordable health care. i yield the balance of my time to the gentle lady from tennessee. >> thank you mr. chairman and thank you all for being here to talk with us today. we realized that the affordable care act products is unaffordable and is indeed on shaky ground as the hearing title reflects. i will spend some of my time today talking about the special enrollment period. i come from tennessee. we know the special enrollment periods have a tendency to get

these programs into trouble. like a verification and delay the verification all of a sudden what you do is end up with a plan on shaky ground and without a balanced risk pool. so as you look at the end balance withi within these we wo drill down on that just a little bit. i do have legislation hr 5589, the plan verification fairness act that would get to the heart of this issue because it is a problem that worsens every single day and where you have not the appropriate oversight or due diligence, then you do end up with an end balance in these risk pools. so, welcome, we look forward to a hearing and i will yield back. >> of the chair thanks the gentle lady and now recognizes the ranking member of the full committee from new jersey for five minutes for an opening

statement. >> thank you mr. chairman. this will be the committee's tenth hearing on the affordable care act and while i continue to hope my republican colleagues will come to their senses and finally hold a hearing to work in a bipartisan way to improve the aca, unfortunately once again this will not be that day. it's clear the gop wants to repeal and continue to point out problems with the healthcare system in general without proposing any alternatives. and we are here today to discuss before reports on different aspects of the affordable care act two of which were only made available to the staff and the public on monday. one report on the conversion found that no wrongdoing occurred. the report simply found that the co-ops were in compliance with guidance and the principles when covering the start up loans. another report released this month examines health insurance market concentration in

competition 2014 finding that in a release tend to be concentrated among only a few issuers. however since the report analyzes the data collected prior to the implementation of the entrance exchanges, it doesn't shed light on whether they have affected market concentration. we will also be discussing a report that is a continuation of the investigation in which the gao used fake identities and documents to attempt to enroll coverage for the health insurance marketplaces and medicaid and let me start by saying that i will continue to be critical of the way the gao carried out this investigation. it's inconceivable to me that anyone would be skilled enough for motivated enough to gain health insurance coverage this way particularly since there's no possible scenario in which an individual could financially gain. even if someone were to obtain health insurance with fraudulent information, they would still need to pay premiums and any other out of pocket cost

associated to actually get medical services. nevertheless for the third year in a row, gao continues with this farce and created false identities and attempted to enroll coverage including the system remains vulnerable to fraud. republicans have translated this conclusion to be the sort of fraudulent enrollment is rampant in the marketplace and i think to use this deeply flawed report to try to say that people can get so-called free health insurance is utterly ridiculous in fact the gao fake shoppers pay premiums each month and didn't seek any health care. the report fails to answer two very important questions. it is a real problem and if it is how can we fix it and these are questions democrats are interested in answering yet once again they haven't provided the information and the identities of created this information could help the agencies learned from this work an and fix the potential vulnerabilities in the system. democrats care about the program integrity and oversight, but

once again i suspect it's not about oversight of headlines as i've already said it seems unrealistic that some of the most vulnerable individuals would have the desired time, money and expertise to gain coverage thway the gaodid and tf recommendations in the report is very disappointing. we in the administration relied on the gao for unbiased reports and recommendations at these fake shoppers provide neither. let me talk about the success because republicans will make you think the health care system was better off before. we can't forget that the uninsured rate is at an all-time low, 20 million more people now have health coverage and the vast majority are satisfied with their coverage and it's important to remember because of the aca americans now have access to the preventative services, kids can stay on the plan up to 26 and there are no lifetime limits on coverage since the enactment.

it is consumer protections that are new and every other with the necessary changes and adjustments but that's what is different about this that we haven't been able to make those changes instead of working together to make sure it works for everyone my colleagues on the other side of the aisle tried to repeal it more than 600 times and we met resistance at every turn. there are ways we can improve upon the successes expand access to affordable coverage and reduce the number of uninsured.

we just get a constant hearing effort to say everything is terrible everything stinks but if we have a suggestion i don't hear anything from the other side of the aisle whatever has been proposed and whatever we try to do to change the system and make it better which has been successful needs to be repealed. obviously i'm not too happy with this hearing but nonetheless we will continue. >> the chair thanks the gentleman as usual all the membermembers present opening statements. at this point i will introduce the panel. we have one panel and i will introduce them in the order of the presentation first the acting administrator of the center for medicare and medicaid

services, the deputy inspector general for audit services and the office of audit services within the office of inspector general u.s. department of health and human services and the director of the forensic audit and investigative service for the u.s. government accountability office. thank you for coming today we look forward to your return testimony each recognized for a summary. you are aware that the committee is holding an investigative hearing and when doing so has had the practice of taking tests under oath. do you have any objection to testifying under oath the chair then advises you that under the rules of the house and the rules of the committee you are

entitled to be advised by counsel. do you advise to be counseled during your testimony today? the response is no end in that case if you would please rise and raise your right hand i will swear you in. do you swear that the testimony you are about to give is the truth, the whole truth and nothing but the truth? >> the response is i do. you are now under oath and subject to the penalties set forth in title 18 section 1001 of the united states code. you may now give a five minute summary of your opening statement. the chair recognizes it for five minutes. >> chairman murphy, ranking members of the subcommittee's, thank you for the invitation to the hearing to discuss the progress we have made as a

country under the affordable care act as well as key priority is for improvement. with the enactment of the law we have taken a significant step together as a nation to provide for the first time access to quality care to all americans regardless of their health or financial status. for millions of americans, this represents the largest shift in how our health care system works since the creation of medicare more than 50 years ago. as you all know well, medicare that has lifted millions of seniors out of poverty was launched amidst a great uncertainty and is succeeded by continually evolving to reflect the need of our seniors adjusting to cover prescription drugs, new modes of treatment and payment to support high-quality care delivery. i continue to appreciate congress's leadership on medicare's latest evolution and hope he can continue to work

together to fulfill your vision of a payment program that is focused on affordable high-quality patient care. undertaking fundamental change is rarely easy. from the outset we knew that like medicarwith medicare the in of the affordable care act would be a multi-year process. as we look to the fourth open enrollment, we are very proud of what we've accomplished so far. more than 20 million people now have coverage because of the wall. 8.6% is the lowest on record. first, cms is learning from the early years of implementation using data and feedback to refine the policies to build strong sustainable marketplace. their recommendations and input of the gao both together conducted over 50 audits and have been especially valuable in our efforts to strengthen our

controls. in this vein we've made improvements to the marketplace so that it continues to function properly, predictably and securely. this has included changes to the risksharing mechanisms, program integrity and eligibility rules. we are targeting bad actors who are using the marketplace and appropriately and we've significantly increased compliance with documentation requirements. our mantra is to continually learn and adjust. second, we stand ready to work with states to expand medicaid eligibility and finish the job of covering all americans. expanding medicaid is not only help slow income people gain access to care that helps reduce marketplace premiums for middle income families and the data shows marketplace premiums are up 7% lower than states that expand medicaid. third, we know the costs are a critical consideration both of purchasing coverage and for taxpayers.

the good news for the vast majority of americans is the affordable care act offers important protections to keep coverage affordable. even if premiums were to rise substantially next year with the vast majority of the marketplace consumers would still be able to do the plan for less than $75 per month and the good news for taxpayers is that we received these coverage games at a 25% lower cost than the cbo originally projected and this has also benefited going into 2017 independent experts calculated marketplace premiums are correctly 12 to 20% lower than the initial predictions. with the greater consumer protections caprotections than f course any conversation on the cost of health insurance is actually a conversation about the overall cost of care and value that we get for the money that was spent.

cms access and affordability for the 140 million americans we serve every day is critical. this is why we must work to keep medications affordable, prevent waste and coordinate care and why we have a special task force focusing on access to care in rural america where costs and the lack of competition have long created concerns. personally it's been very rewarding to serve cms during a time of so much transformation. for the vast majority in 25 years in healthcare it didn't seem possible that we would ever achieve a reduction in the uninsured rate or see the time that having a pre-existing condition didn't disqualify a person from coverage. as the marketplace continues to grow and mature we will continue to listen, and capabilities, adapt to serve. thank you and i will be happy to answer any questions. >> the chair thanks the gentleman.

five minutes for your summary. >> good morning chairman and ranking members green and degette and other members of the subcommittees. thank you for the opportunity to testify today about the office of inspector general's oversight on the health insurance marketplaces. as part of this strategic plan to oversee implementation of the affordable care act, we have completed a significant body of audits and evaluations by addressing federal and state marketplaces and other provisions. our marketplace oversight work focuses on payment accuracy, eligibility systems, management administration and security and data systems. my testimony today focuses on the most recent work which is the consumer operated oriented plans were co-ops and state marketplaces. regarding the co-op, we recently looked at the conversion of startup loans into surpluses. these are bond instruments issued to provide capital.

we conducted this review to assess whether they complied and the centers of medicare and medicaid services guidance and applicable accounting principl principles. we found that they generally complied with the guidance and applicable accounting principles when converting the loans into surplus notes. however, they did not adequately documented the potential impact of convergence on the federal government's ability to recover the loan payments if they were to fail. based on the findings, we recommended that cms improve the decision-making process for any future conversions to the surplus notes and document any potential negative impacts from changes in distribution priority and to quantify the likely impact on the federal government's ability to recover loan payments. following up on these recommendations, we are currently reassessing the financial condition to determine if any improvements were made in 2015 and 2016. we are also monitoring the

actions made by cms to address underperforming co-ops. this work is issued in fiscal year 2017. regarding our state marketplace work we recently completed a series of reviews to determine whether marketplaces have effective internal controls in place to ensure individuals signing up for health insurance and receiving financial assistance through insurance portability programs are eligible. we reviewed the first open enrollment period as seven state marketplaces we found the internal controls were effective, however most of the state marketplaces had some ineffective internal controls to ensure individuals were enrolled in a qualified health plan in accordance with federal requirements. with respect to establishment grant funds we are in the process of completing a series of state marketplace reviews. this work primarily focuse workn whether marketplaces allocated costs to their establishment grant in accordance with federal requirements. recently issued reports

determine to some states reviewed the allocation percentages based on outdated estimated enrollment data into the updated data that was available. based on these findings we recommended the state refund this allocated amount or work with cms to resolve the this allocated amounts. with respect to privacy and security in the state marketplace we have completed reviews of the data and system security and pride states that are close to completing the review is up to others. all of the states which we have completed reviews have implemented some security controls to protect personally identifiable information. however, vulnerabilities assisted in the states and each had at least one voter ability that if afforded could have exposed the information. states generally agree with the recommendations to improve security and in many instances reported taking action to correct the identified vulnerabilities.

in closing we appreciate the committee's interest in this important issue and continue to urge them to fully address the recommendations to the proven oversight anbe provenoversight l sovereignty of the co-op program and state marketplaces. they are committed to providing continued oversight of the programs to help ensure that they operate efficiently, effectively and economically. this concludes my testimony and i would be happy to answer your questions. >> of the chair thanks the gentleman 80 and now recognizes you for five minutes for an opening statement. >> thank you and good morning chairman pitts and murphy, ranking members green and members of the subcommittees i'm pleased to be here today to discuss the three recently issued reports on health care issues. this morning at the subcommittees request i focused my remarks on the results of the undercover testing of enrollment processes and related control used by the federal marketplace and the california state

marketplace for coverage here 2016. i note these results are not definitive regarding the entire application population. our work focused on identifying indicators of potential fraud vulnerability and risk for further review as a highlight. we discussed the results with cms and the california exchange, and there responses are included in the final report. in terms of what is at risk, the coverage covered a substantial commitment for the federal government. about 11 million enrollees have coverage of which up to 85% received subsidies. we estimate the subsidy costs for fiscal year 2017 and about 56 billion in total 866 billion for the next ten years. in this regard i would notify all subsidies are paid directly to in sugars, they nevertheless

represent a financial benefit to the enrollees in the form of reduced overall cost, but his premiums and deductibles. turning to the coverage in 2016 results, we initially obtained subsidized qualified health plan or medicaid coverage for all 15 fictitious applicants. in doing so, we successfully worked around all primary enrollment process checks namely identity proofing, submitting documents to clear inconsistencies and filing tax returns to reconcile subsidies. they subsequently maintain coverage for 11 applicants to the presents that is well into the coverage here even though some had not filed tax returns are submitted documentation to clear information inconsistencies as required. the subsidies totaled about $60,000 on an annualized basis. we failed to maintain coverage for three applicants because of payment issues and for one

applicant whose coverage was eventually terminated because of intentional failure to submit requested documentation. these results combined with those from our earlier work involving coverage years 2014 and 2015 form a consistent pattern of three principal inter related indicators which we are pursuing further during our ongoing related work. first, no year on year changes in the enrollment processes and controls are appearing suggesting that these remain fundamentally vulnerable through fraud and multiple points along their entire spectrum front, middle and end raising the overall program integrity risk for aca. second applicants intending to ask fraudulently to obtain coverage which they are not otherwise entitled such as the fictitious applicants could exploit the enrollment process and its various accommodations

such as deadline extensions and relaxed standards for resolving inconsistencies to their advantage and maintain policies virtually through the entire coverage here. third com, even if such applicas to complete our flag and you'd lose their coverage for administrative compliance issues, they are able to apply for new coverage the following open the season as allowed by program rules thus engaging essentially in a form of health coverage arbitrage. in closing i would underscore that a program of this scope and scale is inherently at risk for fraudulent activity and accordingly it is a sensual that a high priority is placed on implementing effective enrollment processes and controls upfront to help narrow the window of opportunity for such risks and safeguard the government a substantial investment. in this regard by cms told us that it's responding to age recommendation we made in our

february 2016 report and if executed well and sustained, this represents a major opportunity to address the vulnerabilities that we identified in the reduced risk and enhance program integrity. the chairman pits and murphy this concludes my remarks and i look forward to the subcommittee questions. >> the chair thanks the gentleman and i will begin the questioning and recognize myself for five minutes. let me say in the beginning, it's been a great government watchdog for taxpayers and while the undercover enrollment testing for the exchanges is thorough and helpful, troubling to learn just how bad the vulnerabilities changes remain. your testimony offered a preview of your agencies findings. let's examine the numbers and talk about the fictitious scenarios. as i understand, this is the first year coverage eligibility must be verified to determine whether an applicant who previously received in exchange plan filed federal tax returns

is the correct? >> yes that's correct. >> the gao tested fictitious applicants that you previously used for the planned year 2014 now of the 15 applicants that you attempted to gain coverage for all 15 were initially enrolled in plans. it's my understanding that still today ten of these fictitious applicants are receiving monthly advanced premium tax credits and about $1,100 a month and all ten qualified for cost sharing reductions or csr payments. are any of these ten fictitious enrollees false applicants you used in 2014 who never paid federal taxes? >> four of those are revived identities from the work. >> cms announced that the subsidies would begin for 2162

received the 2014 but did not reconcile the payments on their federal taxes. and one of these fictitious cases, a federal marketplace represented and told of the enrollees thetheenrollees they d for subsidies but after the fictitious enrollees verbally tested that they had filed a return to represent the approved subsidized coverage even though it was a false attestation, why doedoes cms allow applicants to solve the test to this safeguard designed to protect the premium credits? >> thank you chairman pitts. and thank you for the work that you all have done. i think with respect to the people who have failed to reconcile and have received an advanced premium tax credit but haven't yet filed, many of those coming and i work with them for

filing taxes for the first time what happened is when they came back to get coverage in 2015 if the irs didn't have a file for them that they filed, they were not able to get coverage. we did allow people to test if they had an extension or filed taxes and claimed that the irs hadn't received them yet but that's not where we stop and i think to the heart of your question we had 19,000 people who so tested and many of them have demonstrated that they have paid their taxes and as of this month, those that have not yet demonstrated that, the people will be terminated from the advanced payment. >> how many individuals have had it due to violating the safeguard? >> as of this month it will be several thousand. i don't have the exact figures. >> the irs expressed concern to the agency about this and also point out that in february 2016 the report from the gao

recommended that they conduct a risk assessment of the potential look strange. has cms conducted a risk assessment of the application eligibility enrollment process? >> i'm not entirely sure what you're referring to. they did give us a wrec wreck ie nation earlier to create a risk assessment framework through which we assess all of the potential risks through the exchanges and we have indeed implemented that and it's been extremely helpful. >> can you provide the committee with a copy of that report? we will get that. >> we now have three years of undercover testing. the results have not been proved and i know i speak for taxpayers across the country when i say this is frustrating and alarming and i will yield my time to cathy mcmorris rogers.

>> [inaudible] our state insurance commissioner recently approved premium increases for 2017. on average they are increasing by over 13%. rating increases like this are being seen across the country and they are far from a affordable. i affordable. in my state to go from 4.6 to 22.75. i want to take a moment here to thank my colleagues for their efforts to come up with common sense solutions to ensure americans will have access if we must respect the relationship between the patient and the doctor. >> we recognize the ranking member for five minutes for questions. >> we thank the witnesses for being here today for the work you do. let me talk about texas under

the affordable care act millions of americans were able to access vital healthcare resources in the communities and my state texas relies on the following benefits during the last enrollment appear co. over 1.3 million individuals selected a marketplace plan. 48% of the individuals were new consumers. unfortunately 1.2 million individuals who would otherwise be covered remain uninsured because texas refused to expand medicaid. as i said earlier 50,000 of the 1.2 million are my constituents. as of 2015 the aza provided community health centers with over 470 million in funding to offer a broad array of primary care extended hours operations and hire more providers and develop clinical spaces. medicare beneficiaries in texas saved more than $971 million on prescription drugs because the affordable care act and the closing of the doughnut hole that was created in 2003

medicare part d.. i'm proud of the progress we have made with the aza and i couldn't be more pleased with these results but congress could make it better by stopping the dozens of efforts and help provide more health care for our constituents. regardless whether you support six years ago when it passed into law it's hard to deny various historic success. premiums before the affordable care act was passed the entrance system is broken. premiums are increasing rapidly. for example in 2009 and 2010 according to the kaiser family foundation survey, the average increase in the individual market premiums for individuals were covered for more than one year was 15%. under the pre- aca system there were no protections for consumers and insurance companies could drop them anytime. administrator, before the aza was passed, could an individual of pre-existing conditions be charged more for insurance than

his or her healthy peers? >> yes. >> before the aza was passed that insurers protect their bottom line by avoiding the six costly patients in the market? to yes in almost every state in the country. >> before the aza was passed was there any mechanism for the government to review health insurance rates to ensure the rates were reasonable and good consumers have any recourse of premiums went up 20, 30, 40%? >> not in most places, sir. >> was there any out-of-pocket maximum consumers had to shoulder, potential the tens of hundreds of millions, hundreds of thousands due to medical emergencies? >> there was not. >> let me give you an example. when i was in business, we had a printing company. we had 13 employees, and one of my jobs as the manager was to negotiate for insurance rates. small business, 13 employees, we could ever get one of the top companies to give us did, but we did the select coverage because

we also have a union contract so we have to match wit had to matn plan would have done. so we negotiated it would sign a three-year contract and with renewal opening in the premiums every year. well, in my experience in that come every year of the contract they would come in and offer 20 or 25% more. we would negotiate it down and ended up i almost had to negotiate every year with a new company. but my experience with 13 employees, one of the carriers said we need to raise your premiums substantially because one of your employees had a double mastectomy. he said what we would suggest if you kee would keep your group ae 12 people and buy a separate plan for the 13th employee and i said well i appreciate that option but that particular lady

is the owner's wife and i will be glad to share that you are willing to put them on the individual market and the negotiations got much better. that doesn't need to happen today because the affordable care act and that's why it's successful and it could be more successful with this congress would do like we've done every other piece of legislation that's ever been passed. something its past, you wait a few years and see what the problems are and go back in and fix it. but we haven't had that opportunity since we've tried to repeal it over the last six years probably sixtysomething times. but if you are looking for perfection you don't come to congress. we compromised, we work to get things passed. so whatever we past needs to be looked at by the new congress or the next congresfor the next coe sure we can fix it but the affordable care act hasn't been subjected to that because the repeal. i would love to see a plan that would actually help expand

coverage more than we've done. thank you and i yield back my time. >> i will recognize the chair of the subcommittee, doctor murphy. >> thank you mr. chairman. first, i want to ask you mentioned in your testimony that premiums have gone down in actuality or they are less than estimated? scenic i think what i said as is after 2016 the current premiums are between 12 and 20% lower than the going estimates and i can get you that. >> they are lower than they are estimated. >> if i just want to deal with the reality and not the estimates have you shared this information with aetna united because the fact that they bailed on the market saying this is out of control maybe you have a breakthrough that these

companies haven't seen. it's amazing to me .-full-stop costs have gone up. i saw one that had gone up about 69%. insurance premiums have gone up so they have people enrolled in the pages enroll them. copayments and that the bulls are still high. so i hope you can show us the source of this. i don't want estimates. i want hard-core data with regards to the premiums going up or not. all the data that we see they are going up and in the market they are going up and other communities they are going up. co-ops are failing because they can't handle the finances. unless something is heavily subsidized or old or a problematic health-care program, the costs are going up and that's why people are not signing up so it isn't a matter of -- i just want accurate data so we can deal with this. the committee report released yesterday examined the federal

tax dollars to the federal-based exchanges. federal-based exchanges. the aza states that the exchanges were supposed to be self sustained by january 1 of 2015 but cms gave them extensions that the basic exchanges could use federal money. so your staff tells me correctly as of september every state of the exchange is still using federal money. is that correct? >> to clarify no new money has been granted after that initial startup. there are states that have no-cost extensions that allow them to continue to complete the startup activity. >> and again i say when you talk about premiums being down, the fact that they are subsidized as phony. how can you have a premium going down if you're still subsidizing if we ourselves bailing out insurance companies premiums are not going down. it's being subsidized. so when do they think that it will run out for 2017, 2018?

>> i think that it will differ by state. we can get you the schedule of that. >> and that's when we'll find out the premiums. when the money runs out you think that the exchanges will be sustainable? >> each state has its own calculation either as people are probably aware kentucky decided to move off the state-based platform to the federal platform. i wouldn't necessarily say that was for reasons that were not sustainable. they just chose that they would rather be on the federal platform to them that state based. >> that is obvious getting because it's not just lets get together and switch to a different platform. it's because they've been financial disasters. let's go to the co-ops. you get 17 closures issuing an audit just a month ago found that four of the remaining six co-ops fell below the cms

risk-based capital requirements. if you think the remaining will survive to enroll individuals for the 2017 plan year? >> i think the assessments, and we will make it along with the states is whether or not the remaining co-ops have sufficient capital to get through. we've given them $1.8 million in taxpayer loans. so when you see sufficient capital, we have to give them more sufficient capital to help them? >> congress has rescinded i think 6 billion of capital that was due to the co-ops. so that's part of the issues they have. we have given the co-ops trying to level the playing field more options to raise outside capital and i think several of them may in fact do that. >> so the outside capital being -- >> premiums are not just paying for the plans indicating other outside sources to help bolster

the plan so it's not just shouldered by the people paying on the premiums am i correct? >> it would be the risk-based capital needed. >> back to my original point if they have risk-based capital coming in and federal subsidies coming in from anything you say that the premiums going down i doubt that is true because we are not hearing from constituents. the second thing if you are subsidizing it, any reduction is false. >> the chair thanks the gentle man and recognize the gentle lady from colorado for five minutes. >> thank you so much mr. chairman. i wanted to clarify about the gao undercover study that they did. as i understand from your statement, there were 15 attempts in three states to get into the system is that right? it wasn't actually 15 people, it was 15 attempts by the gao.

>> these are essentially -- >> yes or no will work. >> it's 15 individuals. >> so separate individuals? i thought there was one individual that tried in three states. >> that was to test identity theft. >> but 15 individuals in three states. >> correct. >> okay. now these were fake shoppers, not actual consumers, they were people getting in to see if they could do this? thank you. now an beast type of scheme is that report discusses, these 15 fake shoppers, they pay their premiums but then they don't get any health-care benefits, is that right? >> that's correct. >> and they didn't try to get health-care benefits and they just wanted to see if they could get the premium. >> that's correct, yes. >> i guess i'm a little unclear

about why somebody would do this in real life if they pay the premium and then not try to get health-care insurance so i guess i wanted to ask you do you know of any actual cases of real people who did this? >> i do not. >> so you're not aware of any widespread fraud of actual people trying to do this, you just know it could be done theoretically. >> we know -- >> thank you. now i want to ask you something else because i'm really supportive of efforts to rule out fraud in the system but i don't really understand how this is a useful exercise in the real world to see if someone could pay a premium, get a tax credit and then not try to get insurance. i don't think i would hav that n in the real world. so, what i'm wondering about is why this is useful but i'd want to ask about something else. and that is about this gao

report that was released by your agency on monday. we are handing you a copy of that right now. what this kid is looked at the experiences through the first year of the exchanges and it collected the consumer satisfaction information. it's entitled, and i'm quoting most enrollees reported satisfaction with their health plan although some concerns exist. are you familiar with that report? >> yes i am. >> so then you know that the main finding of the report is, quote, most qualified health plan enrollees contain their coverage through the exchanges reported overall satisfaction with their plans, is that correct? >> that is correct. >> i would like to enter this report into the record. >> without objections show ordered.

>> there's another piece of evidence that shows what we are trying to do here. we have one report that shows 15 people, fake shoppers in three states trying to do something that no real person would do in real life and have reports from the same agency on the same day about the satisfaction taken from large national surveys but that's not the subject of the hearing today. only the other thing that's not likely to happen in real life. and so, i just think we have to keep the record clear and again we have to focus as we move forward on fixing the aca. i just want to ask you a question about this new report in the data that shows uninsured rates are at historical lows.

the census shows that though 9.1% in 2015, down from 13.3% in 2013. is that correct? >> that's correct. >> the cdc showed a drop in the rate to 8.6% down from 16% in 2010 is that correct? >> that's correct. >> so it shows that there are 20 million americans who have health insurance because of the aca coverage provisions is that accurate? >> yes it is. >> the chair thanks the gentle lady and recognizes the gentleman from illinois mr. shimkus. >> thank you mr. chairman. welcome to the witnesses and this is a contentious issue and the facts are important and the data and customer satisfaction viewed by the constituents is what drives a lot of this.

under the affordable care act, if you like your healthcare plan will you be able to keep it, yes or no? >> if it continues to be offered, yes, if not you can switch -- >> so no you can't. the plan you had prior to the affordable care act is no longer available to americans. the plans available are -- >> let me ask the second question. if you like your doctor you will be able to keep them with no changes prior to the affordable care act and now. >> i think it's always been true physicians and health plans continually change -- >> there are limited networks so that is no longer true. our premiums lowered by $2,500 per family of four? >> i think if you are referring to the -- >> the promised by the president when he campaigned. >> the analysis is that it's lower than it otherwise would have been. >> been the answethen the answe,

premiums have increased. they haven't decreased. the promise was premiums on average would decrease by $2,500 per family. obviously premiums have gone up. then the promise was 80 or 90% of all americans insurance would be stronger, better and more secure. do you think that's true? >> yes. >> let me read to notes from constituents of mine who obviously are living it. and these are follow-ups from the august break. before this bill i paid $78 a month for my child. health care coverage premium and had a good plan. now i pay $167 a month and have a much worse plan with a high out-of-pocket cost. he recently got tubes in his ears, a common procedure and cost over $5,000.

that's why this is real to us and we continue to have problems with the affordable care act. ..

note >> >> we have the challenge and premiums are up and if you make this statement the premiums are not up then you disregard the fact of the coupes and deductibles are up. so premiums are going up that is not debatable but you don't talk about the deductible or the co-pay which make that unaffordable

for average n, americans under the health care plan and policy. what idiot consider to be a competitive market to what is your definition of competition greg. >> i grew up in eleanor. >> before the affordable care act. did we did not have a state public utility commissioner for health insurance only after words. we had a very robust and competitive market because our health insurance was driven by competition on the quality without intervention of a government bureaucrat trying to dictate the terms was. >> the uninsured rate of eight-point 8%.

>> argue disputing these numbers by. >> i yield back my time. >> >> thank you, mr. chairman but i continue to be amazed by the republican attempts and it is clearly not the case. and for republicans to repeal and undermine that makes health coverage reality who don't have coverage before. that the uninsured rate was from 2015 down from 16% and according to recent data of eight .6% of the first quarter of 2016 for the

first time more than 90% that have insurance for the states like texas by the ranking member mr. green. so can you put this in is an historical perspective? can you comment how different provisions have operated together quick. >> dinky for the questions baird my entire career i have not seen any meaningful reduction. but those numbers are gratifying and is a sign of progress. there are millions of people who live in states where not chosen to expand medicaid if they did it would be lower walker. >> there is no question we

made great progress from those that were previously uninsured but the remaining individuals may be harder to reach. but how many people are still not aware that they can go on the exchange with the subsidies? but in the last six months individuals have asked me when the federal government will make available health insurance to those who don't get it through their job. i said we have affordable care act if you are eligible for subsidy. this was less than six months ago. so according to some experts many of the remaining uninsured are not aware to

help the of purchase insurance. so how does that calibrate that enrollments strategy? and then my correct more than 80 percent of the consumers. >> most of them won in premiums are still not aware sabir extremely excited of the enrollment season. to have a significant effort by lot of that requires an in person assistance.

it is very complicated people are intimidated. and minister to for the prescription medicine so we tell people at the local level. >> i don't want to put words in your mouth but about reducing the amount of money that is available for this data exchange. and what they use for our reach but it disturbs me because it don't want to see that g.o.p. effort. and that will not run out to that money for that outreach.

>> so they will continue to have that money available. >> they typically have other appropriations. >> to address my remarks but last fall asking if you could get back to us why the premiums are so high in west virginia. the second highest rate in the country. and brcs still waiting on that short call because we only have one exchange we

see the premium increases continue to increase. i need that and thrive expecting that answer with a 24 percent hike in premiums. and then the approval of 32% in did the coming year as a small group trying to penetrate western gymnast being 49-point 8% increase and they will likely e get a. -- get it to. what is the incentive for the regulators in west virginia to hold down premium increases? >> that the irish trade has

dropped from 17 percent down at 7.5% but with the cost of health care enroll america and then in some parts of the country are areas we need to redress. to speak to the issue that you raise. and to a get back to the rebates. >> i don't know how that breaks down. if there is an incentive to hold that down to granted an increase of the 50 percent hike. maybe i would work my way through this but they have to have a subsidy a 600 the

who is working her husband just lost his job she was covered under his insurance policy so now she doesn't have insurance coverage in doc past he is retired on medicare she is 62 she does not have coverage. she said the would have had catastrophic coverage but i am not permitted some now have to buy coverage the cheapest is a hundred dollars $9,600 per year to pay then you will say we will provide a premium or a subsidy? >> ed don't know this situation before most people they destroy not guaranteed

access if they were of the 129 million americans. that is a critical levant's we think subsidies are important. >> i appreciate that. and how much rededicating the encumber co and help you can get back to me. spee9 that is a of a hospital complex that is trying to get a permit and it took them several years. and as a result to being held up for the of water or environmental permits it did not ocher until after

november 2015 and as a result to invest $30 million to lose 4.5 million dollars in revenue. so homage more flexibility can we have because if it is not of their doing that is the arbitrary date. i would like to hear if that has an impact that 4.5 million dollars will be borne by somebody else. and that doesn't have to happen if we have a little flexibility of that day. can you get back to me? >> and listening to your comments in this situation to understand the details. we will get back to you.

>> very soon. >> i recognize the gentlelady from california for five minutes. >> the affordable care act is a significant investment to improve the health of our nation i would like to highlight these benefits. web .5 million individuals have coverage for the health-insurance marketplace. there are 70,000 children in california that cannot be denied coverage because of pre-existing health conditions. the uninsured rate topped by six percentage points. and as reported the national insurance rate is at historic lows.

health insurance companies must spend at least 80% of premium dollars on health care or improvements as opposed to ministry of cost. or they have to issue a refund. more than 490,000 private insurance coverage but they are doing great things in california i am proud to see that the b.c. how medicaid expansion has helped to bring the uninsured rate to the current historic low. seven out of 10 states was the largest reduction of the uninsured rates. gallup also found the state's were less likely to see improvement that expanded coverage.

with the expansion states and on expansion states administrator d sync that will continue to choose not to explain and medicaid greg. >> administrator do you think if they chose to expand medicaid we could see that drop even lower than where it is now correct. >> between three or 4 million people easily to be covered. >> with the premiums on the insurance market to expand medicaid. and everytime one provision

with the republican colleagues and confirmed on those across the country it is important to put this into context. and it is a transition year for the marketplace. with a higher premium increases. >> there are two principal reasons. the law created one that expires this year so by definition that will increase premiums and second it is the fact in the first couple of years the price without having data they now have that data and in many cases and states to have the

justifiable rate increase. and once they can still mendez these market like tax credit to provide choices for consumers. so the majority can benefit from the financial assistance measures. administrator how are these tax credits with the opportunity to shop for rampant help coverage as the market stabilizes quick. >> as consumers learn the vast majority of them can purchase for $75 a month or less, that is astounding to them that they have never been able to obtain before in their lives.

with that fourth opened in moment we are eager in waiting for those benefits to come back. >> issuing a five paragraph memo on the risk corridor payments several insurance companies are suing in ministrations over the 2014 payments because the league collected 12 .6% of the industry requested to be made whole of the last part of the memo the agency wrote as a quotation where there is a litigation risk reopen to excepting a resolution to those claims. we're willing to begin discussions at any time''. cms takes the position that insurance plans are entitled to be made whole on the rest corridor even though there is no appropriation to do so

? >> we have police said there the obligation of the federal government. that is standard practice. >> yes? >> rephrase the question. >> does cns take the position insurance plans are entitled to be made whole even though the restore appropriation to do so i think jerry answer is yes? to make the obligation of the federal government. >> yes? seriously? deal intend to use the judgment fund to make the corridor payment plans? >> i would say i would not be comfortable commenting on any current legal proceeding >> with an invitation to a settlement?

are you intending to use the judgment fund? yes or no. >> again, this is a case before justice. >> see you are saying you turned this over to justice and the talk to the justice department? >> i personally have not. >> can you give me the names of the people that have spoken to justice about this matter? >> yes. >> i appreciate that. >> which are some cylinder indicate that they will because of the relationship to the risk corridor payments? >> absolutely. >> i appreciate that very much. you have not spoken to justice but do you know, anybody who just discussed

supplement plans with the department of justice? in mike our general counsel speaks redo a. so i assume that they have. >> you authorize that memo to create the imitation to settle prior to making an invitation. >> there have then discussions about how you will settle the u.s. soon dad it will. >> they are representing us. >> caddie had any conversations with your predecessor who was now top representative about the risk corridor situation? yes or no quick. >> no. >> prior to issuing a the memo did the justice apartment approve the memos

you released to settle? >> dave reviewed the of language. >> has cns spoken with any insurance plans directly or indirectly about a settlement of the risk corridor lawsuits? yes or no? >> cms has had inquiries that we've referred over to justice. >> day remember what they were? to make a can get you that. >> is a time sensitive manager -- a time sensitive issue. i heard a lot of people talk about the uninsured and of complaints with the obama carat is over insurance so with the co-pay and deductibles and two before the insurance they have to pay higher deductibles day

don't avi enough insurance with a catastrophic illness occurs, they find they have to sell off assets including homes. does anybody keep numbers on be under insured? they may have a plan not to but that shows the pilot -- despite the headlines the medium deductible was $850 a decrease from the prior year where it was $900 be met with the new river valley better average hard-working people of my time is up. i yield back. >> >> thank-you very much but

it does sound like the movie groundhog day. it becomes very peeved frustrating but the title of the affordable care act on shaky ground because republicans in congress and across the country have the authority to plant dynamite under the system that we are ignoring their progress that's been made, not only the number of people that have been protected since of financial loss for the unnecessary debt. >> the chairman's report.

>> gimmicks and jokes and up the exchange in kentucky and mischaracterized what is going on. you were here last time i asked unquestioned because the new governor promised to dismantle our exchange during his campaign. i said if you could the income of any way that any resident would be better off than the federal exchange? you answered you couldn't? between the time that they submitted the request to you that he would tease connect? >> not to my knowledge. it wasn't because of any way to provide service but.

>> while we had the most successful exchange with the most dramatic increase because of the expanded medicaid with more than 400,000 have coverage food did not have it before and now to make a proposal and he made a proposal that before he made the proposal that you told him what might be acceptable or not. imi correct greg. >> yes. we did have a dialogue. >> so he said the did that to you that i think according to the lawyer were

almost public k. did to reject on page 14 is not approved spew and just for you to react dismantled medicaid expansions in in kentucky and jeopardize many providers of scar i walked back and with those ideological reasons. and the point is there are a lot of problems that they call it to question the what they are doing it to seven irish -- sabotages why we are frustrated is set of operating positions, the

republicans have held hearings and an alternative is for you to where we were before rent. >> and he said the facilities to do and they have not proposed and going back to the pre-situation because the only but every complaint raised. >> but we need to be honest about the options available

to the american people and the success for the maxwell. >> i now recognize the gentleman from missouri. >> is it true that the current but you know, why he is not here proximity is traveling today. >> south carolina? >> that is my and standing. >> tri-care the idea where he was back of september 6th or 7th come at arizona to mysteriously to sell plans or but they would have been in arizona at the time.org you tell me if you having

never sure he has had. >> taken not tell you the dates but i assure. >> you don't know whether or not he has that conversation after the deadline question mike cavanaugh and knowledge of the dates. >> have you yourself? '04 connecticut it care. >> i'm not sure.

>> we will investigate you run not the dreams have holes but civic but you have to understand what gone -- what you're talking about. >> we do give them but for them to expend the instant the ins. >> u.s. stand of the deadlines they will have enough time to sit in but we will do the best interest

and two were former and that is the dedication and have hired there was a head and he said you have he put with that's 35 hour work week ago now as employer mandates but

for those who work more 921 fluff the food them to provide. they are retired teachers then assumes the -- the system and it may have it end at her age in and did this happened to his shirt but probably latticed to

like cow is the love and its >> thanks for the of witnesses to being near today. but it been has been very significant. by one to focus on how many you have been voters have in my state and californium have very if he and but it looks like the other major oil was ddt frist and fred and me for those that sign

up for insurance including over 1 million women and children. is important because we have serious and growing concerns and florida because of zika the current account in this a hundred individuals including 86 so we have to hundred 50,000 women from my state to have gained quality affordable coverage in the marketplace.

we have more than that that should be recovered if the state expanded medicaid. it is growing at the time of a public health crisis. >> but 3-point 1 million seniors are available for preventive health services with no co-payments and ticketing new vantage. 346,000 seniors receive medicare part that -- party discounts worth $306 million averaging $884 into the pockets of beneficiaries. it's interesting more than 38% and consumers this is something we worked on

bipartisan. >> we knew that they love to shop and they are doing that . but we have to work together to maintain the competitive marketplace is to have the ability to do that. they say an average $34 per year. then for the vast majority about 60% of floridians already have health insurance through their employers and it was interesting that the insurance premiums are now growing at the slowest rate on record? and. >> something we have to analyze to make sure this is the case of their own. returning to that challenge in the state of florida we have so many better falling into that gap. but it is fiscally

irresponsible not to expand medicaid and what we can do for mental health coverage. there is a new piece of data . medicaid expansion brings down the marketplace rates. bringing down premiums by 7%. what is going behind the pressure of the marketplace quick. >> for everyone here who has an interest of the affordability to eliminate those places where the of -- they are not covered but those who don't get coverage through medicaid find their ways on two companies in the marketplace and drives up

costs to needlessly so that is a critical priority. >> so we're spending so much money up to the central government as a partnership. we're not bringing those dollars back so what happens to those jobs? >> >> but there was an interesting study from kentucky a couple years ago that showed 40,000 new jobs of $30 billion.

>> the ladies yields black and to jack about the rating ratio pico if you're using five between 2010 benefits is one of the least expensive in my home state we did not even had a mandate regardless of their unique needs this has led to thicker insurance and driving younger healthier patients away from the market place in my view. the baseline has increased so the fact that the saves money may not be true and i don't think it is it just increased cost for younger people. including doesn't have an

immediate impact on the unclasped? >> i think they're based on two factors. >> retracting incorporations to your bathroom? they are about 4.eight times height. >> that is cost if you to get the costs selecting said did not see any steadies near the topic and the event

bastions of the buffer them to report under the claims and analysis section with the intentions of congress. so what we need is the appropriate representative example but it is impossible.

>> that they are responsible to work can with this but absolutely . um free ahern. i am very concerned from the community there forced to send patients but even a 2%

of cancer treatment would cost medicare in additional to madrid million dollars but the intent is to get the cost and expand it until we can resolve some of the issues. so the question is with the potential cost increase with savings from the program could expedite putting that together we were not looking for that exact feed the that consequences of that we touch. we will take the feedback. >> but i don't appreciate that if you have the analysis different than what

i suggested on the increased cost. if you can share that with my office i would appreciate it. i yield back. >> we now recognize said gentle lady for and abbas said dennis said he did - - subcommittee meriting. thank you for in. >> simon of favor of the the willy day moment. >> by enrolling in the insurance marketplace 195,000 people with medicaid received almost 180,000,007

prescription drugs because of the affordable care act and but to provide primary to over the wind went to to expanded decision to have a nd dna in but i am

encouraged by my but to talk about the chance and if -- prescription drugs. how has this aim maximum of or the cost the half because

fed but to increase transparency the road semple last year the medicaid drugs dash bordet details the price for many covered by medicare parts me and could he also the average in the call price cancer early and

the status it is helpful for those policy makers to get a better understanding of how drug prices are impacting public health programs and consumers. so why has increased transparency important and how does disinformation allowed to better protect medicare/medicaid and the beneficiaries wet. >> these are federal dollars we are spending. >> calving insight into what they spend their money on. because we cannot negotiate prices we think it is important that there is the ability of when there is a cost increase because in effect that is that the

heart for this hearing today does underlying cost goes up the insurance premiums go up . we are trying to bring more visibility rather than just a headline issue. >> administrator the last december oat issue report titled cms could not ensure the task credit payments made under the affordable can act in the report notes id stated they had advance premium tax credits based on the insurance companies

without verifying on the individual level. recommending the automated payment process to verify premium payments on a real-time basis. has cns instituted autumn of 81 dash automated payment process for the federal marketplace? >> yes are the state based exchanges using an automated policy? >> i have to check. >> please check doesn't have any plans to run the payment against an individual's who may have claimed cost in premium tax credits but not current on payments. >> i am not sure if that is even possible. >> and her stand the state is changes are not

participating i need clarification. does cns heavily la obligation to recoup advance premium tax credits? one big. >> i think it depends on the circumstances but it is under the province of irs. >> taiwan's more clarification please. as of zero ig tested the autumn of one dash automated process? >> not yet. we reported december 2015 with our follow-up on the open recommendations. >> when you be looking? >> as part of the work in 2017. >> it will be reported on some time during the first

part probably. >> i will keep track of that . when cms instituted a policy homage did you find enrollment reduced greg. >> add-on know if it was material but i will give back to you. >> again i want to follow-up so let's get together soon i needed these dancers. i will yield back. >> minnow recognize the gentleman from oklahoma to answer questions. >> thanks for being here i know we have done this before and of last time with

that repayment? reinsurance said. >> again that the time with the opening statement you said be mad at 500 million to the u.s. treasury from the targeted amount called deductions. >> have you made any payments to the treasurer? recollection date is november 15th december 15 they will make the payment after the next collection. >> have you made any payment quite. >> know that is what we make >> anybody?

>> company is? this year? >> i have to check. >> ee according to information we received you have made several payments to carriers and the famous was made right before the open enrollment. >> last year. spin mendez any payments to date been made? >> but the payment is made after the next collection. i can recall which. >> the reason is because this uh discussion, regis opposed to be paid to the treasurer pet said they should receive 500 billion not 500 million are you one

target? america recall that conversation i believe that isn't our understanding of the law. >> i know and i believe the interpretation seems pretty clear you decided to change that without notice. >> we went through a proper comment . >> and responded back to us howdy interpret the of law? >> i think it was not clear in certain cases. >> is seemed clear to us. >> is stated what to do of $12 billion was collected it was silent with the prior to is nation was -- prior jurors asian -- prior.

>> bed did you specifically ask for guidance flex there mike ably last reverie buddies guidance spank if that is the case and why is there a confusion? >> nobody in the comment . objected to what we put forward in the proposal. >> l. long kazakhstan for word greg. >> we have objected because we had this conversation with you so there has been discussion on your interpretation but this seems to us or myself that the payment made to the insurance companies is questionable without giving it to the treasurer and in the amount to hold the premiums down. it isn't working because in

oklahoma the only program we have left on the exchange is split cross blue shield they one of 42% this year and they're asking to go up another 40 or 70% this year. prices are skyrocketing across the country right now when we were told this program would cost or bring premiums down. i guess the question is your interpretation isn't working because it still cost us more and the treasurer is a receiving those taxpayer dollars. if it is a working them let's work together to change it so the tax dollars can be used in the appropriate way. i yield back. >>

. .