from more than $11 million in refunds. the affordable care act is doing great things in california. i'm proud to see that. we see how medicaid expansion has helped to bring the uninsured rate to its current historic low. data from earlier this year found seven of the 10 states with the largest reductions in uninsured rate for medicaid expansion states. gallup also found the safe if not expanded medicaid were less like late to see improvement in uninsured rate compared to states that are expanding coverage. unfortunately we see a widening gap in the uninsured rate between expansion states and non-expansion states. administrator slavitt, do you think that trend will continue to choose not to expand medicaid? >> yes, i do. >> administrator slavitt, if all

states chose to expand medicaid, do you imagine we'll see the uninsured rate drop even lower than what it is now? be my guest, three to 4 million people it easily would you convert. >> thank you. we know many other benefits including medicaid premiums on the individual insurance market are average 7% lower in states that are expanding medicaid. i'm hopeful we can see the uninsured rate drop and i hope more states do right by their citizens by choosing to expand medicaid. ..

that expires this year. so, by definition, that will increase premiums pretty meaningfully. secondly, it is a fact that in the first couple of years of the exchange the insurers price without having data what claims costs would be. they have the data. they priced too low and are receiving justifiable rate increases. good news, medical cost trend across the country are very low. once these one-time effects kick in, our expectation we'll see normalized continued low rate of growth. >> as the insurance market adjusts aca has other measures in place like tax credits to

keep premiums affordable and provide choices for consumers. my understanding the majority of current marketplace consumers benefit from the financial assistance measures. administrator slavitt, how will the mechanisms including tax credits and opportunity to shop around for different plans help consumers find affordable coverage as the market stablizes? >> when consumers learn the vast majority are able to purchase coverage for $75 a month or less in premium, it is absolutely astounding to them given the amount of financial health security they have never been able to obtain before in their lives. we think during the fourth open enrollment we're eager for people who haven't yet heard about marketplace and understand benefits to come back. >> thank you. i yield back. >> chair thanks, gentlelady. recognizing the gentleman from virginia, mr. griffith for five minutes of questions. >> cms issued a memo on risk

corridor payments for 2015. several insurance companies are suing administration over 2014 payments because they only collected 12.6% what the industry requested to be made whole. in the last paragraph the memo, your agency wrote, in all cases where there is litigation risk year open it discussing resolution of those claims. we are willing to begin such discussions at anytime, end quote. does cms take the position that insurance plans are entitled to be made whole on risk corridor payments even though there is no appropriation to do so, yes or no? >> i think what we've always said risk corridor payments are obligation of the federal government. >> yes or no? >> i think statement is just standard practice. >> so it is yes? >> i'm sorry. can you rephrase the question for you. >> i will restate it. does cms take the position that insurance plans are entitled to be made whole on risk corridor payments even though there is no

appropriation to do so? i took your answer is a yes. am i correct? >> yes. obligation of the federal government. >> so it is a yes. >> that is how you interpret that, yes. >> seriously. do you intend to just the judgment fund to make the risk corridor payments to insurance plans, yes or no? >> i would say further questions, i would not be comfortable commenting on any current legal proceedings. i prefer to -- >> you you did an invitation to settlement. there is no appropriation for the funds. are you intending to use the judgment fund, yes or no? >> again, this is case before justice and so i would be more comfortable not talking publicly. >> what you're saying you have turned this over to justice and talked to justice department about the various suits? >> i personally have not. >> you have not the? can you give me names, by

16th of september. this is the time sensitive, can you get me names of those people that have spoken with justice about this matter? >> sure. >> thank you, i appreciate that. which insurance plans are suing or indicated they intend to sue cms or united states in relationship to the risk corridor payments? >> i don't have a list with me. >> time sensitive, can you give me a list by september 16th? >> absolutely. >> i appreciate that very much. now, you indicated you haven't spoken to justice but do you know of anyone in your department that has discussed settlement plans with the department of justice? >> i know that our general counsel speaks to justice regularly. so i assume that they have but i don't know any details. >> well i'm assuming you authorized the memo i quoted earlier where you created an invitation to settle. i would assume you know there were some discussions with justice prior to making an individualtation to settle with

these companies, is that not correct? >> that is correct. >> that is correct. there have been discussions by somebody with justice about how you're going to settle and you don't know where the money will come from but you assume somewhere it will come from. >> they are representing us and we in fact talked to them. >> all right. >> i am curious, have you had any conversations about the lawsuits with your predecessor who is now a top representative for the insurance industry, about the risk corridor situation, yes or no? >> no. >> and prior to issuing the memo, i touched on this briefly but i want to make sure i'm clear, prior to issuing the memo did the justice department approve the memo you released on friday which had invitation of part of it to settle the lawsuits? >> i believe they reviewed language of it, yes. >> has cms spoke with any insurance plan directly or indirectly about settlement of the risk corridor lawsuits, yes or no? >> cms has had inquiries from insurance companies which we

have referred over to justice. >> and do you remember which insurance companies they were? >> i can get you that. >> if you can get me that by september 16th i would greatly appreciate it, it is time sensitive matters a you can imagine. i appreciate that. with the last few seconds i have i want to switch gears a little bit. i heard a lot of folks talk about uninsured. one of the problems i'm having get complaints in my district about obamacare is underinsured. that with the co-pays and deductibles and the in order to afford the insurance because the rates have gone up my folks are paying high deductibles. they don't have significant insurance. when a catastrophic injury occurs they have to sell off assets they have had to work for years, including homes, et cetera. and i'm just wondering does anybody keep numbers on those who would i call the underinsured? they may have a plan but not one

that keeps them from being financially crippled should they have a catastrophic illness or injury? >> yes. most recent numbers that i have seen despite the headlines, show that in 2015, in the exchange the median deductible was $850 which was decrease from the prior where where it was $900. >> all i can say to that, administrate tore slavitt, folks come up to me new river valley fair hard-working folks in a relatively poor district that's not what they're telling me. i yield my time back. >> i recognize the gentleman from kentucky, mr. yarmuth for five minutes. >> i thank the witnesses for appearing. this sounds like the movie, "groundhog day" and it becomes very frustrating. this hearing has a new title, affordable care act on shaky ground. i would submit it is on shaky ground, republicans and in congress and across the country

where they have authority are planting dynamite in the the ground under the system. and i think that is why all of my colleagues have talked about the fact that we continue ignore the incredible progress that has been made under the affordable care act. not only the number of people who have been insured who were previously uninsured but also the people who have been protected now against significant financial loss or even unnecessary debt because they have coverage. i want to talk about my state though and the chairman's report, cms's regulation of exchanges and so forth, makes some statements about kentucky's exchange that i think dramatically mischaracterize what's gone on there. you were here the last time, you were here i asked you a question because i knew that our new governor at the time promised to dismantle, connect our state exchange during his campaign and i asked you if you think of any way in which any kentucky

resident would be better off in the federal exchange than the state exchange. you answered, you couldn't, is that correct? that's right. do you think anything happened in kentucky between that answer and the time that governor bevin actually submitted his request, notification to you that he was going to disconnect, any difference? >> not to my knowledge. >> and in fact the reason he did that was not because of any reason that made sense either economically, in terms of providing service for our citizens but because he has an idealogical opposition to connect and promised to do it during the campaign. you don't have to answer that that is my characterization. now what he's doing is even worse because, while we had the most successful exchange arguably in the country, that he has basically dismantled, we have one of the most dramatic increases in reductions in uninsured because of expanded medicaid.

more than 400,000 kentuckians now have coverage who didn't have it before. what governor bevin has done now, made a proposal for a waiver to change a lot of the medicaid system in kentucky. he has made a proposal to cms which, he counseled with you before you and your staff, before he made the proposal in which he, you told him what might be acceptable, what might not be acceptable under the proposal, is that not correct? >> we did have a dialogue, yes. >> and in spite of that he has submitted a proposal to you which i think according to the law you are almost obligated to reject. on page 15 of that proposal he says, if this demonstration project is not approved i will dismantle connect, i will disp man he will the medication did, dismantle medicaid expansion in my state. he is setting up for you to

reject the proposal, he will dismantle medicaid in our state, take away sit insurance from 400,000 citizens and doing it again for idealogical reasons. so the point i want to make is, that yeah, there are lost problems, a lot of things going on in this state in this country right now that may call into question the affordable care act but the things that are going wrong are things that republicans are doing to sabotage the functioning of the act, the law. and that is why we're so frustrated that instead of offering suggestions to improve the aca, which we could in many, many ways we all agree on that, the republicans in congress hold hearings like this, vote time and time again, more than 60 times to repeal the aca, never proposed an alternative but anything going back to where we were before the aca when insurance companies controlled the system. they want to throw it back in the private system. that is what matt bevin says he

wants to do in kentucky, if that is some noble objective. and the reason that they have not proposed a viable alternative to the aca, other than going back to the pre-aca situation, i'm convinced because only other alternative is single-payer. if you listen to virtually every complaint raised during this hearing today and in every other hearing, those complaints would not exist under single-payer system. now i don't think anybody it ready to go there right now. we'll end up there eventually, but i think we ought to start being honest with the american people what options are available to them and how important the the aca's successs to them as well. i yield back. >> chair thanks gentleman. recognizes the gentleman from missouri, mr. long, for five minutes of questions. >> thank you, mr. chairman. and, mr. slavitt, is it true that the current ceo of federal exchange, healthcare.gov is kevin cunahan? >> yes, sir,.

>> it is also my understanding i'm sure he was invited to testify here today, did not come. do you know why he is not here? >> he is on travel today, sir. >> i'm sorry? >> he is traveling today. i believe he is in south carolina? >> south carolina? >> that is my understanding. >> do you have any idea where he was on september 6th or 7th, whenever arizona, same day that arizona's blue cross-blue shield mysteriously decided to sell plans in pin kneel county, do you know if he was in arizona at that time? >> i don't know his schedule of december 6 or 7. >> can you tell me if he had conversations with air zone blue cross and blew blue shield of connecticut to sell plans after the deadline of federal exchange. >> i don't know the timing. i'm sure -- >> was first part of your answer, i couldn't hear you. >> i can't tell you the dates but i'm sure he had conversations with many of the plans, many of the major health plans.

>> do you think, you don't know where he had conversations after the deadline? >> i don't have any knowledge of the dates he's had conversation. >> have you yourself had conversations with blue cross-blue shield of arizona or connectcut care after the deadline to sell plans on the federal exchange? >> no. >> no negotiations after the deadline's passed. >> i have not. >> okay. is it fair to say both carriers were allowed to sell plans after your own deadline? >> i'm not sure. i don't know. >> you're not sure that pin kneel county was -- >> not sure which deadline you're referring to but i'm happy to investigate and we can get back. >> i appreciate it if you would. so you're aware or not aware that deadlines have been passed and then plans were offered after these deadlines passed? you're aware of that or not aware of that. >> i would have to understand what deadlines you're talking about. we certain -- >> to settle plans.

>> we certainly give states dates which we like to receive things. sometimes if we don't receive them on those dates i'm sure we extend those deadlines but i don't know that in this particular situation that's occurred but, that certainly wouldn't be absolutely out of the question. >> okay. but, do you have any idea why there would be deadlines if the deadlines are followed? >> typically our team has to do work like loading plans and loading data and like to have enough time to do that and do it right. but certainly we're going to do what is in best interests of consumers and americans in the state to make sure that they have coverage options available. so if our team has to work a little harder or work over the weekend in order to do that, that is the kind of dedication we have on our team. >> okay. thank you. in my district, in august, i had the opportunity to visit with a large school board. they're in the district and i was kind of surprised at the end

of the meeting when the chief financial officer been with the school district 33 years and looked at me and volunteered that she said, i was thinking last night if i could ask you to do one thing for me as congressman, that one thing would be to get rid of obamacare. and that honestly shocked me. two of the more pressing problems with the law that she referred to were the 30-hour work week and 26-week break for retired teachers. 30-hour work week, also known as employer mandate requires all businesses or organizations with 50 or more employees to provide health insurance to their employees who work more than 30 hours a week. this particular school district currently has 921 full-time staff. the 26-week break is required for educational organizations that are unto provide health insurance to faculty that recently retired. if ignored the retired teacher would be seen as continuing

employee which would require them to offer health insurance. these are the teachers that retired teachers that know children in those schools. they know the schools. they know the system. they know the teachers. they have to take a 26-week break because of this law. mr. chairman, i write a weekly column, called long's short report, it just happened that today in our local paper the gannett paper, the springfield news leader, published my latest column on this very subject about my trip to the school district. so without objection i would like to offer that into the record and i would encourage everyone to read that, get more details of how this law has affected school systems and small businesses. >> without objection so ordered. >> i yield back. >> chair thanks the gentleman. now recognizes gentlelady from florida, miss castor, for five minutes for questions. >> thank you, mr. chairman and thank you to the witnesses for being here today.

the progress that we've made since the adoption of the affordable care act has been very significant and before we turn to questions i wanted to focus on how meaningful it has been to my neighbors back home in the state of florida. in florida we're fortunate we have very competitive marketplace, so families and consumers have a lot of choices. they have a good, affordable options. in fact it looks like in the coming year that 82% of marketplace consumers in florida will be able to purchase coverage for less than $75 per month. during the last open enrollment period, 1.7 million floridians signed up for coverage in the health insurance marketplace, including over one million women and children and this is important because we have very serious and growing concerns in

florida because of the spread of the zika virus. the current zika infection count in florida is 800 individuals including 86 pregnant women that we know of. so this is very concerning. and what is especially troubling now is that florida hasn't expanded medicaid. so even though we have over 250,000 women ages 18 to 34 in my state who have gained quality, affordable coverage in the marketplace, we've got more than that that should be covered, could be covered if the state expanded medicaid. so you can see why this is especially troubling at a time of a growing public health crisis. there is a lot of good news too. over 3.1 million seniors are eligible for free preventative health services with no

deductibles and co-pays. they are taking advantage of it. in 2014 alone, over 346,000 seniors in florida received medicare part-d prescription drug discounts worth over $306 million. or on average $884 back into the pockets of beneficiaries. it's interesting that more than 38%, or about 383,000 returning healthcare.gov consumers last year switched plans. this is something that we could work on in a bipartisan way. it is very interesting, i guess we you knew that americans loved to shop and compare and they are doing that. but we've got to work together to maintain these competitive marketplaces, so they have the ability to do that. when they switched, they saved on average about $34 per year. then for the vast majority of,

about 60% of floridians already have health insurance through their employers. i thought it was quite interesting that there the insurance premiums in florida now, now growing at the slowest rates on record. this is also something we've got to continue to analyze and make sure that this is the case overall. but i would like to return to the medicaid expansion challenge because in the state of florida we've got so many that are falling into the gap and we're, we know it's fiscally irresponsible not to expand medicaid. we know the most important thing we would do for mental health coverage is to expand medicaid but there is a new piece of data that administrator slavitt, i would like for you to address. medicaid expansion brings down marketplace rates. you said it brings down premiums by 7%. is that just in the marketplace?

is that overall? what's behind, what's going on pressure in the marketplace? >> that 7% is in the marketplace and you think, for everyone year who has an interest in helping all of your constituents and all of their concerns about affordability, that is really one of the top, most important things that can be done is to eliminate all those places where people are uncovered and they, a lot of those people who don't get coverage through medicaid sometimes find their way on to coverage of the marketplace, and that drives up costs needlessly. i think it is a critical priority that we complete the job and expand medicaid wherever we can. >> one of the things that drives a lot of businesses and the folks that the florida chamber crazy we're sending so much money up to the federal government because medicaid is a state-federal partnership.

we're not bringing those dollars back and putting them to work, creating jobs and taking care of people. what happens to those dollars. >> well they certainly go to the states that have chosen to expand medicaid. i will add one thing, to congressman yarmuth raised, the question of kentucky, there was very interesting study in kentucky a couple years ago which i think showed that kentucky saw 40,000 new jobs, something to the effect of $30 billion improvement to the state economy through 2021 with the expansion of medicaid. you can imagine economic benefits which we're talking about are quite large. >> thank you very much. >> lady yields back. chair now recognizes gentleman from indiana, dr. buschon, five minutes for questions. >> thank you, mr. slavitt for being here. this is directed at you, mandates in the affordable care act talk about the age rating ratio. they're using five to one ratio

which most expensive plan can cost five times more than least expensive plan when it comes to patients ages. in my home state of indiana we didn't have a edge rating mandate. president plan moves three to one for all states regardless of unique state patient needs. this led to sicker insurance pools and driven younger, healthier patients away from the marketplace in my view. the baseline has increased. so the argument that the three to one ratio saves seniors money may not be true. in fact i don't think it is true. it is just increased costs for younger people. my question would be, would moving ratio back to five to one have immediate impact on the cost, do you think for many people who potentially enroll? >> i think this is going to have to be studied based upon two factors. what does it do to the economics or the cost and what does it do to the coverage and who benefits and who doesn't. so i think a kind of proposal that should be thought fully evaulated. i have not done that. >> would moving the ratio back

to five to one attract younger, healthy every patients to the plans? the reason i say that, according to cbo, and i quote, average spending among people 64 years old or older is 4.8 times higher than people 21 years old. that is cost to the health care system. so to me it would make sense if you get, if you could shift the baseline back and get the cost down for younger people, you get more people into the plans. that might help balance the demographics, right? >> that could be one. benefits. i haven't seen any studies on topic. >> i would encourage you to look at that because i actually have legislation to actually to allow states to do that because that's the premise. the other, couple other questions, on global surgical payments in mcra, replacement for the sgr, our language authorized cms to use a representative sample of docs for reporting data on 10 and 90-day global surgical codes you but most recent physician fee schedule is requiring all docs

report relative procedures to report under the claims analysis section. this is in my view not in line with the intentions of congress in mcra. so, what we need today is appropriate representing sample. how the data is collected must change. the 10-minute reporting increments is, i can tell you as a surgeon, i was a surgeon before, actually, it is impossible. so what i'm asking for is for cms to give time to work with surgical societies and other stakeholders to determine what is an accurate representative sample. this is really important. so what i'm asking, can you commit or whoever at cms is responsible for this, to working with my office and others, stakeholders to work this through. >> absolutely. as you can imagine we've gotten a lot of feedback on the proposal. is a proposal i think we're still working through the commend period but we're

absolutely need the input and we're committed to coming out with a final rule which does get that right. >> because, that's really important because what we want is accurate data, right? at the end of the day we want accurate data. >> right. >> one final he question on the proposed rule for medicare part b model. i'm very concerned by statements from the physician community that practices may be forced to send patients to hospitals to receive care, particularly oncologists. particularly because hospital-based care can be more costly for beneficiaries. i've seen estimates suggest 15% of cancer treatment, for example, shifted to the hospital would actually cost medicare an additional $200 million. the intent of this was to try to get down drug costs for people. and i understand that. there is bipartisan concerns to this rule as you proposed rule as you know. so what i would suggest i would urge cms to hold off on the rule

until we can resolve some of these issues. so the question i have is, did cms factor in the potential cost increase into its estimated savings from the program when it developed the proposed rule? >> you i think putting the proposal together we were in fact looking for that exact type of feedback relative to consequences, unintended consequences of anything we test. we've gotten a lot of feedback. we will take that feedback, including specific feedback you mentioned into account when we finalize this. >> i really appreciate that. if you do have analysis than that different than what i suggested on increased costs because of shifting care to hospitals, if you could share that with my office and the committee i would appreciate it. >> will look into that. >> i yield back. >> the chair thanks the gentleman. recognizes gentlelady from illinois miss schakowsky, for five minutes. >> thank you, mr. chairman. i want to apologize to members

of the panel. i was at another subcommittee hearing and was just able to arrive but i thank you for being here to testify. i wanted to just highlight some of the benefits of the affordable care act to my state of illinois. during the third enrollment period 388,000 people from state were able to gain coverage by enrolling in the health insurance marketplace. 2014 nearly 195,000 people in illinois with medicaid saved almost $180 million on prescription drugs because of the affordable care act. with an average per person of $925 per beneficiary. that is a big deal. in 2015 the aca funded 44 community health care centers in illinois that provide primary and preventative health care to over 1.2 million illinoisans,

including 100,000 children and 900 thou racial or ethnic minorities. and since november of last year 200,000 illinois women gained access to preventative health care services with no cost sharing including reproductive health care, domestic violence counseling, and screenings for cervical cancer. despite the challenges that we're facing in illinois, this law is doing incredible things for my constituents and i'm encouraged by the progress that we're seeing. mr. slavitt, i wanted to talk to you about increase in the cost of prescription drugs. how does, how have rising drug costs, rising drug prices, led to increases in insurance

premiums, and should we be doing more to control growing the cost of pharmaceuticals? >> this is incredibly important question, congresswoman. because when people are concerned, as they you should be, about the cost of health insurance, because the law requires that a maximum of, that requires that 85% of the cost be actual cost of health care, what they're really concerned about is the cost of the underlying health care system, which is a top priority for us and prescription drugs and insecurity that both seniors as well as people in lower incomes face when they can't afford prescription drugs is really significant issue and only getting worse. we are troubled when we see large increases in prescription drug costs. and we are, we have proposals for it as you know, to attempt to find ways to begin to control

those costs in ways that still allow us to create cures an innovations for our country. but also allows the cures and innovation to be accessible to everybody in the country who needs them. >> right. i also, cms has taken action. i noted increased transparency for the price of drugs. for example, last year cms released medicare drug spending dashboard which details the price paid for many drugs covered by medicare parts b and d. the dashboard also includes the average annual price you increase of each drug and the average annual cost to beneficiaries, and the state is incredibly helpful for policymakers and providers how prices are impacting public health programs and consumers. mr. slavitt, why is increased transparency for drug pricing important and how will this informational louse us to better

protect medicare, medicaid, and the beneficiaries? >> well, first of all these are federal dollars that we're spending. and so these in effect are people that are contractors to the federal government. so it's important that taxpayers have insight into what we're spending our money on, and because we are not, as you know, able to negotiate part d prices because we're restricted to, we think it is important that there is at least visibility into what things cost and particularly when there's cost increases because in effect at heart of many concerns of this hearing today, some of those underlying costs go up, people see insurance premiums go up, and that's what, that's what they have to deal with. we're trying to bring more visibility to the root cause as opposed to just the headline issues. >> [inaudible] >> the chair thanks the

gentlelady. it recognizes the gentleman from florida, mr. bilirakis, five minutes for questions. put your mic on please. thank you. >> sorry about that. administrator slavitt, last december hhs's oig issued a report titled, cms could not effectively insure that advanced premium tax credit payments made under the affordable care act were only for enrollees who paid their premiums. in the report oig stated that cms was paying advanced premium tax credits based on the attestation of the insurance companies without verifying on an individual level if monthly premiums were being paid. the oig recommended that cms institute an automated policy based pavement process to verify premium payments on a monthly or real-time basis. yes or no, please, has cms instituted automated policy-based payment process

with insurers for the federal marketplace? >> yes. >> okay. thank you. are the state-based exchanges using an auto he mated policy-based payment process at this time? >> i would have to check. >> please check. does cms have any plans of running the policy payment process against prior years to find individuals who may have improperly claimed cost sharing reductions and premium tax credits when they were not current on their payments? >> i'm not sure if that is even possible. i would be glad to get back with you. >> get back with us. i understand the state exchanges are not participating but i need clarification on that, so please get back to me. does cms have a legal obligation to recoup advanced premium tax credits or cost sharing reductions that were improperly claimed or paid? do they have a legal obligation? do you have a legal obligation, cms? >> i think it depends on the circumstances but some of this

is under the province of the irs. >> okay, again i want more clarification on that please. miss jarmon, has the oig tested the policy payment process cms is using? >> not yet. as part of our ongoing work as you mentioned, we reported on in december of 2015 as part of our follow-up on that, on the open recommendations we'll be looking at that. >> when will you be looking at it? >> as part of our work in 2017. >> in 2017? >> right. >> so early part of '17. >> will be reported on sometime in 2017. >> early part of '17 probably sometime during the first part of 2017 yes. >> i will keep track. mr. laugh individual, when they introduced the policy for the federal marketplace how much did you find enrollment reduced? can you give me answer. >> i don't know that if is material but i will certainly

get back to you what that is. >> again, i want to follow up, so let's get together soon. i need these answer. >> okay. >> thank you very much. i will yield back, mr. chairman. >> chair thanks the gentleman. now recognizes the gentleman from oklahoma, mr. mullen, five minutes for questions. >> thank you, mr. chairman. and, mr. slavitt, thank you again for being here. i know you and i have visited before. in the last time we visited you were in front of the o&i committee and we were visiting about the risk mitigation program, the repayments that comes to it, for the reinsurance. are you recalling that? >> was it risk adjustment or -- or was it reinsurance? >> reinsurance. >> right. >> at that time in the opening

statement you said this year we'll add approximately 500 million to the u.s. treasury to the program as collections. we'll exceed the target amount to reimburse high-cost claims for 2015. that was a quote from you, is that correct? >> sounds right. >> have you made any payments to date to the treasury on those? >> i think our collection date, if i'm not mistaken, this is from the top much my head is november 15 or december 5th teen. we'll make the payment after that next collection. >> have you made any payments out of reinsurance program? >> that will be the payment -- >> have you made any payments to anybody out of the reinsurance program? >> to any companies? >> yes. >> this year? >> yes. >> i have to check. >> i believe according to the information we received, you have made several payments to carriers. in fact this was, payments were made right before the open enrollment period. are you familiar with that? >> you mean last year?

>> i believe -- >> last year, yes. >> yes. so has any payments to date been made to the treasury on this reinsurance program? >> as i said the payment will be made after, our next collection which, is either november, december, 15. i can't recall which. >> reason i asked this there has been a discussion how much is supposed to be paid to the treasurer. in the federal law which says that the treasurer should receive 5 billion, not 500 million over three years, are you on target to hit the billion dollars mark? >> i recall the conversation and from that hearing, that is not our understanding of the law so. >> i know. i believe there's, the interpretation of the law seems pretty clear, and you guys decided to change that without notice. >> i'm sorry, we went through notice. we went through a proper formal

notice and comment period. >> and you responded back to us, how do you term the law? >> i think the law was not clear in cases where -- >> do you ever it where you could read it. >> pardon me? >> do you have it where you could read it? it seemed pretty clear to us. >> the law what to do in cases where $12 billion collected, the law was silent less than $12 billion was collected. where the prioritization was. >> did you ask for guidance from congress from that? >> we asked guidance and congress by making open rule making progress. >> in the public comment period you don't have to respond back to congress on that. did you specifically ask for our guidance on that? >> i believe we asked for everybody's guidance during that process. >> then why, if that is the case, why has there been confusion on the payments, that 5 billion should be paid or shouldn't be paid. >> nobody in our comment period in if i'm not mistaken objected

to what we put forward in the proposal. >> how long was the comment period open? >> i will have to check. it was a standard comment period. >> we had objected to it. we had you in o and i and had you with the conversation about it. there has been a discussion on your interpretation of where the funds should go to. it seems to us, or well, let me say myself, it seems to me that the payments made to the insurance companies, is questionable without paying it to the treasurer and the amounts being repaid to them just to hold the premiums down. it is not working. because in oklahoma the only program we have left on the exchange is blue cross-blue shield's. they went up 42% already this year. i believe they're asking to go up another 40 to 70% this year. we're seeing prices skyrocket across the country right now when we were told that this

program was going to cost, bring premiums down. the question i guess, i'm trying to get to is your interpretation, isn't working because it's still costing us more and the treasurer isn't receiving taxpayer dollars we were promised with the $5 billion. if it is not working, let's work together to try changing it or at least tax dollars could be used in the appropriate way. i yield back. thank you. >> chair thanks the gentleman. i recognize gentleman from new york, mr. tonko, five minutes for questions. >> thank you, mr. chair. in the six short years since its passage the affordable care act has transformed the health care industry and made coverage more accessible, more affordable, and more secure. i would like to take this opportunity to share some of the encouraging benefits of the law that we have witnessed in my

home state of new york. in new york over 450,000 individuals applied for coverage in the marketplace during the aca's third open enrollment period. as of 2015, the aca has provided community health sent grantees in new york with over $445 million in funding that offers a broader array of primary care services, extends hours of operations, hires more providers, and develops clinical spaces. the nationwide uninsured rate continues to drop as the cdc reported last week. in new york state alone, the number of uninsured dropped by over 350,000 individuals between the years 2013 and 2014. new yorkers, like all americans, have seen substantial benefits because of this law and it is indeed reassuring to know that

our work has allowed for these results to impact favorably those in new york. if i could continue on now with the issue of premium increases that i was hearing from the last individual. ever since the republicans gained the majority in the house they have been sounding the alarm on the potential for skyrocketing premiums resulting from the reforms of the affordable care act. and the fact is that we have seen, not seen this happen. in fact the non-partisan congressional budget office, or cbo, made predictions about premiums around the time of the aca's passage. and so to administrator slavitt, i ask, did cbo predict that average premiums for 2016 would be higher than what the insurers actually charged this year? >> that's correct. >> and why do you think premiums

are coming down? why are they lower than was expected or projected? >> i think that in some cases are lower because there is good competition and good innovation. that has been terrific and welcome part of the marketplace. i think there are other occasions where premiums were priced too low because i think no one knew exactly what things would cost. therefore i think as a result we'll see more increases this year than we have in the past. >> while those early reports have suggested we may see those higher premiums in 2017, and why, can you explain why that might be the case. why would they be higher? >> i think there are go principle reasons. most of them, the good news i think is, a lot of these center on one time effects.

one is, that by design reinsurance that supported marketplace expires january 1, 2017. there will be meaningful increase from that alone. and secondly i think you have, now that you have insurance companies that have a couple years worth of data on what things actually cost. they can use that information to price appropriately. i like to remind people that in a country, this is the very first time we have said to people, if you're sick, we will take care of you, and we will allow you to buy insurance anyway. no one knew when we entered into this exactly what that would cost but the great news is we're doing it. no one likes to see costs go up and i don't think they will continue to go up beyond this year very significantly, in large part because medical trends in this country are still at historic lows but we achieved something significant. we've got more work to do. we can do better.

if medicaid expands we'll do even better. i look forward to continue to work through this. >> in a sense there is outlyer effect that impacted 2017. an would you expect 2018 to be different? >> it's, far bee it from me to predict the future but 2018 will probably be more normalized year, in line where past years have been the first couple years. >> okay. with that -- >> mr. chairman, the gentleman yield me your last 10 seconds? >> sure, absolutely. >> thank you. our colleague from oklahoma, i meant to try to get time there. blue cross requested 45%. mr. slavitt, has that been considered by steak of oklahoma or cms? is that a request, not actual increase? >> i'm not exactly sure where that stand at this point. >> okay. >> although, i normally agree with mr. mcmullen except on the football field exempt our

colleges play each other. i will mention it to him later. >> i yield back, mr. chair. >> the chair thanks the gentleman. now recognize the gentleman from new york, mr. collins, for five minutes of question. >> thank you, mr. chairman. before i ask mr. slavitt a couple questions, i would like briefly for the committee highlight some of the latest very troubling news on the affordable care act as it impacts western new york, the area of buffalo, that i represent. so in august a month ago governor andrew cuomo's ad administration, announced the health insurance premiums for those on the state's obamacare exchange, will increase, this is after review, average of 16.6% next year. for over two million people enrolledded in the program, many of them in western new york. i did say average. some plans have already now been approved with a 29% increase. even 89% for one plan.

now at the same time, the individual mandates compelling americans to buy these health insurance plans with higher premiums were also continuing to see in our area big increase in deductibles and insurance companies facing multimillion dollars losses, terminating plans. i'm not sure how mr. slavitt can say this may be outlyer year. we're not seeing any of those trends that wouldn't continue on into the future. i don't think the president, i don't think anyone at cms ever will acknowledge what western new yorkers are living day-to-day, and that is, the affordable care act, obama care, is fundamentally flawed. can't be fixed, and is imposing unsustainable, ever-increasing costs on americans, including my western new york constituents. now perhaps the next administration will have a better understanding of the health care market place, the plight of the middle class and

we can finally get rid of this unaffordable plan. but, mr. slavitt, i would like to speak to you about an often overlooked aspect of the affordable care act, provision that many new yorkers didn't know existed until they were kicked off their plans last year, kicked off in november last year. so last october 200,000 new yorkers were informed, out of the blue, that they would be kicked off obamacare's co-op health republic and forced to find a new plan immediately. this co-op was propped up by more than $265 million of squandered taxpayer funding and lasted less than two years. the health republic of new york had the highest enrollment numbers in the nation. this wasn't a low-enrollment problem. yet they lost 35 million in 2014, 53 million in the first

half of 2015. basically the co-op was never going to be able to operate properly. and despite all these warnings and losses and losses, cms neglected to even place the co-op in a corrective action plan. there is a couple words that come to mind. negligence, incompetence, mr. slavitt, my first question is, they weren't put into corrective action plan, so if they're not, what is the purpose of even having something we call corrective action plans? >> so, certainly, i will acknowledge, it is no secret many of the co-ops across the country, not just new york, faced significant financial challenges. these are, businesses that compete against much larger companies with limited capital bases, and they have very little cushion for error. i think in the case of new york they, in the beginning of 2015,

if i have my timing right, i thought they were in relatively good financial position, and saw losses mount as claims costs came in throughout the year. i would say even more aggressively than any plan we can put on paper, i had a whole team up in new york working with the co-op and working with the state. in fact i think our auditors were ones that were pointing out some of the problems. >> let me just say, you can't defend the indefensible. i hear you try but you know, mr. slavitt, even after this, what cms did was even more egregious. they forced current plans to take those people that were kicked off. they told those plans they had to accept them, at the low pricing that health republic was charging. in november when many of them already hit deductibles, and current healthy plans suffered millions upon millions of dollars of additional losses because cms said, you got to take these people. i'm sorry their deductibles are burned out. can only charge them what the

low rates were to begin with. so what we ended up with, i will use the words again after losses and losses, them not being placed it was negligence and incompetence of cms which hurt taxpayers, hurt participants and hurt other health insurance companies, something i call a lose, lose, lose, and that to me was unacceptable. i yield back. >> chair thanks gentleman. recognize the gentleman from california, mr. cardenas, for five minutes of questions. >> thank you very much. i have a bit of a different narrative coming from the state of california as to what the affordable care act has done for millions of californians. i don't have time to speak to the tens of millions of americans across america who are in better position with their access to health care that they didn't have before you but, that having been said, the affordable care act has improved millions of lives in my state. for example, we have been able

to expand medicaid with over 3 million californians having gained access to medicaid or chip since 2013. i know you're not allowed to applaud in this room but i'm sure you're applauding inside. as of april in this year, 70% of calfornians who were previously uninsured before the affordable care act now have quality, affordable health insurance because of the affordable care act. medicare beneficiaries in california have saved more than 1.2 billion on prescription drugs because of the affordable care act. the expansion of preventative services with no deductible or co-pay under the affordable care act allowed more than 3.6 million californians with the medicare to access preventative care services in 2014 alone. i'm pleased with the progress that has happened in california, but yet, at the same time, anytime a law is passed, with

all due respect the affordable care act is a product of the legislative bodies of the united states of america and every time we passed laws, i personally have been passing laws for 20 years both at state, local, here at the national level and i have never ever written a law myself, nor have i ever seen anyone of my colleagues i have served with in the last 20 years, republican or democrat, pass a perfect law that doesn't need some changes subsequent to the initial passage. it is unfortunate, i believe, that we have a congress of the united states, the majority parties, that want to just tear down this law. it is unfortunate. what we should be doing is looking at the disparities and the things that need to be fixed. i know some of my colleagues on the other side of the aisle have been talking about many so of those things but it's one thing to point out flaws, and throw up our hands, saying oh, my gosh,

isn't this horrible? that is not our job as legislatively elected people, democratically-elected individuals who are supposed to be responsible and make sure we fix things when we see something wrong. and it is unfortunate we haven't advanced but very small, small minor changes to the affordable care act through the legislative process. i do agree that there are many changes that need to be made, but i'm appalled at the idea we would take opportunities like today to just say this is wrong and it needs to be repealed. that is not the case. i for one, in a portion of my life when i was a boy lived in a household where we didn't have access to health care, and what that meant was that my mother would give me some aspirin, send me to bed, and literally pray that i would wake up the next day feeling better. and if i didn't what happened

was, my family, with my hard-working father, providing for 13 people, 11 children, and him and my mother, every single day would go to work. but because we didn't have health care coverage, our only alternative was to show up in the emergency room when we thought somebody just might die. because of the affordable care act now over 20 million people in this country, who were in that situation, literally overnight, are no longer in that situation. around the number of people who are getting true access to health care is in fact growing. that's what the affordable care act is about. one life at a time. through a massive law, thousands of pages, that, yes, it does have flaws. but the atrocity of the affordable care act is

subsequent to that law being enacted, that we as a legislature collectively are not making the necessary changes that we all can easily identify. it's embarrassing, that in the most capable country in the world, in the most powerful elected bodies in the world, that we effectively have done almost nothing to improve the health care of americans since this law has been passed. i yield back. >> the chair thanks the gentleman and recognizes the vice-chair of the health subcommittee, gentleman from kentucky, mr. guthrie. five minutes for questions. >> thank you, mr. chairman. i want to follow on that. governor bevin is trying to take a program that he inherited that was 100% federal taxpayer paid for, now the state has got to start putting money into, putting money into the program and trying to make it work.

he is trying to make improvements people say republicans over here at some political hit. he is trying to put a program together that work. i heard my colleague talk about kentucky and heard i am speak back home during the break and spent hours with kentucky's medicaid task force and tried to figure out exactly what they're trying to do. what they're trying to do is make a program work. . . creates a more traditional insurance. is it unreasonable to treat

able-bodied nontraditional medicaid, is it unreasonable to the medicaid program set up in an expanded state that more like traditional insurance? that's what governor bevan is trying to do. is that unreasonable? >> try to not get into coming on the waiver request, given that we're just open for public comment period and it would be inappropriate for me. >> a couple things on my colleagues from california, poison pill. able-bodied should pay a premium that could be up to $15 a month. we for people talk about being 800, 900, $2000 a year. the other one is if you're able-bodied, that you have a community engagement requirement. go to work 20 hours a week, go do a service project for 20 hours a week or go to school for 20 hours a week. there is an ideological difference as my friend from kentucky said. one is 25% of kentuckians are on medicaid.

let's create a system and the medicaid program where people would transition off so they can improve themselves, go to school, become productive and move forward. that's exactly what governor bevan to try to do. if that's unreasonable to see a mess, to my colleague from kentucky, i know it's not unreasonable that people receive something for free should want to improve their cells, have an education required to move forward and that's what governor bevan to try to do. i want to switch to one of the state. in louisiana, the expanded medicaid started july 1 but in louisiana they allow people are currently in the exchange is a way to continue in exchange, medicaid eligible. if i can submit for the record, a baton rouge newspaper and double quote, the state says people who bought individual policies in the federal marketplace but now qualify for medicaid understate expansion can keep their obamacare plans if they prefer the overmedicated.

they just have to keep things agreements. is that correct, if you qualify you can maintain your obama to bring them subsidize? >> i would have to look at the details of that. i'm not sure. >> well, when the cms explicitly explain the rules of the road and had we not seen this isn't in a properly double dipping? they could be medicaid qualified and to be receiving premiums. i don't think that's within the statute, allows them to do that. >> let me check on that. i have not seen that article. >> without objection that article would be placed in the record. >> in february of this year secretary burwell said cms would check whether exchange in rowley's with subsidies are enrolled in medicaid or chip. she said i quote, notices, let me start december. exchange in with subsidies are also enrolled in medicaid or chip. she said notices will be made. does have a forward speak with yes, it has.

>> difficult forward in a? in "new york times" article talked about happening in august. do you know how many consumers have been in enrolled? >> i don't know. i'll be happy to get back to you and your office. >> thank yothank you very much i yield back. >> the chair thanks the gentleman and recognizes the gentleman from new york, mr. engel, five minutes for questions. >> thank you. thank you, mr. chairman. thank yothank you mr. green. thank you for holding today's hearing. let me say this in terms of overview. any major bill or major undertaking that has been passed why congress needs to be tweaked once we see how effective it is, what we see when we see what the problem is. it's true with medicaid, medicare.

it's true with any big deal. and that's true with the affordable care act. the way i look at the problem is our friends in the majority don't want to fix it. they want to break it so it will go away. there are some problems with it, no doubt about it, but if we didn't vote to repeal it 63 times and voted to approve a 63 times, i think we would have a much better law. and having been on this committee when we were first drafting this long, i know that there are many different opinions and there are many things that i and others thought should've been put into the bill that were not put into the bill because we took the senate based bill and we thought we would be able to negotiate it, events or circumstances he couldn't to deal with. so i would just say that, they say if it ain't broke, don't fix it. it a little bit broke.

a little bit broke, or broken. and it can be fixed and we should fix it instead of trying to kill it. so to echo mr. pallone, i'm mystified by republican attempts to paint a rosy picture of the insurance market prior to the passage of the affordable care act. let's go back and let's remember what it was like, denying insurance to people with preexisting conditions, forcing certain populations to the outrageous rates, applying lifetime limits to care. before the aca this is standard operating procedure in the individual interest marketplace. it was incredibly horrible to her family, friends and constituents. and begin not to mention some popular things about keeping your child on having insurance on your policy till he or she is 26. so we've come a long way, estimated 20 million american safety and health insurance through the ac. my state of new york, there are some problems but basically it's going very, very well.

we can rest easy in knowing the sudden illness or re- catholic -- when i recounted on our finances. preconditiomore than 39 millionn medicare have received free preventive services without co-pays thanks to the affordable care act tax free preventive services benefit. unlike any major legislation, as i said it's not perfect but we've made a world of difference for millions of americans who once were denied coverage or could not afford it. you know, i just think that we should do right by the american people and stop trying to turn this into a partisan issue. there are a lot of good ideas on both sides of the aisle. when i go back to my district i hear people telling me, can't you guys get along, can't you guess work together? the american people want to see his work together, not lurch

from one thing to another. let me ask mr. slavitt, thank you for being here today. i think is a major before new york provides a good example of what's possible when the federal government has a willingness, if enthusiastic partner in aca implementation. every county in new york has seen its uninsured rate declined and qualified health plans are 50% more than they were for aca implementation. would you talk about what your experience has been an states that obstructed efforts to implement the aca versus your experience in states that have been good partners like new york? >> i think there's a fairly well documented difference in the uninsured rate now. congresswoman degette i think refer to this. states that have expanded medicaid have lower rates of uninsured and a number of other benefits than the of the state. i might also comment on your earlier comment about working together. my understanding of the history

of medicare very much falls on long the line with what you said, which there were a number of efforts that were required after medicare advantage past to find the things that wouldn't work as well as they should enter a name them. as a result i think we're one of the most popular long-standing bedrock programs today in our country in medicare. and so i think we have to -- with the same opportunity without a doubt cannot just do what we've done but continue to do better. we look forward to working with congress on this. >> if i might, thank you you noted during the testament that cms, and i quote, has learned more about what kind of outreach for most effective i should seek to reach out to the remaining americans who are uninsured and eligible to enroll in market place coverage. i'm pleased they're seen as destroying upon lessons learned to reach americans who remain uninsured. can you talk about why targeted outreach is so important and how

might we expect these efforts to affect the risk pool of enrollees? >> the gentleman's time has expired. >> i will take it -- >> please respond in writing. the chair now recognizes the gentleman from north carolina, mrs. ours, for five minutes. >> thank you, mr. chairman -- ms. ellmers. >> mr. slavitt, i would like to go back to some of the issues with meaning increases that are projected for 2017. there's been some discussion here today about the projected cost increases for 2017 when it comes to the premiums, and i'd just like to shed some clarity on. i know you feel as strongly as we can congress do about transparency in making sure that information to consumers is readily available. in north carolina one of the top insurers has projected that there may need to be about, although less than 20% increase

in the premiums. i've heard from some of my colleagues substantially larger increases in premiums, and i really do believe that this is something that even though we can congress understand it because we have the ability to get that information, and our staffs are able to do that. the average person, the average american really doesn't. so i would like to understand what that process is. for instance, in the discussion about the oklahoma increases, you would basically said that you were not sure that that have been determined yet. at what point will oklahoma's premium increases be determined, and how wel was the rest of amen note each states renewed interest is? >> thank you, congresswoman. so right now in its date has a slight difference schedule. states are going through rate review process and each state has a little differently which is why it's hard to generalize

your they are in the process of reviewing the rates and then they were finalized and approved them. most of the states, i can't think of one that doesn't, but most of the states make that information public immediately within their states as that happens and then they get reported in a number of studies. i think we have been quite visible. i can get back to give any specific questions about states. >> i'm concerned, and i'm wondering if cms, if you actually at some point post this information so that it's readily available? and as for the date i know you said the process is being played out right now. correct me if i'm wrong, you said november 1 is the beginning of the military for people for the affordable care act. will these numbers be know by november 1? >> consumers will have access to this information beforehand but we typically do is we open a website up early so that even before november 1 consumers can

get a sense of what things cost, and as a result of the general public also is access to that information. >> just for verification purposes, any american who was ready to sign up or start looking at insurance for next year, they can know that cms is going to that information by november 1? >> that so we have done historically, yes. >> for the purposes of making sure this information is readily available, i have dropped the bill, 5960, which is basically the consumer health insurance transparency act to make sure that we are making that message and known to cms that we would love for the information to be out there for consumers by november 1. and i would like to see that happen, and i hope that we'll be able do that again for the same purposes that you believe in, which is consumer transparency. in the remaining time that i have i would like to ask, for

the insurance companies that have come forward, three major insurance companies have said that they're backing out of the affordable care plan or limiting the number, the most recent being humana come and others have discussed the possibility of it. what do you say to that? if this is working within a man manner way or only minor tweaks need to be made, which my colleagues, my democratic hawks continue to say that we just need to make a better. this really doesn't seem like it's getting better. what do you say to them? >> one thing we all have to recognize is it's not only change for us, it's not only change for consumers, it's a chance for these insurance companies as well. the way they historically operated where they would essentially be able to assess people's health before they would right policies has gone away. and so insurance company are adjusting and i think it's hard to generalize.

many, many companies are doing that well and doing it successfully. many as has been public as you pointed out have retrenched big even those that have retrenched a little bit are still committing hundreds of millions of dollars of capital to do so, but they're doing it at different paces. that's just an acknowledgment of the qaeda tresemme that i think everyone has to go through. >> thank you so much. and i yield back. >> the chair thanks the gentleman and now recognizes the gentlelady from indiana, ms. brooks, five minutes. >> administers slab, when you came before the oversight committee on december 8, 2015, he came to testify about the sustainability of a state-based exchanges. at that hearing you testified and i quote over 200 million of the original grant awards have already been returned to the federal government and where in the process of collecting and returning more come and go. and de facto significant media attention that went out the day

indicating that cms had recouped over 200 million from failed state exchanges. the committee that issued a report in may and falling the release of the report be responded to the committee stating that, in fact, cms had recouped $1.6 billion from the 17 state-based exchanges. not the 200 billion initially stated during the hearing. you clarified that it was simply an estimate of funds that cms had be obligated from states that did not establish the exchanges. but could you explain that cms arrived at the estimate initially when you came to testify in december? it's a pretty significant discrepancy. >> i believe that the transcript shows i was asked a question about 5 billion plus of funds that were sent out total, and at

the time i estimated that of those five, i think 5 billion, 200 million or so was being recovered. in fact, that number is now over 300 million. says that time i have got a letter from subcommittee chair who said that was, in fact, -- wasn't the question if it is asking something to do. so we clarified that he was, in fact, asking for something different. i served will take responsibility for making sure that i'm clear. because when i come before these committees, whether the news is good or bad my job is to tell a straight. if i don't do that then i needed to better. so there was a miscommunication, i will say that fraudulent numbers, we just i believe received a check for about $14.2 million on funds recovered from a state that did have trouble. so it's actually, it's more updated than the 1.2 million,

and so that continued ongoing and unhappy come and we do keep it updated. i'm happy to continue to do that. >> the discrepancy was with respect to the characterization of the -- >> i think i tried. >> so the recruitment was 1.6 million at that time? >> is greater than that today. >> and you tell me today, and thank you, that was my next question. can you please talk to me about update on the amount we took from the 17 state exchanges at a? >> i don't have exact figures with me but i know it's at least higher by about $14 million. because we just received a check back for one of the states for over $14 million. i can give you a complete -- >> which state? >> maryland. >> summarily just wrote a check back for 14 million in addition to the 1.6 million, and at the time the 1.6 million, do you have any idea how many states that come from?

>> not sure exactly, three or four, something like that. >> so the other, then you know, 12 or so states, can you talk with us about what is being done with respect to the recoupment of the font? >> which find? >> the recoupment that we initially were talking a. are you expecting to receive additional funds from other states? >> so we expect to recover funds that are improperly spent and we can document that improperly spent. we with the help of the oig, who has been very helpful in providing analytics, go out and look for an assessment funds have been improperly spent. in those funds that we did recover, and we also i should say review many funds before they are spent, and so we don't need to go through a collection process if we require an

approval process which we put in place as well. >> and the 14 million that merrill lynch is returned, was that for improperly spent funds? >> so that was for, their technology vendor was essentially the state can we get into this date within for overcharging them or wasting technology spending. they settled the lawsuit and the 14,000,001 as a down payment on the federal share of that funding. i think the total number will come in from maryland at 32 million based on specifics. >> thank you. my time is up, however i would be interested in the committee receiving report on the status of where the recoupment of funds is today from all other states. >> we will update you. >> the chair thanks the gentlelady. i'd like to clarify that mr. slavitt maybe $200 million estimate in his opening

statement, not in response to a question. that concludes the first round of questions for members present. we will go to one follow-up per side, and i'll start. recognize myself five minutes for the purpose. to follow up on mr. griffiths questions about risk corridors, mr. slavitt, you said that there is an obligation to make insurers whole. my question is how does the cms plan today for this quarter obligation to make insurers whole under th that program? because there are no appropriated funds to do so. >> i can't speak to that directly today. but this is, as you know, as i said earlier, the subject of a lawsuit sigh think that will, that will settle out.

>> this is not a question for doj, because not all insurers are in the litigation. so the question is how do you plan to pay for the obligation when there are no appropriated funds to do so? >> i'll consult with omb and get back to you. >> thank you. another question. the committee's investigation into the co-op filters examined the negative -- failures examine the negative impact of the 17 co-op closures. what they had on individuals enrolled in those health insurance plans, and the closures created uncertainty as individuals are forced to find new health insurance coverage. in some cases with midterm shutdowns can individuals have to act fast in order to avoid gaps in coverage. based on this, one of the recommendations from the committee's report released today is that the individuals be

exempt from individual mandate penalty if they coverage under plan offered by co-op is terminated due to failure of the co-op. we believe this recommendation is commonsense as wish not be punishing individuals who make a good faith effort to comply with the individual mandate as the result of their plan no longer being offered. does seem as agree with this recommendation? >> we didn't receive the report until late in evening last night so i haven't had time to study in detail but we will. >> will you please respond to the question? >> will do. >> thank you. that's the only follow-up questions i have. the chair recognizes the ranking member mr. green 40 follow-up. >> thank you, mr. chairman. i have to issues. one, my colleague from denver, colorado, earlier mentioned the gao study. if you'd listened all the questions on the republican side

you would think people are up in arms about how bad the affordable care act, but the gao study that she mentioned was that there were studies in colorado, indiana, montana, north carolina and vermont, and consumers, assisters, shareholders concluded most customers are satisfied with your coverage despite long-standing issues of out-of-pocket expenses, health literacy and access. mr. bagdoyan, is that something gao was going to comment on, the study that was released on monday? >> it was -- >> i think a lot of us would like to see the consumer feelings on the affordable care act. of course, we trusted gao for your work. >> unfortnuately, i was not responsible for running that engagement that resulted in that report but we would be happy to get back to you in writing with

an answer. >> i appreciate it. we wasted countless hours in this committee, colleagues criticized provision after provision of the affordable care act and the route for its failure. we should instead be using this time to build the loss success by improving quality, affordable care available to our constituents. administrator slavitt, i applaud cms to let you work to implement the law better know the agency has taken steps were possible to make administrative fixes. some of the fixes require legislative action. unfortunately, my republican colleagues are only interested in undermining, weakening or repealing the law. what steps has a position taken to ensure the long-term success of aca? but more important i would like to ask if you know what steps should be taken by statute for congress to do to help make the affordable care act moving forward and to be more

successful? and again i don't think into a three minutes or so you have, but i would be glad if you could get back with us and if cms and list what cms has done, but can also say these are issues that you have that congress needs to act on them so we can fix it so we could cover more people. >> we would be glad to do that. >> mr. chairman, i thank you and i yield back my time. >> the chair thanks the gentleman. that concludes the question of the members present. we will have some follow-up questions in writing, and other members who maybe were not able to attend may have questions in writing. we will provide those to you. we ask that you please respond promptly. members should, they have 10 business days to submit questions for the record. so members should submit their questions by the close of business on wednesday septembe

september 28. another very informative and productive hitting. thank you very much for your expertise or and without objection the hearing stands adjourned. [inaudible conversations] [inaudible conversations]

[inaudible conversations] [inaudible conversations] >> the u.s. senate is gaveling back in momentarily. they are going to pass the water resources develop an act which authorizes dozens of water related infrastructure projects around the country, providing around $220 million in direct

assistance for committees like flint, michigan. the house version could see a floor vote next week. that doesn't contain the flint component to do your special differences between house and senate. peter deposiwe take you live no. senate. the president pro tempore: the senate will come to order. the chaplain dr. barry black will lead the senate in prayer. the chaplain: let us pray. eternal spirit, refuge of all who flee to you, send your power among us bringing comfort and direction

for our lives. be with our lawmakers. if their eyes have been closed to your graces, open them. make them so aware of your providential movements in their lives that in the quietness in this moment of prayer, they will feel true gratitude. lord, strengthen them to do your will on earth, causing justice to roll down like waters and righteousness like a mighty stream. may they measure their attitudes and responses

by the standard of divine love. we pray in your strong name. amen. the president pro tempore: please join me in reciting the pledge of allegiance to our flag. i pledge allegiance to the flag of the united states of america, and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. mr. mcconnell: mr. president? the presiding officer: the majority leader. mr. mcconnell: i understand there is a bill at the desk due

a second reading. the presiding officer: the clerk will read the title of the bill for the second time. the clerk: s. 3326, a bill to give states the authority to provide temporary access to affordable private health insurance options outside of obamacare exchanges. mr. mcconnell: in order to place the bill on the calendar under the provisions of rule 14, i would object to further proceedings. the presiding officer: objection having been heard, the bill will be set on the calendar. mr. mcconnell: mr. president, today i have the distinct honor of welcoming my dear friend, burmese state counselor as she visits our capitol. she is an incredible woman with an incredible life story. she endured much, much since pro-democracy protests first swept her country many years ago. what follows was a story made for hollywood. in fact, it's a story that

hollywood has made, but the story of aung san suu kyi, of the long-time political prisoner who had become the voice of her people, then the de facto leader of her country is about more than the lady herself. it's about the journey of a country and a people. i first learned of that journey decades ago as i read her heroic support for democratic reform, peaceful reconciliation and human rights in her country. it may not have been the most popular political cause back then but it was important. i decided then to make this cause my own whenever possible. over the years it meant sponsoring sanctions on the burmese regime, it's metropolitan promoting political and constitutional reforms and meeting with burmese leaders and it's meant keeping in close contact with dal su.

whatever the task, it's been my honor to support my friend. it's been truly remarkable to see the changes that have taken hold in burma in recent years, changes that once seemed literally unobtainable. last year the world looked on as daw suu looked on. for those keeping score, this was actually the second time she has done this, but unlike the election in 1990, these results were actually accepted by the regime. it was a moment many of us had eagerly awaited for decades. in many ways it reaffirmed the purpose behind daw suu's lifework, her sacrifice and indestructible resolve. but it was also a reminder of the many challenges that still face the burmese people like addressing the much-needed constitutional reform and the military's disproportionate

power in parliament. like ending decades-long conflicts and promoting peaceful reconciliation among ethnic groups. like encouraging economic development. as daw suu knows best of all, burma is a country with many challenges to hurdle as it strives to achieve a more representational government, but the burmese people are not alone. they and she have much friends here in washington as they work toward reform and reconciliation. it's been four years since daw suu last visited us. it was a privilege then to help bestow her with the congressional gold medal she earned many years before. it's a privilege to welcome her back now in this new capacity. i look forward to meeting with her later today and again wishing her all the best and reaffirming my own commitment to support her and her country on the path ahead. now, on another important matter, from the gulf of mexico and the chesapeake bay to the inland waterways that are so

important to kentucky's maritime jobs, america's waterways play a crucial role in supporting the economy, transporting goods and people from point a to point b and supplying communities with drinking water. as the chairman of the environment and public works committee, senator inhofe understands just how critical our waterways are and the importance of maintaining them. that's why he has been working with ranking member barbara boxer to craft the bipartisan 2016 water resources development act, or wrda. this responsible water resources bill authorizes more than two dozen army corps projects from the east coast to the west, and it's expected to save taxpayers $6 million over the next decade. it is also completely paid for. the projects authorized in this bill range from strengthening our waterways infrastructure to helping support raise and reliable drinking water sources. they also invest in priorities each of us cares about like

improving public health and safety, enhancing commerce and supporting america's ecosystems. here's what i mean. by investing in flood control projects, dam maintenance and drinking water infrastructure, this bill will enhance public health and safety. by investing in ports, harbors, locks and dams, it will strengthen commerce and by investing in restoration and revitalization projects from the florida everglades to the los angeles river, it will support america's natural ecosystems. i'm also pleased the bill supports several projects in kentucky that are important to me and to my constituents and to the united states army corps of engineers. one will transfer aging infrastructure along the green and baron rivers in kentucky, over state and local entities so they can determine the best use of this infrastructure. another will help my constituents in paducah better protect themselves from flooding from the ohio river by helping

complete repairs to the city's flood protection infrastructure. the bill also includes an important coal ash provision that will give states the authority to create their own coal ash permitting requirements and systems to ensure that coal ash is recycled and reused in a safe and effective way in accordance with current e.p.a. guidelines. to quote senator inhofe, the top republican on the committee, this bill will support our communities and expand our economy. to quote senator boxer, the top democrat on the committee, it will provide a perfect vehicle to upgrade our water infrastructure. i appreciate their work across the aisle to move this important water resources bill forward. its passage will represent another bipartisan win for american transportation infrastructure. and it's another example of what's been possible with the senate that's back to work for the american people. i look forward to its passage later today, and i would encourage our house colleagues to take action soon so we can

send the bill on down to the president. now, one final matter. i'd like to say a few words about tim mitchell who has hit a significant milestone in his senate career this week. 25 years of service. as the democratic leader has noted on several occasions, tim's love for baseball and the red sox in particular is hard to miss. how big a fan is tim? well, a few years back when the sox won the world series, the democratic leader gave a shoutout to tim when he offered the resolution honoring the team. if it were in order, he said then, which it wasn't, as tim would be quick to note, i would ask that this resolution be passed with the name of tim mitchell on it. i consider myself a fan of baseball, the democratic leader continued, but i have never known a more rabid fan of a baseball team than tim mitchell whom we depend on so very, very much to help us work through all we do in the senate. and i have to say this is an area where the democratic leader

and i absolutely agree. tim has been a staple around here for a quarter of a century, working his way through some of the most difficult jobs in the senate as part of the florida staff. to paraphrase laura dove, the secretary for the majority, the work of tim and his floor staff colleagues could be compared to that of a duck gliding through a pond. above water, the duck appears to be moving through the pond effortlessly, but if you take a look below the surface, you will see its feet working, putting in difficult and often unrecognized efforts to keep it afloat. tim certainly does so to keep this place afloat, coordinating with his majority counterpart robert duncan, sifting through heaps of paperwork and putting in long hours that turn into late nights. but even on those late nights, tim makes it a priority to not only make it home for family dinner but to prepare it, too. well, tim, from what i hear, it's takeout night at your

house. i would imagine tonight's dinner will be a little more special than usual. and i know your wife alicia and your son ben couldn't be prouder. your senate family is proud of you, too, and we thank you for these 25 years of dedication and service. mr. reid: mr. president? the presiding officer: the democratic leader. mr. reid: i appreciate those remarks of the republican leader regarding tim. people have heard me talk about baseball, how i fell in love with baseball as a little boy, listening to the radio and the game of the day. i so wanted to be a baseball player. but as time went on as a young man in college, i realized that i wasn't big enough, fast enough

or good enough to be the baseball player of my dreams, but that didn't take away my love for baseball. living in southern nevada, las vegas, we had a team. it was the dodgers. we listened to those games, watched the games in the reno area, northern nevada, the team was the giants, but we in southern nevada didn't like the giants. the days of sandy koufax, don drysdale, claude ostein, those were the days of real baseball. games 2-1, 3-0. not these slugfests. we didn't have them then. in coming back to washington and in the many years i have been here, we had the baltimore orioles. i love their owner, wonderful man, peter angel owes, and --

angelos, and i have been disappointed they haven't done better, but they did pretty well this year. i followed them closely. of course when the nationals team came here, our attention focused not entirely on baltimore because it was the only team around back here, but the nationals. we divided our attention. and of course i have been to the nationals games and it's been great. as the republican leader and i have said many times, we bicker and fight on some things but never on baseball. we both watch the nationals and we follow what they do. and as everyone knows, greg maddux from las vegas, the best athlete to ever come out of nevada. we have had some in northern nevada. i recognize them also. some of them played professional football. but no one was as good as greg maddux.

winning more than 350 games, unheard of today. a man of, as he would admit, of average talent, average talent but a mind and such dedication and such composure and such confidence that he became one of the best of all time. tim and i talked about all of these things i talked about regarding baseball. we talked about bryce harper mpt we recognize him thought having a great year this year. they're afraid -- he's walked 104 times which is unheard of in baseball. but his batting average isn't as good as it was but he's still the most valuable player in baseball at age 22. been an all-star team i think four, five times already in his young career. so tim and i have talked about all this. and as he knows, i like the boston red sox. i like the boston red sox but

i'm not in the same league as tim mitchell. tim is the assistant secretary for the minority and was for the majority of course during my many years as the democratic leader. we have such a nice relationship where we can do our business when we need to and we do that a lot but we have a good time talking about family and baseball. i don't know if any of you saw me grab his tie and look at it. he has over a hundred ties that have baseballs on them. has one today. a little harder to see. it's one of those john kerry ties, one of vows vineyard joins from massachusetts but it's a beautiful tie and it's typical for a baseball tie. he wears one of them to work every day. i wouldn't say some of them are ugly but some of them catch your

attention. he watches the red sox whenever he can. he goes to games. he takes his dad to the games. takes his son when he can. he watches games here. watches them in baltimore as often as he can with his son. this is -- i wouldn't put it in the class of weird but it's close. he has in his basement two seats from fenway park. they were worn out there but he bought them anyway and now he watches his games in his basement on fenway park seats. can't make up stuff like this. [laughter ] mr. reid: so tim is dedicated to baseball and we recognize that and i admire him for that. tim, i think you and i are going to go through the same

withdrawals in a few weeks because baseball season is ending. for me baseball season is a tremendous respite from what we do here. frankly, i'm not much of a football fan anymore, become kind of addicted to soccer after baseball. but during baseball season, i can go home and watch a few innings and it's a complete deliverance from what goes on here. it's really very, very nice for me. and when i come home to nevada, wow, is it pleasant. i can watch a 7:00 game starting at 4:00 in the afternoon there. pretty good, huh, tim? so, anyway, we all will have a little bit of depression here in a few weeks, but his team is doing well. the nationals are doing well. baltimore is doing quite well. so we're going to be fine. as dedicated he is to baseball,

he's also dedicated to this institution. a quarter of a century he has spent here as the republican leader mentioned 25th anniversary of working here in the senate. he started as an intern for someone i served in the senate with, don from michigan. during his jr. year of college owe junior year of college. he moved to washington, d.c. and became a full-time employee. he started out like a lot of us do answering phones but he moved on of course because of his personality and his talent. following his time on the banking committee which regal chaired, he worked on the whitewater committee and we all remember that. there are still parts of that dribbling on in this presidential election. he worked then for senator tom daschle who was one of my predecessors as a research assistant and then the democrat policy committee which i led

during part of my tenure here in the senate. in 2001 tim made a move that would forever change the senate for the better. he joined our floor staff here. that's a long time ago but he's been here diligently since then. he's armed with an incredible work ethic and a very keen intellect. he's worked his way up on the floor team. he's become an expert on senate rules, procedure. he's a lawyer at the law school at night. worked as long as he could missed a few classes because of working here late. throughout his time on the democratic floor staff, he's become someone who the republicans appreciate and go to for help as we democrats do. in 2008 the senate adopted a resolution making tim mitchell the assistant secretary for the majority. when republicans took control of the senate, he assumed his

current position. think about all the important legislation that tim has helped us with and i mean helped us with. we have a number of senators on the floor this morning and they're all -- i see senator boxer and senator durbin. it's my bad eye, folks. you'll have to take those that i can see. we are all pretty good at what we do but we would be lost without the tim mitchells and the gary myricks of the world. we would be stumbling around here. we depend on them so very, very much. tim has helped us. he's helped us in so many different things, through the affordable care act, the automobile bailout, the stimul stimulus, on and on with all we've done. and he's been here helping us. he's accomplished so very, very

much, but i know he doesn't have to give me a long dis ser taition on this -- dissertation on this. his role in life is to be a good father to his 10-year-old son ben and of course a good husband for his wife, alicia. i'm sure he accomplishes that very, very well. ben is a budding skier and to no one's surprise a baseball player. he speaks as we all do about our athletes about how good they are and in our eyes they're the best. thank you for sharing tim with us all these years. so i join the entire united states senate, democrats and republicans in thanking tim mitchell for his exceptional work for 25 years. mrs. boxer: would the senator

yield for 30 seconds. thank you very much. i see the leadership team is here and i know they're going to speak at length. i'll represent the rank and file, tim, to tell you what you mean to us. lots of times there's lots of stress around here, not that i've ever experienced it, not that i've before gotten worried, nervous or annoying to people, but through it all, there you are with the team. they know who they are. just giving us the advice, protecting us, telling us what our rights are, what we can do, what we can't do. people don't understand it outside it chamber what it means to have people like you. so, tim, you love baseball. i grew up six blocks from the field and saw civil rights unfold with jackie robinson on the bases so we have that love in common. but if we were voting today, you would be most valuable player. we do love you, tim.

congratulations. and we look forward to working with you for a long time. i yield. mr. durbin: would the senator from nevada yield. mr. reid: be happy to yield. mr. durbin: mr. president, i say through the chair, i want to join in this. i started in my career as a staffer, as a parliamentarian, and so i know what happens behind the scenes is sometimes even more important than what you see on the floor of the senate. tim mitchell for 25 years has been behind the scenes but at the heart of the activity of the united states senate. i've been here for 25 years and -- 20 years and relied on tim and our great team that stepped up time and time again. and like most people, it took just a minute or two in the senate cloakroom to realize that tim mitchell is the biggest baseball fan i've ever run into. i don't know anybody who has a hundred baseball neckties but he

does. and as senator reid said some of them are very challenging from a style viewpoint but he is loyal to his sport and particularly loyal to his team, the boston red sox. and i've watched as he came into that glory moment with the win in the world series after a long, long wait. i know now that he's looking for a return to the world series for the boston red sox, and i have a pairing in my mind take i think would be perfect. it involves a former red sox president who came over to help the chicago cubs by the name of theo epstein. he made history in boston taking them to the world series. we think he's getting to make history in chicago. so this would be the perfect world series for tim and for me and for baseball, but let me close by saying if that's a perfect world series, you have been a perfect addition to the senate for 25 years.

we look forward to a lot more aide. thanks, tim -- a lot more ahead. thanks, tim. a senator: mr. president? if the minority leader would yield for a minute. mr. reid: would be happy to. a senator: i just want to add my congratulations to tim for his tremendous work here. i've been here for 24 years. every year i've been here he's been a critical part of the work we do here. mrs. murray: the leader mentioned a number of issues you helped us work our way through. for me, when i was chair of the budget committee and what we know is a very chaotic, long, tedious process, tim was there to make sure that we did it right, that we were in order and that things moved smoothly. tim, we could not have done it without you so thank you for your 25 years of service and thank you to your family for allowing you to be here with us for 25 years of service and

thank you for all you will continue to do. thank you. a senator: mr. president? the presiding officer: the senator from new york assume assume would the democrat -- mr. schumer: would the democratic leader yield. mr. reid: would be happy to. mr. schumer: every organize -- organization has what they call unsung heroes. on the battle feedz they're the soldiers. in the automobile plant they're the assembly workers. in the hospital it may be the nurses. the organizations can't go on without these people. they are the heart and soul of these organizations, and they do their work quietly but proudly. if you had to pick someone who personifies the unsung hero of this body it would be tim. he does his job every day. you can see when you talk to him the pride he has, the knowledge he has in doing the job and doing it well.

barbara boxer mentioned there are lots of moments when everyone is in a stir. never tim. he calmly and directly gives you the right advice. he is a hero, a hero not only to those of us who are here but i think to every member of this senate. and, tim, we love you. we love you. god bless you. mr. reid: mr. president? the presiding officer: the democratic leader. mr. reid: i ask unanimous consent the next part of my presentation here this morning appear in a separate place in the record. the presiding officer: without objection. mr. reid: mr. president, i want to switch from my friend, tim mitchell, to another friend i have. ten years ago i was in search of somebody to help with my scheduling, to work here in my capitol office.

the office just a few feet from here is extremely busy. we have people coming and going all day long into the night. and so i knew i needed someone that was good and would get better. little did i realize that the woman that i hired didn't get better, we got the best. krysta, that's her name. last name jurys. i have a few months to go as a member of the congress. been here 34 years. i've had some remarkable employees. i've had such loyal staff that are with me now that will stay

to the bitter end. but it's hard to find a description for someone as capable, as nice, as competent, as smart as krysta. david mccallum who helps me line up staff, told me he had a candidate and he thought she was really good. gave me her background, and that she had worked in senator clinton's office. and in her presidential campaign. told me, i guess the clincher was she was a collegiate lacrosse player. lacrosse is a game i have gotten to know quite well because i have grand sons that that's their sport. it's really a difficult, hard game. c