than the house right now than they have been. >> covering the home lapped security debate in the house, tim starks of congressional quarterly. read more at cq.com. thanks for the update. >> thank you. mr. gorbachev, tear down this wall. >> sunday night at 9:00 eastern and pacific on american history tv, mark the 25th anniversary of president ronald reagan's 1987 speech from the brandenburg in germany. our series "the contenders." 14 key political figures who ran for president and lost but changed political history. this sunday james blaine, american history tv this weekend on c-span3.

they're often referred it to as the conscience of the congress. having worked there almost two years, i can't think of a better name. it is really the heart of the people. >> executive direct or and general counsel of the black caucus, angela rye on the role of the black caucus. >> it is designed to make sure members of congress, who are african-american, can come together on issues plaguing the community at-large, issues that maying plaguing their districts where they can find commonality, to discuss legislative solutions, proposals to advance the causes of people who don't have a voice. >> more with angela rye on c-span. coming up thursday morning on c-span3, federal reserve chairman ben bernanke. he testifies before the joint economic committee about the

economic outlook and the fed's efforts to improve the economy. that's live at 10:00 a.m. eastern here on c-span3. under the president's health care laws states are supposed to set up health insurance exchanges where consumers and employers can buy health insurance plans. maryland and virginia's state health secretaries recently spoke in washington about designing their insurance exchanges. also at the event were representatives of the insurance industry, a consumer group and cds. >> what's up with health state exchanges and what's really going on in the states and how ready everyone is going to be. political crow has quickly become the leader in news on health care and energy and technology and transportation policy and more to come. and we're excited to have this timely discussion today.

let me tell you about who we have here today. we have bill hazel, virginia's health secretary. josh sharp steen, maryland's health secretary, dan durham, america's health insurance plans and ron pollack, family executive director of families usa. and before we get started, i'd really like to thank cvs caremark for making these events possible, our partner on all of these events. we're really thankful to them for allowing these events to be possib possible. so i'd like to bring out larry burton, the senior vice president of government affairs and cvs caremark to say a few remarks. >> thank you very much. it's great to be here and thank you for having this breakfast with politico pro. i'm larry burton, vice president of the government relations team. a lot of us are looking at the supreme court decision and what happens, what's going to happen

at the state level? what's going to happen to health exchanges? and so in spite of all the coverage and dialogue about it, there's uncertainty and confusion about what's out there in terms of choices. our own cvs consumer research has shown 78% of the consumers we interviewed who would be eligible for the new health care insurance coverage have never heard of the state-based health care exchanges. the need to shop for health care coverage starting in 2014. in addition, more than 60% said they need help in choosing health insurance when the system changes. so with this backdrop, i think the panelists today will be providing us insights and interesting information in terms of what the choices are and also how government, how consumer advocacy groups and private enterprise can partner together in looking for solutions in the future, so thank you very much. >> thank you so much, larry. [ applause ] next we're going to bring out joanne kenen the deputy health

care editor and we're going to give you a very, very quick lay of the land of what we're watching over the next few weeks. and it's this. everyone is waiting on the supreme court. but there is other stuff going on, too. the fda user fee bill seems to be zooming on through congress. there are few issues that are going to have to be worked out between the house and senate now that the house has passed its version. but really not expecting that to take very long or get tripped up by big issues. there is another -- there is another pretty big health care vote that we're expecting on the house floor next week and it's a vote on repealing the medical device tax in the affordable care act. a pretty safe bet that will pass. the only question at this point is whether there will be a lot of democratic support or not and

that depends on how it's paid for. if you want to say anything, joanne -- >> go through the senate? >> no, no, it will not go through the senate. but in the meantime, yes, things are at a standstill waiting for the supreme court. are there any other big issues you can think of? >> the supreme court decision. >> there we are. >> i guess one thing we want to see is does the supreme court really clarify things, what we'll be writing the day after. that's one of the things we'll be hearing about from the four speakers. it may not be totally plaque and white. >> and just to clarify with everybody, we're still expecting the most likely week that we might be hearing from the supreme court would be the last week of june, june 25th, which is a monday, or june 28th, which is a thursday. and my daughter's birthday. so that's the prediction. so, if we can, let's bring out

our panel. we're really pleased to have, again, dan durham, executive vice president is at america's health insurance plan, bill hazel, virginia's health secretary, ron pollack, the founding executive director of families usa and josh sharfstein, maryland's health secretary. thank you so much. i guess let's -- we'd like to start out with the state health secretary, bill, we'll start with you. if you can just give us kind of a bullet summary of where virginia is right now because the state has had a little bit more of a complicated history. >> i think complicated is probably the understatement of the year. where we are is basically the governor instructed me two years ago after the signing of the act was to prepare virginia. the general assembly passed the bill, a section one bill which

said if there's an exchange virginia will build and operate their own exchange. under that authority we continue to plan even though probably is a little unpopular. and so it makes it very interesting. we clearly are waiting for the supreme court to decide what happens. and we are challenged by things related even not to the budget. if there are significant budget cuts to medicaid, affecting our medicate match, and we have an influx of individuals, 425,000, virginia will have to pick that up. that's 1% is 40 million. 2% is 80 million. over here across the potomac ocean those sound like small numbers but for a state like virginia those are really big numbers. and what does that say long term about the ability of the federal government or the willingness to do the insurance premium support in exchange. long term that's a tremendous challenge.

exchanges don't work without the premium support. that being said we have a group called the virginia health reform initiative and between the advisory council which is now about to meet for its, i think, ninth time and the subgroups which have met 18 times, we have a fairly good plan in place. we have done a lot of the technology infrastructure previously. we have upgraded management system. we now have a consumer portal that will be rolled out officially, completely through the state in june which would allow individuals to apply for benefits including medicaid. we have an rfp posted last friday to replace the eligibility and enrollment system which will allow individuals to apply for medicaid but energy assistance and child care. so we're taking that approach. and the way we've done this is anything we've done technology wise we need anyway. and if the exchange comes on,

the enrollment comes on line, we are doing things that have made sense anyway so that's how we get there. but the health benefit exchange module is also part of this rfp. we have zeroed in and will likely recommend to the general assembly an essential benefit package based on the small group package in havevirginia and whee have meetings set up dealing with the exchange and so forth. we've done a lot of planning and in some ways i think we probably are ahead of states that even are more in favor which puts us in a weird position. suppose this thing ultimately falls apart and the technology isn't there and virginia's done it when we don't want to, what do you do? >> at this stage, you know, say the supreme court comes back and the law is upheld and the

elections don't really change anything, would virginia actually be ready to run your own exchange completely in 2014 based on where you are now? >> there are some -- that's complex. i think if you saw the articles yesterday in "the journal" you saw that people are worried about the i.t. and been in on a number of meetings and everything has to go right to get there. we are probably one of many of that hand pl of states that probably could pull them off. now the governance piece is entirely different and that clearly can get set up and those policies can be in place but we're very sensitive right now to issues related to our insurance plans. they need information now so they can start doing their planning. so the sooner we get clarity around things like essential benefit packages, we are a little worried since that really hasn't gone through a regulatory process at the federal level as called for in the ppca, we don't

know where that's going to end up exactly. so there are lots of things out there that even if you're making a good faithed effort like josh is doing to get this done, there's some challenges ahead. >> definitely. let's hear from josh then because it sounds like maryland has been charging full speed ahead and how do you think things stand at the moment? do you feel confident that maryland will be ready in 2014? >> thanks. well, first, let me thank you and politico for hosting this event. i think the amount of commentary out there at the pundit level is really high and the number of articles and events like these where people are talking about what's going on in havevirginia maryland, or another state are not that high. i think this is great, this kind of event. i appreciate it. i agree there are a lot of complicated details. i believe it's not that complicated and fundamentally maryland has looked at this as

an issue of how we improve the health care system both for hundreds of thousands of marylanders who do not have coverage and face financial ruin or the inability to get care they need when they need it, and those are stories i hear across the state when i go on radio shows, the people that call in. that's fundamentally what this is about and it's also about the cost of health care which is a real drag on the economy and jobs. and really figuring out how we can turn the corner on cost. right after this law was signed, governor o'malley set up a planning process that has involved everyone in the state who has been interested across provider groups, insurance brokers advocates, really -- businesses, everybody. very early on we saw the affo affordable care act as a great set of tools, a great set of tools to help us address these fundamental questions of access and cost. and that initially led to a recommendation that maryland set up its own exchange and there is definitely an irony.

i see it as a different irony than dr. hazel. i go to the various panels with other states where they are very against the affordable care act and they're going to wind up with a federal exchange in their backyard and we see the affordable act as a great set of tools, but we would like to control our own destiny. there have been a couple of laws that have passed the general assembly. we have a staff for the exchange. we have gone through an extensive process to go through a whole bunch of very important policy issues that the general assembly adopted. we're set on all the different kinds of insurance rules and the navigator program and a whole bunch of details. people are very excited to see this work in the state. we also see the i.t. part of it as a big challenge and we have completed an r fp, have a team f contractors. it doesn't make it easy. i've been doing weekly meetings since i started around the i.t. things. it's important to realize what

we're talking about when we talk i.t. we're talk iing about people having the ability to easily get affordable health care. that is a huge value across both medicaid and the exchange. i think that we're really looking forward in maryland to a point where people can get health insurance at an affordable price and they're laepier, healthier, more productive and maryland really benefits. >> what are the dynamics of the debate is what you are talking about, state control versus turning it over to the government. you're one of the handful of exceptions saying this does give us some tools to make it look the way we want it, and some other states, i call them the over my dead body states. have you been on enough panels and meetings together that you can each give two or three examples of why maryland and virginia are going to look

different, assuming we are on january 14, that the exchanges do open up, is there some decision you've made that's going to make the virginia exchange because you are exercising control look different -- within the exchange or out of the exchange or something that the audience will understand is a difference? >> i don't know but there is a group of individuals who believe that the states should just stop all work now, default into a federal plan and assume the feds can't get it done. that's not a bet i would recommend yet to the governor that he take. i think there's been a tremendous amount of work at the federal level. there are decisions yet to be made whether this can be done or not. i would also want to say that like josh we are concerned about affordable health care and access to it. our concern is this may not

prove to be as affordable. i think that one of the problems folks will have in 2014 is sticker shock when all of this comes about and i'd be interested in your comments on it because i've heard that concern about the plans and the access depends on affordability. part of our work in virginia has been to create a center for health care innovation which lives in the chamber of commerce. we feel we have to align the private sector to move towards deliver delivery system reform in a major way. now maryland has done that differently over the years because they do statewide sort of rate setting and they have a different, more involved approach governmentally. now to your question specifically we would have a facilitator exchange. i would assume that maryland would be a little more active in the negotiation of prices but i don't know that. we would likely have a single

mechanism for the individual policies. i don't know what decisions you've made in that regard. your benefit package may be different. those are places where within the framework we know we're working in, states can choose things that are different. josh, i don't know where you are in those. >> we have decided not to merge individual and small group markets. we have a nonguaranteed issue -- i mean a guaranteed issue. >> we're not merging the markets from a risk standpoint, we're running a single administrative in two pools. >> i'm not so sure we would look all that different. one of the things we'll be doing on the small business side is partnering with the private insurance brokers and agencies so that they can integrate the exchange into their daily business. on the active purchasing side, the exchange has authority by the legislature to add additional minimum requirements to the aca requirements but we haven't made any decisions on whether we do that. our initial sense is it's very

important to get this up and running as robust participation as possible. after a few years we can add on some act of purchasing. i think it will be interesting to see whether there are local variations. i'm sure little be local flavors. we're very interested in innovative ways to control costs, and i see the affordable care act as just one piece of the puzzle, a relatively small piece of the puzzle but a very important one. if you don't have people having access to care if they can't get to the primary care doctor, it's hard to fix the other parts of the system when there are people stuck outside the system. it's only one piece and there are a whole bunch of things. we do have a system around hospital pricing that is unique, but there are a number of ways it's been very helpful and there are a whole bunch of other efforts we'd like to get up and running. at a certain point in time it may make sense for the exchange to engage with those and to be a bit more of an active purchaser. if there's a great health care innovation out there that's really lowering costs, we want

to encourage that. and i wouldn't be shy about using the exchange to encourage that or medicaid to encourage that. my guess is dr. hazel would want to do the same thing. if he has a tremendous innovation somewhere that's getting better outcomes at lower costs, you want to drive the in innovation. >> our governors would be up happy if we agreed about everything. it wouldn't be allowed. so i think the likelihood in virginia with politics being what they are and the general prevailing thought is it's unlikely that the government would want to directly tell the exchange or give the authority to make changes through that. however, what we're using in virginia is the innovation center, changes in the medicaid policies that we have and we are looking at using the state employee health plan as a model for what we would like to buy. and as you talk about those that are probably not as much on the forefront as the mandate decisions and coverage and so forth, you have the innovation

center and we are not so sure that there's a body of evidence that supports things like acos that are top down driven because the building blocks in various areas of virginia, and i know in maryland, too, are different. you cannot do in virginia in appalachia what you can do in charlottesville or in northern virginia or tide water. if you think of legos and building, you have different building blocks to work with. and so we're trying to build from the ground up the delivery system that makes some sense, and we're not sure that there is yet an evidence-based model from top down that will work in all places. so we're spending a lot of time and energy on that area as well. >> i want to bring in our other panelists and remind this is supposed to be an interactive conversation. so you should all have note cards by now that were passed out at the beginning of the event. and in a little bit we're going

to get to questions. we're going to ask -- we're going to collect the note cards and pass them up in a little bit. we're hoping you'll have a chance to get some of your questions in as well. the other thing i wanted to mention is for anybody watching the live stream, you can follow at #prohc. ron, i'd like to ask you as you listen to this and you look at the landscape of what the states are doing on exchanges, what are your biggest priorities, your biggest concerns that you're looking out for right now, and are there states that you think might actually be better off with the federal exchange? >> i think there's an interesting example in respect to virginia in terms of the overall landscape. so the story -- >> i'm not sure i want to be interesting, ron. >> you've got your attorney general who was tripping all over himself to be the first to

the courthouse door. you've got a governor who doesn't have nightmares about exchanges or dreams about being a vice president on the republican ticket and who hasn't said the most wonderful things about the affordable care act and here you are doing great work. you know, implementing the affordable care act. and there's a lesson -- >> would you please not say that? retract all of those statements. >> you have a tv camera here. you know your public. so there's a lesson here that's a really important takeaway from this discussion, and i have great admiration for what governor o'malley and josh are doing in maryland. i think there's a very important political lesson from what is happening in virginia. so the story often these days is

that you know there are going to be very few states that are going to implement these exchanges. you've only got 11 states that have enacted authority to set up exchanges. you have two states that have done this by executive order. you've got massachusetts, which has been there, you know, even before the starting line was created. and so the assumption is, gosh, you add those together, that's 14 states. there are other states that are still might pass something. and so what i hear from reporters is, well, gosh, this is a tiny minority of states that are moving forward, and i think a key takeaway is don't only look at those states that have actually adopted legislation to set up an exchange as those are the only states that are going to actually have exchanges ready. and i think a better

indication -- none of these are fail safe, but look at the states that apply for and receive funding for the first stage of setting up an exchange. and you've got 34 states that have done that. some states have refused but they're still working to do so. you look at some of the very conservative states where the governors are bombastic about the affordable care act. virginia is an example. certainly the attorney general. and yet behind the scenes there's work being done to set up exchanges. and so i would suggest to you that there are going to be a lot more states that are going to be

ready to set up their exchanges come mid-november when they submit the paperwork to hhs, then you would assume by just looking at the states that have enacted legislation. take governor christie of new jersey, not exactly a shy guy when it comes to anything let alone the affordable care act, and he vetoed the legislation to set up an exchange. and yet new jersey feels they've taken enough preparatory steps that if the supreme court moves forward and allows the affordable care act to be implemented, the exchanges be implemented, they think they're going to be ready. i would say two other things, if i may, dave. one is the fact that the federal government is now, in effect,

providing flexibility about possible partnerships, that makes a significant difference so that some states that may not have done the full panoply to implement exchanges all by themselves and there are some opportunities for partnerships that may not be the neatest way to do things but i think it provides hope that we'll be ready to go come january 1, 2014. and the last thing i really want to emphasize and that is, you know, the affordable care act did not do everything. josh is absolutely right. it's an enormously important foundation for the future of america's health care system. the one thing the affordable care act does that makes my heart sing is we have 50 million people who are uninsured and this is going to allow tens of

millions of people to gain health coverage, and that's an important thing to emphasize in terms of what the states need to do because it's one thing to have legislation with expansion of the medicaid program, increasing eligibility, particularly for the adult population, and then too much tax credit subsidies for people up to 400% of poverty which is $75,000 for a family of three, $92,000 for a family of four. but you still have to get these folks enrolled. and we have got to have enrollment friendly systems in place and there's going to be a greater challenge with the partnership with maybe the state doing medicaid and the feds doing the exchanges. we've got to make sure simple application forms that you can apply online, that there's no -- every door you can get your application in and it goes to the right place.

you're eligible for medicaid, for a tax credit subsidy. that is critically important and has to be done absolutely right. >> we're going to get to the audience questions in just one second. dan, i wanted to ask you what's your perspective as you hear all of this and what are the biggest concerns that you're looking at with the exchanges, and do you have a sense of whether enough insurers will be willing and able to participate in the exchanges to make them viable markets or could we see a problem down the road? >> does it really matter for a health plan whether it's the state or the fed running it or a hybrid where they're sharing responsibility? how off putting or is it irrelevant to a health plan? >> very good question. from our perspective it's important we have a true marketplace where the emif a siz is on maximizing competition and choice.