no one is turned away from services and becomes more vulnerable to disease because of what we're doing ourselves. so you're absolutely right, the community piece is essential and remains a barrier for both mothers and baby. >> so the last question on -- >> on tptimism. >> and the post 2015 agenda. just to start it off, i am an optimist. i always approach it very optimistically. but that was a feeling at the conference. so if we didn't convey that, most of us felt it. i think what's changed from my perspective is just in the last four or five years we can actually say now we know what to do and the fact that there is more of a -- or is a consensus on those things. so a few years ago we both didn't necessarily have all of the evidence and the tools, we did a lot but not all that we

have now and there wasn't this consensus around doing those things. those are two things that have come together that i hope will get carried forward in the next few years to really reach those goals. anyone want to add on optimism or post 2015? >> let me just say that in my incoming address at the close of the conference also tried to share in that optimism but also back away a little bit from putting ourselves in a position where our concerns are 2030 and saying really what do we want to do by durban, which is two years from now. if we just keep the pace we're going at, we should add at least, you know, 4 million or so more people on to treatment between now and then. that would be actually where we are plus a little better. and it seems to me that what we

need to do with this every two-year global convening is to start to use it more as an accountability tool and really to use it more as a formal way to measure where we are and what we've achieved. i feel just for myself the new goals, the 90, 90, 90 is laudable. it makes sense. 2030 makes se s sense. that's a long way off. ride now at a place where we have -- i think the community that cares about hiv, this consensus that you heard about, about now we really know so much more about what to do, probably the single biggest change in that is the recognition that treatment is prevention and that by getting folks on therapy we really are impacting the dynamics. but there are notes of 'cause caution there for me. one of them is key populations, the homophobia, the bad laws that go in precisely the

opposite direction. and the second is a geographic one which is eastern europe, central asia, we know the epidemic is expanding with what little data we have. and that's a tough challenge. one bright note of optimism there is alix sheshana is strik's representative to the think tank on the bricks snd working closely with the bricks. that's brazil, russia, india, china and south africa. so maybe there's no hope that that form which will not include us, the u.s., it maybe is a place where the hiv issues and the global health issues and public health practices can really be brought to the fore in a different and new form. that maybe will be something of a way forward. i know that we've already discussed that in some detail

and very committed to it. so that's a stay tuned. >> just one quick comment. if you look in the gap report again, there's this great diagram that shows if we continue to do what we're doing today at the rate at which we're doing it today, the number of new infections creep up. and what's missing in that is where you end up at 2030 is 80 million people infected and a treatment gap of $31 billion, $31 billion every year. so there is this imperative for us to take the tools that we have, all of us in the room, and accelerate that in all our programs. because treading water gets us to twice as many people infected. by 2020 it gets us to another five or six or seven million people infected but an $8 billion treatment gap. these are not small numbers.

these are not numbers that we could make up. that any country could make up, that global fund could make up but look at that doi gram and count out the number of new infections there are per year and realize the cost of only doing what we're doing. we're doing a lot. but we won't be on the right line unless we do more. that's the call of action to all of us that somehow we have to do more with what we have. we've done it before and maybe we'll get some additional funding, but we can't wait for that. we have to figure out now how we can get more control now rather than just doing more of what we're currently doing at the rate we're doing it. so that diagram to me is one of the most telling diagrams in the gap report. we should all look at it and study it and understand what those differences and lines really mean, how you have one case, maybe 43 million infection

patients and now you have 80. we can't afford another 80. we've already had 75p to put on top of that 250 million people that have been affected by hiv. that's too much. one's too much. that's truly too many. >> let's go to more questions. someone back there. pu have somebody back there, katie? and over here. >> thank you. my name is sister veronica. i worked in tanzania for many, many years. and i worked for 12 years hiv/aids program. and we were very grateful when pepfar began in the early 2000s. and what is happening today? i've received two e-mails today, one from kenya and one from tanzania. and they are saying that, because pepfar is being

lessened, their funding in kenya and the funding in tanzania now will go down quite a bit, i understa understand. they're saying who can we pressure, how can we start to get that funding back again to a level? because now the incidence, they're afraid the incidents will rise again. so thank you. >> yes, over there. >> hi there. i'm julia hots from international press service. i spoke with ambassador brooks earlier this week about this. but i'd like to ask the question to the rest of the panel, which is about especially in terms of educating these populations about the need to seek treatment and diagnoses and whatnot. i'm wondering how, if and how you've utilized the extension of

social media and internet and mobile technology to help raise awareness and about proper treatment and just even correcting some misinformation about hiv/aids. so thank you. >> hi, my name is anna fluoresce, i'm an independent consultant working on women and hiv prevention. i want to thank all of you for a helpful discussion but for editing the lancet series on workers and hiv. a brilliant issue for those who haven't seen it. seems to me that the empirical data in that issue particularly by the study of kay chen and her colleagues, is sort of equivalent, the empirical data showing the decriminalization of sex work and reduction in hiv is sort of equivalent to the data tipping point we reached in 1996

where it really became irrefutable that these two things were connected and that we couldn't achieve hiv reduction in the way we want to without syringe exchange and the decriminalization of sex work in the other. what kind of political response can we expect to see based on this data? and even more specifically, how much we can expect the research community to step up and use its political clout to advocate for dekrimlization. we saw with syringe exchange after the 1996 data came out there was increased pressure not only from theed a vo cass ke community but the research community for syringe exchange to reduce hiv. now we have canada on the verge of changing and decriminalizing its sex worker laws or possibly not. the south african aids council pushing to decriminalize sex

work. i'm sure the issue is coming up stronger in other countries. how much can we expect these communities to step up and make an issue out of what we now know is true? >> thank you, great questions. one was around funding concerns e focus on tanzania and kenya, but i think it was a larger question. and the last very important question is what's the role of science now on the political on the issue of sex work and the relationship with incidents and criminalization. would you like to start? >> i can talk briefly about the budget. i think we had tanzania come back for a week of discussions with us last week. very important discussion because we're not cutting the budget in tanzania. the budget hasn't been cut. and the budget isn't being cut in kenya. they're total funding envelope is the same. it's the mix of how it's old and new money and creating that total funding envelope.

but i think what your question is do you have enough resources. and so what we're doing right now is try to look how to get to 90, 90, 90, and there are places that don't have hiv but there is service provision there that we may not be able to support any longer so that we can move that human capacity and the funding to where hiv positive patients are, where they can be found and to the communities that surround those patients. so we're looking very carefully at the geographic analysis and using data down to the site level of every single site showing how many positives they have for every six months based on the number of tested. so we're going down to a very granule level so we can make decisions based on the funding level that we have. once we do all that and see what can be done, your question begs

that bigger question of do the countries have enough resources between pepfar, the post country and the global fund, to meet the demands of controlling the global pandemic. that's the question on the table. when he says there's consensus, there's enormous working relationship between ambassador diebold, michelle and myself since we knew each other since we were babies. we've grown up together. we've done nothing like this. we've only done hiv/aids. we're passionate about turning the tide of this pandemic. so i think there is consensus of how we utilize every dollar we have collectively to have the biggest impact. i'm reassured by that. i have one social media thing i'll do quickly. this incredible work coming out of i think cambodia, i'm not sure, on different internet communications strategies that resonate not only with different

age groups, different sexual practice, so everybody can click on a site and find the voice that resonates with them and gives them the knowledge that they need. so i think it was just incredible. they had 40 or 50 different individuals talking and you could click through them and decide what voice resonates with you based on some profile that was done anonymously. i found that so incredibly powerful. if we could figure out how to do that and how to get broadband through sub-sa haharan africa, would be more. >> i was on a conference call today. of course they dropped off. and all the connectivity problems right just remains a reality that we all have to deal with. i think there's a lot going on in terms of innovations in technology and not only in mobile technology and internet-based technology but also other domains like

self-testing, home testing, getting testing out of clinics geing it to people. so lots of effort around that. point of care and other home diagnostics. where now the technology is moving to a place where there are much more local kinds of facilities that can actually do staging. you don't have these big problems with people waiting forever to get it and then being told to go somewhere else. and all those challenges. that area, which broadly is in the implementation science arena is, as i said, now the largest area of scientific endeavors, really very striking at least for what we see coming to the conferences. and i think, you know, part of what we're learning is one size doesn't fit all with these innovations. it turns out, for example, there are more several studies on this looking at interactive supports for treatment and prep,

adherence and use that they're very age dependent differences even among one population, men who have sex with men, men under 25 really like interactive sms messages and want to be notified all the time. older men, no thank you, leave me alone. so very age specific. we're going to have to get that right. i would just say as something of a plea, i think one sector that hasn't engaged very much in hiv has been the social media sector, facebook, google, all of that silicon valley and we need them. and we would love them to be way more engaged. >> on the special issue. >> on the question. when we do one of these comprehensive reviews and really try to look at the field. you have an army of graduate students harvesting publications. one of the things that really is

striking is that basically for the last ten years of innovation in hiv prevention and other domains of hiv, sex workers have not been a part of the research agenda. none of the trials, prevention trials in men, women or transgender people have enough strata of sex workers in them to be able to do independent analyses the way that sex work is assessed in the research agenda is inconsistent and unhelpful. there's a lot of confusion about what is transactional sex, what is survival sex, what is sex work. sex workers themselves have been reluctant to engage because of feelings of mistrust and concerns around coercion. and the whole issue of the legal and policy environment that's been seen quite rightly as hostile to their interests and needs. one of the things that came out

of this series -- and we hope this will really resonate with the research community. we need to be doing, prevention research studies with this community very much in a new way of engage iing the communities t includes that meaningful. right now we don't haven't assessed bedroom herbicides. and that in 2014 is a real gap pe we sincerely hope that that happens. i have to say that on the issue of decriminalization, that will have to be a country by country issue. but the cbos, ngos really have

embraced this data. they're taking and running with that. as a researcher, that's what you hope. that people will find what you do useful and go with it. i think you'll find hopefully a lot more evidence based activism now that the evidence base is better. >> i think we'll take two more quick questions because then i want the panelists to talk -- sort of look forward on durban a little bit and what that means, then we'll wrap it up. now i see a lot of hands, of course. one over here and one in the back. >> all set? and a third over here. make it quick, please. >> i'm andrew forsythe with the office that's charged with implementing the new strategy. one of the things we've learned is that to make the most of the

dollars means we have to reallocate to maximize those dollars and we won't be able to do everything. part of our decisionmaking depends on the cost effectiveness of interventions. can you say a word or two about how that process is informing what you think is going to need to take place through pep dt far and other international donors? what will not continue to be able to be supported in order to have the greatest impacts on home testing or whatever those new innovations are? >> second? >> hi. i'm angeli and i'm from interhealth international. you mentioned that a central consideration in the future global hiv/aids agenda include ensuring treatment, follow diagnosis, you have technology like therapy and how can we know having a well staffed work force

is essential to delivering these services and with the current enormous shortage of global health workers even if new treatment and prevention options were developed many countries would lack the capacity to administer these services. so i wonder where health work force strengthening fits within this global hifb strategy in the future? >> and our last question? >> my name is mike. i'm a fellow with the international -- association. my first question is during the conference we had the youth faction. i'm looking at how pepfar and global fund is looking to engage the data that was released. and regarding the aids conference, we had several panels on discrimination and one of the key at risk populations

is transgenders. i'm looking at how having programs to address this population. >> you want to address those, then you all have the last word. steve? >> well, so thank you, michael, for that question. i'll just say that happily we now have an adolescent trials network that's expanding its footprint in trying to do meaningful research and is going to look at adolescent key populations. the other i think really encouraging things relates to the w.h.o. guidelines. for the first time they address adolescent key populations, really included them in all the recommendations. and in some countries w.h.o. guidelines don't necessarily mean so much, but for many they

play an enormative role that allows for all kinds of activities to occur and people that want to do more of this critical work with adolescents including lgbt and adolescents selling sex and using drugs. they're empowered by using those guidelines and being able to say this is w.h.o. standard of care now. we have to do this. >> let me quickly address the strategy and the great work you've done and congratulate them on their line of programs to really have a bigger impact on maternal and child mortality. extraordinary work. we're learning from those groups. that's why we have the 12 countries coming back emergently before we release the 2014 money. we know we can't do everything everywhere, but what can we do in certain places, what are the right things and the right place at the right time?

and getting that right will be absolutely key to either going on this line or this line. and we feel such a strong moral imperative to do the hard work that you did and do the hard work that u.s. aid did, we're running as hard as we can. it's not only a matter of doing what we have been doing but doing that cheaper so we can address young women so we can deal with issues of stigma and discrimination, training at the community level. there's all of those pieces that we feel like we have to respond to at the same time that we're trying to focus the programs both geographically and in this core areas to control the pandemic. it's an exciting time. it linked to that and we start an entire program of high level and hrh and systems strategies. we've gone to every one of the agencies where we know there's incredible talent and we've said, give us your talent.

every agency has come forward with five to ten additional people to work on these core strategies. we've gotten janice timberlake and the team really helping us, looking at the hrh strategy. task shifting has worked extraordinarily well. the nurse previbers in botswana are among the best physicians we've seen. and we need to bring them to the children's world, too. we know they're all interconnected. but the human rights piece is such an important piece to us also. and we're trying to weave that through this whole health care worker piece because that's where patients come and that's often where they first get stigma and discriminated against. we have to ensure that our training also cover those areas and make sure we funded that adequately. >> great. because we only have a few more minutes. and i would love to hear from each of you your just concluding

thoughts on durban, which is where the next big conference will take place. the every two year conference going back to durban after being there in 2,000 which for those of us who were there was quite a turning point. what are your hopes for getting us there and, of course, i'm going to end with you since you're really the person who is going to take us forward. you can use this opportunity to solicit input. steve, i'll start with you and get your thoughts, then to deb. >> okay. i think coming back to durban, coming back to the epicenter of the global pandemic, coming back in partnership with olive and celine and others in south africa, that's just an exciting and buoyant sort of opportunity for us. and the memory of 2000 will be very much there. i'd say a couple of things could

be done that have been problems to address recurrent problems. one is to work realto recover h level african leadership into this. that if you go into durban and you don't have them, it will be yet another sort of sense that the leadership is wont. second is to figure out in practical real political terms how to address the homophobia and the surge of bad laws and who needs to be there that was not there this time, who needs to be there that is credible and can be empowered and come out of the woods and talk about these problems and not feel threatened and be able to put forward a concrete agenda. if you do those two things you'll have advanced the agenda very dramatically.

south africa's transition, of course, many of those people that need to be brought on treatment, both chris and deb referred to are going to be south africans. and the u.s. will also be in the midst of its own transition towards lowering its support according to current plan. so trying to highlight some of that. the fact that we're coming into a zone where our own programmatic achievements and engagements and partnerships are so rich and so deep gives us all sorts of opportunities to be so much more creative in the way the conference is used to build congressional support, to get other people excited. it's just so much -- it's a very promising set of opportunities, thank you. >> i love the way you talked about the road to durban as a way to really mark our progress. if we reflect back to 2000 and that very difficult time between

then and about 2007 in south africa where there was difficult with even awareness of hiv/aids, as the agent causing aids, putting road marks down about each of these things, stigma, discrimination, south africa has some of the most important laws. and working with our south african colleagues to say let's in these next 24 months work with other countries on the african continent to move towards your vision and really accelerate south africa's leadership in this area and celebrate their leadership and investment in hiv/aids. they've stood up like botswana and are investing the billions of dollars that it's going to take to control the pandemic in their country. and they've identified the young women issues. so i think getting them to have that discussion now so that that leadership exists in the role up to durban will make it such a

much more vibrant conference on where it is a report card, did we deal with the issues in melbourne and did as a continent we move together. so exciting. chris. >> well, thanks, for those -- very helpful. believe me, all three of you are going to be part of this effort, so please, please, your engagement really matters in a big way. i'll say a couple of things. one is, of course, we have not had or won't have had an international aids conference in africa in 16 years. so it's been a very long time south africa's story and trajectory from 2000 to now is just a sea change, an extraordinary transformation. that would be a huge part of this story.

we always try to have the conferences in places that will make a difference. people don't know but steve does when the president lifted the hiv travel ban and we could, in fact, come back to the united states. many of you were there in d.c. in 2012. we'd make the decision to come back to the u.s. and we had to choose cities and we ended up choosing washington because it was the highest prevalence city in the country, sadly. kwazila natal is the highest rates for women. we'll truly be in the epicenter of that component of the epidemic and that's the critical part of all that we need to do human rights and stigma. so for those reasons, it's the right place. the head of the human sciences

research council and been one of the architects of the system is really a leader in how you integrate hiv into a health system. that's one of the reasons why we asked her to do this. she'll be the first woman in history, first woman from africa to chair an international aids conference. we're very excited about that. when i brought this up to her, of course, we're going to focus on women and girls. she said, well, i think it's really important that we focus on human rights and key populations and men who have sex with men in africa. so i said, you're on. we're going to do both of those. finally i would say the nis is a member organization. i hope all of you are members. if you're not, please join us. you actually do have quite a lot of input. it's an elected representation. your new regional representative

for north america and our executive committee is ken mayer, a real leader in the field. and so please go on to the is website. join if you're not a member or get involved. we think that durban is going to be the same landmark as in 2000 but in a very different way. there we were trying to make the point a rather simple one that hiv is the cause of aids. this time we're really going to be, we hope, at a real turning point where we can start to say, all right, we have the measures, we have the deliverables, how are we actually doing on this promise and that will be the key. yes, july -- the third week of july. it's always during -- it comes out to 22 but 27, 2016.

>> we're here to help you, for sure. >> wonderful. >> please join me in thanking our panelists. thank you, everybody, for joining us. [ crowd noise ]

a reminder that if you missed any of this discussion, you can watch at any time in our video library at cspan.org. more live coverage coming up here on c-span3. at 7:00, carl bernstein takes part in a discussion on watergate and the resignation of richard nixon 40 years ago this summer. he'll be joined i by historians douglas brinkley and luke nikter

who co-authored the book "the nixon tapes." that's live beginning at 7:00 p.m. eastern. and tonight we'll be looking at senate races in hawaii, tennessee and virginia. we'll begin at 8:00 with hawaii senator brian shotts debating. plus we'll open up our phone lines for this year's upcoming midterm elections. that all gets under way tonight at 8:00 eastern on c-span. >> while congress is in recess this month, c-span's primetime programming continues on friday with the western conservative summit in denver. saturday robert gates, condoleezza rice and madeleine albright on the situation in ukraine. sunday on q&a, edmund morris. the house energy and

subcommittee on oversight recently held a hearing examining the implementation of the health care law. the next open enrollment starts on november 15th, ending next year, february 15th. the centers for medicare and medicaid services testified on whether the government's website will be ready and available during the open enrollment process and how the administration is handling inconsistencies in health care applications submitted. >> the subcommittee on oversight and investigations to review the implementization of the patient protection and affordable care act. the principal deputy ur administrator at the centers fo medicare and medicaid services. this m is his first testimony a an cms employee but not before the subcommittee.estimony some of you may recall he ttee. us last october to testify on behalf of one of

the health kacare workers who built the website. we're holding this hearing today exactly one year ago this week, members of this committee will g remember that we heard from cms administrator tabner who told us that healthcare.gov would be ready on october 1th. we were told it would work, everything would be fine but later we found out that that wasn't quite the same thing. in fact, the contractors told us that it would be working. wo our reviews of the website weree blushed aside, but we know how our fierce of a massive flop. the rollout was an unmitigated disaster. i think everybody agrees with that. we hope to hear from you candidly about how things are th progressing and weat hope to he with the same candor as an prog administration official that testified last fall. the company that built the hub s

freehealthcare.com. it comes at an opportune time for the government to address the health disaster. after mr. slavitt, we'll hear about the launch of healthcare.gov confirming what this committee learned after its own review of the website. the administration didn't have the exper cease or the ldn't leadership or organizational h scales to manage this massive undertaking. a broken website that the president promised would be as easy to use as any e-commerce site cost taxpayers $1 billion. that took money from their hard earned paychecks to come up witc that 1 billion and many aren't happy about that. these costs are still going up so my colleagues may want to complain that we're spending too much time examining the failed website launch, i'm not the

surprised they don't want to talk about it. but the reality is these problems are still playing out and may affect this fall's open enrollment period. the system has a system in place capable of handling the we inconsistencies or if they'll b ever put in place a functioningn payment system. about t we'll ask about healthcare.gov a contracts in the gao report.rept but as we head to open to ope enrollment in the fall, patients and families need to know how tl this law will affect them because each day the health care is making it more expensive and fragmented. insurers were required to let oy them know of premium rates. p we hope that today will provide information on the rates submitted and if the public will know them with time before theyb purchase and if the public ever will see the savings the president promised.the we want topr know if americans . were able to keep their doctor l

and keep their plan if they eirp liked it.la earlier this year this committee heard testimony who noted that the requirements required the es cancellation of millions of policies. we hope to hear whether the administration predicts widespread cancellations and uncertainty again this fall. not only individual plans we're. concerned about. last week the irs finally began releasing information related to the nenforcement of the employe mandate. this may beem surprising to man. the administration hat after all delayed this several times. but it certainly raises questions about what will happen when one of the law's most controversial pieces finally ppd goes into effect. finally, our main concern aboutf the overall t impact of this la. millions of americans had theiri health insurancensur canceled hl becauseaw of the law only to fi that the plans they're forced ty buy are moch more expensive ande premiums and co-pays and deductibles. some may qualify for subsidies d and othersies do not. the law's massive cost will

continue to be felt for years. r i thank both the witnesses for k testifying and now recognize the ranking member for five minutes. >> thank you so much, mr. f chairman. well, i've got to say i don't really think we could go on august recess without having another hearing on the aring affordable care act because this is now the 12th one we've had ie the last ten years.th as i've been saying the last couple years, the aca oversight is a really important topic, but i'd feel a whole lot better if we were actually doing oversite on what's happening now with thy aca instead of just rehashing sp old issues over and over again. you are right, we will stipulate the rollout of the aca was an unmitigated disaster, but i guess i'd like to know how long we're going to keep beating this drum because when you look at hp what happened since the en the unmitigated disaster rollout sar things are actually improving.aa just about every prediction that was made about the law has turned out to be wrong once we

got going. so i think we should spend our a time trying to figure out how to make the law better for americans who are enrolling and now getting health insurance. in the last year we had hearings where the majority insisted that americans would be hit by insurance rate shock. instead the majority of new enrollees in aca coverage are paying less than $100 a month. they said the healthcare.gov website would never be fixed, but thank goodness it was and millions of americans used it to sign up for coverage. they insisted people would not pay for coverage once they signed up. heae. but the insurers came in and said that's not correct, that people were paying. they insisted that 2015 premium, would skyrocket, but again that's proving not to be true. in fact, in many cases, t enrollees will be able to reduce their premiums next year.

they insisted that americans dis not want or need health in insurance coverage, but over 20 million americans have receivedr coverage under the aca, and thee uninsured rate has dropped precipitously since january.s the vast majority of new enrollees are happy with their u plans. these are important facts, mr. chairman. and in interests of making the hearing as fact-based as possible i want to talk about fact sheets released by the energy and commerce democratic s staff on the benefits of the affordable care act in every congressional district in the country. i'd ask unanimous consent to enter the fact sheets for each s committee member into the record, mr. chairman. >> without objection.ets >> thank you. i just want to talk about some n of the benefits of the law in ma home state of colorado. in colorado, there are 240,000 state residents who were previously uninsured but who now have quality affordable coverage because of the affordable care act.

in colorado, our uninsured statn resident -- uninsured state residence has declined by aboute a third. almost 2.1 million people in colorado, including 460,000 60,0 children and 860,000 women now have health insurance that vers covers preventative services without any copayments or deductibles. 50,000 young adults in colorado retain health care through their parents' plans. more than 40,000 seniors have received medicare part d drug discounts. 1.8 people in colorado are protected by aca provisions that prevent insurance companies fros spending more than 20% of their premiums on profits and administrative overhead. because of these protections, e over 210,000 individuals in the state received approximately $41.7 million in insurance

company rebates. up to 294,000 children in col with pre-existing health conditions can no longer be denied coverage by insurers.so e so even if you disagree with the law, it's important to note that the aca is helping our i constituents.s i hope we can end these relentless attacks and we can help more constituents obtain coverage under the law.he we should look at the example ot for medicare part d. i can attest to it because i was here. many democrats, including me, e did not vote for the law and had real concerns about how it was n implemented.t was but we still had town hall meetings and other events so that our seniors got coverage that could cut their drug costs. i hope we can work as we look into the next year in a bipartisan way to make the aca w even better rather than to find ways to undermine it and repeal it. i know witnesses are coming forward today.es are i know they are going to propose

contracting for healthcare.gov. anything we can do to improve that contracting is good for me i hope cms has learned from the website's flawed launch.they hav and i want to know the plan to make sure they do better moving forward.i want t and i want to welcome you, mr. slavitt.rward. ou're new to cms. you'll have primary responsibility for the website, so i hope you can tell us what h you plan to do in 2015.av thank you, mr. chairman. >> time is expired. recognize dr. burgess for five minutes. >> thank the chairman for the recognition. thank you, mr. slavitt, for joining us again. our subcommittee throughout us development and the rollout of o healthcare.gov, this subcommittee had repeated assurances that the systems werh and would be ready to go and that implementation was on track

at a hearing in october literally days before the launch of healthcare.gov. we had repeated assurances from the director of consumer lt information and insurance oversight, mr. gary cohen, he said unambiguously that on october 1stun americans would b able to go online, would be able to see premium net of subsidy and be able to sign up. we all know now that those assertions were fact challenged. the center for medicare and medicaid services undertook thi mammoth project without effectively planning for its development or its oversight. this has led to hundreds of millions of taxpayer dollars being wasted. again, gary cohen, other hhs officials told us time and again that the website was working. that was factually incorrect.aly it was not working and it still. may not be working because the back end systems, those systemse that are responsible for tems actually paying providers, have

not been built. consumers may believe the website is fixed because some of the front end problems have beed addressed.but th but there is no way to verify o inaccuracies about things like citizenship and income level ort ensure that the correct he subsidies are being paid for insurance premiums. thanks to this investigation, we now have definitive proof that t the department of health and human services was fully aware e that these systems were not rea ready for prime time. own their own contracting documents shows that they only expected 65% of the federal exchange to be ready on october 1st. and then, of course, we're continuously reminded that the promises made by the administration simply couldn't be kept because the groundwork had not been done and the website was not prepared.gr we are all still wondering whatd

happened to the promised $2500 in premium savings that every family in america could look p forward to? we're all wondering what happened to the ability for people to keep their doctors? we're all wondering whatwe happened to the ability for people to be able to keep their insurance plan? mr. slavitt, mr. cohen also was asked in his last appearance here in january about the issue on the risk hoarders and the risk sharing.the the question came up about whatt if there is not enough money in the risk order to actually premi cover the premium shortfalls that the insurance companies ar experiencing? and would he look to -- that was mr. cohen -- would he look to supplementing those funds from k general revenue of the treasuryf of the united states? couldn' he couldn't answer the questionf

i asked him if he could provide us with a legal memorandum upon which he relied to obtain the ability to get funding from other sources if the internal funding was not enough to cover the cost of the risk corridors. that was january. i'm still waiting.that was i would like to know if i'm illa going to receive an answer to that question, and if so, when n that answer might be forthcoming. fact of the matter is, both ther department of health and human services and the white house failed to heed internal and external warnings about the lack of readiness of the exchanges. now we have the general accountability office ex report, and it is astounding to see that all the money that wa spent, and not wisely, the organization continues to ignory recommendations and continues to pump money into what seems to be a futile effort.continue we're well on track to sink $1 t

billion intoo the development o this website. we have very little to show for our money. t i'm eager for the testimony of e the witnesses today and thank r the chairman for the recognition.th i now yield back the remainder of my time >> now recognize the ranking member, mr. waxman, for five minutes. >> thank you very much, mr. chairman. this is the 12th hearing this committee held on the health sdh care act since enrollment began on october 2013. these hearings, if you look at them, all have one purpose. to undermine the affordable car act regardless of the facts. r the hearings have misled the fa. public and i think squandered taxpayers' dollars. in fact, the affordable care act is an historic success. it has made comprehensive healta care reform a reality for the n american people. more than 8 million people havec signed up for private health insurance plans through the forv

federal and state marketplaces, exceeding cbo's enrollment estimates by over a million people. an additional 7.6 million people have enrolled in the chip program as of may of this year, three million young adults under the age of 26 have enrolled in their prparents' health insuran plans. and the fact sheets that democrats put out from our staf reveal that in my district alone, if i can be parochial, 17,000 residents who were previously uninsured now have quality, affordable health coverage because of the affordable care act. so i'm giving you some ab perspective that the law has been a success.so th it is accomplishing what congress and president obama intended. instead we have another hearingr of this committee or another ancommittee of this full committee trying to say how thee affordable care act has problemg

and did things wrong, and presumably they think it shoulds be repealed. well, in a lawsuit there is a h world called stipulate. ther we can stipulate to what the gau has reported. and they have reported some things for which we ought to be concerned.ha because despite the success of s the law, the initial rollout ofl healthcare.gov has serious flaws.lo i'm glad we're going to hear ers from gao, government of from accountability office, on their investigation of healthcare.gov contracting. we should always try to learn from mistakes.ve not dwell on them but learn frot them, and i'm glad mr. slavitt l is here to tell us what the ea administration has learned and t what is being changed as a result.ing i've had experience with flawed contracts.ge i was chairman of the oversight

committee and we released a report that identified nearly re 200 contracts worth over a trillion dollars that involved significant waste fraud abuse or mismanagement.smanagem the fbi had a contract created virtual case file system that had to be canceled after se fil spending over $100 million. the department of homeland security's contract to build a 1 hi-tech border fence, that was . supposed to keep out all these immigrants. and they're still havinggh-t problems.that was that fence had to be canceled e after wasting a billion dollars. the coast guard had a multibillion dollar deep water t contract to build boats that would not float. now, my point is not to excuse the healthcare.gov problems but to put them in context. with the exception of tom davisi congressional republicans showed little interest in these enormous wastes of taxpayer dollars when george w. bush was president.ars wh

i think we should care about en waste, fraud and abuse no mattea who is president. and i'm proud health care.gov was fixed. not exactly quickly but fixed nonetheless, and in time to help appl millions of americans apply for health care coverage. i want to know what to do different next time.di not the waffy the republicans u handled this. see, we told you so. we told you there would be problems. okay. and then their conclusion is, repeal it so they could replace it, but they've never given us a replacement. people are getting insurance who couldn't get it in the past because they had preexisting medical conditions. people are finding that their ia insurance can't be canceled just because they got sick. women are not discriminated against.nc people who can afford it can now get insurance because we give them tax breaks in order to pay

for it w.o so i'm eager to learn what the agency is doing, so enrollment in 2015 goes more smoothly. we have unequivocal proof that health care reform is a successe we now need to make the 2015 alw enrollment period as smooth as possible so we can build on this success. let's go for trying to make things better, not dwell on things that were wrong, things especially if you learn the n lessons and fix the problems. >> gentlemen, the time has expired.the just a message to members and to our folks giving testimony today.red. we're expecting votes around 10:30, 11:00 -- 10:25, 10:40, i should say. we'll try to get through this. i will have a quick gavel and ask that all members really stick with their five minutes as we go through this or i'll really bang it hard.

and we will move forward.rd. if we need to be interrupted bye votes, we'll come back right ed after votes to complete things.g i now introduce the witness on h the panel for our first hearingi mr. andy slavitt, deputy le, he administrator for the w centersf medicare and medicaid services. in his new role, he will be responsible for nationwide cy policy and a coordination program as part of a new management instructor that comes in response to lessons learned in the rollout of healthcare.gov. adim as ct of and recommendations put forth tt the secretary. i'll now swear in the witness. are you aware that the committee is holding an investigative hearing, and when doing so, it has the practice of taking testimony under oath? do you have any objections to testifying under oath? >> no,i don't.ig fte? >> and the chair advised you, d. under the rules of the house anu of the committee, you are entitle to be advised by counsel? do you wish to be advised by counsel during this testimony? then stand up and i'll swear you in.unsel [ witness was sworn ]he

>> the witness has answered the affirmative and you are now under oath in title section 1001 of the united states code. oath you may now give a five-minute n summary of your written ited s statement, mr. slavitt. >> good morning, chairman murphy, ranking member degette and members ever the sub committee. i'm andy slavitt, principal administrator of cvs.si' i joined cms three weeks ago from the private sector where i spent the last 20 years working with iphysicians, hospitals, health plans and employers on solutions to problems of health care costs, quality, and access. in the private sector i started my own health care technology my business and ran larger scale health service organizations with more than 30,000 employees0 in late october of last year, ir began my involvement with the affordable care act lvement implementation when i joined a group of people helping the cmsa team on the turnaround effort of the health insurance marketplace. i'm very pleased to be here with

you today and before answering y your p questions, will briefly w walk you through some of the w progress of the affordable carek act to date, and talk about our priorities for the coming period. there is growing evidence that suggests the affordable health care act is making a differencee in the millions of lives of americans. a dif in the first full year, millioni of americans selected a private, insurance plan through the statf or federal health exchange a te marketplace and millions more have retained coverage on their parents' policies or have qualified for medicaid or chip. we're seeing an overall growth in our health spending which has continued into 2014. this is good news for consumers with the typical premium paid mt for a policy in the marketplace under $100. good news for taxpayers as the s recent medical fund trust repor shows.eport and importantly, this success is not being achieved by government policy alone but in partnership with the private sector as insurers grow by competing to p

provide better access to quality affordable services. now, as we move into our second year of marketplace limitation,f we must build on the progress li that's under way and heed the gs lessons of the last year. let me outline for you our highest priorities. first, we are focused on increasing the value the consumers get when they come to the marketplace. this means continuing to of ime the information, plan options and affordability of the increa shopping experience.si second, we have critical, technical and operational priorities. we must continually add , we automation that has begun with critical releases this summer and will continue this year and in following years. while the consumer website is, s of course, live, we are adding functionality to allow consumers to easily renew their coverage.s whether on the consumer facing side or the back end, our technology improvements will be more continuous and more incremental.

we have a very strong sense of our critical path. our software releases so far have been on time and we are r managing these deliverables daily.el third, let me address our management priorities to include execution. -- improve execution. as part of the turnaround team, i experienced firsthand the i challenges of the first year of marketplace implementation. at cms, i'm now helping to oversee a series of changes to improve the management of the marketplace. as secretary burwell announced k in june, we have created clear,n top-down accountability.ou we have also improved the also management of and communication with our key contractor, with better defined requirements, metrics-driven contract reviews, and requirement for skin in the game. we've expanded our testing in

protocols and built more testing into the schedule. even as we address the major concerns for the last year, new ones will emerge, and our management structuring team musu surface and address issues in an disciplined manner just as we did during the turnaround. this coming year will be one of visible and continued improvement, but not perfectionb we are in the early stages of ae program newly serving millions of consumers and are still learning about the best ways to support their unique needs.eds. and we are setting up and ing testing new processes and new technologies along the way. from my experience at this e stage, businesses begin to see p how closely their design matches the battle-tested needs of the market. clo good organizations focus, prioritize and learn and continuously improve their operations and the services they provide. it is not always easy but we si understand what we need to do ii and are making the right s but progress to have a successful r open enrollment and continue to

deliver on the promises of the affordable health care act, to r improve health care access, cos and quality of all americans. to thanks and i look forward to your questions.y of all >> thank you. i appreciate your comments and appreciate your candor here. in fact, my very first job as a young man was mucking out horse stalls, and i felt like the difference between -- what i got s to do, i got to ride the horsest so it was a nice reward. the difference between that jobt and this job is i don't get to ride the horses. so i appreciate your honesty ani candor in this and want to ask you questions along those lineso you may recall a year ago a congress was told repeatedly the healthcare.gov website was fine, it was ready. ycare.g in the months and days leading up to it, everything is ready to go .in the and the president said it would mirror the public's experience b with other websites. so i have to ask, will healthcare.gov be fully ready this fall? >> thank you, chairman.oheal i obviously wasn't here last year. last

it does sound like certainly from the gao report that i've seen that a couple of things happened.ort first the technology build was bigger and more complicated than people expected and i think the scope expanded because of that. secondly, as the gao pointed out, there were significant issues with the management of the project.se >> but for the future.ou sai youd said there wouldn't be perfection, areing there going w be some hiccups in the website implementation this fall? >> i think this year we can expect a vastly different situation. for one, we have a website expet that's already up and live and running, we're adding continued improvements and we're adding i them in a much less risky fashion. we're doing releases frequently. over the course of the summer, putting things live into production. we built in a big testing window. big so everybody will remain on their toes. and nervous, everybody knows

what they need to do, but we'rt expectino g to have a good rollout. >> but the gao said there are still specific risks for the enrollment period.ill sp but you think they'll be ready? >> i think our yob is to understand those risks, manage those risks, service them -- >> i don't want to take out my shovel. i would love to tell the ntifel. committee, we anticipate these problems, here's the actions takingions to move forward. the committee would love that so we're not caught up in this guessing game.e >> i expect it won't be perfect, with serving millions of people. there are certainly different situations. many are enrolling in insurance for the first time.in the it was a bumpy process at time. we got a committed team of jo people, though,b, who are doing good job, but there will clearle be bumps? >> in anticipation, how many will you enrolling in the fall?? or how many will be enrolling for the first time? >> i do not know that. >> do you know in terms of your review of this, how many of of

those have been enrolled the first time? >> i've only seen the media ve n reports, but it was, i think, far greater than half, but i've only seen that in the media. >> when secretary sebelius was i here, i asked questions but i'lt repeat them. how many were new? how many people were got a pink slip because it was ny wer discontinued? how many were eligible because of medicaid? and of all those signed up, howd many were paying the same, less or more?many w and she said really the websited has no way of knowing any of those things. kno would you agree that's true? >> yeah, i think that data is not yet known by us. i think we're getting an idea of what previous insurers were paying.g an so we have a sense there's good. affordability to it -- when we see these numbers, however many signed off, compared to the 45 million of which there wasud a need for

health insurance. we don't know how many of the 4 million are served new by this. >> so the administrator has a h chart in her office which she calls her prettiest picture andh it's a graph of the uninsured rate over time. and it shows the drop to 13%. >> so is that specifically by reviewed by your office specifically to look at people who were uninsured before and now were insured? you told me you can't really determine that, and secretary sebelius said there is no way to determine that from the websitek weno do know the uninsured rate from the latest gallup reports.e it's down to 13%. >> have you tried to sign up? >> now that i'm a federal feder employee, i'm in the red cross -- blue cross health plan. have you also reviewed with people when they've tried to access their positions? the plan allows the initialtheyr visito and some other preventative care. not as much preventative care as

i'd like, butin have you surveyc persons toia find out if they'ro able to see their co-pays, >> i deductibles, any'l of those o things? >> i don't think we have any tc hard data, but i can certainly look and follow up.fo >> that's the five minutes. >> thank you, mr. chairman. i agree that it's important to k make the federal exchange webst website and also the states' 's work as well for people, and i' sure, mr. slavitt, you agree with that too, don't you? >> yes, i do. >> we want to make it as easy for people to enroll, especially as we re-enroll in the 2015 >> a plans, is that correct? >> that's correct, wi your honor. >> up to now, even despite the admitted problems with the website, 8 million people enrolled in the marketplaces; is that correct? 8 >> correct.

>> and about 6.7 million enrolled in the medicaid expansion, is that right? >> that's right. >> so obviously people were ablb to use those websites to get health insurance, is that right? >> that's correct. >> now, i was looking at the part of the gao report, and thee grchlt ao made five o recommendations in the report. are you aware of that? >> yes, i am. >> what is your opinion of those recommendations? wons? >> we agree with most of those recommendations. >> which ones don't you agree with?>> >> i think the only thing in that gao report that i think needs a little further clarification, not necessarily t that i don't agree with it, it's the characterization of the i i eccentric contract and, i thinke it was characterized as the ballooning in cost when skt i sh think the contract, there was as initial contract before the work

was completely scoped -- >> let me stop you. that was one of their findings, but that wasn't one of their recommedations. their recommendation oos. . >> correct.ith so i agree with all of their l e recommendations. >> you agree with all five of no the recommendations. and what steps are you taking to implement those recommendations >> so we are doing a number of things. first of all, in the contracting front, it is very clear now who can give work to eccentric, how work gets approved, how that contract gets managed and frankly, importantly, they have skin in the game to make sure they deliver. there is -- again, i wasn't here last year, so i can't speak to precisely how the project was managed.r,ecisel but i cany tell you that now g. there's daily intensive management of the project.ment o risks and issues and concerns c are all surfaced and dealt with. we built early warning . indicators so there is an -- there is an accountability is difference that i think is very significant.

>> are you looking at the interoperability issues as well? that's one of the problems we had before. that's >> this is, as you point out, congresswoman, many different ys pieces of this project in orderr to go well, so the coordinatio and system integration is was something that was missing last year and it's in place this year. >> are you doing anything that goes beyond the recommendations in this gao report? >> yes, well, fortunately or unfortunately the gao report th wasn't news to the people at cms.fort i think the people at cms who e worked hard but lived through that nightmare don't want to go through that again.ed so i think actions were under way well before seeing this report and i think they fall into the categories that i've talked about, contract reform, technical and managerial oversight, focus and discipline project management. >> we keep hearing about how expensive the cost overruns and

everything else in setting up healthcare.gov were. as an aside, i would like to s know how much this lawsuit an s against the president is going to cost, but be that as it may,h mr. slavitt, i want to ask you, do you think we're going to be g protected from cost overruns fo the 2015 enrollment period? >> so, again, i wasn't here lasi year, but the two things that went wrong last year, one of oe them actually was simply the ws inability for anybody and quiten reasonably so, and this happens in the private sector, to estimate how big this project is and how complex it is. we have got a better handle on that now and i don't expect those overruns. secondly, to the point of the gao report, the contractor wasn't managed tightly with clear deliverables and requirements. manclear that's been put to bed as well.e those two things are in much, much better shape. qu >> and were you -- one last question, were you aware that

the uninsured rate in this country dropped 25% after the implementation of healthcare.gov and the full implementation of thean aca? >> yes congresswoman, that sounds right.ounds >> thank you, i'll yield back, . mr. chairman. >> i'll recognize mr. harper for five minutes. >> thank you, mr. chairman. and thank you for being here today.er and i have a couple of questions i'd like to ask. h first of all, who is performing the role of systems integrator now?firsrole who is doing that?no >> optum. the firm is optum. i'm >> okay, i'm sorry. >> my prior company. >> who has that role now?y pr >> optum, the firm. >> okay.op i got you.t some questions i'd like to ask about some reports.y ask earlier this summer we learned there were nearly 4 million e w inconsistencies in the

applications submitted via healthcare.gov. those inconsistencies are for citizenship status or income. the failure to calculate these properly could mean that millions of americans could have to pay back incorrectly calculated subsidies.e so earlier this summer it was so reported that there were ed tha millions of these, first of all, how did this happen?t and can't the website check fort accuracy? >> sure.check so appreciate the question.ac inconsistencies occur because of the changes that occur in becau people's lives. and people that end up having more current information than n government databases, so we have run last year during open enrollment hundreds of millionsg of checks against government databases to check on income anm citizenship status and so forth. and some occasions where people particularly are in low wage in jobs, in seasonal work, and jo other kinds of circumstance, their income is unpredictable,

or in other cases they haven't t filed taxes before because theyt haven't made enough money. what happens when that happens,e just to give you a perspective . on this, for a typical family oi four there are 21 records fo searched through automated ur process.proc if one of those records turns up not to be a match because of income or some other thing, we have to pursue documentation and we do indeed pursue documentation to try to ensure that these people are, in fact, telling the truth. in as we have done that -- that - >> how could a person on a forum be a citizen or not be a citizen?ers isn't that something that you b can verify? >> there is documentation status, there is -- whether it s is a naturalization status and a so forth, those are sometimes not as current in the government database as what the individuall resident has, in fact, done in their life. >> so in an application on one

application could have multiple inconsistencies. >> that's correct. >> and do you have a number of how many americans were affected by this problem? >> so i think there were a couple of million people who had inconsistent information that needed to be matched of some form or another.ese ar about, i woulde say, roughly hf of those are income changes. these are people who will have s to have to come back to the website and we're urging people to do that, make some adjustmeny because it will spill out, of course, on their tax form. of the other half, we have greae cleared as of july 1st 425,000 inconsistencies, and 90 -- co greater than 90% of those are indeed in favor of the individual consumer who had more up to date information than we did. >> and this is obviously something we want to make sure e doesn't continue, so what assurances can you give us todan that we won't see these problemw during the next enrollment period? >> well, i think we're learningn

is that a certain amount of these data discrepancy problems will be a fact of life because act of the fact that we have peoplee who do have variations, high variations in their income levels.ave and so that's going to occur in the coming years. what is going to be different lo next year is we have now just xa released software that allows uw to get at those inconsistencies much more quickly.ch mor what is important, though, is o, that people who we reach out to, we need additional documentation from, get in touch with us and t get them back to us. >> thank you, sir. i'll yield back. >> mr. tonko for five minutes. >> thank you, mr. chairman. mr. slavitt, welcome.n. and you earlier went through some national stats and i natia received information out of my i district, we have been waiting to get info and in the 20th congressional district in new york, 11,000 residents who were previously uninsured now have un quality affordable health

coverage because of aca. the number of uninsured residents in my district declined by some 23%. 214,000 individuals in the indi district including 137,000 women and 54,000 children now have cd health insurance that covers re preventive services without anyn co-pays, co-insurance, or deductible. and 260,000 individuals in my d district now have insurance thai cannot place annual or lifetimen limits on their coverage. and up to 37,000, 37,000 0, children in my district with pre-existing conditions can no longer be denied coverage for lo health insurance purposes. i think that's a tremendous bit of improvement. we obviously want to continue to grow those numbers. ki but it's comforting to know thag kind of success is coming the r way of our district. and so mr. slavitt, part of thef promise of creating the one stop

marketplace was the ability to y shop for health plans, side by side, and apply in an apples to apples comparison. while the federal healthcare.gov site has done a good job in this regard, in displaying the premiums and deductibles of various plans, it has been moref difficult to assess differences in health plan networks or whether a particular doctor is a in network for a given plan. could you tell us what cms is doing to make it easier for consumers to access this ea information in advance of the upcoming open enrollment periodo >> thank you, congressman. so you're indeed correct, and ib fact, last year i believe the typical consumer had dozens, several dozens of options to nsf choose from in health insuranceo and our job is to try to continue to grow that. to as you point out, we have to nt make the information people arei looking for more readily r apparent, more easy to see, so we are asking the insurance

companies this year to put ies h direct links to the provider is directory that fits the individual plan, but i would also ask consumers to do and ast if you talk to people in your if district is that those directories that the insurance companies keep, they're not always up to date.ret they try to keep them up to date, but it is always good to call the insurance company or te check with your -- if there is c physician you want to see to make sure that they're in the network, because this is really important information for people to choose from.>> >> okay. and in terms of allowing a consumer, for example, to searcr only for plans in which their doctor is covered, could -- >> we don't have that ability. that's the kind of thing that might come in future years. s. >> what kind of obstacles stand in the way of that happening? >> you know, i think one of the lessons learned from this project is to take disciplined incremental steps to making incm progress, not trying to do too n much, and, you know, this -- our

schedule is pretty much filled with things that are important to make sure we're executing well.re and i think those are the kinds. of innovations that i could inn really see us getting excited ry about adding in future years, ed but didn't make the cut this year. in this >> if i could just ask you a quick question about the quick medicare trust fund, the trustees report as you know, came out on monday, and they'ren talking about the fund being secure through 2030. that's 13 years longer than was projected in 2009 when the aca was passed. the report noted that these changes may be due to the cost saving provisions of the aca. do you believe that to be correct? >> well, i'm not going to say i'm an expert, but it sounds logical. >> and in fact since passage of the aca, the medicare costs hav grown at or near record lows, is

that not correct? a >> that is correct.would >> so would you anticipate any continuing or additional ntinuig benefits coming via medicare?bei >> yes, i would.medic >> okay.ar. well, we appreciate the leadership that you have borne t with the aca and we thank you for the improvements and i known on behalf of the district that i represent, the numbers are very encouraging. i share them with you here this morning. with and we're going to continue to o work to further improve so thatf one of these fundamental rights that the affordable and th accessible quality health care for all is continued. and strengthened. with that, i yield back and an thank you, mr. chair. >> the time is expired.ou, mr. i recognize mr. griffith for do five minutes. >> thank you, mr. chairman. i do appreciate that. mr. slavitt, thank you for being here this morning. you indicated and testified you're previously employed by optum qssi, correct?yo >> that's correct.

>> i think i heard you say you k left there three weeks ago, is that correct?d y >> a little longer than that, that's correct. corre >> how long?ct >> i could get you the exact date. how >> i don't need the exact date. between three and four weeks. >i >> something in that nature, yeah.. >> here's the question. you now work for cms. and from what i understand cms. you're very talented individuale and that's a good thing for cms. but if i understood your testimony as well, you indicatel that your previous employer is managing the website as the systems integrator, is that correct?e >> that's correct. >> okay. so then the natural question as an oversight committee is how o are you able to manage your former employer and doesn't thiy create a conflict of interest? >> sure.create a yeah. thank you for the question. so congressman there is, as you know, an ethics pledge i signed

and along with that disposed of all of my stock basically that i had in the company, t i completely -- >> you disposed of all of your stock? you said basically. >> all of, yes.>> a >> okay. >> yes, i'm not trying to qualify that. i'm >> i didn't think you were. but i wanted to make sure on the record you said you got rid of all of your stock -- >> got rid of all my stock and e any other ties as appropriate. i have signed -- not as as appropriate, as is appropriate, so now as a public servant, i a have a very clear set of rules e to follow. i have an ethics pledge and within that ethics pledge, i have a limited waiver, which allows me for the purposes of health reform implementation only on the website to be able m to interact with all of the contractors, including optum ast it solely befits the

implementation of the project. i do that and exercise that very carefully and very prudently.vey but that's publicly available waiver that i can make sure to get to you if you like. tha >> if you would, that would be great. >> okay. oue. uld, t >> i would like to talk about that waiver process. s. because normally in my experience, when you move from n the private sector to the publih sector, there some kind of period of not dealing with yourt former employer that is usuallyl a year or more and if you coulde explain that process, how they o came to this and you said it wad limited waiver and we'll look at that later. if you explain that process, i'd appreciate it. l >> it is a 15-page document, which is -- i can get you the details. y >> i'd appreciate that. ou >> it is a two years is the ani waiver and i think the only exception -- sorry, two years is the agreement, not to is communicate with my old employe and there is this narrow this exception for interaction relative to this implementation process. >> all right.

i appreciate that. let me ask you questions about your former employer because optum qssi is a subsidiary of t united health group. isn't that correct? >> that's correct. >> and in their 417 quarter onei of this year earnings call, the united health group president and ceo stephen j. helmsley recognized employees and said we try to move our employees around in different e divisions of the company, and s i'm a little concerned about how much of a firewall is built much between optum qssi and united o health group because united health group is participating id some exchanges and the federal exchange and so we have a situation where again there is n an appearance of a conflict, or impropriety because if you're pt shifting folks around, i said to one of my staffers, they have a machine like they did on men in

black and they zap their me memories and they remember nothing they saw because it remr would appear that the folks at e qssi who then report to united health group and in fact larry renfro has an office, a title or a hat in both companies. if that's the case, aren't they able to gain information on competitors by participating in the process and all of the meetings and then get an in and advantage over their competitors in the health care websites? >> let me clarify two things. >> okay, please. >> first, nobody on the healthcare.gov project is roject permitted to go back and to go outside of the project and transfer into united health care.oftransf that's expressly prohibited. exe secondly, just an important clarification because it is a t little confusing, united health care and united health group are two different things. united health group is a parent

company, hasas t two divisions. and so i don't want anybody to have the impression that optum is a part of this insurance an o company, it is actually a sister company, a separately run entity. >> but a wholly owned subsidiary, correct? >> correct. at >> the gentleman's time is expired. >> i have follow-up questions that i'll present for answers after the meeting. ctw- a >> okay, thank you. thank you.ter i recognize mrs. castor for five minutes. >> thank you, mr. chairman. good morning.oui ou, mr. throughout the country everyone is seeing the benefits of the affordable care act. as of today, americans who are interested can access new fact sheets that provide statistics based upon each congressional district. each so i encourage you to go to the democratic website of the energe and commerce committee and -- on call your member and we can provide those. a i want to share some facts abouo the benefits of the law in my florida district and the tampa bay area.w there are over 24,000 individuals in my district who were previously uninsured and

now have coverage because of the affordable care act the number of uninsured in my an district has declined by 15%. that could have been higher if the republican-controlled legislature and our governor would have expanded medicaid ino florida.ed medic in fact, almost a million florid additional residents could have health insurance. that's 43,000 of my neighbors in the tampa bay area who could have been covered, but they ben remain uninsured because floridh refused them medicaid.over but over 40,000 people in my e a district were able to purchase coverage through the new health insurance marketplace.th and nearly 10,000 young adults 0 were able to retain coverage ge through their parents' plans. 43,000 of my older neighbors received medicare part d prescription drug discounts worth $8.2 million. that's a great shot in the arm and terrific money back into their pockets.

so as we plan for the second year of open enrollment, we all want to make sure that we don't have the computer problems that we had last go round. i want to ask you some questions about premiums, especially for the 2015 period. now, open enrollment begins in november. is that correct?now, >> correct. ohat >> november -- >> 15th. -- >> so folks need to at some to point -- when will the website be ready to compare plans? rea >> so we're going to be sending out notices to people starting in october to come back to the website, update their information, and letting them ft know that on november 15th, noe they'll be able to either -- ifl they choose, come back to the website, shop for a plan, ch compare premiums and choose the plan they want, or as happens with medicare part d, medicare advantage and most employers, i they choose to do nothing, emply

they'll be able to automatically re-enroll, if their existing plan is offered. >> the deadline is in february. >> february 15th. >> february 15th of 2015.15 republicans predicted that premiums would skyrocket for the next go round, increasing by d, 50%. we can now test those numbers because the new rates are rolling out across the country.t are there any signs of out of ry control rate increases that the republicans have predicted? >> so far the rate increases far have been publicly available ha from rhode island, washington, e delaware, have all been in the mid-single digits.midsin california, i believe, has a big -- is going to come out with their numbers today. so i think that will be closely watched because of the size of the state.wi c colorado's has been steady, by and large. been while this isn't going to be true for every single individua in every county in america, by

and large, the early results look very positive. >> great. and is it accurate to say that r there are more choices in the marketplace this go round or mat will it depend upon the state? >> there will be more choices wb this year than last year. yearh >> so what does competition tenp to do when you have -- when consumers have more choices?erse >> better prices, better value, better services. m >> does that mean that if you >d have greater competition that puts pressure on the insurance companies to keep their premiums low?p t >> i think this is one of those win-win situations where the private sector can grow by providing more value to consumers and that appears to be what is happening. >> and what else -- what else helps keep premiums low under the affordable care act? >> well, certainly the preventive visits do, the ability for people to qualify for tax credits.ve i think there is a whole host o. things that --

>> one of my favorite ones, what we did in the affordable care act is the 80/20 rule, the medical loss ratio that says when a consumer purchases a policy, they have to get something meaningful and insurance companies can't spendn too much on profits and administrative costs.s. and when they do, they have to rebate the money back to consumers. and for -- i represent the stats of florida, we're really happy e that our consumers are going to receive $42 million back this summer. i've already heard from many of my neighbors and sometimes thosi rebates go back to the employero so you do need to keep an eye, isn't that right?loye>> >> yes, the number i've seen are that something like $9 billion 9 has been returned and saved to n consumers in that process. and >> that's been very important. thank you very much. >> the time has expired. now recognize mr. johnson for five minutes. >> thank you, mr. chairman.gnize mr. slavitt, good to see you today. ch you and i have had chances to e

interact before. and i appreciate you being with us. i agree with mr. griffith basedh on your background, looks like u cms is going to be the ndks l beneficiary of your experience and background.ik >> thank you. >> you've talked about your many years in the private sector. could you give a very quick summary of your years of experience and expertise and ye what it primarily focused on?are >> sure. so i started my own health information technology company back in the '90s.e a small business that ended up u serving consumers and ended up selling that business.serv i worked with optum for a number of years. oversaw the health information technology business and grew that. infor worked very closely on buildingl lots of industry wide os indus capabilities around things like revenue cycle management, li population health management, worked closely with hospitals,

with physician groups, with health insurance plans, state a governments, all really focused on quality cost and access issues.go >> okay. and to summarize, i think when you were responding to mr. resp griffith's questions, you led the team that made healthcare.gov usable in october, correct? questio >> that's correct.r, cor >> i want to ask you, you have all of those years of experience and expertise in information technology specifically in the health care arena. how much should healthcare.gov have cost? >> that's a really good question. and i'm not sure i know the answer to it. it is a -- it is not unusual for large scale health projects, fo example, i can think of big he project kaiser permanente when a

they installed electronic medical records, cost a couple i billion dollars to put in place. it is hard to know what the a benchmark is to build a consumer facing website instead of back end systems that connect to 50 o states, to medicaid plans, to insurance companies. so i'm not quite sure. >> let me help you a little bit because i don't know if you remember or not, but my ou background is a 30-year information technology professional. >> i do. >> so i have been through the e lessons learned and the trial by error of trying to project costt of complex i.t. systems like this. the gao says we spent nearly a billion dollars on this, with the cost climbing.ly a do you believe that taxpayers have received a good return on their investment thus far? >> congressman, i think two things happen and it is hard to know how much fits into each category.d one thing that happened is clearly this was a more complex project and needed a lot more work than people expected and

for that part -- ople >> that goes -- that goes back t to the genesis of some of the questions we got into the last time we were here. if you have a firm set of firm requirements.ents. and if you have a systematic c life cycle design process, it is much easier to project those es, costs. proje i know when i was doing large i scale program management on n large i.t. systems, the industr, general rule was t that in the e life cycle of a complex system, that the implementation part, im the design, the building, the mt implementation part isio only about 25% of the cost -- the of life cycle cost of the system. the rest of the cost is in st maintenance, operations, and further on down the road.rther so if this thing is already cost the taxpayers a billion dollars or more, to get to where we aree today, we can reasonably expecte that this is going to cost

billions, billions more over the life cycle of this thing, correct? over >> yeah., i couldn't put an estimate on that. i >> but you do agree with the concept in general that maintenance and operation costs a heck of a lot more over time than the initial implementation does. >> i think there will be an ongoing operating cost.nt will i don't know if it will be greater.e i have to look at the budget request which i don't have with me. th >> okay, the budget request hase nothing to do with how much it is going to cost. req you understand how the industryo works, you understand life cycle software development. you understand that. but i appreciate it that you don't really want to answer -- >> i don't know the answer. >> gao says ultimately more s money was spent to get less capability. do you agree with that?sth >> i think there were clear inefficiencies -- >> a lot of it is still not trking. >> there were clear inefficiencies of how this was managed.here

did i also say, in the real world, it is not always possible to know your scope going in. in an ideal world, you can. you but i think the estimates provet it, they needed to do more -- he >> thank you, mr. chairman.ore i agree it is not always possible to know the scope, but it is possible to fence the it scope and therefore knowing that what you're going to pay for isn what you're going to get, which is clearly not what happened here. at time >> the gentleman's time is expired. >> please keep it in the time frame, because we're expecting votes in a few minutes. i want to be fair to everybody. mr. yarmuth, you're recognized for five minutes. >> thank you very much, mr. chairman, mr. slavitt, thank you for your testimony and your work.fr einoryboth,edfor your one of the -- i want to talk about some of the things that k happened in kentucky since we'rt doing an update and i'm proud oo the experience we had so far in my state.e but there was actually some . pretty astounding news early r w -- earlier this week regarding e the trustees of medicare, coming from them, about the prospects for viability of the medicare .

trust fund. are you familiar with that information? >> yes, i am, congressman. ith >> could you tell us what has happened? as i recall, when we passed then affordable care act in 2010, th trustees were projecting the trust fund would be insolvent by 2017. >> i believe if i'm not mistaken that the -- in summary the projection is that the trust s t fund was -- life expectancy t extended to 2030. >> that's pretty astounding in y four years the projection four extended the life -- the viability of medicare by 13 years.and ther and there is also some really fascinating and i think inatin impressive data about flat ye per beneficiary expenditures, that they basically were flat year to year, no increase, when historically they have been running at somewhere between 5 and 10% annually, is that correct? >> that's correct. >> all right. thank you. one of the things that i know we spent a lot of time talking lo about, people who signed up for insurance, the private

insurance, in -- under the affordable care act, this is data that has come about from the commission of medicaid in kentucky.t and i think this is so impressive. if you look at the top map, tha, is the 120 counties of kentucky color coded by the amount of co percentage of uninsured citizens in those counties prior to the ca. and red and orange, which are most of the counties in w kentucky, i think, all but probably a dozen, were rates ofr 17% to 20% and then more than 20%.ete this is the bottom map is the e current situation. and it is staggering to me me because the green is under 11%, 8% to 11% and blues, 5% to 8% 5% and dark blue, less than 5%. we have counties in appalachia, in southeastern kentucky that went from having the highest su uninsured rate in the state, sua

over 20%, to the lowest the uninsured rate, under 5%., unde and that, to me, is a staggering accomplishment. st in kentucky, we essentially have insured about half of the half previously uninsured population of the commonwealth, in the state that has very poor health historically and currently, and people who are desperately in need of health care.ed of he what is even more important, i think, than that, is that the report of the commissioner, edii again ofd, medicaid in kentucky, talked about how preventive service utilization has increased dramatically.ti almost 16%, an annual dental visit, which they weren't doingy before, adult preventive services increased by almost 37%.'t d breast cancer screening by 20%. colorectal cancer screening by

16%. very, very important health measures that i think will pay off for the commonwealth economically, but also for the life of these citizens going forward.ns and also what is very important to note is how much reimbursements went up for providers in the commonwealth. n totals of -- let's see, reimbursements for those now covered under medicaid expansion went up by $284 million. in just the first six months. many of the hospitals and doctor and providers who were providinp uncompensated care for kentucky residents are now being compensated and that also is a benefit to the taxpayers and the treasury of the commonwealth.so i just mention those things hose because it is very clear to me that states that embrace the cat affordable care act and committed to making it work are having very, very positive experiences. it ver the adverse experiences were vee coming in states where the

administrations of those statese the governments decided in someu cases just not to participate in and other cases to try to sabotage the law.e i thank you for your work and ih for the information you brought to us today. i yield back. an >> gentleman yields back.to mr. gingrey is recognized for five minutes. >> one of the members earlier cz asked or made the comment that because of the medical loss ratio, i think they were uk taing about the state of florida, how much money was returned to the consumer of to e health insurance through the plans. let me start out by specifically asking you this, because this ic also been reported. if an individual ended up receiving an incorrect subsidy, that they were not entitled to, what will be done to rectify this issue, specifically will pa they be sent additional funding, if the subsidy was too low? or will they need to pay back ay the money if the subsidy was too

high and when will consumers know if they owe the government more money? >> thank you for the question, congressman.ou fstion, so if individuals have changes in their income, the best advice is they should come back to the website and update that information so that their tax credit and premium can be updated. for those adjustments that are not made when it comes to tax n time, they'll either receive a refund or they'll have a additional that they'll owe. >> well, i think we need to gete some specific answers on questions like that because this pay and chase model as we know a in the past absolutely in regars to let's say, paying medicare nd claims that were fraudulent and then you have to go chase them down and try to get them back, you never do. you are aware of this gao report that came out, i guess today, and it states that in january, cms awarded a new company, a co contract to continue work on the

federal marketplace for $91 million, right? >> correct. >> gao says the cost now has owh ballooned to more than $175 million, is that correct? >> that's what the report says, yes. >> and the investigation, of course, ended a few months ago. do you know if the cost, the estimated cost of $91 million that is now $175 million, that's in the report, has it gone up even further since the report?tr >> no, i think the estimate of the total contract and, again, , not what's been paid, this is what is being budgeted, is about $170 million, that's correct?are >> that's a pretty big error, it $91 million versus $175 million. how is it you can offer a $91 contract for $91 million and have it grow that much over such a short period of time?ucriod >> so i think the proper characterization of that contract is that the scope of f

the contract was completed after the initial contract was awarded.awar so i don't -- i wouldn't uldn't characterize the cost as ballooning, i would characterizc it as the proper scope with the contractor accenture was ractor determined after they got goingt and the reason for that, if yous don't mind me saying, is becaus they needed to be brought in ane urgent situation to take over n for a contractor that was leaving and so they agreed to an initial amount, and this was before my time, and then agreeda they would come back after they got started, started the got transition from cgi and then would come to terms with how wol much the scope ought to be. >> mr. slavitt, in my remaining time, let me ask you this, you've been with cms for three weeks. >> three weeks. >> and you're the number two guy there, right? >> correct. ba >> back in 2009-2010 time frame when we marked up this bill, a lot of us on this side of the aisle felt like if the american

people were going to have this affordable care act, ican unaffordable care act forced arc down their throat, that members of congress and members of the administration, the president, cabinet members, political appointees like yourself, you're not a career bureaucrat -- >> that's correct. >> you've been appointed by the- president to come into this rre important position.impo we felt, and still feel, many ol us still feel that you ought tol eat your own dog food. and members of congress, i thinm it is appropriate, we are doing that.be,e, we had to come off the federal employee health benefit plan ann get on the d.c. health link, and yet you members of the administration, the president, and his family, really ought to hing.ing the same thing. i know you worked in it, but let's say if you worked for ford motor company, would you drive a chevrolet?cve a i kind of doubt it. i think you would probably drive a ford.d

>> probably. >> what doiv you think about th in these remaining few seconds? respond to me. do you think it would be appropriate, a show of good faith to the american people riate, that you guys and gals that are running this show, that forced d it upon us, would be in the same plan that the american people have to be in?e >> it is my understanding that the president and his family are on the exchange. i don't know this for a fact, but that's my understanding. and if it is determined that the rest of us should be on the erme exchange, i would happily do that. dld >> if that is true, please let s me know and i know we are w limited in time and i yield back to the chairman. >> i thank the gentleman for yielding back.cve now rg mr. green for five od minutes. >> my good friend and colleague from georgia i'm going to miss.g i normally drive chevys and i'm. on the plan. we had to buy ours through the exchange. so -- but i want to thank the wt chairman and ranking member andm our witness for testifying.nd for decades the united states ds had highest rate of uninsured in

the industrialized world.famili this drives up costs and puts familiess at risk of bankruptcys when they get sick. the main reason is why we have a health sick system rather than a health care system because millions of americans can't get the care they need outside of h care system because millions of americans can't get the care c t he they need outside the emergency room. in ouran own district in texas, very urban district. almost 20,000 people previously. uninsured to get quality affordable coverage and overall the insurance rate is by 8%. 52,000 people in the district h who have access to coverage if texas had expanded medicaid and hopefully, we'll still get to that. earlier this month, in new england journal of medicine not fox news, not a left or right-wing internet site but th new england journal of medicine released two reports on the coverage. with continued enroll lt with e numbers of americans gaining e t insurance for the firs it time u insurance that's better in quality or more affordable thanl their previous policy will totai

in the tens of millions and mr. chairman, i would like to place that art quell in the record.mr thank you., a are you familiar with these t reports? >> yes. at the high level. >> earlier this week, the gallup poll released their own latest numbers that americans have numr insurance. are you familiars.fa with that s survey? >> yes, i am, congressman. >> the similarly, the urban ucd institute and commonwealth conducted surveys. can youcuss that also?se >> -- can you discuss that also? >> i'm familiar with those, too. >> would you agree that the nalf findings are bot mh consistent f with millions of americans signing up for health care?y're >> they're consistentnd very encouraging. >> okay. the only thing that keeps milli millions of more americans from signing up is the republican pd governors and state legislators to expand medicaid.nothe if they did, another 5 million americans would be el general su assembly forra insurance.nc eligible for insurance.hink i think the affordable care act

obviously coming out of the chute, it was a problem. but it's been fixed and hopefully, we'll see in the renewals that it happened but it is working although a lot of us had tough times in october and the mid november who supported it. what is tt,cms doing to addresse execution of the technology gy s lessonsso learned from the firs? enrollment section? >> congressman, i got to this project when it was beginning the turn-around stage at the eno of october and i think what don we're doing now is essentially u carrying over just asts we did the turn around. no magic to it. it's basic block and tackling.ie good communication and quite frankly a lot of the recommendations that came out of the report and making sure thate we have precise requirements.. it's daily management. se it's senior level accountability that goes all the way up to the secretary. >> you ,know, i advocated in er

texas havingve served a lot of l years in the state legislator es that we should have had a texas plan that we could have done.esd some states had good examples o their plan.not some not.that, could you talk about that?ke, in i know the state of maryland ans some other states had problems.e i don't know if they're fixed oy not but were they similar to what we are had open a national scale for our states that didn'e have the state plan? >> in terms of the challenges?rm or just thes of terms of what t got done in their state? yeah >> yeah. were they on a smaller scale, he having the same challenges that we were? >> i think it's probably at thie point toward e the end of 2014, that it was the rare state, maybe kentucky is one of them, that didn't underestimate how df difficult this would be given all of the complexities of tying into medicaid, tying into mpani insurance companies, offering u theme consumer website and the first year of any new program, in my experience, whether it's public sector or private sector, sometimes bumpy.n th

same is true in the second year. but those problems become more w and more minor and we get better all the time. >> to the best of my knowledge, for example, if the statere wanh to kreer yaet their own plan noo there's knotting in law to prohibit them from approaching cms or hhs or expanding the medicaid coverage? >> that's correct. >> thank you, mr. chairman. i yield back my time. >> chairman. yields back. now dr. burgess for tifive minutes. >> you heard my comments during the opening statement about the memorandum that they suggested that i might have and again, i want to underscore that's important to me. even though mr. cohen is no longer at cms i would very much like to see that. >> it's my understanding that e we've recently sent it so if yoo don't receive it, i'llw up folla with your office and make sure you have it. we >> youll .know, it was i was thi thinking it was a year ago, rih really, right now, that the your

boss was here and we talked alkd about things about the upcoming launch of healthcare.gov. a but that was just a little less than a month after the unilateral decision by the pr president to delayes the employ mandate. askin now, i remember asking about wa she of involved inta that decisn and she asserted that she was ss not.was i asked her how she found out about it and she said her chief of staff told her, which i found rather astonishing. my my chief of staff gave me information like that, i would be curious as to where that came from. sheed seemed to lack curiosity o about how that decision was reac reached.t me ask let me ask you this. a year later, the employer is mandate is now supposed to kickk in about a week and a half after election day in november. is it your understanding that the employer mandate will, in fact, be enacted in november? or can we expect to further

delay of that?o i >> so i'm'm still working my wa and the federal government trying to understand how it all works. >> good luck. >> thank you. my understanding and you can if please correct me if i'm wrong, that is a irs and treasury area of responsibility. so i haven't been exposed to that so much yet. >> my personal belief is that we'll never see the employer mandate. i have no inside information, na obviously. i'm not speaking for the committee. i'm just speakinghe for myself. when you look at the disruptiond that was i caused in the individual market october, t, november and december of last year, and remind yourself that t that was only 15% of the that insurance market that had that o convulsion, had that happened tb the entire both the large group market and the small group market, the individual market, all at once, it would have beend pretty mdisruptive. you heard mr. gingry talk about ag members of congress and take is

same thing people should have to take. i agree with that.t i did not take the bc exchange that was offered tome members a. congress and staff.'ll i said, i'll do what other people in my district have to do. i went to healthcare.gov and pa bought a bronze plan off the big website. biggest mess i've ever been lif. involved in my life but i ough, finally got through. mo it took about three and a half months to do so.no now i'm wondering what my rate e is going to be next year. i've got the most expensive health insurance policy i've ever had, enormous deductible. what can i look forward to?ance the next insurance year? tal you talked about you wanted to successful open enrollment. is it going to ben successful?oi what areng the rates going to li like? >> so i think we'rk ewe in a st now where indeed, this is one o our high measures for success ie making sure that there's enough choices and enough affordabilit and of course, each state is going that you their own procesh and going through rate reviews.t

we have seen some states publicly now come out where their rates. i believe rhode island, rnia tod washington, california today is, going to have, i think, an announcement what their rates are. i couldn't tell you, congressman, about texas.boi because i don't know.bu but generally speaking, what we've seen are rates that are ii not the double digit increase t levels but in thehe mid single-digit levels.case that's not going to necessarilyc be the casoue in every county i america but that seems to be what's happening on average. >> but, still, i mean, you thatt mentioned three or four states.y we have a long way to go before renewal rates across the country. >> no question. >> are inuntr evidence. >> no question. >> you're the principle deputy administrative. do you have any responsibility in thefi renewal or the rate fig filings? >> i think the rat e filings get reviewed and approved at the . state level. there's a process and i think ei it's in the mid process. now t

i believe right now that -- e >> let me interrupt you.ve do you receive interim reports r or updates on what the state filings are? >> i think there's been an initial submission and i've seen a high level report but this ist not yet final information. >> and is your -- office going make those rate filings public i information willabso available to access that? >> when they become final, and absolutely. >> as a healthcare.gov member i would like to know what my renewal rates are for next year. thank you, mr. chairman, i yield back. >> thank you. >> i just wanted to it will you, mr. slavin, i don't know if your office and your position is actually in charge, but we have gotten tremendous cooperation from cms when we have had tituen

constituent issues. and you know, clearly it comes . out, consumers get confuse. have a lot of questions. have some problems. i get irritated sometimes on the other side. i feel like there's an embraci, of these problems rather than a constituent service altitude to fix the problems.an and when we've tried, we've had good success.an and sod i just wanted to tell you, i appreciate that. i also just wanted to say that the minority staff has done a ,e district by district, the benefits of the health care reform law in all the districtsi in the country and it's just se wonderful to see how the number of people that in my district, 283,000 people in my district, including 51,000 children and n 120,000 women, now have health insurance that covers