>> you talked earlier about the soviets having this idea that they could limit a nuclear threat from america by making a counter force attack on us. >> not exactly. the theory, as i understand it, is that the russians believe that they could get into a situation in which the asymmetric advantage the united states has in its ability to project conventional force would leave them in a situation of not being able to defend either their territory or their forces in a circumstance that would put them in dire straits, and that rather than seeing that situation escalate to either have that loss to the united states or have it escalate to

the strategic nuclear level, they would use tactical nuclear weapons in a mode designed to limit collateral damage and de-escalate the crisis by demonstrating their seriousess, -- seriousness, indeed a much better work. >> your close personal friend has always argued that a counterforce attack on the united states would be responded to by counterforce attack from the united states. so therein he never accepted the idea that their empty silos would now be attacked by us. he accepted that was the only option. i only address this in the sense of iran and israel. israel has a very suspect capability to do any damage in counterforce to the iranians. but israel has a genuine

possibility to be a deterrent threat -- have a deterrent threat of countervalue and it would be sweet to see them publish that and identify which downtown shopping areas are going to be destroyed once an attack on israel -- which any attack on israel would be countervalue. >> so you have unintentionally confused me massively now. so don't sit down yet. please. hold on to that mike. so here's what. first of all, i have -- and street gi strategists i think generally -- of which i am not one but i do read them -- reserve the phrase "counterforce" for a strategic strike. so i have not been talking about a russian counterforce attack on america. i've been talking about perhaps

a demonstration detonation, perhaps a limited attack on u.s. forces where they're not going to have an impact on surrounding territory or population. maybe something, even in kind of the united states. this is very scary stuff. mostly for me because it completely misreads, my perspective, the likely american response to any use of nuclear weapons against us, united states of america, our allies, our territory, our forces, anything. that if they honestly believe they can de-escalate a crisis by attacking us with nuclear weapons, we're all in a lot of trouble because i don't -- i mean we have been misread before by countries about our usually-read resolve. this would be a big, horrible mistake on their part. if we were talking counterforce and what would happen in

counterforce attack against the united states, i hope and pray, a, it will never happen. but g it happened, that our retaliation would go completely counterforce and completely aimed at war termination, completely aimed at shutting down the conflict. i think one of the things about the nuclear weapons being back -- which i haven't dwelled upon -- remember, i'm teaching graduate students this semester at georgetown, and many of us looking around this room know about what nuclear weapons do has been lost. these kids have not gone under their desks in grammar school. all right? i did. so i worry a great deal that we have a lot of people in this country who don't understand the magnitude of the destruction twe

we're talking about. so the idea of doing anything other than counterforce, anything other than striking back in a way that aims at disabling and ending the conflict is so reprehensible to me i can't begin to express it. >> yeah. unfortunately, we have the same idea. i was chief of european forces a quarter century ago. one of the concepts was that we needed to let them know what kind of shape our conventional forces were in so that they understood that our only viable response to the soviets might very well -- very quickly include nuclear tactical weapons and we had a series of step-downs. but i'm worried about the influence across the world. if i was a soviet and reading your close personal friend's comments, saying if it is a counterforce attack saying we'll respond counterforce, it's not

sufficient. and he would never step off that. and they have every reasonable right to believe that a counterforce attack anywhere, including a tactical situation, would be responded to tit for tat and that -- because that got us into war fighting. this was a concept of war fighting with nuclear weapons. >> so something i should throw in to this conversation for everybody. my thesis advisor and professor when i was in graduate school was one of the great theorists of international relations, maybe known to some of you who were in that field, kenneth wall walz. the one best flown was titled "more may be better." we actually, if you can imagine how uncomfortable it was for me debating him, he actually believed that the slow spread of nuclear weapons was good for international stability, that the nuclear weapons are chilling

to everybody, even crazy people who run countries understand about nuclear weapons that you can't win if they start getting -- start being used. so it actually will stabilize. the last thing he twroet before he died was a piece in foreign affairs about why iran getting nuclear weapons would be a good thing for the middle east so there are other views here that i don't have any sympathy for but there are views that nuclear weapons could be stabilizing and i probably should say that, though i have no sympathy for the position. >> share jackson. i'm an independent consultant. if you exclude the declared nuclear weapons state, is theon. i'm an independent consultant. if you exclude the declared nuclear weapons state, is the

distinction between thermonuclear weapons and nuclear weapons any consequence for how deterrence works going into the future? >> the first part of your question i didn't quite understand. >> if if you exclude the declared nuclear weapons states -- so the u.s., france, england -- >> the five. >> yeah. the five. is the distinction between thermonuclear weapons and nuclear weapons important going forward into the future for how deterrence is going to work. >> it's important, but i don't think the way deterrence is going to work. i mean it's important because when i said a while ago that think in terms of two orders of magnitude. 100 times more damaging -- actually, it could be more depending on the size of the thermonuclear weapon. the amount of death and

destruction is massively different and if -- when we say tactical nuclear weapons, what we usually mean is something about the range of delivery system and the yield of the weapon. it doesn't mean it can't be a thermonuclear weapon. in other words, be our boosted vision weapon. it could be one of these things and still be tactical. because you don't have to design the thermonuclear weapon so that it produces mega ton yields obviously. so this all may get lost. and i don't think this is an important thing for you to focus on when you think about detenks and the way we've been talking about it. it is important though -- this is my last argument -- for security of nuclear weapons and nuclear weapons technology. there was a time -- and the

believe the year was 1979 when i was, as they say, minding my own business working at the department of state and i was approached by someone in the auditor's office and some funny looking people about an article that was going to be published by howard motherland in "the progressive" magazine. the question was, should the united states, for the first time in history, attempt prior restrained publication. my instinct was absolutely not. and then i looked at what was going to be published. at that time, we have what we call tickets. right? for the cue and all kinds of stuff that goes along with nuclear weapons. i would not have had clearance for this kind of stuff in nuclear weapons and it was going to come out in the magazine.

and we knew how long it took the frens to go from fusion to fusion and chinese to go from fusion to fusion and the russians. and we knew these other countries were out there. this was enormously important. by the way, as you may know, it was published and "the secret" as it was said conceptually of thermonuclear weapons was put out in the open literature. to what effect, i don't know that it may have done damage on that, i don't know. but whenever i hear that a country -- and it's happened a few times -- has claimed that it has specifically detonated a nuclear weapon, then our judgment is, nah, not really. this is a long way of telling you that because the level of destruction can be so much more damaging with thermonuclear weapons, the difference makes a difference. but in the terms we have been talking about here, in terms of deterrence, theory, credibility of a deterrent, all of that, i

would say not much. not much. thank you all very much. the 2015 c-span student cam competition is under way open to all middle and high school

students to create a five to seven-minute documentary on the theme "the three branches and you," showing how a policy, law or action by the executive, legislative or judicial branch of the federal government has affected you or your community. there is 200 cash prizes for students and teachers totaling $100,000. for the list of rules and how to get started, go to stude studentcam.org. now health and human services secretary sylvia burwell talks about the upcoming open enrollment period in the health insurance marketplace which begins november 15th. she sat down with former ohio congressman and governor ted strickland this week. the center for american progress hosted this 45-minute event.

well, good afternoon, everyone. i'd like to thank you for coming to center for american progress for this timely and important forum. we begin open enrollment for the aca next saturday and that will extend for three months through february 15th. so we're happy to have this opportunity to spend some time with secretary to talk about open enrollment and other aspects of the aca. but before we do that, as i said, thank you for coming not center for american progress. we're happy that you're here. and we're going to have a discussion up here. then later on there will be questions that we'll take from the audience. billy is going to be passing cards around in case you would like to write your question on a card, you'll be able to do that.

then we'll have those questions at the end of the hour. the aca is currently providing about 10.3 million americans with quality, affordable health care individuals who did not have health care previously. more than 7 million have enrolled in the state and federal marketplaces. 8.7 million in medicaid and chip, and 3 million more young adults being able to stay on their parents' plan and receive coverage in that way. so that equates to close to 19 million people benefiting today from the affordable care act. but there's still a lot of work to be done. about 5 million americans fall in the medicaid gap because their governors in their states have failed to expand medicaid.

so this is a timely forum and i want to take a moment just to say a few words about our guest, secretary burwell. secretary burwell is the 22nd secretary of health and human services having been confirmed in june of this year. but prior to her coming to hhs, she served as the director of the office of management and budget. and we had your successor, sean donovan here, just two weeks ago. secretary burwell has done a lot of things. she's been president of the walmart foundation which she led efforts to fight hunger in america, empowering women and reaching millions of people through walmart's community presence. she helped the foundation surpass the $1 billion mark in total giving. secretary burwell has sent ten years at the bill and melinda gates foundation in seattle, and

she's also served in the administration of president bill clinton. so secretary, we are happy to have you here. we have lots of questions and i'm sure you have lots of answers. but i want to begin with an easy questi question. just last friday the united states supreme court has decided to take a case that many believe could threaten premium tax credits for millions of americans thereby putting the aca in a death spiral, as some have chosen to use the term. what do you want consumers to know and should they be concerned as we head into this open enrollment period about this supreme court decision. >> i think the most important thing for consumers to know is that nothing has changed, that the tax credits that they'll be signing up for and the ones that they have, for those that are enrolled and want to stay enrolled will be continuing. so as we go into open

enrollment, nothing has changed. i think as the administration has said, we believe that the law stated that the tax credits are an important part of affordable health coverage and that is for all. >> so you believe that people should enter this enrollment period with a high level of confidence that what the aca promises to them will be there for them. >> that's correct. tlaeshg. that's correct. i think the administration has been clear all along that we believe that's the intention of the law and that's where we believe we'll stay and be. >> i've heard several authors of that law in recent days saying that was in fact their intention and if the congress intended it and the supreme court understands what the intention of congress was, your belief and the administration's belief is that the court will make the -- ultimately make the correct decision and this will no longer be a problem. >> that's correct.

i think what's most important is that nothing has changed. as we go into this open enrollment which we'll be starting this saturday and glad that to see folks from a number of organizations, whether enroll america, planned parenthood, others of our community organizations that are out there making sure we'll be able to enroll folks, that nothing has changed. >> we all know that the initial rollout had some problems. but the administration went to work and the ultimate result was more people actually enrolled and signed up than were expected to do so. but they had about six months to do that. this enrollment period covers a shorter period of time and perhaps a more difficult task is confronting you. so let me ask you, you've been testing the healthcare.gov leading up to this enrollment period. how confident are you that

people are going to have a good experience when they sign on or get in to healthcare.gov? >> we are confident that we are going do have a successful open enrollment. when we think about that, what is a successful open enrollment, there are really three fundamental elements of that. one is affordable choice and that is for the consumer. the idea that the consumer has an ability to choose and have affordability. we know already that there's been a 25% increase in the number of plans participating in the marketplace. so that question of choice and affordability. the second thing is we want to continue to make progress on that fundamental number of reducing the uninsured. when you think about one of the fundamental things when we talk about access in the affordable care act, we are talking about that number of uninsured. there are three ways to move that number. one is you move that number through people who have

employee-based care. we're all for people who get unemployed and the unemployment number goes down, you can see people getting employed, that's a great way to do it. we're all for medicaid expansion. something else that you mentioned and believe that's another great way to expand the coverage and care. finally, the issue of getting that care in the marketplace. so as we think about that idea of moving that uninsured, the third element of a successful open enrollment has to do with the consumer experience. that consumer experience has two fundamental parts to it. one you touched upon in your question which is operational functioning. does the website work. and are people able to go in and get on the website. with regard to that piece of it, have been spending a tremendous amount of time to try to do some things differently. last year our testing went ten days. this year our testing is five weeks. and our issuers and insurers have been in testing, testing different things. we've tested load testing.

we've tested end to end. in addition, have also focused on security deeply and make sure we're bringing the best practices from the private sector and whether that's bringing our colleagues at dhs in or the fbi in, to the best practices in the private sector, which include things like we actually scan every day. in addition to that, we have people try and hack us. we have people try and do that. as well as once a quarter having folks come in and do security checking. the last piece of this consumer piece -- because this is what is a successful open enrollment -- is the concept that the consumer has a better interaction. things are simpler, faster, and more intuitive. but those who are returning to re-enroll in that state-covered part of it, for those coming back, for most of them 90% of the information is going to be pre-populated. what does that mean? you don't have to keep entering your address. all that information you entered from last year, 90% of it will be there to make that easier when you come back to check

things out. second place is actually those new folks coming in. for those folks what we tried for 70% of the people we're going to see a situation where they have an application that has -- it's gone from 76 screens down to 16 screens. in addition, going to be easier to use mobile applications because we know many of the young people that we're trying to reach use mobile applications. so that ability to connect there. those are some of the things we're doing to get us to a successful open enrollment. >> there are people out there who are opposed to the aca, do not want it to succeed, and are looking for ways to attack it and to create suspicion or doubt perhaps in the minds of the consumer. so can you tell me, as we sit here today, that a person who applies does not have to worry about their private medical

health care information becoming public. >> so in terms of the issue of security, it is one i touched on a little bit, but it is a very important high priority for us as we work on the affordable care act and the question of the marketplace. what we've been doing is putting in place, as i said, the best practices in both the private and public sector. we're applying -- we've added new teamsexisting team. making sure we've done everything possible to test and try for that security. we all know, we've seen it in both public and private sector, that there are things that can happen. so our job is to put in place everything we can, all that testing that i've said. but then we can't predict, and there are many malicious people out there but we stand ready and have practice drills so when something does happen we can react quickly if something did happen. last thing i would say is just at this point we are fortunate

that we have not had a malicious attempt on people's private information. could that change? it could. but to date we haven't had that and have put in place both preparation and an ability to deal. >> it sounds as if you feel that you're ready for this open enrollment period to begin and that's gratifying. now you mentioned one of the ways that people are getting health care is through the expansion of medicaid. having been the governor of the state of ohio, having been su s succeeded by a conservative republican governor, governor john kasich, i was clithrilled. i congratulated him when was a conservative governor he chose to expand the health care to the people of the state of ohio. unfortunately, that hasn't been the case in some other states and that's something that those of us here at the center for american progress are concerned

about because our position is every american should have access to high-quality health care. i know that's your goal as well. so that's an issue that will continue to be of concern. will it not? that there are people in many states in this country that fall within that medicaid gap and do not get access to coverage. >> yes. one of the core priorities since i have gone to the department in terms of the space of the affordable care act. we think about the marketplace and the importance of bringing that number of uninsured down through the marketplace. but as i said, medicaid expansion is another very important tool and it's something that as secretary i have been focused on in july, less than a month after i was confirmed, went to tennessee to speak with the national governor's bipartisan gathering to talk to both governors and make sure both parties, all governors, to say i'm ready to work with you. we want to expand medicaid.

we understand different states have different needs. we saw pennsylvania expand in its own way. we saw iowa expand in its own way. we saw arkansas expand in their own way. i wanted the governors to know we understand and respect different states have different needs. i'm personally engaged with a number of conversations, a number of those conversations have been reported on and going to continue to work on that. last week i went and spoke to the medicaid directors of all 50 states because i want them to know the importance and priority of their work, both in terms of this question of expansion as well as the work they did every day to innovate in the health care space and deliver well on the taxpayer dollar. >> let me ask you this question about the consumer experience and those who have already enrolled, than those who enrolled last year. my understanding is that if they do nothing, their enrollment will be automatically renewed. and so some people may think,

well, if it's going to be automatically renewed, i should do nothing. but it has been pointed out to me -- and i'd like your opinion on this -- that it's important for people who are already enrolled to go back and look at their options going forward because they may be able to find a plan that is better and cheaper. maybe not, but it is important that they at least have that option and understand that option. is that correct? >> i think that is a very important part. that's why right now, and as of saturday, and many of the folks that are here know that it is important as we are talking about staying covered to encourage people to go in and make sure that they check and make sure they check and make sure their information is updated and make sure that they are making the best clohoice fo them in terms of different options. when there is a 25% increase in plans coming on, there may be something that would work better for you. that may be in terms of either the type of coverage or it may be in terms of the cost of coverage which is something that

is very important to people and we know that's something that many people are making choices and desixcisions on. we want to encourage everyone to do that before december 15th. because that's the point of the auto reenrollment, that you referred to earlier in your question, that that will just start happening. yesterday we put up window shopping on the site already so that people can go in. you can enter -- i did it yesterday. you enter in a zip code and you can go from and you can see and look at different plans. you can sort by cost of premium. you can also sort by deductible. so as you're trying to think through and understand in your region what is it that you are looking for -- so making that shopping a little easier for the consumer so that even those who are re-enrolling can go in and do that. >> yes. and i think it is important for people to understand that because although they have coverage that they're satisfied

with, they may be able to get a better deal. so it's worth checking. i'm glad you were able to clarify that. let me ask you this. the republicans have overtaken the senate. some of the leadership is highly critical of the aca. there have already been comments about the things that may be done once the new congress convenes to go after the 30-hour work week requirement, the medical device tax. the individual mandate which is so critical to the success of this program. let me ask you. are these attacks of concern to you? and in your judgment do you believe the last election was an

expression of the american people being being negative toward the aca? >> so, i am obviously not an elected official. not a politician. and will turn to how i think about this question overall. the affordable care act was passed -- there was bipartisan agreement about the three basic premises of the act. and those are -- affordability, quality, and access. and so when i think about the question of pieces or parts, what i believe is, we've made progress. quality, 115,000 fewer readmissions. need to make more progress there, but that's an example of quality of care. people aren't being re-admitted. the question of affordability, whether that is the fact that many people were paying $82 in a premium last year or the affordable care act made the opportunity for over 8 million seniors that are part of medicare to save over $11

billion. that's what some people refer to as the doughnut hole. or the fact that as the american taxpayer, and in my old omb job, we saw medicare spending be $116 billion less than the trajectory it was on before so that affordability is there. the last one is the issue of access. and 10.3 fewer adult americans than last year are now uninsured. the idea that 10.3 million more americans are not uninsured. that's the facts. those are the substance. as we think about the go forward, that's the conversation we want to have. i think the president's been clear. the idea of repeal of the affordable care act is not something that this administration will let happen. what we will do is work to improve. if people have ideas in places where they believe we can increase affordability, quality or access, let's have that conversation and we would

welcome that conversation. but with regard to other things, let's measure them. let's measure them substantively against what we actually agree on are the fundamental premises of what we want to try and improve as a nation. as far as the conversation, i hope that the conversation will ship to a substantive conversation about the three things that we can agree on and how do we move forward on those. >> let me pose another criticism that may be relevant to this discussion of whether or not there is trust in what people hear from the administration. what do you say to critics who say you held off publishing updated rates until after the election because you were concerned that those new rates would equate to bad news for the consumer? >> with regard to the issue of transparency which is something that i have talked a little bit

about since i have been secretary. whether it's the numbers -- we put out exactly how many letters we were sending out with regard to there were data matching issues. there were issues around immigration. we said how many people we were sending letters out to. it was a very large number. as folks may remember, the initial -- it was 900,000-some. with regard to income, the inuse with regard to income data, put those numbers out. we put out effectuated enrollment. that's what people wanted to know. number of people paid and getting insurance. we had to put out the new aff t affectated enrollment. that number is 7.1 million. that's the number of people currently enrolled and paying in the marketplace. in addition, today in terms of this transparency issue, what we

are trying to do is make sure we're clear. today the fact that -- what's our goal. i talked about the goal broadly. people want to know how many people are going to be effectuated, signed up and pay in the marketplace. we try and give you information that we have that's accurate. on that one we had to think through. i wanted to understand, we needed to build what those numbers should be. so what we did was we had this many people enrolled. right now that number is 7.1. how many of those people do we think will re-enroll. how do you get to that number. analysts and the insurers and folks had a range from 70% to 90 pr 90%. we came back, talked to a lot of folks, said that number is going to be about 83%. that's where we put it in terms of the number and percentage of people who re-enroll.

how do you get the rest of the number? it's new people who are coming to the marketplace. so we took the time to size that and the sizing of that has to do with how many people are eligible, that aren't el zbiigi for medicaid but are in that space. then took that number and created a range. and we think that range is about 9 million to 9.9 million. then because i know i will get the question so i may as well answer it now. a range is hard to manage, too. what are you doing? what number? what number? so what we do was looked at a number of different analysts in terms of growth of plashmarket. when have these different markets gotten to their stabilization point. cbo had numbers out there. 13 million that would go to 25 over a three-year period. what's that right trajectory. we looked at that. then we look at actually what we have. which is we actually have data.

one of the predictions was that people would move from employer based coverage to the marketpla marketplace. that's been much lower than the prediction. so we have that number. we also have what the market did last year and we had a huge growth in the market. we settled, probably the market will grow between 25% and 30% this year. if you take that number and you add that number, we said around 28%. if you take those two numbers, the number that we are going to -- your question was with regard to trarnsparency. we wanted numbers to be accurate, aen litically based. moving on to those folks who we were writing letters to that would come off the system, that's not news that's good for us. >> i'm just looking at one of

the questions. it's from someone in the press and it says, how do you respond to critics say the administration moved the goal post with today's enrollment estimate. i think you tried to respond to that. >> sure, i'd be laep to ahappy . where do people disagree? the question about the substance in the affordable care act, where do you disagree? do you think that reenrollment should be greater than 83%? is that where you disagree? it is not about a number. it is about the actual analytics to get to the number. do you disagree and think a market should grow baltimore than 28% in its next year. one of the things i asked the team was to go, look, let's see what growth of new products in this space traditionally are. how do we think about that. how do you think about it. so how i respond to that is also

always hearing legitimate questions. i obviously spent time with the time down to the numbers trying to press and road test on that. so the question i would just say is one of the things with the cbo numbers -- everyone knows i come from omb so i have a tremendous amount of respect for my colleagues at cbo and have worked with them two different administrations and have a great respect. one of the things is the question of that line. they suggested you'll get to -- if you accept that the 25 million number is where you will level off, they went in three years. what happens if you do that over a different period of time? and how do you think about that and how do you think about the new information that we have about what happened in reenrollment? so the question of what one's goal should be, to me i came in and asked the team, let's analytically build it.

that's what we've done. >> let me suggest -- this is just my thinking. not sure it is yours. but let me suggest that with the continued attacks on the aca from various quarters from individuals and groups that are opposed to it, do you feel that those attacks are having an effect -- or will have an effect on the flnumbers of people who will choose to try to enroll or enroll? is it creating doubt in their minds that the aca is here to stay? what's your personal opinion about the the effects of the negative outlook on that and it looks like it will continue to endure for the foreseeable future. >> i think there are two important things in terms of this question of the attacks. i think about it in two ways. one, i think about the numbers and then i think about this

board. i think those are equally powerful in terms of what is going to keep this moving forward. that's not to say -- i should say when you're being -- when something glrm it whether it is the numbers that i went over, people who are uninsured, people who are under 26 and on their parents' policy. for everybody in this room who actually had employer-based insurance but now doesn't have to worry about pre-existing conditions. for everybody in this room who had that insurance before but now has preventative care that they didn't. those kinds of things i think will make a big difference and the other thing that's going to make a difference are people's individual stories and we're joined today by a person who has one of those stories.

who came here from philadelphia today and has one of those incredibly important stories of her coverage and what it has meant to her and her life in terms of a very healthy working out, eating right, doing all the right things. but then her mother encouraged her to signnd and she did and ended up needing the coverage both from a health perspective and a financial perspective. so with voices like ann, that is going to carry the day. >> ann, how old are you? 28. you really want to reach that age group, do you not? >> that's right. ann is courageous to be here today. she's in the middle of her treatments. but it's that courage that's going to make the difference. >> i've been puzzled, having been the governor of a large

state, at the governors who have made the decision not to expand medicaid. i assume that they're acting in good faith based on what they think is best for their states but i know in ohio, our hospital system, our children's hospital system, the entire hospital system, would have suffered greatly had medicaid expansion not been pursued by governor kasich. can you just speak to the effect -- many hospitals are closing in rural areas and in other areas because of the decision. so could you just speak to that? >> i think when one thinks about medicaid expansion, it is about the individuals that are going to get covered which is a very important part of it. but it is also about the economics of medicaid expansion. and the pressure that not having that expansion puts on especially rural hospitals. i'm from a state like west

virginia where there are a lot of rural hospitals. and the pressure it puts. that is why so many hospitals in so many states support it because the indigent care, they'd rather have that care being paid for. and it makes a difference to the bottom lines. there are estimates out there from the council on economic advisors that those states that have medicare expansion are going to get 350,000 more jobs. so the economic issues, as well as the care and health issues are very important as we have this conversation and we recently saw the most recent state to come in was pennsylvania with a republican governor come in and over 400,000 people will now be eligible for care in the state of pennsylvania. i think folks know that as has been said in conversations with a number of other republican governors as well. >> i just know that our hospital system in ohio was deeply involved in encouraging this

expansion. i'm a little curious as to how governors are going to deal with their local hospitals if they continue to choose not to expand medicaid because, as you say, it is not an economic issue. not only affects the individual person who's not getting coverage but affects it the entire health care system within that state and that's a serious matter. i have a question here. another question from the press. what does the administration's enrollment projection say about how it is going to reach new enrollees. what's going to motivate them to sign up in 2015 and deciding not to do so in 2014. >> i think that question actually reflects something that's true which is the next group of people will be harder to reach. i think that's true and that's fair and i think it is also true

that we're on a shorter time frame. last time it was six months and this time it is three months. but i think in terms of -- there are two parts to that question. one is kind of push and pull, demand and supply. and in terms of the question of demand and how we think about the fact that the benefits and the affordability and the question of ease of application and speed are things we're going to do to try and bring those people in. in addition, this room happens to have a number of people who are extremely important to helping bring those people in, helping educate those people about what the benefits are, what the costs are and how to do that. the groups that have experience did this last year are working across the nation to make sure. the other thing that i think is going to help is the stories. the other thing is for anyone who wants to, this is the new

enrollment, this question was new enrollment, not re-enrollment. this is the get-covered, not the stay-covered group. i just want to remind everyone because i think it is really important, you can go to healthcare.gov. you can actually go and find where there are local people who will assist you in your local community, individuals to help you, many of whom are from the groups here represented today. then the last is 1-800 to address what's embedded in that question. make sure there are lots of ways people can do it. there's lot of help to get. when you do it, it is easy and affordable. >> what are you most concerned about, madam secretary, in terms of this enrollment period? >> so i think in terms of this enrollment period, there are many details and many things but little things i think are important. one is the idea that we do have

a shorter period of time and we have a group of folks we're moving to the next group that may be a little harder to reach. that's one concern. the other concern that i have is, this is actually the first full round. i know everyone thinks this is the second open enrollment. but because of the topic which we discussed, which is re-enrollment, this is the first time that you're going to go through the whole -- we have to technologically and from a consumer perspective both -- both of those things i think are challenging. any time you do things for the first time it's hard. and you worry. and that's one of the things. talked about all the planning and preparation we've done. we have tested for an extended period of time. we've load tested. we've done all of those things. but i also know that we are going to have things that will go wrong. the private sector, the public sector, any time when you have a system that's complicated, when you have a product -- health care is difficult in this

employer based market in terms of people understanding all the different pieces and parts. this is hard. we will have things that won't go right. we will have outages. we will have down time. but the most important thing we can do about that is make sure that we are prepared. that's one of the other things we've been testing is we run tabletop exercises for what do you do when something goes wrong. and we do that so that it will happen. something will happen. what we need to be able to do is be transparent, fast and get it fixed. those are some of my concerns and also how we are addressing some of those. >> so i'm a person who already has health insurance. why should i care about this? >> first of all in terms of the things that happened and the benefits that were received when the affordable care act was passed and whether that's the up to 26 year-olds being on coverage, the fact that there

are no bans for pre-existing conditions. the fact that there is more affo affordable health care and that will work for everyone. the fact that as we think about the economics we just talkedeco about, those we all benefit from. when fewer people come to emergency rooms and have care, we benefit from that in our system. it's about your own personal coverage and economics. the other piece of the economics i would say are important are economics as a taxpayer. because one of the parts of the affordable care act that i think continues to sometimes not be focused on is affordability for individual. it's important in terms of some of the changes that have been put in place to try and slow some of the growth in medicare. >> aren't there provisions within the aca that have nothing to do specifically with getting coverage that offer protections for people that do have

insurance or say i'm in a job and my company goes bankrupt and i lose my i job and health care. there's certain projections that apply to everyone whether they are receiving health care through the exchanges or not, are there not? >> that's correct. in terms of trying to make sure there's downward pressure on premiums -- >> another question we received. you've alluded to this. how confident are you at that the website will work? you've spoke ton that. you're as confident as you feel you can be because you've gone through all the -- there's another question that d deals specifically with end to end testing, something that i don't really understand. you mentioned more time for --

can you say more about that? what is end to end testing? >> so there are a number of different types of testing that we've done in terms of the website and even the products. we have -- the application is the shorter application. what we refer to as application 2.0. that was started in early as late july and august starting to test that product. we had that product out in the marketplace for people who are part of special enrollment periods. so that type of testing was occurring so that we could see a if it was working, make corrections to it. the other types of testing we do, end to end means different things to different people. it's from the beginning steps through. there are many, many steps and many pieces. whether that is having to do with pass words, whether that's

having to do with how it actually happens when you sign up for your coverage that it goes to the insured. it's all those steps. we've been working with insurance to make sure those things are tested. there's other testing. one of the other things we're hopeful is that there will be more people on the the website at a given time so load. i said load testing. how many people can the site hold at a given time and what is the capacity? we've worked to increase that capacity the. this having gone on for a period of five weeks. we use the testing to see if we can catch things if there are problems or changes we need to make as we go forward. >> and you're feeling confident that the consumer is going to have this when they get on healthcare.gov. most likely this is in most

situations a positive one? >> open enrollment this year will be a positive experience for the consumer. that has two pieces as i described. it has the operational piece but also the consumer engagement. will we have challenges? will there be consumers? yes. the experience overall is one that will be positive. >> one of the things that people i think are rightly concerned about is the costs. what is the projections regarding premium costs? some people are saying they're going to skyrocket. others say they're going to really reduce costs. what is the factual information you can provide us? >> about 40 states have started putting some form up in regard to premiums. the most important thing is yesterday when you start window shopping, you the consumer can

see what the premiums are for you. that's one of the things i think we think is the most important thing to do. as we've said all along, the growth of premiums in this market is going to be slower than it has been in the years before the affordable care act. in addition, we will do everything and are doing everything to make sure there's a downward pressure on the premiums. whether that is supporting states, we can review those that come in over 10% or creating pressure to keep downward pressure on the premiums. those are some of the things people referred to. insurance, risk corridors. those are steps to help the insurers during this early time. some of them for a limited time that we used in medicare part b to put downward pressure on premiums. >> you have a high level of confidence that in a sayers are

talking about skyrocketing premiums are not likely to turn out to be telling us the truth. >> i think a what we will see in numbers and what people see on the website is that most folks, especially those that want to reenroll, most of them that come back in, will be able to find something that's a better choice for them in terms of affordable. >> we've talked about a lot this morning or this afternoon. we've got a few minutes left. what would you like to say that we haven't addressed thus far about what you're facing in terms of the enrollment period and what people need to know or you would like for people to know in order to successfully enroll? >> just sort of two categories. one is what is the open enrollment. what are expectations. how do we think about success?

>> that's really just three things. one is affordable choice for the consumer. two is high quality consumer experience. and three is continuing to make progress on reducing the number of uninsured. then second category, i think it's important two fundamental concepts. stay covered, get covered. for those in the stay covered, it is important for you to do five easy steps to go and just make sure you have the right plan for you. those coming for the first time, if you prefer doing it yourself on the website, or you can go locally to find somebody face to face to help you. if you'd like to do it on the phone, that's great too.

get out there, stay enrolled and thanks to partners working on all of that. just the idea of what we think of success. >> i understand you're going to be in my home state of ohio in a few days. >> are you spending a lot of your time promoting this open enrollment traveling and speaking to groups? >> i will be as we're gearing up. i'll be spending time out in the country and places we know there are many that need to stay covered and get covered and make sure i'm out there speaking to issues that we spoke to today. looking forward to getting out and and and being able to meet the folk who is are assisting in this process and also those getting insurance. that's is one of the best things. whether this job or the other work i've done, when you can get out in the field and actually see the impact of the work, that is one of the best things to be

able to do. so i'm looking forward to it. i'll be making a few trips over the next three months. >> in conclusion, can i give you advice? >> i welcome it. i think the fact that millions of americans today have health insurance coverage that they did not have previously that younger people can stay on their parent's programs, that medicaid has been expanded, that literally some 19 million people have already benefitted from the aca. i'm wondering why there isn't a greater cheerleader section. so thank you for coming. thank you for answering the questions. i think you answered them candidly and factually. i encourage you to continue to be a cheerleader. those of us here at the center

for american progress believe that every american regardless of where they live, station in life deserve to have high quality affordable health care. we believe that the aca is a major step toward getting that accomplished. >> been a pleasure. thank you all. [ applause ]