there were 2, would immediately go out and shoot someone to prove he was out there. in the space of about 20 minutes, law enforcement agencies in america were able to get that message out and get no one of any substance to reports that there had been an arrest. i think you can make a reasonable argument that it probably saved someone's life that might. fast forward to boston, and i think what was most alarming to me is there turned out to be a false report of an arrest. that lingered and stayed in the that lingered and stayed in the space for a number of hours. i'm not casting aspersions on anyone because we are all working on things that are difficult. i would be a happier human being in general. in the space of several hours, there was a lot of confusion about whether there was a person

captured or not. what that says is that the trust relationship has eroded to the point where there is no longer a person in each house to can call up someone else in the other house to say that is wrong -- kill it. and have the person on the other line said, don. i believe you. we know each other. that worries me for the future because, one, you could get a situation like the sniper case if it happened again. does someone go out with that and get killed? or in a broader sort of social media context, not just old medium, twitter put a lot of awful things out during hurricanes and that could in theory got had -- could have got people killed. but if 9/11 happened today? would more people's lives be saved because of twitter or read more people be killed because of twitter? these are the things that i grapple with. what is responsible and with the

b invoices in the world, hopefully we do with being a voice is, how we try to do the most constructive thing to both inform the public cannot jeopardize anyone? what worries me again, just get hopefully we do with being a started talking, i feel like the back to the point of trying to make 20 minutes ago when i trust relationship is eroding and it's a very dangerous thing. >> can you talk about your position being in government on the other side and now being a journalist? you have seen both sides. at the end of the day, we're talking about leaks. should they be prosecuted? >> let me start for my government perspective. this is a source of enormous frustration when you are on the government side because you're holding accountable for prevention and being from in that very difficult mission.

you have the median nipping at your heels looking to pull threads and constantly pulling on a friend that would require a you to react and respond. during my time in government, i was privileged to work with dana and david. talk about a trusted relationship. in the green room, we hugged hello. i was there when she was working on her piece on this secret prisons and there was a very mature, adult conversation and there is also a recognition when those conversations start. it may begin with a public affairs officer, but it should never stay there. dana knows that. if she does not see it moving up of that chain, she knows there's a problem on the government side.

how much i'm willing to share to persuade them is a function of how damaging the release of the story is going to be. and just to make sure that as we would say showing all leg gets me somewhere, i want to be sure that it is not just the reporter who is very personally invested and the publication of the story, i want to make sure the editors and executive editors are involved.

i want someone who is more dispassionate can help the balance, listening to what i have to say. i will tell you more often than not while it is enormously frustrating, it gets to reasonable place. when that balance is but it is reasonable. the most recent story we've seen last week is the subpoena. there's no question based on what i know about the operation that was compromised. you ask yourself, you heard us talk about this process. this is a piece of information to your point about an erosion

of trust. it came out in dribs and drabs. they gave enough to make the second and third step. that is a problem. that requires people on the government side to calibrate who they are talking to. you may be able to say to local reporter that you have absolute control. there was never risk to the united states but to a national security reporter that deals in classified information and security it is patently obvious when someone senior in the government says that. there is only two things that that means. those are the-you made both. those of the only two possibilities. while the official may not have intended to say that, to brag that they had complete control

told a much more finely detailed story than they could have what it. we were talking in the greenroom. it was a lack of experience. it is a lack of maturity in terms of understanding who you are talking to and understanding what the implications of that are. we do-i am very concerned about the erosion of trust. oftentimes if there is a story out there because there was a former senior arab official will be the person who gets the call from the government when it gets haywire. it is a horrible place for the government to be. you cannot try to massage this one. you're really lost your

opportunity. typically the government goes dark and then you cannot get anything out of them and a bad story gets perpetuated. that is a problem. i do think the government is when it writes especially when there is a leak of information. my concern is that there is also a process. you heard the journalists appear explain to you the process pre- publication. when there is a leak investigation there is a similar channel by which prickly legally, respecting the first amendment, consistent with department of justice guidelines, that a leak investigation can be pursued. in terms of the relationship of trust it is important that is narrowly defined. the government use every means short of subpoenas and wiretaps

and when they're going to do that not only did they follow their internal process but that is the time when it is incumbent to open that channel. there have got to be a relationship of trust the where the conversation begins. >> to the ap investigation look like that to deal? as you speak to sources now and say it was narrowly, you have missed the upper today to tell that story. you need to give people confidence that you understood why the complete brushless breathlessness over this. though that has been said to me, i am skeptical. i have not seen anything that

reassures me. >> there were two other factors in here to build on what france said. sometimes reporters here things in briefings and they put two and two together and get more than four. in this case. sometimes it is outside evidence. what was the first big disclosure in this case? it was when the technological air that made in the summer 2010. a worm that had made it into the computer system got out and broke free. i imagine as you am all getting out of the cage. suddenly replicating around the world was the most sophisticated computer virus anybody in the computer world had ever seen.

this did not look like the work of teenage hackers. when you tore apart the program, it had a sell by date. teenagers do not make programs self destruct. with analysts picking apart the program. for the methodology by which a terrorist would build a bomb. why were they looking for the bombs? because there would be the signature and that and how it was constructed.

it is true and comes to cyber- cases as well. that is where we started. who had a copy of that entire program went to the doubt? the iranians. they did not accuse stretch of land. while the government thinks it is in complete control of the set of information, accidents happen. they work with other governments. most operations and terrorism and cyber, and drones, all involve other governments. they all had different agendas. there was this model in washington that all information the reporters get comes within a 12 block radius of the west wing.

we have not adjusted our concept. to the fact we have allies, we have partners and people make mistakes. >> aware -- what we're talking about here are leaks and i am curious to get your perspective. should they be prosecuted and if so, hal? tell me about your methods to go after whoever leaked this material. i would like to know who-what the government should be doing. >> other things should not necessarily be secret. i have to remind myself that when george brush-that is not my choice. we had to go behind the wall. david's point about overseas

leakages. if i were within the everette i would begin to think a lot about how your putting operations together. what rowling needs to be secret. what is going to remain secret? as we saw, 99 percent was publicly available information. and allowed us to create a universe of material that was really surprising to us. and that surprised the government when we showed that

to them. had to do with agencies. the government does not have a clue what is available in an unclassified realm and u.s. these factors together that we're talking about a global liaison relationship. it cannot reasonably think that drawn strikes will remain secret. especially this for a long after 9/11 when you have a senior court reporter to have been doing this for a long time.

you would think that would factor in. what is going to hurt us ever comes out. >> even which should remain secret. the drone program is the least covert covert program in america. it can tell that by the fact that the president got out and started discussing the drug program. he did it on late night comedy shows. they wrap themselves in this concept that everything about the program had to remain classified even though it was blindingly obvious. to anybody on the ground in pakistan.

it does raise the question, would we have as a government, would there have been some benefit to american diplomacy, american ability to explain its own policy. how the ambassador in islamabad able to get out on pakistani tv and say this was not a random strike. we're going after these five bad people who were living in your territory. instead the embassy had to say no comment. >> ok. there were legal constraints. plenty of debate of how that drone program [inaudible] is under one set of authorities that requires you not to acknowledge it. that is what caused disorder if odd twist themselves into knots about nine not technology yet-- not to acknowledging it. one could argue for it.

>> do think the senate's report should be classified there is a huge conspiracy around the world where people think there are drones in their country. i do want to tell you, i think it should be out there and knowing how much detail is in it.

in the end, we could not sanitize certainly the findings and recommendations, that is the first thing you look at. there may be a way to get this piece is out there in an unclassified way that will allow their to be this kind of debate. there ought to be a discussion and debate. i think the government actually benefits when the public voices heard on policy issues. absent a public debate during their level best, members of both parties to try and make these judgments on your behalf the best they can.

when you're in there inside the bubble of the west wing, you're trying real hard to make those judgments, there may be a dialogue with members of congress to try and advise you and get their input, but you're always better off under standing how does the public want those capabilities deployed on their behalf. that becomes a role. when the camera is trained keep the secret, the role that the press plays a that in fostering that public debate. >> you have worked for three different organizations. >> cc any differences? >> when you get into this, there's not much variation.

you're talking about unlike what is happening, i do feel like you're talking about a confined in limited group of people who for better or worse get to know each other a little better and work it out among themselves.

i do not think there is a liberal, a fresh voice on national security. you're working the same space. this will be a function of you have to be crazy to do some of the stuff for a living. is like covering icebergs. you see some of it. you'll never see all of it. to the way you're just making, a lot of these operations will down to i can tell you why you're wrong but i cannot tell you that. you have the traces and what do you do when you reached the limit of i cannot tell you. angelique should never be prosecuted. part of the reason i think that is any time you get one of these roads the obvious question is what was the harm? i need to know the actual, specific harm. the cannot tell me what the harm is or the sticks are, i personally do not feel much of a vested interest in taking your word for it. that gets back to the trust issue. >> what was said was that no one would sit and talk to american diplomats.

i am sure to this day there are people who are reluctant to tlak to some -talk to some diplomats. a lot of diplomats send e-mail. -do not send e-mail. it would not be in a big database that someone could download. you ask senior government officials, let's match that with the lasting damage done. the ambassador to libya had -- he probably would have been living fairly quickly. no one knew that the arab spring was about to happen. when you compare the set of warnings we got from the damage done, it was pretty over the top.

i'm not arguing for a minute that that means there's never damage done. france made a compelling case. there may have been something operational. i do not know. i did not work on that story. i am not as familiar with the

details of it. damage can be done. it is incumbent on the u.s. government to be as clear as a kidney. >> that is the public space. how much does the public space impact what you'll do? how much of what you do and i expect the answer-is this awful vs. reactive given how much media time you have to fill at harmony diggs of the internet space you have to fill.

>> boston saw some of the stuff presented to us. it affects what we do. we have all moved into cyberspace and that is great and we brought our credibility to things like twitter. part of me spent a lot of time thinking about what does twitter bring to us?

what happens on twitter affects how we do our jobs in real time. that is something i worry about a lot. the simplest example, police scanners are now, you can listen to any police scanner to the internet. it used to be a thing that reporters did. no one ever reported anything of a police scanner. it is crazy. it is a good fear. then you can figure it through reporting. sandy, people put on twitter over and over that coney island hospital was on for fire. i think as far as that goes, we need to take deep breaths.

because there are human reactions that go in when there is something that happens. i worry that the freneticness of the web spills over into what we do. >> [inaudible] i think you live with that risk. you can possibly say it is better to be fast then to be wrong. it is better to be fast and to be right. i do not know anyone who preaches that as a value in the business. it is hope that there's enough people of good judgment who work hard enough and get it right. again i think that goes back to

the trust relationship and what i view as their russian of that. back in the d.c. sniper case, the top that with the law enforcement agencies for years, this is how you do it. you kill that thing before it hurts anyone. they did not do that this time. that worries me a lot. i do not pretend to know the reasons why they did not do it this time. i find it very stressful. >> anyone else on the panel have an answer? >> there is still some merit in being right. and the bin laden raid was an interesting example. i had put myself on an airplane to brussels to go to nato. while this entire thing was unfolding. twitter was full of this.

the media reporter had tweeted or re-tweeted an account that he had seen the mib bin laden. on the times' website, even though cable tv was running and so forth, i was about an hour before we put up the first story. because helene cooper was going about the old village of thing of trying to find people who would now and get sources on at that there were confident in the story. or we behind as a result? absolutely. with this of look different if it turned out that had not been bin laden. it was what the president had feared. there were times when you have to say you're going to take the hit.

most of what we do is more protection oriented work. the series that donna did. those for projects of the year or more. the work that we did on 8 q qana a.q. khan. that was another year's project before went into print with our first story. what i worry about in the journalistic world is the compete more with all the social media is making sure that there is a space for people to work on something for year.

before they publish something. that is the bigger risk to investigative journalism that we get caught up in the first that media is making sure that there is a space for people to work on we do not spend the time it takes to do deport. >> not only are we not out on twitter, you're trying to make sure that david does not hear what i am working on and vice versa. it takes a long time for these things to build. >> we have time for one more question. in the back. there is a microphone over here. >> i have a question about the bizarre moscow-u.s.-cia case. he is the third secretary and russia. he has been paraded on russian television. i am happy subscriber to york newspapers here but i have not read anything interested in there.

takes to do deport. i read in lots of russian media is that because you do not have any leads? are you preparing something big for the next weekend? you dug into what the tsarnaev brother were about. what was that about? was there a tacit agreement? >> i do not know the answer to that question. i would say we're reporting on it.

and these are not easy tease to pull all the time. they were working on a number of different things. we have not printed them yet. >> it would have been unlikely to the extent these journalists were working their sources, it is not likely they could have gotten very much until vogel was out of russia. you would not have wanted to put him in harm's way. i will say it doesn't surprise me you have not read anyting yet. is not likely they could have

>> the government has been remarkably unremarkable. my sense it was about removing him and getting him home. we will find out more soon. >> this implies that someone is out there handing over things and it does not work that way. to assume-i do not know if i can pull this off. i do not know if i can get more confirmation and i really feel that way. despite the fact that it seems like there's a lot of information out there, it is not easy to get. >> there is this concept that has been generated by the movies.

reporters are sitting at their desks or sitting on the back porch with a martini and someone calls and asks to meet in a parking garage and get a document done. i worked for the near times for 31 years. i have not got that phone call yet. i am still waiting. it usually is an accumulation of all kinds of information. only when you come back here and present to government officials or findings. when you get them in europe or washington or asia or wherever. and put it together that you manage to then be able to leverage out other information here.

sometimes things you try to keep secret the are happy they get out. i will give you one short example. i mentioned the a.q. khan case. the bush administration were unhelpful in describing his activities. they did not want to upset the pakistans. they had some other reason. we went out and did our reporting for a year, we published this long story, the pakistani foreign minister set i have not read the story but it is a pack of lies. they arrested a.q. khan today's

letter. a friend calls and said i was i to think you for publishing the story. we do not think the pakistanis would have locked him up without that. i said thanks for all the help. >> you have heard danna and david talk. "leak" makes it sound easy. it is about relationships. it is recognizing the policy officials. the most important conversations are happening on the margins of a cocktail party or a starbucks on the sidelines.

there -- they are happening there and it may be an innocent conversation that generates an idea for lead but one of these reporters goes and checks with the source and begins to weave the fabric of the finished piece. that you read in one of their is papers. it is all about as the most businesses relationships. with that i think we can continue talking about this issue. i want to thank the members of the panel. i want to thank the advance panel for putting this together. and thank you.[applause] >> john delaney of

maryland on the first bill he has introduced. we will talk with republican .ongressman of virginiana he has introduced a resolution creating a select committee to investigate the attack on benghazi. washington journal is live on c- span every day at 7:00. congress will hold more hearings this week on the investigation into the irs targeting of conservative groups. outgoing acting irs commissioner stephen miller will also be at the hearing.

wednesday, questions before a .ouse oversight committee we will also hear from the treasury department inspector general. that is live at 9:00 on c-span3. secretary of state john kerry talked about last year's attack on the u.s. consulate in benghazi, libya, and about security for u.s. diplomats around the world here and he made his remarks the national foreign affairs training center. . we will also hear from the treasury department inspector general. that is live at 9:00 on c-span3. [applause] there will be no test, but i am

happy to spend a few minutes with you. thank you very much, madame ambassador, for your wonderful start ship of the fsi. it was a great pleasure for me to be able to join you at the graduation of the 100 class. i am glad to be here with undersecretary pat kennedy. it was much on top of this agenda. and our chief of security. thanks for being here. one of the things i have learned is you can train men and women for the assignment she will take on when you leave here.

and fsi does that exceedingly well. we have some senior officers here and people from other agencies here who have been out in the field. the fact is i think you know this. now trading here. none of us who stand up in front of you and talk to can teach the special instinct that brings you here as a dash to a life of public service. the comes from your sense of the self-yourself as americans and your understand that the understanding of it -- your understanding.

your dedication to our country and our determination to make the world better. these are the singular traits of very special people. who are the face to the world in ways that so many of our fellow citizens will never know or understand. little more than 100 days ago i was privileged and honored to become your colleague and joined the state department, joined the state department family which is what it is. when it took the oath of office and began my service. this is the same oath that our investors take and it is the same one that people in the military and other states who are on the front line. wayne solly scored to support and defend the constitution.

with that both i assure you and i think you understand this. we also pledge to defend and support each other. a way to know that every damn privilege to be here in this position i have no greater priority, no greater responsibility than insuring that we do all the weekend within reason and capacity to protect you. a suicide bomber killed the family. i spoke at a memorial service which we dedicated a beautiful fountain. his name means flowing waters. he had guarded the gates of that embassy for 20 years and now everyone, he moved in to challenge an intruder who was walking in door and that is where he gave his life.

he did so bravely, acting quickly to save the lives of others. i met ann smeddinghoff. she would have come to be part of this training this summer. but a week and a half after she helped organize my vist, she was gone. she was killed while delivering books to schoolchildren. i am aware of the risks we take. i think of them every single day. you are deeply aware of these challenges.

i am enormously appreciative. president obama shares a deep and abiding respect for and understanding of what you undergo and the challenges you undertake. we are enormously appreciative of the fearlessness that you somehow muster as to confront these challenges. in the shadows of the attack in afghanistan fanned anger of than last year's terrorist attack in benghazi which killed ambassador chris stevens and three other reckons, will understand it is how difficult-important is to protect our people. that is why i held both classified and unclassified briefings to make sure that we

understood what went wrong. and to do all we could to ensure it would not happen again. this is why i am committed to implementing every single one of the recommendations in the report. mccarren never eliminate every last risk but can never stop working to mitigate those risks as much as possible. right now we're working to upgrade our capacities. we're bringing in more security personnel. where enhancing our training per we are enhancing our training. and our first responsibility is protecting people. linking to make emergency extradition more central.

we are living in embassies and consulates in making sure that the concern about safety and security always gets the attention and needs and deserves. in addition to doing what we're doing to be sent abroad we as a nation need to engage in the larger conversation about the inherent dangers of diplomacy, ever mindful that will undertake them clear eyed and will undertake them for reason. must remember this conversation that we need to engage our country and is not a new one. the dangers of diplomacy are not unique to this moment. serving in our diplomatic missions did not become dangerous that night in benghazi. this is not a new phenomenon. the reason we continue to do this work is embedded in our dna as americans.

it is part of our patriotic pioneering character. the memorial wall in the lobby of the state department which vice-president biden and i stood at a few days ago as we unveil the additional names of the -- that has been added, that wall in the state department bears 244 games. including chris stevens. most gave their lives long before september 11, 2012 or events of timber 11 of 2001. the first black on the wall and foggy bottom is dedicated to a man named william palfrey. he was lost at sea when the constitution that we suffer to defend was still a decade away from even being written.

the lawyer says that we lost in beirut and bosnia and baghdad attacks like that in our embassy in nairobi. in 1998. and on our officers in far capital cities. even in peaceful times. though we cannot count all their names, the waters the families and loved ones. who served and sacrificed in four places. my father was in the foreign service. we were stationed in berlin. troops stood on the line that divided east and west. i saw hitler's bunker protruding up.

the crossings were dangerous and the families were often trying to escape from east to west. it was a dangerous time and it became more dangerous when the wall went up. people tried to get across to find freedom and liberty. this composition is not new. i believe it is more important than ever today. when we think about and grieve about an honor the bravery that we see in your predecessors and your peers, we cannot at the same time wonder why or be surprised that there is danger.

if we are bringing light to the world we have to go to the dark places. we need to maximize our fork -- foreign policy to strengthen america. if you're right to represent the united states and countries to which your about trouble, you just need to be accessible to people on the ground. and everytime you do reach out, every time you touch a citizen in another country, every time he carried the face of america and the values of america and whatever kind of communication have, you are making our country stronger. you are building the future.

we need to remind our fellow americans we're engaged with the rest of the world because that is in our vital interest. we have to be there. when we are there -- not there, the vacuum will be filled by others with different goals. that is the way we make sure we don't have to send our kids to war. we can work together to solve problems that can only be sold across borders, transnational by reaching out and joining the global community. we have to show up in places where no one else wants to go and when we succeed they're building a safer city, forging a stronger trade partnership,

helping a child to grow up understanding what america truly stands for run of the learning from a hateful propaganda package or false ideology, when we do that, in our interests are advanced, our values are upheld, and the risks that we take a worth it. the skeptics might try to suggest to you is not worth it. there will tell us stay inside the embassy or even stay in the cities. that is not what america stands for. we cannot build the future by hiding. we cannot do this work by stay away. we will never overcome threat by shrinking away from them. in countries with weak rule of law and dysfunctional governments we have an interest in helping people to build a stronger democratic institution, to take advantage of

opportunities and treat the futures they choose for themselves. those are the places where we have the most to gain. every day i get reports about the various threats that we're facing. there will be times when i decide that the threat in a certain place is great enough that we need to adjust our courage and take extra precautions at least for a while. and we do every half. that is the reality. those will be the exceptional cases. retreating behind the wire cannot be the way that we do business. and that is free today in a news to share with america.

we will not pull back. we're going to keep practicing what my father called foreign policy outdoors. working directly with men and women around the world from a government official to local leaders to civil society groups and ordinary people on the street. we're going to build the people to people relationships that help to foster trust and understanding between cultures. we'll bring that -- make that in disman even stronger. chris stevens understood that. he enjoyed and he respected the people that he met. whether it was in this country or abroad. when he was 17, he went to spain with the american field service and he then lived in the mountains of morocco as a volunteer english teacher with the peace corps. one young student of him -- of his became a teacher because of english. chris divens taiex the young man in a point in his life. he made lasting friendships there were built on mutual respect. the band's got a glimpse of the

best of the united states, the decency and respect for others regardless of race, religion, or cultural beliefs. chris was fortunate to live around the world as i considered myself to have been and as you are. most people do not have the opportunity to do what you do. spend time abroad beating people of another language and culture, deeply immersed in their lives but today we also have digital bridges to connect different cultures. i do not dismayed facebook and twitter. the educational and cultural affairs bureau runs a virtual exchange program that connects teachers and students in the u.s. with their counterparts in the least and north africa. the students are working

together on line, learning from each other about their cultures and history and therefore urging western relationships. i am excited to tell you that we are right now working closely with chris stevens'family. we believe this network could lead to the largest ever increase in people to people exchanges between united states, the least, and north africa. we believe it will dramatically increase the number of diversity of young people. these are the kind of connections that led libyans to crowd into the streets of benghazi after the attack. spontaneously, tens of thousands carrying signs thinking of the united states.

they went out there not to shut terrible things about derica. they went out to mourn his death and celebrate democracy and to say thank-you to crest at america. after world war ii as i was growing up in berlin and elsewhere, i watched our country invest in other people in the future.

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>> many states are also in the process, it should be noted, of implementing new eligibility systems for medicaid or integrated eligibility systems. states are availing themselves of federal money to do that. they are at various stages of progress in that the mentation. just as we are looking -- that in clement tatian. implementation. just as we are looking at state readiness. states aret -- thinking about the workaround that they might need to implement.

preserving the consumer experience. another important element is that, while we are talking about the individual exchanges, we are really talking about families more than individuals who would be applying for this insurance. the situation can be complex. depending on income threshold and family composition, a father who qualifies, a mother who is newly pregnant may qualify for medicaid, a child who is about to emancipate out of the chip program. these have influence on the protocol between the handoffs. as we thought about it, we talked about for things that states should be thinking about for day one. analyze the bumps in the road. the first is the importance of the sisters and -- assistors and navigator programs. they need to be well trained

and certified and coordinated in the messages they provide, the policy, the procedures they articulate. and well coordinated with the health fixture didn't -- health insurance exchange. there are four different categories. the navigator we know about, in agents andtors, brokers who can continue to be compensated but can't serve as navigators, and certified application counselors. individuals and families will be coming through multiple channels to receive this assistance from existing call centers. some states have existing 800 numbers that consumers call for information. these new service centers, the navigators, as well as local county and public health wrongs, because of the no door provisions of the act. coordinating and communicating is critical there. not every application on day one

happyng to follow -- a path of transactions. [laughter] the happy path is what we envision with this all -- goal. everything being done seamlessly through a website. that is a great old -- goal, and something we strive for. as well as things like mobile applications, mobile platform use. in addition to those transactions, there will be consumers that will be applying for exemption and exclusion in the individual mandate. they will want to ensure the income being used for their eligibility is more current income than might be available .hrough the data services hub having individuals that are well trained in these contact centers to handle those types of transactions is critical. this is something that we can learn from the medicaid world,

creating special escalation units. more knowledgeable and fully trained individuals to handle those more complex cases can be an effective day one strategy. lastly, regardless of whether a , ate is state-based exchange federally facilitated exchange or a state partnership exchange, we can talk about those shortly -- >> there is a handout that shows the map of which states have which. >> it is important to note that there are certain provisions of the act that create requirements for those states. the no wrong door provision is a critical one. ensuring that there is a choreography between the local public health department offices and county-based offices, existing call center operations, federal call-center operations and so so forth is could tickle. states have to make decisions , whether they are a screen and refer state, efficiently get the information from the

federal exchange, or will they have the federal exchange make the determination. regardless of what they choose, they still on the responsibility for that case going forward. finally, the thing i think they are focused on is insurance market readiness. ensuring that qualified health plans are available, procurement process has effectively run its course. and that information can be uploaded to the website and be presented for consumers to make a choice. >> i think you are beginning to get a sense of how difficult this is. i want to put a personal anecdote in here. when i was a teenager, my father worked for the social security administration, and his job was to write the training materials for medicare. he wanted to be very clear about how he was writing those materials. every night he brought them read the he had me

materials and answer the questions. [laughter] the only 15-i was year-old in america who knew how to determine medicare eligibility. [laughter] don't know that i could have figured this one out. dr., maryland is one of the all- star states. says thats accounts maryland is way ahead of everyone else in planning for this, implementing it, etc. could you tell us, when you started, what you have accomplished and if you are talked -- to talk to a state, that just in the last month decided they would start working on this, where would you have them begin and how would you have them -- what triage advice would you give a state that is just getting into this? thank you.

i apologize for coming a few minutes late. it was not a health reform related problem. [laughter] i think that we are very excited for october 1 next year in maryland. ,e are doing everything we can i am not sure i can say if we are an all-star or not. from my perspective, maryland has been -- had some unique advantages. i am lucky because the level of engagement of people in the state. the exchangeted board, there were some important decisions made. the governor and lieutenant governor had a serious of 20 or so public meetings around the state area and they had hundreds of comments from the public. they established a broad consensus that it made sense

for maryland to do state-based exchange. the logic behind that was that maryland could control its own destiny and there were some unique aspects to maryland system that the exchange could be sensitive to if it were state-based. it was interesting to me, i was on a few national panels, i would sit next to people with some degree of understatement, we are not huge fans of the affordable care act, from other states. they would say how they hated it. i would say that we were supportive of it. there is an irony, i may be the only one on the panel who are supportive, but we are going our own way. else's the federal government exchange in the area. pick your words. our own way.n we see the affordable care act in maryland, and the analogy

that i use most commonly is that it is a set of tools that states can use and customize different ways to accomplish improved access and controlled cost. it does not guarantee an outcome, but it provides tools for states to use. that is how we have gone about it. we have had three separate passe to have legislation and be signed by the governor so far. the first was to set up governance. -- identify the topics that stood be studied in this -- should be studied in the state. >> what year was this? >> 2011. taking it one step at a time. that has been our motto. we did not rush out and say, we are going to do it all this way and we have it all figured out. we said, what is the governance? it is nine people on board, three of them state officials,

the health secretary and chair of the board. really terrific people. one of the retail associations in maryland is on there. the a former director of the american public health association. some health economists, a consumer advocate, a great group of people. and we set about studying these key issues. we set up advisory committees. there were stacks of reports and comments and people felt like they were engaged. we condensed it down to 28 recommendations for the legislature. in the 2012 session, the legislature passed a policy framework. we started, i thought there would be 12 issues that would cause all sorts of ugliness in terms of debate. ,e really resolved them all the legislation sailed through. i give a lot of credit to the lieutenant governor brad

everyone together in the legislative process. we have a terrific office of health reform. we gave everyone a chance to submit amendments, like 300 amendments. we responded to each one individually. if you are in maryland, you got an answer if yours was included, and if not, why not. we did that for three years. then we set up a policy structure. we made critical decisions you need to maryland. we decided we would try to integrate our small group exchange with existing third- party administrators who sell most of the insurance. we wanted to allow brokers to sell on the exchange without having to become navigators. there are a bunch of different things that related to what we wanted to do in maryland. then for fixing little things and getting the funding structure in place. i think that it would be unfair to say that we have not had our share of disagreements. but we had agg sh ssively public and engaged process that we have been able -- everyone

has been able to say, let's get this done as well as possible. i have had to say to people on all sides of the issue, what are the challenges that hit me, people project onto the exchange, their fears or their hopes. both can derail you. the exchange is going to fix this long-standing problem we have always had in this service not being adequately reimbursed. i agree that is a long-standing problem, but maybe not by october 1. exchange't have an that is functioning, it will be hard to fix that problem. to the credit of people in maryland on all types of different issues, people have really been willing to understand our mission and help it be successful. and then decide how we are going to use it in different ways. there are a number of different issues. a central immunity provider, how the contracting will go, the broker's commission, we are not

going to try and micromanage that. we will study it and see how it goes. we will encourage certain things. we encourage robust contracting, maybe some mixers for it them to meet with different people. we are not going to try and dictate and get out doing that when we need to be focused on the fundamental job at the beginning. your question about other states, i think the burning structure is important and the ability to engage the public. people talk about what they want out of health reform, thinking about it not as a uniform thing, but a set of tools that can be applied. you want to create a can-do spirit. , the incredibly lucky board has really come together. we have had two years, tons of contested issues in the sense of, when women into it, i did not know what the answer would be. we had to talk it out.

-- when we went into it, i did not know what the answer would be. we had to talk it out. people are really confident and there is a real spirit of, ok, maybe i would rather have this way, but this is a good interim step. we will collect information to think about the next step. when it was not a fun mental issue, i would say, we have to move on. that has been important. the can-do spirit, focus on the governance, public engagement. then, be strategic. deciding what you can and can't do. it is for people who are just getting started that it will be more than a huge task. you can knew that by being can do that by being really transparent about why. the has got to be part of

approach. >> that is great. sheila, i wanted to ask you something and loaded more about design then it is implementation. it relates. the mandate to purchase health insurance is at the heart of the plan. it is also the least popular item in the law. how do you think this is going to work? will he get people who don't have insurance now to buy insurance? is there a chance that the combination of the mandate and the requirements of the law for will cause plans premiums to rise for those who qualify for subsidies and for those who don't? how is this all going to work together? have to thankl, i you for inviting me. when i first heard you addressing josh, i thought you called him the all stark.

for "transformer" fans. [laughter] >> i guess i could be. you have asked a series of questions for which we don't know the answer. you are right that the mandate is one of the most controversial aspects of the legislation. the supreme court decision and dates that route -- occurred around the mandate height and the awareness. what its effect will, how money people will actually be affected is one of the questions that we don't know the answer to. that henry issues raised are issues that play out here in terms of the tension that exists in rolling the program forward and the tension .etween the feds and the states the absence of a bipartisan agreement and the red blue

dynamic we will have to confront, which will be critical in terms of what people know about the program and enrollment and how that lays out. -- plays out. if you think about the size and nature of the question, there are approximately 300 million people who we anticipate having coverage in this country in the near term. a large percentage of those individuals are already covered. employment-based coverage, medicare coverage, medicaid coverage, they are in one of the many systems of insurance that exist in the country. there are a large number of .eople who will be exempt the basis for their exception could be on income, number of a tribal organization, on a host of qualifications that essentially exempt them from this mandate. the latest estimates by the kaiser family foundation suggest that there are about 30 million people that we believe

will be subject to the mandate. who neither have incomes that thatoo low or premiums exceed the capacity to finance them. you are looking at a universe of about 30 million. one the critical questions in terms of the mandate is the importance to the success of the program going forward. the risk of the exchanges and the other programs that are formed not having an adequate number of people that are both .ealthy and unhealthy one of the desires in creation of the mandate was to get people into the system so you could spread the risk and avoid some of the issues that have existed historically with individual and small group coverage which has been very costly because it tended to draw people who were most at risk. one of the questions on the risk going forward on the exchanges is whether only those people who are most at risk and need coverage decide to require

themselves to purchase that coverage. one of the great conundrums is, how do you get young healthy people? that is the target, truetype to get the rawest possible -- to broadest possible population. i think about my son. some of the questions that henry raises, what the coverage will be, with the cost will be, those are questions we don't know the answer to. we know that there are health benefits that must be covered. we are only now beginning to see what participation there would be on the part of insurers. the exchanges there at the state level making that decision. we don't yet know what the cost will be. some of those conversations are beginning to occur. i am sure josh has seen some of those in maryland. in states

like oregon and washington, we're hearing that the premium premium cost will not be as great as expected. in other states, there is a the that the size of benefit that is now required as a result of the aca will be more costly than people have experienced in the past, even with the protections that are provided with respect to rates. you have a requirement of guarantee issue. ,o pre-existing conditions things of that nature that some believe will increase the price of this product. the question whether people will participate will be based on their knowledge. there are very few people who really understand what it is that is required under the law and what the expectations will be for them and polling that suggests there is a large percentage of people who do not know what is in the aca. this may come as a surprise to some.

you will have people who will make the judgment that the cost of the penalty, which many to believe -- believed to be too low, is not sufficient to encourage people to get coverage that may be quite costly for them. particularly those who may not qualify for the subsidies. you have knowledge, cost, a product that you are not yet certain of in terms of what insurers will participate in each of the states. be discovered. there are a great many of those things that we do not yet know. you have questions again in the loo-red environment as to which states will actively seek out and try to make people aware of what is available. we have heard a lot of discussion over the last few days over the efforts to publicize the benefits of the requirementsthe might be. those will play out differently

in every state. there will be some states, like maryland and others, who will make an aggressive attempt to make people available. websites, the navigators, a variety of sources of information will be important. those will vary enormously by states. some states that are quite well equipped to do that and what putems in place -- systems in place and those that are slow to take up the mantle. we really don't yet know. i think it will play out over the next few months as the efforts take place over the summer. it will also depend on the state and the information that they make available. ultimately, it will also depend on what the product looks like, what the price looks like and whether or not people feel compelled to do so or it becomes a source of coverage largely for people who are at risk and very costly. >> great.

panel, andsk the anyone can answer, a question that is actually prompted by news reports lately. which is, the irs scandal has been bleeding into healthcare as well. over the issue of the federal hub. the federal public -- federal hub is the place where data from five different agencies comes together in order to tell states whether or not someone in that state applying should get the federal subsidy. it is a complex information technology question, but the issues now that are arising have to do with privacy. , thisose who don't know is a place where irs data, your income, has to come together. data from the department of homeland security on your immigration status comes together. the department of justice on your criminal history.

incarcerated people, for, cannot get a subsidy. forand social security enrollment in other entitlement programs. fifth is data from the state government on your residency. these are five streams of data coming into place into a federal hub, and that needs to be able to interface with the state exchanges to determine whether or not you are eligible for the subsidy. this is a fairly complex issue. all of a sudden, we're now hearing, particularly particularly over the weekend, we are hearing, this is a terrible danger to americans privacy because of the amount of information there. , we could start with you. anyone else wants to weigh in on how valid valid you think that critique is. and where do you think the federal hub is in

implementation? ask the perspective i would asr, slightly broader, this debate illustrates, there are a lot of unanswered questions. the policies around how this information will be handled are only now being formulated. they have downstream impact on the designs of the systems in the business processes and workflow. for example, will a consumer be their full federal tax information as part of the information that comes back from the data services hub? our understanding is no, that is not the case. for states that may have designed a business process that began with presenting the consumer with the most current information available from that source, allowing that information to drive their choice as to how they apply for eligibility there is some reworking that needs to occur. a plan b or plan c to redesign a business process.

, while i applaud the shortening of the application down to three pages, with a fourth page which is an impending spec it's filled out if you have someone completing if someone isdix filling it out on your behalf. i came at the 11th hour. ,t is those operational impacts the lack of clarity that these rules present that keeps the community up at night. >> will this be a real potential for violation of american privacy? will this hub be subject to all sorts of funny business? can we build securely enough? >> the answer has to be a straightforward yes, we can. in itsernment has possession, large volumes of

data about the visuals. the problem that has come up with the irs is not one of violation of individual secrecy or privacy, that is not the issue here. it is the alleged misjudgments by a number of middle level irs officials in administering a law. the idea that because the irs may have -- probably has, improperly handled one particular piece of legislation does not mean that it stands as potential malefactor in the administration of healthcare policy. the irs cuts all of our checks for social security. it does not set policy. it is an administrative agency that is involved in the implementation of a particular piece of legislation. as always, attention has to be paid to safeguards, avoiding

serious mistakes, but this is no different in my view than a lot of other situations. i think sheila really put her finger on the critical question. you have an all out effort in maryland, a unified government working on behalf of the legislation. in the state of massachusetts, you have bipartisan cooperation in implementing something very like the federal legislation. as i mentioned, i am on the district exchange and i can assure you that this effort is receding in that same spirit. i am sure this all happen in a number of other states. michigan,mention florida, texas, it is maybe not so much. [laughter] what i think is going to end up happening him a not so much

october 1, but january 1, march 1, as the legislation begins to success will have stories in some parts of the nation, and a royal screwup in other parts of the nation. the question will be whether our political system is able to focus on the fact that this program can and will work in --e places and use that those success stories as a template for where this process can involve. that is the hopeful story. on the other hand, the disinformation system that has taken over certain elements of communication in the united states, are able to emphasize the problems that will emerge, the messes that will occur, and turn this into a debacle. i will end on one note of partisan agreement, i think

mitch mcconnell is absolutely right, i don't say that very often. but he was absolutely right that i think healthcare will be the major issue in a 2014 campaign. --did you want to >> i often do agree with henry and i agree with him here, as well. i think we will see a variation across the country in terms of the ease with which this is implemented. going back to his earlier at the about medicare time of passage, and subsequently the medicare part d benefit. one of the things that occurred was, you were dealing with a known population. these were people in the medicare program, or qualified on the basis of quarters works. you had a relatively straightforward definition of who is eligible. one of the great complexities here, for purposes of the exchange and your description of a source of information into the

exchange shows the complexity, of, we don't know who these people are. we know in a general sense who is uninsured. we know in a general sense who is exempt. a member of the tribal nation. fundamentally, we really don't know who these people are, how they will come to us, and what the force of that information will be. we are also dealing with the enormous complexity of language. one of the points that was raised about the simple side form certainly helped. if you are dealing in the state 27california, you have languages you are dealing with. that is true largely now across the country as well. individual of the to access the information, to confirm the information, whether they have pay stubs, all of the challenges that one faces in trying to reach out to a population it may not have had access to or information from the government, will again make

the success very enormously across the country. in make it quite difficult terms of how the information flows and how you bring people into the system. it is a monumentally complicated assess. >> josh, how do you think you will deal with this question of who is eligible? >> to make one point. we take security very seriously. all the states have security plans, there is a lot of be -- attention being paid to that. in maryland, there is also the private information. we take that very seriously. i was at a meeting with some foundations that want to help us with our outreach recently, and one of the foundation representatives said to me that she was extremely worried, up all night, worried that people would not spend the money because of some of the issues around the mandate, if it is too expensive and nobody would

sign up. the next person said that he was up all night, extremely worried that all these people would get coverage and we would not have enough primary care doctors to take care of them. [laughter] i said, the good news for me is, you both can't be right area. [laughter] i do think either of them appreciated. it was not a winning answer, but i thought it was pretty good. [laughter] there are a lot of things, if you think about this, it is obviously a complex undertaking. there are a lot of different directions that it could wind up going. to rollto be prepared with the punches a little bit. there are risks in a lot of different directions. there is a lot of potential benefit. we are trying to keep our eye on that. even where there are risks, we are tying to make decisions to mitigate them where we can. i will give you an example. we made a decision, we changed

our essential health benefit plan after we got additional guidance from the federal government. we realized we had some flex ability and wound up aching a small group wheplan. we thought that would be the most stable for transition and had extra ability to do that because of some rules that came up along the way. get it right the first time, we explained to people why something they were looking for would not be in there anymore. we were able to get past that. in terms of the high-risk pool in the state, we made some decisions to keep the state functioning for a while longer, easing the risk for going into the exchange. in part because we want to be somewhat strategic about what happens on the individual market to the extent that we can be. we are trying to make those decisions, but really we will have to see what happens.

we will be keeping a very close eye on the enrollment. as we aretem works hoping, we are really doing integrated enrollment. we will be answer to -- able to answer some questions pretty well. we can use that to make adjustments as we go. >> that brings me to a question and wanted to ask the panel, which is, already hhs has had to delay implementation on a couple of levels. and limitation of the shop exchange is for small businesses has been delayed by a year. the pre-existing insurance fans stopped taking applicants in february because they ran out of money. they have been criticized over the last two years for giving out waivers to states and companies for certain provisions of the bill. what is next? is it possible that hhs would pullback on other requirements? the one that comes to mind, you just mentioned, the healthcare

plans be certified. -- as qualified healthcare plans. is it possible they pulled back ifthat for a year or two not enough states are signing up to be part of the exchange? or are there other things out there that could be a pullback in order to get this rolling, without too much confusion? of that hasost probably happened. i don't think they will be major changes. >> we have already -- >> i think so. my understanding is they are not launching the employee choice shop for a year. i think we made some strategic decisions like that in maryland. some things, i have learned the house, nice to have, you hear that a lot. nicee say, that is just a

to have. the other phrase that comes up a lot is contingency. contingencies of this. i never used that word in this way before we got into this discussion. have we mapped out all the contingencies? or dependency is another word. majord not anticipate changes from here. i could be surprised, we will see. >> do you agree, bruce and sheila? i would agree completely, i would not expect major changes. if anything, i think what we are seeing is a great deal of that maddux thought as to what -- pragmatic thought as to what implementation will be and how, through administration relief and within the confines of the capabilities as an agency they can offer some relief to states. an example being as recently as friday, when a letter was sent

to state health officials, outlining five techniques that they are encouraging states to take, targeted enrollment strategies to help facilitate medicaid enrollment and will in 2014. one of those techniques is to allow states to intimate the use of modified adjusted gross income sooner, in october, when those systems are ready and avoid that bridge. -- bridge period. introduces complexity. some of the other techniques are interesting. for example, using income evidence from snap eligibility determination as eligibility for medicaid. mailing them cards that they then activate when the call the call center. if anything, we are giving thought to the process. where the emphasis needs to go on the consumer experience and

trying to facilitate as broadly as possible. not disagree, but i don't expect any major changes. in some issues, the question has been asked and the department has essentially said, we do not have the authority on certain delays. some interesting conversations may occur around medicaid. a number of states are a good example but wanted to approach their expansion in a different way. the question of whether you can phase in, the answer was now, but the question is, are there other approaches? i think there are interesting conversations occurring around what you described as a bridge plan. ealing with people who go in and out of the medicaid program. at one point, you are eligible, and at one point you are not. at one point you are eligible for a subsidy, at one point you aren't. essentially, how to manage those individuals and families that

are in those kinds of transition periods. there is a lot of conversation going on. at the end of the day, and a lot of this is going to be a function of what we find out. how many insurers choose to participate, what are the rates -- each of the state has gone through a similar kind of process. i worked with the state of tennessee as they looked at this question and held hearings around the state on what people's interests were in terms of coverage. as josh pointed out, there is a great desire to have as a required element, certain benefits which in other cases people would not view as essential. we have yet to learn from some of those conversations. that may modify decisions going forward. >> i think there is a simple answer that summarizes what people have been saying. all of the key deadlines are

going to be met. the exchanges will open on october 1. enrollment will start then. the plans will begin, people will begin to go in on january 1. the other key element of the proposal will be met. the administration has shown very great flexibility in being willing to give ground on particular aspects of the bill that were potentially problematic. i think the reason is simple. the first goal is to get this thing up and running. if it works, i very much hope and expect it will, and it will be with us for a very long time and eventually, it may even become possible for constructive legislation to pass congress to fix things that are not exactly right now. the thing is to stay alive, get it up and running, and then try to deal with the problems that emerge in the way that sheila described.

>> one additional comment i would make, we still have legislatures who are meeting, a number of decisions yet to be made by states. i think that is the unknown. insurance commissioner says well. -- as well. there are decisions taking place at the state level, in terms of what what their decisions will be in participation or not, governance structure, that really will get -- inform us as to how this will go forward. >> i want to take some questions from the audience. i would like a quick answer from everybody. , pick up tontinuum out right repeal. where do you fall? >> i fall somewhere between hiccups and seizures.

[laughter] >> josh, don't answer for maryland, and for the country at large. for the country at large. >>@think there will be a lot of variability. i think it will look very different in different parts of the country. that will be an important story. >> i would agree. i think there will be variability. auditable hiccups. certainly enough to raise eyebrows at a dinner party. >> extended indigestion. [laughter] >> ok. we have somebody with a microphone. please, because we are on c- span, we cannot talk endlessly have a mic phone in front of us. don't start talking until there is a microphone. >> i am dr. caroline.

i am a primary care physician. my late husband was head of the pbgc in the clinton administration. my question is about risk adjustment, something nobody has mentioned. stein, briefly. schem the way the small group has worked is by risk collection. some people were excluded. unless this is controlled, it is possible that the company with the best plan will end up with all the sick people. that could terminate the plan very quickly. i wonder if any preparations were being made to do the risk adjustment, it is very easy when you have different lands, to select -- plans, to select

something as simple as a free gym membership. >> anybody like to take that? >> there are set -- several mechanisms to mitigate risk. a couple of them that the federal government is overseeing. one where states have some options and we will be running a part of the program. also some flex ability in state invest state money to do a better job of risk mitigation. i think it will be an important issue. outher or not there is right gaming of the system, selection is obviously a huge part of cost. the fact that insurers have to pay each other under some of the rules that are getting set up lower that. hopefully to a point where it lowers it below the point where insurers can actually compete by doing a good job in helping to

manage cost and joining with the delivery system and accomplishing better outcomes. to me, it is like, you want to lower the reward to risk selection below where you actually get a reward for doing the right thing. hopefully, there will be plans, i think we have some very good plans in maryland that are thinking about the delivery a relativelyeping stable starting place for the plans of its better off in the future than where we are now for that kind of gaming to happen. nothing will happen, but i think there are a lot of things that will make it less of an incentive to do that in the future. >> i would just add, in a way, we need to go back to the future here in a little way. the initial implication of medicaid managed care. going back to the act of 1997,

some of the processes that followed from that, that act created the role of an independent enrollment broker in the process of health plan selection. for good reason. given whatded, went on in the early days. as a consequence, when you really look at how exchange operations are set up, we think it is critical that the information presented to consumers do -- be done in a fair and unbiased manner. the study published in january this year pointed out that participants in the commonwealth choice program in massachusetts besely parallels what would expected in the exchange. 40% of those individuals found the information on plans being presented difficult to understand. when you look across industries, another study published in 2011, if you go from left to right the travel industry to the banking industry, and ultimately to the commercial insurance industry,

the percentage of individuals that need some form of assistance in making a plan selection in the commercial assurant -- insurance industry is much greater. about thel to think travelocity or expedia experience, the reality is that consumers will need help. individuals who have never applied for insurance before. the available of a -- availability of unbiased information presented in a format not overly compensated, because decisions can be viewed with the presence of too much information is critical to ensuring a positive consumer experience. over here, the gentleman over here. then we have two more. .> thanks, charlie clark how successful have the efforts

by republicans in congress to defund it been in terms of impact on the implementation? >> good question. in the press, there is certainly a lot of talk about the effect hub was not funded. secretary sibelius has been to do that -- had to do that out of discretionary funds. what is doing no but that? -- what else do we know about that? >> there is any concern about the move of money out of the prevention fund to find the resources necessary. the estimate for what was required by treasury by hhs and other agencies was substantial. there is no question that it has had an impact on their ability, and going forward, the ability of treasury to participate in the required information sharing. it could well have an impact.

>> not as much in maryland, because of the way the law is written. >> i think we will see this in the federal ones. the don't think we know exact numbers. we know there was money in the original legislation. i think we know it was insufficient to take care of all withe costs associated implementation. more money is needed, and it seems a peculiar strategy of governance to try and make legislation faile by appropriating so little money that it cannot be properly administered. that is a luddite approach to politics. it is deplorable. >> it is one of the things that that was most instructive about your opening comments. that medicare was done with administrators in the room. this was done in a dramatically different way. thet also highlights

remarkable challenge here because of the state federal partnership that is expected. mckissack medicare, you are dependent upon a federal infrastructure. in this case, you are dependent upon both. the navigators could be self funding. 2015, they should be fully funded by their own operations. the expectation was that it would not be federal fund over the long-term. federaltion about the state response ability and how that plays out by state is going to have a tremendous impact. >> state exchanges should be self funding as well. so they are not a burden in the long run to the federal government at all. it is the federal agencies at risk here. >> you also have this problem of the state insurance commissioners that all have different levels of power. in some states, the state commissioner can turn down

requests for premium increases. in other states, they do not have as much -- they can't do that. that is why we hear a wide variety of speculation on, what is this going to do to premiums? in some states, they might go as high as 25%-30%. not much of an, increase. >> i think the main story is not the level, but the diversity of impact across different classes of insurance purchasers. there will be some people who will see big reductions. some people will see big increases. the average effect i do not think captures the amount of disturbance that will occur. >> one thing to mention, we have seen increases in the number of insurers participating in maryland through implementation. different companies coming in, springing up and getting

interested in medicaid. it has created an interesting dynamic. even to the point when, in the lead up to when the proposed rates, there is a review going on, there is a lot of discussion of what one group is doing versus another group. i think part of the theory here is that, having a level playing field for the company with competition around price, we can see that happening. not just maryland, but other places where he heard that people are already revising their rates when they sue it other people are up. >> you are also going to see lands that will wait and see plans that we- can see what happens. we don't know how many insurers will participate. that will be a question of what they are looking at in terms of the market. >> this is why it is possible for there to be such divergent predictions about this. the gentleman in the blue, you had a question.

i have a quick question but you kind of touched on, the topic of young invincible. >> you look like one. >> thank you. and until they get sick then jump on a plan. how well do you believe they can be convinced to enroll in a plan, since there are predictions that their premiums will increase due to the age rating of the aca? >> i don't think we have a clue. arguably, there was an accommodation made in the legislation that allows for those under the age of 30 to purchase a catastrophic plan, that would be potentially less costly. again, i think it is the calculation that any individual makes as to the cost, the penalty, and the risk and the cost of the coverage. the age will increase costs t

younger people because there is a compression. again, i think it will be state- by-state in terms of what is available on the exchange for individuals and small group. and whether or not the young invincible finds that is a better use of their money or they would rather wait and see if they got sick. >> massachusetts didn't do a bad job of that. there is a track record of being able to get people to sign up. marketing materials were directly aimed -- >> they've got the red sox. they did a good job in this mention. to getting small employers to come into the exchange, they did not do a good job erie it could you say something about what you expect to happen in maryland? >> we thought a lot about that. we made an important decision early on and got some invites

and people who had worked what they would've done differently. we realize that small employers have routes to getting insurance now. the usually go through the broker community and have third- party administrators. i don't comee, from this world, but it dawned on me when i met with a physicians group about health reform and he said, before i talked about what the -- what it heard from my broker was, can you address that problem? helpful. something like 90% of people, because they are buying health insurance, doing payroll, doing retirements, all of these different things. they are not interested in breaking out, most of them not interested in breaking up of insurance, going to a separate website, managing that separately. what we decided to do was to do

third-partyer administrators in maryland the opportunity to plug into our exchange and have their system work. people could continue to get coverage if it makes sense to them to go into the exchange, they could do it through the normal channel. there is a lot on our website that walks through all the thinking we did around that, the different models they're making available to them. there has been a lot of work on the small group technical component for us to a consulship. it.o accomplish maryland we already have a guaranteed issue. one value.dits are the other potential value is the employee choice. a small employer may find it to be valuable to offer, if you come here, you will get your choice of different insurers rather ginger swan -- rather than just one.

if the individual market in october, we want people who are covered now to stay covered in it is a big challenge up front area and maybe it is a sprint on that side, and more of a marathon to the small group architecture if you businesses and the valueng, gets more obvious. that is fine. >> another -- right there. >> i am fred altman. there is a lot of talk about the variability. i was wondering how it breaks down. are there enough on the side that is likely to work very well, that there will be less congressional resistance and be able to continue it, as opposed to everything failing and being easy to kill? >> i would add to that a question i was going to ask

henry. he recently said, apropos of your question, the 2012 election kept the aca alive. the 2016 election will determine whether it survives. of senator mcconnell's statement, which i quoted earlier, may have been two years late. what i had in mind, as long as president obama is in office, this will remain the law of the land. the question you raise is one to -- we really give don't know. we are looking to enormous variability around the country. we can count on the fact that various reporters and loggers -- grasp the mistakes and hold them close to their hearts

>> what i hope, and i really that like myself, and i suspect all of us up here, think that the affordable care act is a step forward on balance that should be built on an improved. we will work just as hard to talk about the success stories that are going to unfold in the advances that are made him of the subsidies that are claimed, the people who are insured, the continuation of a slowdown of i hope in the rate of growth of health care costs, a reduction in insurance overhead from the kind of competition that josh described. if we do our job well enough, it will be an extended and very rough voyage, but it is one that can get us where we want to go. >> there was another question over here. somebody else raised their hand.