>> derek wallbank, daniel newhauser thank you both for being on "newsmakers." [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013] kathleen sebelius testifying on the help there -- healthcare.gov website. including a review of the the house of representatives has finished all this is for the year. they will hold a for -- pro forma session on monday. you can watch live coverage on c-span >2.> the subcommittee -- on c-span -- you can watch live coverage on c-span2. is a very bad day for

them to come to the national holiday. furiousas absolutely that members had taken over bosnia. it was seen as a provocation plottersof the great was one of the signals of the depression. it was very sloppy police work. one of the conspirators shot them point blank. >> the assassination of archduke ferdinand and his wife and the events leading up to world war i. the war that ended piece tonight at 8:00 on c-span. kathleen sebelius told members of congress today that she has ordered an investigation into the rollout of the

healthcare.gov website. this hearing is two hours and 20 mean it's -- in 20 minutes. including a review of the -- and 20 minutes.

the chair will recognize himself for an opening statement. throughout this year, various administration officials including you, madam secretary, have sat in this room and repeatedly told the american people that the implementation of the affordable care act was on schedule. as we have seen from the disastrous rollout of healthcare.gov and documents showing that the october 1 deadline could not be met, that was false. every major promise the administration made about the aca from being able to keep your health land if you like it to being able to keep your doctor if you want to, the very premise of health reform in the first place, that the affordable care

act would make health coverage more affordable has proven to be wrong. my constituents have repeatedly expressed to me that they feel they were lied to by the administration about the real effects of this law. l effects of this law. in addition we are also learning that millions may be improperly enrolled in medicaid. as result of the disastrous rollout resulted in washington yet again squandering the hard earned dollars sent to the federal government by our constituents. words start to lose their meaning when they're delivered by individuals who have either misled this committee or were woefully ignorant of the disastrous consequences that have unfolded since enactment of the aca. the last time you were here, madam secretary, you said quote, i know that it isn't fair to ask of the american people to take our word for it.

well, millions of americans are being harmed by this law. my constituents do not trust the administration when it comes to the affordable care act, and it is they who are suffering because of these broken promises. i will yield to the chairman of the full committee, mr. upton. >> thank you, mr. chairman. this committee has conducted extensive oversight of the president's health care law. many of the administration's top health officials have testified over the last year, including secretary, they repeatedly looked us in the eye, spring, summer and fall and assured us that, in fact, everything was on track. but our oversight has produced documents showing the frantic chaos, ms. deadlines and delays behind the scenes. sadly come it seems the administration's assurances about being ready to launch were just as ink as the president promises that this law would mean lower costs while allowing

americans to keep the coverage and doctors that they have in life. and millions of americans are now in during the harsh reality of canceled plans, the burden of finding a new doctor, and the financial strength of higher premiums set to shock family budgets. far too many americans who were happy and satisfied with their health care coverage on january 1 of this year have had the world's turned upside down as we approach january 1 of 2014. this is a matter of trust. it is time for the administration to be honest with folks like mary swanson in kalamazoo, michigan, my constituents who, along with her husband, had an actual plan. no more false promises, no more political gain, no more questionable testimony. it is time for transparency and the truth. a yield accountable time to dr. murphy. >> thank you, chairman upton. thanks for being here today, secretary sebelius.

as the chairman of the subcommittee, i work with my filamentous to conduct oversight of the president's health care law. we've had people before our committee who talked about its implementation. some of the concerns raised in the first part of this year increased premiums, the burden of this law on small businesses, whether the implementation was on track and the costs have come to fruition. documents uncovered by the subcommission of the administration months before the october 1 start up of open enrollment had problems with a federally facilitated market place. yet every administration official can be forced testified before the committee this year that implementation was on track. we are two weeks from the genuine start of coverage in what you. >> and public expect? unfortunately, the record of transparency has not improved. the administration has continued delays, and mostly select the one you delay of the online enrollment to the shop program. failed to punch pro -- problems with writing on wall.

millions have received a pink slip from their insurance plan and others are facing unaffordable care with the new higher rates. last month a top seed this official said 30-40% of the website to get to be built. i hope you can help us provide get some answers for today and commit to help speed up the response to document requests, two boxes of documents into months is not a good response. thank you. >> now recognize the ranking member of the subcommittee, mr. pallone, for five minutes. >> thank you, mr. chairman. let me just say i'm sorry that you can find a way to accommodate members to attend the nelson mandela memorial and not miss today's important but many of the democrats are at that memorial service today, and i know that mr. waxman made a reasonable request that was denied come and i wish this hadn't been the case. but in any case we are moving forward. i listened to what my republican colleagues just said about the affordable care act.

and i don't know whether reality is on their part. sometimes i think that they're living on mars rather than earth. i heard consequences, things like disastrous consequences, harm, suffering, harsh reality, world turned upside down. i mean, they should event at my forum. i had a forum monday night in highland park which was one of my towns on the aca. i heard just the opposite. people were happy because they were able to enroll. some were medicaid recipients who were not eligible for medicaid before. me of them, you know, were remarking about the ability to get insurance for the first time. so you know, it just boggles my mind to hear these republican comments about a world turned upside down when the reality is the affordable care act is working. people are getting interested didn't have it. people are getting affordable insurance with good benefits.

i mean, that's the reality that i hear when i'm home, and i'm not making it up. i'll take any of them to my forum if they want to. regardless, let me welcome you, madam secretary, for joining us can. i understand you've been in front of our to me more than any other and we're grateful for your service and your valuable time. i'm eager to hear what i know it's positive about the enrollment of coverage under the aca and the law's implementati implementation. republicans seem to be saying that things have not improved. they have improved a lot and certainly the website has improved a lot. it's unfortunate the republicans continue to focus their time and efforts trying to obstruct and sabotage the aca rather than working on a constructive way too big sure that as many americans as possible are able to benefit from it. i'm proud of this law, and i wanted to mention a story. one of my constituents wrote a letter to the editor of a local newspaper describing his experience with health insurance pre- and post-implementation of health exchange. i asked cutler be said for the

record, mr. chairman. >> without ejections ordered. >> this gentleman found a plan that was less than his previous plan. better coverage, better deductible, better out of pocket maximum, better prescription drug. his expense demonstrates that this is a quality product that people want to sign up for. i lived that because unyielding now to mr. waxman. >> -- i will leave it at that. >> thank you for yielding to me. i want you to go your statement about the regrets that we have that the majority wouldn't postpone this hearing so that all members could attend the memorial for nelson mandela. obviously, more democrats feel the reason they wanted to be there was more important than to be here and they shouldn't have had to make that choice. madam secretary, want to welcome you back to our committee. healthcare.gov is much improved since he last appeared before the committee.

millions more have applied for coverage and signed up. in fact, we just learned today that enrollment in november quadrupled over the october enrollment. all told as of november 30, 365,000 people have enrolled in private coverage, 1.9 million were through the process, just waiting to pick a plan, and enrollment has been speeding up each and every week. as a result we are beginning to the stories of people finally getting the security and peace of mind that comes with quality health insurance. some of these stories are very powerful. barbara from a district recently found out that her policy was going to be canceled, and she had been rejected in the past for more affordable policies because of her back problem. in her new policy she went -- she obtained on the exchange, her deductibles were cut in

half, she will save hundreds more on free preventive care and are premiums will never shoot out if she has a serious health event. these excess stories are happening in every state and district in the country. you wouldn't know it from the republican members comments. joanne from florida had been uninsured and hadn't seen a doctor in years. she has repaid we try to enroll without success, it in this which he purchased a plan for only a few dollars a month. win that finally occurred she burst into tears. our exchange director in california and said that this is a common experience. i know this law is controversial, mr. chairman. that's because hundreds of millions of dollars opponents have spent trying to demonize the law, i think republicans are afraid that this law is going to be popular when it's fully in effect. republicans are tired of the partisanship of divided congress.

i want to make one request and this will be the last statement i want to make now. i hope that the secretary gives more respectful treatment from all members at than she received after last visit, and at a minimum shot to be allowed to answer questions. this last time she was interrupted over and over again. there are more republicans here today than democrats. we are all going to get a chance to ask questions. a lot of democrats won't because they chose to be at the memorial service, but who ever ask a question, the secretary should be able to answer her questions and not be rudely interrupted. and not have -- she had to endure last time. >> the gentleman's time has expired. without ejections all members opening statements will be made a part of the record. on our panel today we have the audible kathleen sebelius, secretary of the department of health and human services. thank you again, madam

secretary, for coming. i urge all members to use proper decorum to permit her to respond to the questions. but we only have so many minutes. i understand members will be trying to get as many questions in as they possibly can. and we will try to operate the gavel strictly and fairly, but madam secretary, thank you for coming. you have five minutes to some russia testimony. your written testament will be placed in the record so at this time the chair recognizes the honorable secretary, five minutes. >> well, thank you, chairman upton and ranking member waxman, mr. pitts, mr. pallone, members of the committee. since i was last year on october 30, our team has and working around the clock to improve healthcare.gov. we committed to making the site work smoothly for the vast majority of users by the end of november, and after several

hundred software fixes and hardware upgrades, we have achieved this first benchmark. while there's still more work to do, we've made great progress. healthcare.gov is working faster, respond more quickly and we're able to handle larger volumes of concurrent users. pages that once took eight seconds to load are not responding in under one second. the sites air raid which wants top 6% has been driven down to below 1%. the system has more redundancy and stability and we can now handle 50,000 simultaneous users and more than 800,000 daily visitors. as more americans get healthcare.gov a second look, they're finding the experience is night and day compared to where we were out in october. they are respond by shopping plans and enrolling in greater numbers, as mr. waxman has said more than four times as many enrolled in the federal market place in november as enrolled in october. in the first two months, nearly

1.2 million americans either selected a marketplace plan or received a medicaid or chip elderly determination. with no thread safety 5000 people selecting a plan and 803,000 receiving a determination. an additional 1.9 million people have made it through the application and determination but have not yet selected a plan. we expect that as more folks talk things over with the families of learn about their new options, more will enroll. to those who have been frustrated with the experience so far, we are asking you to come back to it's not easy than ever to shop for plans and enroll online, over the phone, in paper, on -- more than 5 million americans have dialed into our call center in the first two months, 450,000 have received assistance from more than 19,000 trained assisters. and in the first week of december alone, healthcare.gov

received nearly 5 million visits. open enrollment for health insurance continues for 3.5 more months. so there's still time. to put this in perspective, most private insurance plans offer open enrollment for only a few weeks. we continue to be relentless in our efforts to improve healthcare.gov, and we're committed to learning and adapting, improving and acting on the feedback we received from consumers and issuers alike. as i told this committee at the end of october, the initial launch of healthcare.gov was flawed, frustrating, and unacceptable. i believe strongly in accountability and our obligations as public servants to be good stewards of taxpayer dollars. now that the website is working more smoothly, i've determined it's the right time to begin a process a better understanding the structural and managerial policies that led to the flawed launch. so they can take action and avoided these problems in the

future. today i'm announcing some initial steps i've taken. i passed out inspector general to investigate the development of healthcare.gov, including contractor acquisition, the overall management of the project, and performance and payment of our contractors. i best cms administrator marilyn tavenner to create a new position of chief risk officer at the centers for medicare and medicaid services, and to expedite the search and hiring. this will be a full-time employee charged with assessing risk management practices and developing strategies to minimize those risks. let me be specific. i will instruct this officer to look at i.t. and contracting management practices starting with healthcare.gov, and the risk factors that impede a successful launch. outdoes for an initial report in the first 60 days with recommendations on how we can mitigate risk as we move forward. i've instructed cms to update and expand their employee training.

they are required to adopt best practice for contractor and procurement management rules and procedures, including internal communications and processes. these actions build on reforms we've already made which have led to significant improvements in the website, includes the addition of the management expert and consultant, administered have any, selecting systems integrator and changing the day-to-day cms management of healthcare.gov. fixing a flawed website has proven challenging, but it's nothing compared to the challenges that american families face every day. particularly those families who don't yet have health coverage. families who are one medical bill away from bankruptcy, one diagnoses away from not being able to afford their mortgage or the rent. and these efforts are about them. before the affordable care act, as many as 14,000 of our neighbors were losing their coverage each and every day. the market operated

inefficiently. we as a nation paid more and got lower health results. today, health care cost growth has been driven down to the lowest levels in 50 years. and millions of americans are already benefiting from new rights and consumer protection. with a new marketplace, choice and competition among private market plans is now available to millions of americans. but our work is not done until every eligible america has the opportunity to access affordable coverage -- coverage. thank you, mr. chairman. >> the chair thanks the gentleman you. out begin questioning, recognize myself five minutes for that purpose. madam secretary, based on current trends is likely that more individuals have lost coverage on january 1 been one of gained it under the law. hhs released data this morning stating that approximate 364,000 americans have selected a plan or a state or federal exchange.

is that correct? >> yes, sir. >> of these 364,000 americans, do you know how many will actually have coverage in effect on january 1, 2014? >> once they pay th their premis they will have coverage in effect. >> so you don't know? these are the ones who just selected a plan but haven't paid the first payment on a premium? >> some may have paid, some of not. we are giving the enrollment numbers. >> this is a critical statistic. it's clear a chess knows the number of americans essentially put a plan in the shopping cart. your testament includes data on the number of users who can use healthcare.gov simultaneously and the number of website hits. however, this most critical statistic, the number of americans who will actually have coverage effective january 1, do you have an estimate? >> sir, i think 365,000 through

the end of november have enrolled in coverage and we're getting with issuers to confirm the actual -- >> would you define enrollment? define what you mean by -- >> we are giving you the numbers of individuals who have chosen a plan spent but not actually paid the first -- >> that's correct, through the end of november. payment isn't to as you know until mid-december in order to be fully covered. so we don't have those numbers and i think most americans probably will not pay and till their money is owed. owed. >> so you can't guarantee the actual number of constituents who have coverage? >> not until they pay the premium. >> and october the ap reported a september 5 memo sent to your list of monthly enrollment targets for the exchanges, and this number indicates that your target enrollment number for the end of december is 3.3 million,

based on hhs is released this morning, your department is more than 3 million author target number, isn't that correct? >> to the end of november that is correct. >> some reports have indicated as many as 5.6 million individuals have had a policy canceled. isn't it the case that on january 1 more americans will have their coverage canceled than will have enrolled in an exchange? >> well, sir, i don't know where the 5 million number council. i know people have been told that their health plan doesn't necessary match the aca compliant plans. they're not in a grandfathered plan. a number of individuals have already reenlisted and enrolled in plans to so losing coverage and being know if i'd that the plan they have doesn't exist anymore are two very different things. >> much like the millions of cancellations in the individual market, the affordable care act requires group coverage to also comply with aca standards. many of these plan plants coulde canceled next year as well.

madam secretary, the issue with the canceled plans and the president's broken promise that if you like it you can keep it, it's because some of those individual plants did not comply with the health care laws 2014 requirements, correct? >> that is true, or they did not stay in a grandfathered plan. with a lawsuit from the outset is if insurers left a plan in place that an individual had in march 2010, and our millions of americans are in those grandfathered plants, that the plan state in effect through the application of the affordable care act spent what about small group market plans used by small businesses and their employees? >> in the same way. at the grandfather plan state in effect, they could still be in effect. if not, the consumer protections that are available through the affordable care act would come into play. >> at some small group plans be council because they do not

comply with the aca? >> yes, sir. again, injures council plans each and every year. a change plans, networks. that's part of the market strategy. >> madam secretary, before passage of the health care law, president obama routinely promise that the average fan would save over $2000 on their premiums. would you agree today that it simply is not true every family will see premium decreases? some will see increases? yes? >> well, mr. pitts, i think that the president talked about health care costs going down for americans. i think that we have adequately documented that health care costs indeed have gone down based on the trajectory that we would've seen thousand the affordable care act. underlying health costs are rising at the slowest rate in 50 years. medicare costs have risen at the slowest rate. medicaid costs have actually come down per capita throughout

the country, and private insurance rates are rising at the lowest level that they have in decades. so americans are seeing a very different cost trajectory than they would have after the passage of the affordable care act. >> my time is expired. think you madam secretary, for your responses. now recognize ranking member, mr. pallone for five minutes. >> thank you, mr. chairman. and again, madam secretary, i don't want to keep beating a dead horse here, but this whole idea that we have from the republicans that the world is turned upside down and aca is a disaster, it's just the opposite. as you point out, health care costs, you know, are going down, rates are rising at a less other level. this whole idea of the president saying if you like it you could keep it, the president didn't say that if you had a lousy health insurance policy didn't cover everything, that he was suggesting that insurance

companies continue to sell it and, therefore, you buy it. i was that the rules committee the other day when the president issued his executive order, and i had one of my colleagues from florida, one of my republican colleagues talk about how his constituents should have the freedom to use the word freedom, to keep his or her health plan that cost $60 a month but and i asked, well, what is this health plan? it didn't include hospitalization. don't think the president meant that you should have the freedom to keep a health insurance plan that didn't include hospitalization. if you want it, his executive order says you can do it, but i think it's absurd to keep arguing over those lousy, skeletal plans. in any case, the reality is that enrollment is accelerating and i want to ask you about enrollme enrollment. the numbers released today are impressive and i wanted to get some broader context from you on how enrollment is progressing. we expected enrollment to be slow in the early months, and

that's what happened in massachusetts when they implement the health care reform. in the first month only .03% of people in massachusetts who ultimately signed up actually enrolled. but the clear trend in the report that enrollment is searching. in november there were four times more enrollments in private plans than in october. october. more than one point to many enrolled in private plans were found eligible for medicaid, and more than 1.9 million people are eligible for marketplace coverage and can enroll as soon as they select a plan. 3.7 going to have applied for coverage, but the most important fact is the trend, the pace at the end of the month was double the pace at the start of the month. that trend appeared to be continuing. press reports have indicated more people signed up for private coverage through the federal marketplace on november 30 and december 1 and signed up for all of october. another press report noted more people selected a plan in the first week of december.

these are exciting science. such as a given the technical issues we've had in the corresponding delays, much of the outreach campaign, how would you measure the progress this morning in terms of enrollment? >> well, i don't think there's any question that flawed launch of the website put a damper on people's enthusiasm about early sign-up. we had a lot of visitors early on who got very frustrated, and have none reengaged. we have been inviting them back to using newly improved site and we're seeing some very, very positive trends trend in that direction. so i don't want to minimize the debt in effect that a flawed technology had, notches on the federal website but i think on the news reports also i think dampened cms is level, it was hard for california, for instance, to assure people that their site was fine blow there

was a lot of news day in and day out about the plot site. having said that, we are seeing very, very positive trends, a lot of people reengage. and it's about not only just the numbers of individuals but at the end of the day, hopefully getting the right mix of individuals and we know that a lot of younger americans are greek text savvy, what a very fully functioning easy site. so getting healthcare.gov up and running correctly also helps with some of those targeted numbers. >> i appreciate that. let me just say, i only have 50 seconds, at my forum which was a successful in highland park, and people were happy with what we were doing, the other night, they were particularly pleased that you have that option where you didn't have to basically provide all your information but good comparison shop without actually enrolling. i thought that was very good. and still, to encourage people

to use alternatives. i know you're right. a lot of people like to use the website, but i know there a lot of people at my forum who were, you know, calling the 800 number, going to committee health centers. and also we had some interest agents and brokers there and i think, i know, i think we should encourage that as well as alternatives. >> we have been conducting some pilots with a large number of insurers in key states. i think they have gone extremely well. we are encouraging insurance companies to have their agents and brokers directly enrolled. and i think that experience has been very productive, and we're working closely with them on the kind of technology fixes that they would find most effective. >> thank you. thank you, mr. chairman. >> thank you, madam secretary. the chair now recognize the chairman of the full committee for five minutes. >> thank you, mr. chairman. so the goal was to enroll seven americans by the end of march.

365,000 folks in rolled through the end of november. premiums are due beginning mid-december. i wonder, madam secretary, if you could tell us, after christmas somewhere between christmas and new year's, as to how many people actually do pay the premium that is due, if you could share that number during the christmas break with us. would that be possible? >> chairman upton, the deadline to enroll is the 23rd. the deadline to pay is the end of the year so we will not have a number until -- >> can you let us know that first week as to how many speakers i will let you know as soon as we have the numbers. >> you indicated to mr. pallone that, in fact, the launch was flawed. knowing what you know today, do you wish in fact that you delayed the launch be on

october 1? >> well, i certainly wish we could'vcould have saved millionf people a very frustrating experience and had a smoother technology launch. i acted on the best information that i had, and going forward i think that having an eight week delay in a fully functioning site is enormously frustrating, and to millions of americans and their families. having said that, i think our millions of people who are going to begin receiving health coverage that they never had january 1 and into the new year. and so on balance, i am not sure what the right answer is. the loss benefits when into effect january 21. people need some time to sort out options. we clearly put a dent in that time, but you are going to be millions of americans with new

health coverage and that will continue on. >> so you would have, knowing what you know today you would've started the launch october 1? >> i would have probably done a slower launch, maybe with fewer people and done some additional data testing which is part of what has happened, frankly, in the early months of the launch to identify what the problems we had. >> so what grade, if you could get yourself -- not you, but the grading of the launch from add, or incomplete, what would you give? >> mr. chairman, i've always said i think the launch was flawed and failed and frustrating for millions of people, unacceptable. we want to both figured out exactly the chain of events what went wrong, which is why i've asked the inspector general to do this investigation. we've made some changes. what we are doing is moving forward. we want to make sure that the

millions of people who are eager for affordable health coverage have that opportunity before march 31. >> so you announce the ig investigation yesterday. do you wish you had started that maybe this summer, asking some tough questions in terms of where things were? knowing what you knew back then? >> i didn't have cause to act the ig to be involved as summer. no, sir. >> the day after they seemed administration announced the states would be permitted to use incomplete enrollment information to sign people up for medicaid. is it possible that by using incomplete enrollment information, states could be enrolling folks, the most vulnerable by the way, for medicaid who are not actually eligible? >> sir, we are working very closely with states around medicaid eligibility, making determinations based on state

specific laws which they have an opportunity to sign off on. so when someone presents that website and we reviewed their eligibility criteria based on the law of michigan, we determined preliminary eligibility and send that file to the state. at the same time, the state is in the same thing for people from michigan who may come to the state medicaid office, thinking that there -- they are medicaid eligible at are determined to be marketplace eligible. they are returning -- >> by the information is incomplete, is it not? >> sir, i'm not sure what you're referring to. we are gathering data and information and eligibility. and again, the state makes the determination based on their state law, and based on the information that we have collected. >> so our income and residency requirements a part of that information that has to be verified? >> i'm sorry? incoming -- >> income and residency.

>> yes, sir. they -- the state again makes a final medicaid determination. we make the preliminary determination and send an individual to the state. if the state doesn't confirm that they meet those requirements, they will not enroll the individual. we have now as of last night, again, at the systems automated so these files will be sent automated but we are also sending what we call flat paper files with full information to the states, and working one at a time with states, particularly those states like michigan, which has expanded medicaid for their population to make sure that the data is verified. but the state makes the final medicaid determination, not the federal government. >> thank you, madam secretary. the chair now recognize the ranking member of the full committee, mr. waxman. >> think you very much mr. chairman. i know that there's a lot of politics very -- this issue.

i sorely understand that change to a system that is more fair and stable for every american, not just a few, at every american, it's not easy. but all of this is exacerbated why wild propagandist, politicized statements that it been made, even today. chairman said more people will have lost their coverage than we'll get coverage. well, that absolutely cannot be true. it is not true. the congressional budget office, which is not democratic or republican, nonpartisan, they estimated that 7 million people will sign up for health insurance in the first year, and that 25 million people will be newly insured in 2016. that's really a major accomplishment. now, we hear republicans say, more people are losing their policy, but who are those

people? we estimate 80 million people will lose their insurance. when you look at that statement, they are saying that people who have a change in the policy have lost it. for example, when they get free preventive services, now covered, all, that means they are losing the policy they had. or if young adults can stay on the policy up to age 26, republicans are saying, see, they are losing that policy. well, that doesn't make sense. and must be tried to exaggerate numbers. there are some small businesses in this country who have offered their employees skimpy plans. and now they are being told they've got to have minimum standards in those plans. so they are complaining a lot, because everybody has to provide decent, quality, reliable insurance. and a lot of them are helping to fuel this argument.

so to say that 80-100 million people may lose their insurance is absolutely crazy. it's just not true. and especially galling to some of us, when we hear republicans so saddened by people losing their insurance when we recognize that they are the status quo, which means repeal the affordable care act, where we have 50 million people uninsured. that didn't bother them. so i just think that we ought to put this in perspective, madam secretary. this is not about this law. and it's not sincerely concerned for the uninsured. it's just a political, constant political attack. republicans do not want, did not want to work with the democrats. they did not want to work with the president. if this bill has problems, let's

work together to fix them, not talk about how it's no good, it's all terrible. because i'm hearing from a lot of people -- i think a headline in "the new york times" captured this. the article was titled a new the uproar over health law, voices of quiet optimism and relief. there are voices like stephanie in pennsylvania but frustrating experience trying to submit your application for the first two months. said after visiting the navigator at a local library, she signed up for a policy that will cost $113 a month with no deductible. and what she said is i'm one of the people whose plans were canceled, and signing at this time was just the easiest thing in the world. there are the voices in san diego come in 2012 they lost their coverage because they no longer live in the planned service area. when they applied for new

coverage, allen was denied because of carpal tunnel syndrome. now they have a plan through the exchange. $142 a month instead of a $1300 per month they were paying before. they have a higher deductible than the old plan. lower co-pays. here's what they described their feelings but we felt we didn't have to panic or worry if not for the affordable care act our ability to get insurance would be very limited, if we could get it at all. madam secretary, you've traveled around the country talk to people about this law. do you think most people look at this as a political issue, or are they willing to put politics aside and look at the plans being offered to make the decisions of what is best for their family? >> well, mr. waxman, what i find is a lot of people are eager for information. they are confused by what they read and hear. and, frankly, the launch didn't

help that, but as people understand their options and choices, i find that there is enormous enthusiasm, often huge relief. a lot of individuals who received the notice of a cancellation, or unlocked from a policy choice that they did not feel was good for them or their families. they were kind of locked into a plan. and i talk to people everyday who now have 40 or 50 choices, a range of marketplace plans, the option to pick and choose. that isn't to say that there are not some individuals who would've preferred to stay in the plans, which is why i think the president decided on the transition policy in the marketplace. but a lot of speed [talking over each other]

spent are thrilled with the choices that are not available to them. >> the chair now recognize the vice chair of the full committee, five minutes for questions. >> thank you, madam secretary. i want to talk to you about data security and privacy. first up. i know you've seen the "usa today" story about people in california having their information released, insurance agents but this all happened after they've gone to the exchange. we are hearing from other states that people are having that same experience. with federal exchanges, so have you talked with the california exchange about releasing that information, help them to realize this is inappropriate to release that information? >> well, i don't think there's any question that there is an issue about releasing anybody's personal health information as was done in california. and there have been certainly conversations about that. as you know, we don't run the california exchange.

that's no excuse. privacy and security are hugely important. >> okay. how is the information being released? who is releasing it quacks who all has access to that? and when it is released, are people paying for that information? who gets the proceeds? ..

if there is a transaction on that, we need to know that. let's talk about -- >> i would suggest the fact that they are getting phone calls suggest customers of insurance companies contacting them because their policy may be up for renewal, those calls are under way. >> i don't think that is the case but let's talk about cost. $600 million is what was spent on the site so far. i am referencing washington post on that. how much money in total has been spent? we are still waiting for the answer to that question from you. we would like to know how much you obligated since october 1st for the cleanup of this exchange, how much money do you anticipate obligating through march of 2014?

since you have the ig do and investigation of the contacting of you going to make these contractors pay this tax their money back? >> congresswomen, date, through the end of october, i am giving you the most recent numbers we have, we have obligated $677 million for the total i t costs and out weighed $319 million of that 677. some of that includes work in the month of october. we will give you regular updates as we have new the audited numbers. task to the ig to become involved because i think it is appropriate to look at all aspects not only of the management practices but contractor expenditures, the specs in the contract, payment issues and i will act based on

his recommendation. >> so six seventy-seven million is what you have obligated through the end of october of this year. >> that is correct. through the end -- the obligated amount. we have spent $319 million of that 677 through the end of october. >> we will continue to watch that cost number very closely. delays. every holiday brings another delay. what should we expect for christmas and new year. we had a total of 13 administrative delays to major aspects of the law and its teams july 4th or any of the holidays, thanksgiving we get a delay. what are we looking at for christmas eve and christmas and new year's eve and new year's day? >> i would say we have extended the deadline for enrollees from the middle of december until the

twenty-third recognizing people need extra time over the holidays. have to pay until the end of december in order to be fully enrolled and working with insurance to make sure there is a smoother transition into the new year. >> i yield to ranking member and maraniss, mr. dingell for five minutes for questions. >> thank you for holding this important hearing. madame secretary, welcome and thank you for being here. we all know the secretary is the famous daughter of a former member of this committee, outstanding member from ohio. madame secretary, we continued to hear nothing but scare tactics from the other side of the aisle. rather than encouraging people to sign up for health insurance doubt is being created where none exists or should. i am forced to admit the

implementation of the law has not gone as smoothly as i would like to. that is in no small part due to the intransigence of many of my colleagues who have thrown ranchers in the deer's at every opportunity. my constituents continue to tell me about the benefit aca continues to bring them. i would like to a share a few letters i have received recently and entered into the record. one of my constituents wrote as follows:i find it absurd, embarrassing and an enormous waste of time, money and human capital to see the taxes being used in washington right now to defund the affordable care act. as someone suffering with ms, a father with lung cancer and a sister with a high risk pregnancy, i can say with absolute personal authority the affordable care act will help in this critical to the welfare of

families like mine. another constituent wrote, quote, i have registered with heathcare.gov so that i could study and compare premium prices i am currently paying for 60 plus employees in ohio and michigan. i am extremely pleased these plans are half of what we are paying now. there are 72 bold plans being offered. that is competition. so let's stop playing politics, look past spin and realize what tremendous good aca has already accomplished for the american people. and get together and make it as successful as it could be. madame secretary, i would like to begin by asking you a few questions about access to the web site. madame secretary, is it correct the error rate on heathcare.gov is under 1%?

>> yes. >> in your capacity that has increased to allow 50,000 confirmed users, more than 800,000 visitors, yes or no? >> 800,000 minimum. >> the web site has improved, we have seen an increase in the number of enrollments through the web site. today we got more good news about enrollments. is it correct that 258,000 people select a plan through both federal and state market places in november, bringing the overall enrollment coverage to 364,000? >> 365,000. >> 1.5 million people have been eligible or determined eligible for medicaid, yes or no? >> 800,000 medicaid eligibility is have been determined.

>> thank you are you comfortable enrollment will continue to increase quickly in the coming weeks and months, yes or no? >> we're seeing a very positive trend, four times as many enrolled in the federal marketplace in november as opposed to october and we are seeing an upward trend in december. >> people like my constituents i mentioned earlier, seeing the reduce costs when purchasing insurance through the marketplace. is it correct that recent rand report found premium tax credits will reduce out of pocket costs for average marketplace participants by 35%, yes or no? >> people are eligible for subsidies, they will see a significant decrease over the -- >> running out of time. you have got to give me a yes or no. the cbo projects, eight in ten

americans who obtained coverage through marketplace will be eligible for assistance to make their coverage more affordable, yes or no? >> the preliminary estimates were that the uninsured population look like. >> aca benefits people who don't purchase their health insurance through the new marketplaces? is it correct that thanks to aca, 3.1 million young americans stay on their parents' plan? >> yes. >> 7.3 million seniors saved over $8.9 billion on their prescription drug costs thanks to provisions in aca that closed medicare part b doughnut hole? that will be totally closed in the year 2020? >> yes, sir. >> the gentleman's time has expired.

>> you have been very courteous and i thank you. >> recognize the chair and maraniss mr. burke for five minutes. >> before i ask my questions, merry christmas. who was your father who served on the committee? >> you may have served with my father-in-law keith sebelius. >> let me get to the non fun part and go to the questions. mr henry chow of cns when he was here several weeks ago in response to a question from congressman gardner of colorado, made a statement that 40% of the computing system hadn't even been built yet. what he called the back end hadn't been built which i assume

would be the accounts payable, accounts receivable, income verification, things like that. could you tell us what is being done to get that ready by january 1st? since almost half the system hadn't even been built yet? >> i am not exactly sure what he was referring to but i can tell you where we are in the bill. the emphasis was getting the consumer facing portion ready for october 1st. as you know that didn't go so well. the financial management system which is getting the insurance companies their money for accelerated tax credits and cost sharing is due to go into effect

in mid january. there are also other pieces of the puzzle, not income verification at the front end in order to qualify someone. >> do you agree with mr. chao that a large part of the system hasn't been put together yet? and if so are you concerned? >> it is in the process currently of being put together. the income issues, i want to clarify for the committee that it has been a bit of a misunderstanding. accelerated tax credit and cost sharing don't go to consumers. they go to companies. and we have a system we have announced working with companies where they will be paid in a timely fashion. >> i don't want to beat a dead horse but we agree the web site to try to enroll people has not worked very well. that is the easy part.

so now we are down in january to lots of people that think they are going to have insurance that don't have it now and the part of the system that when they go to the doctor, to the hospital, give them their new insurance card, they check to see if they are covered and what the coverage is, that is not there and there isn't a system to pay people, there is no system to determine if the stock or hospital is eligible and you still want to get this started on january 1st? >> that is not an accurate statement. we have a plan and we have discussed it with insurers. they are comfortable, to get them -- >> it is going to work -- >> people will be enrolled. that system is in place. >> in mid january or february we will be talking about this

problem. >> this is reimbursing insurance companies at the end of the day. it has nothing to do with enrollment. >> i am not saying it does have to do with a roman. >> people go to the doctor and go to the hospital they will have a card. >> i have a minute left and one more question. i want to put a slide up the says on section 1401, under the law section 1401 says if you go through a state exchange to get insurance under what we call obamacare that you are eligible for subsidy. if you don't go through that state exchange you are not eligible for a subsidy. irs has ruled we are going to give the subsidies we come to the state exchanges are not. what is the position on obeying

the law and doing what the law says which means everybody who signs up for obamacare is not eligible for a subsidy because they're not going through the state exchanges. >> we have deferred to our partners at the justice department and the treasury. >> what is your position? >> our partners, this is in litigation. we feel -- >> i am asking the question. >> we are not worried about obeying the law. >> the law covers state and federal exchanges. >> the gentleman, thank you, madam secretary, recognize the gentleman from utah for five minutes for questions. >> thank you, mr. chairman. thanks for joining us today. we already had one hearing on

the web site before now. we are aware of the challenges to the rollout. when you come forward there are all kinds of topics i would like to raise about the health insurance tax, difficulties providers have with meaningful use stage ii the this hearing is about the website and focus on that and my questions today. we all know that you acknowledged the criticism of the web site when it was coming out. let me ask you a question. as we go forward have you developed a master list of the issues that need to be resolved for the issues you are trying to anticipate as we move forward? >> we are doing that on an updated basis on the policy side and the technology and user side. >> that is not a static list but any evolving list. is it possible for the list to be shared with the committee? something we could see on this committee? >> it is not a static list.

it is a dynamic list and anticipating what the neck policy choices are, what happens. we are happy to give the committee and outline but i don't think there's any great secret to it. >> i want to talk about some of the issues with the 34 perform. i know the error rate has been dropping and enrollment is increasing so you have these lines going in opposite directions both favorable directions but that being said do you have a sense of how many enrollees may have the 34 errors that need to be addressed? >> what i can tell you as much as we know in your early days there were serious number of errors and we are hand making individuals lose that important personnel to the tech team so that they are helping to identify where the bottlenecks

were and fixes we are seeing, a vastly improved system but we want to go back and make sure anyone who thinks they are enrolled in the early days actually is matched with the company and the company folks are matched on our end and that process is underway and a lot of fixes have been added in october and november for the 834. >> the declining error rate, how do you calculate that? is that an average of all the plans or snapshot as you go forward? >> it isn't really plans. it is looking at the site and determining the errors that occur along the way so pages that come out where people got locked out or dumped out or wooden decks of the id. that has been a road map. >> the issues on the back end,

cbo predicted six million individuals potentially going to see subsidies and as these premiums are coming up, are we going to have this system in place where these subsidies and payments, is the system structured where the subsidy payments are going to be made for the first month of participation? >> they will be made and they will be made in a timely fashion in a way that insurers have agreed that works for them. as the full system is being automated, there is a step in the early months to make sure the payment, an individual be enrolled, qualified for a subsidy, the insurer would like that the premium at that point, the individual is in short and has full benefits.

starting in mid january the insurance company that receives reimbursement for the tax credit and cost sharing if it is eligible for individuals. it is the two step process. one accept the individual, the second affect the company, 300 companies total. we have a system that again has been signed up by them. in terms of getting some paid in a timely fashion we will absolutely do that. >> subsidies go to the insurance company. >> not to the individual. >> when we hear about these problems building up the back end this particular components -- >> there is a manual work around for everything that isn't fully automated yet. is in place. it will be manual until the information is complete and we make sure its is complete but the payment system will go forward. >> i yield back, thank you.

>> i recognize the vice-chairman dr. burgess for five minutes. >> welcome back to the committee. an opportunity to go through everything on the list, we have not received answers so let me encourage you to respond to previous questions because they are important and constituents are asking at the town hall earlier this week, single mother earns just over the amount so good for her, she has a good job, work for small employer, lost their insurance in a small group market, now she is being hit with a premium, and subsidize premium, not eligible for subsidy of $1,500 a month for her and her child. when you were working through the nuts and bolts of establishing this what did that situation come to mind? were you concerned about that individual?

>> i am concerned about all individuals having affordable health coverage. >> apparently she doesn't have affordable health coverage. she lost her employer, small group market coverage. >> her employer chose to drop the coverage. >> because of the expense involved with that. you were here in april, april 18th. you received two weeks prior a red team discussion document from mckenzie group. my information is you were briefed on this report two weeks prior. that was listed on the final page of the report. let me play a little clip of our interaction from april. sounds better today than it did then. okay. that is going to take -- let me just tell you what we were dealing with.

the study of the mckenzie group put together dealt with the readiness of heathcare.gov. i was asking you about the readiness and you replied that we are moving ahead, we have federal contracts and on time. do you recall that exchange between the two of us? >> i am sure that exchange took place. >> two weeks before you were told by the mckenzie group that number one, they found extensive problems, were not allowed to change the launch date, it had to launch a full volume, no one was in charge, the completed project was a moving target, you were aware of all that when you testified to the committee in april. >> i asked for the mackenzie group to come in 6 months ahead of launch date and give an analysis of their best advice. i was briefed on it and we acted on their recommendations. >> you were the one that

commissioned the mckenzie group report. >> we ask for them to come in. >> yourself. >> yes, sir. >> what did you do with that information to you were not being honest with us two weeks later when we were talking about it in committee. >> i would disagree. we wanted the report six months out to make sure that we had independent eyes and ears, look at the readiness, and look at the challenges and we took their advice very seriously in. i wouldn't tell you their primary advice focused on the reliability of the hubbub. they thought that would be where the large number of problems occurred. a lot of time and attention, we looked at -- >> they were actually accurate and that assignment? >> the hub has worked beautifully start to finish. >> you testified this morning that there is, people cannot make their payment now when they go on heathcare.gov.

>> that is not accurate. a lot of people haven't made their payment. the payment isn't due. >> i was unable to make my payment on heathcare.gov and the federal exchange from the state of texas and i was told you can't make that payment. >> you don't pay the federal government. the sino site, you make the payment directly to the insurer. >> december 23rd you said of someone worked through the process they're going to be covered, payment may not have been made. >> what i said is that you have to be enrolled by the twenty-third and make a payment by the end of the year in order to be fully insured. >> who is going to guarantee the doctor that sees that patient on january 4th is actually covered for that visit? >> as they do today, you are enrolling in a private insurance plan. >> a premium payment, you said they're covered december 23rd but never write a check or make a payment. >> they are not covered.

in every point along the way on the web site they are enrolled until they make the payment. >> i you going to make good for doctors to see the patients the first weeks and have their cash flow interrupted? you are practicing in a small practice you get your cash flow is interrupted two or tweak weeks that is big trouble. >> if an insurance company gives an enrollment to a customer they will make good with the provider. we tell people over and over again they are enrolled when they make a payment. we turned their name over to the insurance company. >> you said this morning -- >> the company deals with the new customer. >> if their robotic twenty-third they're covered. >> not until they pay. that is what every step along the way. >> the and of how hard it is to make that payment? have you done that yourself? >> i have not. >> is almost impossible. i have never seen a business where you get to the point the fundamental business transaction make the payment and you can't do it.

>> the gentleman's time is expired. chair recognizes the gentleman from georgia for five minutes for questions. >> thank you, mr. chairman and thank you, madam secretary for being with us today. i am glad there has been some progress since last time we met but i am concerned what will happen when the insurance mandated goes live at the first of the year. i voted against the health care bill because i thought bolting was unmanageable big to begin with and we have only seen the tip of the iceberg. i hope i am wrong about that. i want to ask about other approaches to the fundamental shortage enrolled in plans required under the act. are there other insurance plans out there that are internet based? other folks selling health insurance on internet based exchanges? >> i think some of the company's

have internet sites and i know that the health brokers have a variety of plans available. i can tell you how broadbased that is but i know a number of companies you can sign up in person with an agent or broker or sign up online. >> to what extent records made to reach out to such folks to learn from what they are doing argued lies the technology they are already utilizing to sell health insurance on the internet? >> there was a lot of outreach and conversation about what works and what doesn't. i would suggest that this is a unique integrated product because not only is an individual identified and verified but can qualified than for tax credit and cost sharing based on his or her income, can

be qualified not only for the federal marketplace but medicaid shipped services and in the federal website each plan, each state offers a different plan, each state has the consent of medicaid rules and the state has a different level of benefits so is basically an integrated system that tries to get you to the right place to make it choice. >> our private health insurance plans that are internet based health exchanges able to take advantage of the unique features of the law? the fact you get subsidies if your income eligible or there a specific package is not required? >> verify that through the hub, no one can have -- >> is that being done? >> yes it is. >> private insurance companies? >> yes. they don't have direct access to the hub and. they come in through -- >> i understand that. >> blue cross blue shield are doing this enrollment all over the country now that the site is

functioning. >> if there are other sites, other internet based exchanges already functioning it seems to me it would be a hopeful approach to have all hands on deck. >> to clarify, they are. the health insurance folks are now engaged and in fall, brokers involved in that, companies are directly involved as well as individuals navigating on their own. >> are you telling us that folks who would otherwise be able to get health insurance through health care -- heathcare.gov can get it through an internet based exchange? >> if they are subsidy eligibles they need to get that verified so that the subsidy goes forward. >> 2 needs to do that? >> sitting in an office with a broker, they can do it with the e health-insurance folks, they can do on their own, with a navigator, on the call center. there are a variety of ways

individuals can do that. is there not some the eligible, they make more than $46,000 as an individual or $92,000 as a family, they can go directly, and role in the marketplace plan -- >> back to the point you began with, rolled that heathcare.gov is supposed to provide is to match polk with subsidies and products out there. that can be done through private exchanges that exist right now. doesn't have to be done through heathcare.gov. >> the subsidy eligibility which involved verification of income, verification of citizenship, verification that you are to use a you are has to touch heathcare.gov. other than that the enrollment process can be done. >> the front door provided by private internet based exchange can communicate with folks in the back room on the government end. >> they do not have access to the social security database,

the irs data base, homeland security database. that is the peace that verify individual eligibility and can move them forward. that is being done by agents of brokers, the health folks, a variety of people along the way. >> madam secretary, the chair now recognizess the gentleman from kentucky for five minutes for question. i would like to ask the gentleman from pennsylvania to take the chair. >> thank you, mr. chairman and madame secretary, thank you for being with us. mr waxman admonishes us to treat you with respect and certainly we should do that and we want to do that. i will tell you our first concern is with the constituents that we represent and some people have said we are simply trying to put obstacles up for the successful implementation of

this act. i can tell you for myself and many others, we are here because our constituents are genuinely concerned and upset about what is going on and the lot of it begins with the way this bill was passed. when it came to the floor the most comprehensive change for healthcare in america that has ever been undertaken, no one could offer one amendment to the bill. so there are very deep feelings about this bill and many health care experts today say that we are going quickly to a new health care system. we will have one health care system for wealthy americans and everyone else is going to be under the affordable care act. that is exactly what has happened in other countries that have gone down this path.

when this legislation passed, your office was given immense powers, decisionmaking the authority. we know many regulations have been written. could you tell me how many pages of regulations have been written to implement this act? >> i can get you that number. i do not know. i do not know. >> the have a range? >> i'd like to get you accurate -- >> is a 100 pages? >> i will get you information. >> you don't know? >> just told you i don't know. >> the president talking about how this is going to save money, people will have lower premiums. i can tell you those of us on the hill going on but d.c. health exchange discovered our premiums are much higher than they were and when we talk to our constituents going on the exchanges discovering the

majority of their premiums are much higher, and my understanding is o m b said the subsidy would cost taxpayers over $1 trillion. we have been told -- i am sorry. the subsidy will cost the taxpayers $1 trillion because somebody has got to pay for it and i would also like to ask you up question because of what is perceived as a real inequity in the system. some people are being favored, other people are not being favored. when you go to the rotary club and speak and people ask you do you have to go to the exchange does the president have to go to the exchange, the political appointees have to go to the exchange and you say no, do you

think that is fair that the rest of the american people have to go to this exchange? but you and the people and the president and the executive branch do not have to go on the exchange? >> the vast majority of americans with insurance will not be on the exchange. 1 seventeen seven million people, it is as i said to this committee in october, illegal for me to go to the exchange. i miss spoke slightly because the reason it is illegal for me which i knew, i am an old lady, medicare eligible. it is illegal for a company to sell me a policy. >> you don't have to go on medicare. >> i am not allowed to be sold a policy in the private market -- >> thank you for your comments but the bottom line is the executive branch of government does not have to go on the exchange but everyone else does have to go on the exchange. in addition to the $1 trillion taxpayers pick up on the subsidy

they pick up another $710 billion because the president agreed the federal government would pay more state medicaid costs. >> that is from the paid for in the health care law and -- reduces the deficit. >> it is fleet paid for by taxpayer dollars by general fund dollars. >> this actually this bill was paid for. >> the president said everyone's premiums would be free. the president said people can keep their plan. the president said they would be able to keep their doctor. it is turning out that is simply not the case. there is a lot of frustration. we are upset about it and my time is expired so thank you. >> you are recognized for five minutes. >> let me clarify something

using the dingell yes or no strategy. is it not true that the congressional budget office said eight of ten americans who will go to the marketplace will qualify for assistance? >> i think that is true. >> yes or no, is the affordable care act paid for? i know you refer to that but if you could explain. >> it is paid for. again, the congressional budget office estimates that it will reduce the deficit in the first ten years by about $120 billion and over the next ten years reduce it closer to $1 trillion. so defunding or delaying or repealing the affordable care act actually adds to the deficit. >> isn't it true that many of

the people who have gotten these letters about the cancellations will be able to go to the market place and find something better or at least as good? >> again, in the individual insurance market which we are talking about, the plans change on a very rapid basis, constantly refresh so having a plan cease to exist is not a novel idea. significant percentage of people have the same plan they had in march, they don't change at all. for others they will have choices. many of them that they never had before both to get some assistance, financial assistance if they don't have affordable coverage in the workplace, get financial assistance paying for health coverage but also be able to choose in a competitive marketplace and not be locked out because of a preexisting

condition, not pay 50% more because they are a woman, not be worried about being dropped or kicked out if they get sick down the road. >> we have been going by anecdotes. i wanted to read you a letter said i got. i will contribute to the anecdote pile from janine and jeff. , affordable care act debate focused on anecdotes and many benefits such as not denying coverage for preexisting conditions and coverage for young adults under 26, we thought we would share our experience with the web site like many american families, young adult children ask for help reviewing the options and making the health insurance decisions when they were visiting us over thanksgiving. we went to heathcare.gov and it worked. not only did the website work but it was easier to navigate and faster than the web sites of the private-sector health insurance companies. the other good news is our

daughter erica is pregnant with a baby due in march of 2014. current health insurance policy is expiring on december 31st and were it not for the affordable care acted is unlikely one and 6 months pregnant would have been able to obtain health insurance at all. the aca is helping her just when she needs it from most. i ask two others i would like to submit for the record. positive stories that i am getting. we are getting more and more of those stories and i want to say to you, madam secretary, i am absolutely confident that the role that you played in bringing affordable health care to millions, tens of millions of americans, will go down in history as one of the great achievements of our country, throughout its entire history and i want to thank you for that. i understand and full be agreed to rollout was, is unpleasant

and as horrible as it could have been probably, but by the new year and into the new year we are going to find all these stories. my understanding is thirty-nine million people went either to state or federal websites in november. is that true? >> that is accurate. we had at least that the federal website five million visitors in the first six days of december. >> what do you think that indicates? >> would there is tremendous interest, there is now a very outdated and easy-to-use anonymous shopper that will give people information before they go on and and roll and we see people coming back several times. this is an important decision important to them and their families and visiting the site, they are eager for information and desperate, many people, for affordable health coverage they never had before in their lives.

>> recognize the gentleman from illinois. >> thank you, madame secretary. i will try to be nice and polite and kind. these are difficult because we want to get some of the truth out. last congress you testified and to me and this committee, that we double counted the $500 billion counted to preserve medicare, $500 billion went to was credited to pay for obamacare, you admitted that. you can't tell us that this is paid for when we double counted $500 billion. i want to put that on the record and for the amount of enrolled in the plan, 1300, 20 times more have a role in medicaid and this medicaid explosion that are enrolled fraudulently or enrolled through woodworking or and rolled through the new

expansion are going to kill the state's. when amazon.com recorded the books sold, they record a book sold based upon someone who has paid for it. not what is in their shopping cart and not what is on their wish list. our concern is 364,000 numbers fraudulent because it is not those who have purchased plans yet and so i would ask that when you return, that you give us actually to has purchased plans. do you understand our frustration with that? >> as you well know we did not take over the private insurance market. people -- >> you are telling us that those -- >> i told you who is enrolled in. >> that is why we are frustrated. >> this is medicare. >> let me go to my next question. let me go to my next question.

i had my phone on and when my phone rang on left on because i wanted to talk to democrats state senator from my state of illinois who was on the insurance commission and he said mandated preventive services are laid directly on premium prices. so you cannot say as you have numerous times that these preventative care services our, quote, free of charge, can you? >> they are free to the consumer. >> there is no free lunch, madam secretary! if the premiums increase because of the mandated coverage based upon state senator from the state of illinois, a democrat, who is in oversight of the insurance of the state of illinois and he said when you mandate coverage it is ruled directly on premiums, premiums increase, that is paying, you cannot say these are free of

charge! >> consumers will not have a co-pay or deductible and i think -- >> we would they have higher premiums? >> no i do not. .. >> you have to leave her the opportunity. >> we all agreed on that at the beginning. suspend.ntleman will

give the secretary time to answer questions. >> through the great work of congressman smith, we know 112 plans offered to congressional employees and members, only nine exclude abortion coverage. last time you were here that you would provide a national list of those who cover anddo not cover abortions abortion services. we have yet to receive that list. folks are shopping now. when we went through this last time, we received a call from someone in the country who was , thanking me, because they want to know. list today. when will you provide that? -- plan listsr benefits.

one they must list by law is abortion services. i would highly recommend they look in the benefit section. >> last time, i held up numerous policies. you promised to provide a list of those plans. all we're asking is for you to keep your promise. >> we provided a list. you promised last time. >> it is on the website. >> can you provide us a list? >> madame secretary, answer the previous question. were you able to answer the question the gentleman asked? >> i assume so. >> mr. green of texas is recognized for five minutes.

>> let me give a history lesson. i was here in 2003. the prescription drug plan did not allow amendments on the floor of the house. i remember walking to the front of the capital and seeing the sunrise from the east on the prescription drug plan. we were there all night. you can dislike the law. cannot say it was not passed. i only have five minutes. is the reason it is not covered on the exchanges, any employee with insurance does not need to go to the exchanges. the exception was part of the

bill that came from the senate. i disagree with a lot of the things the senate but in the bill. the ranking member and i both have some issues with that bill. but the house bill, we had hours and hours of amendments in this committee. i had 30 amendments on my own. a number of them are bipartisan. they were adopted by voice vote. our committee had plenty of time to debate this bill. we did that with the prescription drug plan as well. i was here in we had a lot of 2003. committee amendments but not one , on the floor. let me get to my questions. first of all, since logging onto the exchanges on october 1 and problems with the healthcare.gov website, there were glaring and unacceptable issues. i know you took responsibility for that. i'm pleased that we have seen a great deal of progress being made since then. i hope that the affordable care act can deliver on its promise to deliver coverage to americans.

that market is still available. in many cases, the aca is broken needed because it was broken and fixes need to be made. we need to make the experience of purchasing health care on healthcare.gov easier for consumers. it is a process that you are learning every day? in business, we learn everyday to fix things to serve the customer. >> we are definitely learning every day. since i was here last, the the greatly improved anonymous shopper feature is on. we just added today the automated medicaid transfers recognizing that some states are not able to accept them in an automated fashion. accept them n automated fashion so we will do both. we have added the spanish version of the website experienced that rolled out last week. we are in the process, as i

said, of building the financial management. but each and every day we learn something from consumer experience. it is a process where each week we are adding fixes and identifying problems and will continue to do that. this is the first of the conference and we're going to continue to make the experience more smooth for consumers. >> and it is important, the website to work. because in the middle of november we had anything in his where we at eight and people show up on a saturday morning and we use paper applications. that's my next question. the 400 or so people who filled out the paper applications in that for hours on a saturday morning, how are they being dealt with through the exchange is? >> well, sir, we have a number of people who use paper applications early on or pdf applications, and we are we contacting each and everyone of those people, offering them either someone to help them walk

through the web experience or inviting them to do it themselves. so that is very much underway on a casework bases. we want to make sure that anybody who filled out a paper out is actually welcomed into the system and gets through the process by the 23rd everyone coverage january 1. >> i think it's interesting though because my colleagues objected to the market place but the marketplace is a compromise in the senate. the house bill that passed did not -- we had an exchange but it was supper because we also at a public option on that exchange. so it's only market-based. when i went on to by our insurance, and i agree with my colleagues, my interest went up like you, i'm over 65, and you rate my wife and i, we are going to pay higher premiums. we did have trouble even through the one for the members of congress, but most of the people in our country are not going to do with exchange because if their employer continues to provide the coverage they don't have to worry about this.

and i can also say that i've had dozens and dozens of seniors because of all the misinformation out there who are concerned to have medicare and say, i'm concerned about my medicare. well, medicare has only been benefited by the affordable care act. and again, thank you for your time. thank you. >> the gentleman's time has expired. not recognize myself for five minutes. first of all, thank you for being here but i also want to thank you for giving -- there's more work we ought to do on mental health issues and would welcome an opportunity to meet with a number of us to talk about some things we need to help mental health america and i appreciate your dedication to the. i want to thank you for this analysis. it is helpful for us to see some breakdowns of what's taking place with regard to the states in the market place. i want to ask some clarifying questions to cev no or you can find out on this. of those who have signed up you have a list of those who have signed up for medicaid and chip

market place. do we know how many were previously palatable for medicaid? not those that were added on or previously eligible, do we know that number? >> i don't know that number and we're trying to get those numbers at the state level. again we know that a number of people even in non-expansion states have come forward and now our present themselves as medicaid eligible. but what's the old rules and what the new rules, we will be getting but that number. >> we had the previous level, now 133% of income or whatever it is interest states. it would be nice to know how many previously of approaches never sign up. thank you if you can get that information. also in terms of the data which is important, of those who have speeded can i interrupt one second? there is a third category. we know that there are people who are currently enrolled in medicaid who are sort of reagan rolling. they are not native to either category but they actually are

renewing. we will get that break them. >> renewals, previously eligible and newly out of children will. thank you. also, of those -- newly eligible. those of gone to the marketplace but not medicaid, how many were previously uninsured but are now covered? how many were ensured that had a plan and canceled it? do we have that kind of information? >> may be able to get some of that from the insurance companies. we would not collect that specific information. >> and people are talking of whether or not a policy cost less or more. it's critically important the facts. is there a way that your office or is the indian building where we can find out how many people are paying more, less? >> again, we will relying companies because we talked about formally insured -- >> switch plans? >> switch plans, they may have

paid something. but that's really going to be company data, not bad that we would have. no one newly insured would have that comparison. >> people of different opinions and a good be great if we facts on that so that would be helpful. of the demographics, when i talk to some people who are insurance brokers or agents, they are describing that many of those are some of our people who may that health problems with high-cost already and they're going to the mark place to find some way to low-cost. there's also groups who may be healthy and they're seeing some prices changes. if the affordable care act was designed to help a sign up the were not able to afford health insurance before, or who are having difficulty because they had illness, what we have breakdowns a stop on those factors? >> again, we will be able to tell you hopefully in the not-too-distant future demographic breakdowns. because we don't collect personal health information from

anyone, because there is no longer a preexisting condition. nobody is medically underwritten anymore, which everybody was in the individual market. we won't be able to tell you who of the population is six or not -- >> probably only item, the question on the questioner, disability or mental health problem or emotional problem. i guess we could look at that data and people check that box, that would tell us something. >> for medicaid eligibility there is i think a question on pregnancy and question on disability. those are the only two questions because that may qualify someone of a different income category for medicaid. those of it with you i think health information that is collected. but we don't have personal health information. >> we will get those facts. >> usage as mckinsey -- to the white house encourage you to ask or was that a decision on your own?

>> we made the decision going forward. >> why was that? >> i think it's prudent to invite people who have not been directly involved with building a product to take a look at, get their assessment of how things are going, what the problems are and do it enough and events that hopefully you can take their advice. >> i would love to know from you. let me ask this, the president said it people have suggestions to improve what's going on he would like to know. i'm wondering, is there some recommendations you have for congress what we need to do to take care of some the problems we are facing? >> well, i certainly think that we will know a lot as we complete this first year of open enrollment. i would love the opportunity to come in and discuss those with this committee, and others. this is as you know the final

phase of the three and half your implementation that has been underway, and i would say that we know a lot about the young adults that we didn't know them. we know a lot about some of the preventive care issues, if you say, mental health will be a part of this so i think we will have a list to actually share with you. and we would love to work in a bipartisan fashion to actually fix the bill. there's no question that a brand-new bill, you know, will take some and amendments and hopefully move forward, but i would welcome that opportunity. >> thank you. now recognize the gentlelady from florida for five minutes. >> thank you, mr. chairman. secretary sebelius, i'm very pleased to see all of the progress that's being made with healthcare.gov. report from consumers and recent enrollment numbers suggest that individuals using the website to obtain quality, affordable health insurance are having a much smoother and more successful experience. thank goodness.

weeding over the statistics from the new report -- reading over the new statistics i was surprised the state of florida is leading enrollment out of all of the state on the federally run exchange is. because we've had so many political roadblocks. there's been so much misinformation. this is good news for floridians and it makes me wonder what is the website have been working great right off the bat, these would probably be doubled. so i know families and individuals have more time. we really want to push over the next few weeks, but you said they have three and a half months? >> that's correct, congresswoman. and as you know because you've been a key part of this, i think the assistance of not only key members of the congressional delegation throughout florida but mayors, civic leaders, health care providers, navigators, assisters, stepping up and really getting information to people who does billy needed. florida has one of the highest

numbers of uninsured americans in the country. and clearly people are eager for information and welcome the opportunity to make some choices for themselves and their families that they've never had before. >> in fact i had one report yesterday that a local enrollment there at a church, they kind of -- i had this e-mail from a tampa family health center but two stories. one, rodriguez, a 63 old woman who has been without health insurance for three years stated, what a blessing to finally have insurance. she said this with a smile and replied hashes able to finally afford her medication for her preexisting conditions. her tax credit is $530, and she purchased insurance for just $35 a month. and then robert welsh, a 29 year-old single young man who had no insurance for the past two years, he works for a small business and his employer was

not able to afford private insurance. he was able to get a tax credit for $2200, and this premium is $28. he was extremely pleased and agreed to share his story, but he said he is too shy to speak in public. so, robert, we are sharing your story today. i want passionate i'm grateful now that we can replicate these good news stories. we have a long way to go. on his small business question, we are all a little disappointed that the shop, the small business website is not going to be up and running as early as we would've liked. but this that effective tax credits that are available for small business owners, the tax credits that encourage small businesses to provide health insurance or to help make it more affordable for their employees to? >> no, congresswoman. it will not impact event. as you know, we had earlier suggested that at the federal

level, and this is different in some of the states but at the federal level, year one we would not be able to aggregate premiums that give employees of businesses under 50 a choice. that will happen in 2014. the tax credits are very much in place. we have, again, a process where we are working with agents and brokers which is the way that small business owners have gotten coverage traditionally come and accounts. >> there are three or four employees, especially in a tourism field state, you know, a lot of restaurant owners. >> but the tax credit this you will go to a 50% tax credit for eligible employers. if the tax credits that did not exist before the affordable care act. it's been a 35%. it rises to 50% and we will absolutely be enrolling. with thousands of applications for shops. we are working to get folks enrolled, and shop is different

than the individual market, where business owners have a 12 month enrollment period because of the timing of plans. so shopowners or small business owners will be able to enroll each and every month as their employee insurance comes up for renewal. >> any file for the tax credit when they file for -- >> that's correct. in 2015 they would be eligible. >> so planning a very small business owner looking into that, because i don't think that many small businesses understand this very robust tax credit that's growing from 35% to 50% might make a huge difference. >> the sba has been a trip a partner in that effort. they're using their channels to do a lot of outreach and education. >> thank you, madam secretary. now recognize mr. lance for five minutes of questioning. >> thank you very much, mr. chairman. good morning to you, madam madam secretary. >> good morning. >> my question will be in two parts.

first regarding the rule of law, and second regarding the medicaid expansion. regarding the rule of law, i will be going into an exchange and that's how i read the statute, even though i didn't vote for it. i hope that it is replaced and those who work with me at our office will be going into the exchange. and i would urge other members, for example, senator reid, that as i read the statute, that is the rule of law. in answer to ranking member waxman, you indicated, and i certainly agree with this, that the president decided a transition policy. even though the statute as i read it has requirements that began on january 1, 2014. from the perspective, madam secretary, what is the statutory

authority for the president to have announced the transition policy? >> sir, i think the statutory authority is the enforcement discretion which is available under the law to us and the president has asked us to our enforcement discretion, to not pursue penalties against insurers who would voluntarily decide to allow a transition of individuals in the market plan to continue in that market plan. this the first to state regulators. they get the first call, because they regulate the marketplace, and it ensures, there is no mandate to insurers. it's voluntary but it allows them to take up that option. >> from your perspective, the ability of the president to do that is based upon enforcement discretion. i respectfully disagree with

that. thank you for answering the question. number two, and mr. barton did raise this. as i read the statute, the our subsidies for state exchanges but not subsidies for the federal exchange. and i presume that that was placed into the statute to encourage states to have their own exchanges. the carrot and stick approach. from your perspective, madam secretary, what is the statutory authority for permitting subsidies for the federal exchange? >> again, sir, i'm not a lawyer and i would defer to the department of justice for the statutory authority. i think the framework is that i am mandated by statute to pay the subsidies, and that i think the interpretation is both by the omb which is worthy of procreation leader on this and

the department of justice, that the authority is, consented you even though it's not explicitly spelled out, but again, i'm not a lawyer. i would defer to them. >> let me state it is my legal position the courts will rule against the administration in this regard, and, obviously, this is not before the courts. iin the three and half years since the ack's passage, as the president ever proposed a legislative change to any aspect of the law? >> sir, i'm trying to refresh my memory. i cannot answer that question but i will come back with an answer. >> server. it's my understanding the president has never asked o for any statutory change whatever. he has made -- >> i can tell you one. that i do recall that i think has been in his proposals. we do have a provision involving

state waivers of medicaid expansion and then into the marketplace. that is time to start at 2017. is suggested that he think it's part of our budget proposal that they would be accelerated so states would have full authority. there are other provisions i think in our budget plan, not necessary pieces of legislation not coming through the way that we could get you -- >> thank you. finally, regarding the medicaid matter. i have great concern that many who have signed regarding medicaid expansion, where eligible before, and i know you're not able to provide those figures today but i would like at an opportunity that is convenient for you, madam secretary, to have those figures. because it's my belief that quite a few are, were already medicaid eligible and not based upon the new law. >> the gentleman's time has expired. now recognize the gentleman from

maryland, mr. sarbanes, for five minutes. >> thank you, mr. chairman. thank you, madam secretary, for being here. you've been very stored in the face of a lot of adversity over the last few weeks. you've accepted responsibility for what you yourself characterize as a failure in the launch of the website, but have obviously been a crested in trying to improve the situation. the evidence you presented today suggests that things are on the mend and a lot more americans are being able to access the government website, which is the portal to affordable health care for them. i think if you step back, the bigger story here is, they were previously millions of americans do were essentially trapped in a world where they could not access health care. there was literally no options available to them. if they had a preexisting

condition, even the substandard plans that were offered in the individual market often did not provide any option for them. so they didn't have the opportunity to complain or face the challenges. now some of them are facing. but the fact that they are trying to access an option of affordable care, and yes, encountering some difficulties and having to push through those, et cetera. even that is progress, because before they didn't even have the chance. and i think it's important for us to keep that in perspective. and that's why you said earlier, i heard someone say that -- maybe it was chairman waxman -- that one of the common emotional responses for people when they

actually can enroll is a breakdown in tears. because their years of pent-up frustration and not be able to access to affordable care. >> august and, we know a game in the individual market, which is the market that the new marketplaces are addressing, a large number, national studies show that it could be as many as 25% of people who tried to buy a plan were turned down totally. no plan at no price. then you have people who were individually medically underwritten to virtually everyone in the marketplace. and that is very beneficial if you're healthy and don't have any likelihood of a pre-existing condition and typically if you're a male. it's not very beneficial if you're not. and if you get sick along the way or if you're diagnosed, you could be again medically underwritten going for to eliminate the condition that you need the care for.

the choices were somewhat limited to a lot of people. >> the promise of this is to create a new normal for the american people where the option of getting health care israel. and that wasn't the way it was before, for tens of millions of americans. >> depended on where they were. if you were at a company and the vast majority of large employers -- >> then you have the access speed and you were not medically underwritten and get work penalize based, as long as you were in employment. but if you work for yourself, if you're an entrepreneur, if you were a service worker and didn't have affordable coverage, your options were greatly -- >> but even that system will be more rational going forward, because as you eliminate discrimination based on preexisting conditions, you address the problems, the portability that we saw before. when somebody leaves one input and goes to the next, those are

all fixes that will again improve the employer based system as well. in terms of the challenges, obviously the launch of the website was much more difficult than was expected. but there were always going to be challenged. there's going to be new challenges. there are things, you look around the corner, there's going to be difficulties and challenges associated with some of the pain and issues that will happen down the line. these were always going to be there. they were always going to be difficulties. this is a major, major structural change to the health care system, which is going to improve it eventually, but we have to anticipate that there will be difficulties. we've got to soldier through those. that's the american ethic, right? is you take challenges and you overcome them. and alas, i just want to make is i think one of the issues is that a lot of the people who are coming and finding new plans, and maybe they have to pay a little bit more, or maybe the

deductible is higher in some instances, for example. but what they don't compare it against is the exposure they had under the old plan that maybe they never had the experience. so that's the apples to apples. >> the gentleman's time has expired. we have 15 minutes left. we have seven members still asked question. we will go to two minutes per member. chair recognizes dr. cassidy from louisiana for two minutes of questions. >> your answer to mr. shimkus, did you really mean to say the affordable care act has not resulted in increased premiums for the non-subsidized? >> sir, what i said was preventive care -- >> no, no. are premiums higher? >> premiums overall in terms of -- >> you are describing it to the preventive health care aspect? >> that's what he asked me. that's what answered. >> jonathan gruber, the architect of this bill said that this bill is basically income redistribution.

there's the taxes that are a trillion over 10 you but also the increased premium that people are paying. for the policy that did not subsidize. do you have an estimate of how much increased in what amounted increased taxes -- excuse me, increased premiums people are paying to subsidize others on the exchange of? >> no, sir. i don't. and i think you can only talk about increased premiums and i think dr. gruber would be one to suggest this. if you compare like benefits to like benefits. >> so let me go on. danny from baton rouge is losing his coverage. he says that -- this is my apocalypse now. the company i have, my family coverage one of 371%, monthly premiums for family of four on two and $45 a month for 913. with a $4000 deductible. wow, i think danny would like to choose his benefits as opposed to the. many small businesses according to your office are going to lose

their benefits. as many as 66% of employers according to your analysis will lose their grandfathered status. you think administration would support my employee health care protection act which would allow workers to keep their group health care plans they have not in 2014 and beyond? >> sir, as you know, the snapshot is not our office estimating anything. it was a description of the turnover that existed prior to 2010 in the individual and small group market. those statistics that you cited. and i think come again, the small group market there are lots of plans that are grandfathered. there are other plans that offering transition and early renewals and we're watching that everyday. >> could i get an answer to my question? with the administration approved the same law given to the individual that is a small business wishes to keep the policy they would be allowed to do so?

>> the president's suggestion about a transitional policy applies to both individual and the small -- >> beyond 2014? >> the gentleman's time has expired. the chair recognizes mr. and go from new york for two minutes of questions. >> thank you, mr. chairman. i just want to say that new york -- mr. dingell. a good example when the federal government has a willing and enthusiastic partner in aca implementation that we set up exchange, we have hospital participant in the first delivery system reform. our medicaid program is expanding. states that are thought to make the law work for the citizens like new york are finding success. madam secretary, i would like to know what your experience has been in states that have obstructed efforts many republican governors to implement the aca compared to states that have adopted all its measures. are americans expensing easier times obtaining affordable health care coverage in states

that have their own exchange? has the refusal of some ask states to expand medicaid affected the rollout? >> well, i think that what we are seeing every day is governors actually considering the medicaid expansion. some as you say in new york, california. others adopted very early on. we were please yesterday that the governor of iowa indicated an interest in moving it on medicaid expansion. that was not -- the governor of pennsylvania was recently also indicated his interest in doing the same. so we are working actively with states around the country. i think it is enormously difficult for consumers in states where there is no medicaid expansion. they hear about the opportunity for affordable health coverage only to find out that they earn to less qualified for a tax credit in the marketplace and really they have no viable option at all.

and that i'm told by our navigators on the ground, our ancestors, the people ingenuity health centers is one of the worst conversations that they can have in this period. >> we spoke with the governor of kentucky the other day, and he explained to his kentucky jelly a republican state where it's working really, really well. you have a governor who is a partner who wants to see it work. it can work and it should work. i hope that more governors would continue to do what is in the best interest of their constituents rather than playing political games. thank you spent the chair thanks the children. now recognize the gentleman from conducting. >> thank you. 80% of the people signing up on our exchanges our medicaid. that's been a concern of mine. i was in state government before. medicaid as a national program has 72 million people and were expecting an increase of 25 million over the next 10 years. i do believe medicaid for low

income, disabled and seniors. should it be a program of last resort where it just becomes its own engine program as it is no? >> first of all i think the enrollment numbers are about 51 million, not 72. but also medicaid has played i think a critical role for lower income americans, not only offering wide range of health benefits but at a lower cost per capita than private insurance -- >> i've only got -- they can to stand a couple of minutes. the question of what to get tht though, your department has estimated about 5 million americans have previously purchased interested of what will lose medicaid. that's in the office of actuary, the number we got. are you familiar with that come that we're looking over the next four years estimate fight like americans have employer-based insurance will move to medicaid?

>> i am not aware of that. the office of veterans with an independent -- i can check that out. i'm not the money without specific number is the the estimate is $20 billion in this group of people who present purchase health insurance through their employer but who will be moving to medicaid. the question that chairman upton at about income, there's a question with chairman upton about income verification and residency verification. i know that's up to the states be but the state to don't expand medicaid, the information right now is just like trust the federal government numbers, right? >> again, we don't enroll, we don't enroll anyone in medicaid. what we do is look at income eligibility. and based on the state law, send that individuals name and information that has been collected to the state. the state actually is the connection between the individuals and medicaid.

>> but by january 1 they will just have to accept that. >> that's going on right now. but we don't enroll in medicaid. we just -- >> right. >> the gentleman's time has expired. thank you, madam secretary. >> thank you, mr. chairman. secretary sebelius, let me just let you know that i agree with representative lances reasoning on the matters he brought up earlier in his testimony. i do find it interesting when we are listening to my college on the other side of the out and to talk about scare tactics. this is similar to what they said back in the summer and in september when we were holding hearings because we are hearing that the plane wouldn't be ready on october 1. so i'm just concerned we will have some of that same kind of thing now that we are being attacked for asking questions. we're just trying to get the information. it's not that we are interested in scare tactics or witchhunts. it's a matter of we're trying to get to the bottom of a lot of these problems that we are

concerned about. obviously, one of the tactics, this is all just political, but you certainly have accepted responsibility and you don't believe we cause the problems with the website, therefore making the public distrust it. isn't that correct? >> i do not believe caused the problem to the website. >> thank you. some of my colleagues have implied, maybe not that but somehow we are responsible for all the distrust out there and i don't think that's a good. also i don't believe that the federal employee health benefit plan is a skippy play. some of the folks said the reason that cars are going up is people that this can't be blamed. i was pretty does on the federal employee health benefit plan and my family is facing 117% increase out of our pockets. that's out of our pocket increase to go onto the exchange here in d.c. and so you don't think the plan you have is skimpy, do you? >> no, sir. i don't. but as you know -- [talking over each other] >> have some adrian fenty

federal employee health benefit program an did not so you will e younger employees paying a lot less an older -- >> i'm running out of time. let me say this with regard to medicaid. one of the problems is your send people to the states based on income alone and in virginia and no states they have an asset amount. in virginia it's only $2000. they may have sufficient income -- are they may not have enough income but they qualify for medicaid under income but they don't qualify because they own a house. have to choose whether they want their assets or medicaid. >> again, state law and state medicaid enrollment officials will make the determination of whether that individual will be enrolled. when they present at the marketplace based on 133% or less. in virginia right now it would be based on a lot less because virginia has not raised their medicaid eligibility. we would make a determination and refer that name.

>> dr. gingrey, two minutes. >> madam secretary, a question on the medicaid program. take the dealer george, i am sure all the other 49 governors would one inch. the americans -- affordable care act for states to retain the of the requirements for medicaid to the maintenance going back what, the 2009? with the expiration of these provisions states will finally have the flexibility -- tailored to the best addressed health care needs of their medicaid populations. this is the question. will the medicaid m.o.d., maintenance about to expire for all states beginning on january 12014? >> yes, sir. >> thank you. madam secretary, real quickly, in regard to e-health plans, this company, california-based company i think 10 years old, we talked about earlier in the discussion, i think they spent about $109 developing the

program allowing people to go onto the website and find place. and yet we spent seven times that much reinventing the wheel. can you tell me why we didn't just use that technology, or maybe some other silicon valley company, to have a public private partnership rather than starting over from scratch? and he made that decision? >> well, sir, i would tell you that while there are some comparisons with the e-health situation, there are a number of features very different in the federal website that were required. the health doesn't determine citizenship eligibility. it doesn't -- >> yes, but did you make that decision? or was not made by someone else? >> what decision? >> decision to start over from scratch. >> i don't think they did start over from scratch. actually i think along the way

adopted a number of the known technologies that were in place. >> let me ask you. how many times did you actually visit with the president since 2009 or 2010 when he came on board, how many personal visits did you have with him at the white house regarding the affordable care act? >> a lot. >> can you verify that? >> i -- >> the gentleman's time has expired. the gentleman from florida for two minutes per question. >> thanks are holding the string. madam secretary, in november, a proposed rule in november, cms announced that they were considering increasing payments to insurance companies under section 13 fortitude of the ac. this program is proposed, is supposed to be financed by insurance companies participating in the exchange, but the proposal appears to put taxpayers on the hook.

specifically, the rule states that and i quote, this proposed adjustment may increase the total amount of risk payments that the federal government reduce the amount of risk quarter we see. did you, madam secretary, estimate how much more money taxpayers would have to pay to insurance companies under this proposed rule? >> sir, the risc core door has always been a part of the affordable care act and was anticipated for the first couple of years to be used for reinsurance and risk corridors for the new market place. so did put out a proposed rule. we talked about the fact that we would look carefully at what the immelman is at the end of -- >> i want you to answer the question. did you estimate how much money? >> we won't know anything about what that risk quarter looks like until we get more involved. >> the rule says, ethical, we cannot estimate the magnitude of this impact on aggregate risk

corridors, parents and charges at this time to like to get to the next version. do you think is responsible to put taxpayers on the hook for insurance companies losses in the exchange? do you think it is responsible to make these payments without estimating the cost of? >> again, sir, it will be based on what the risk pool looks like. we always knew in the first couple of years the market would be attracting some customers and not attracting others, and that ithere would be some risk. and what we are hopeful for as the affordable care act continues into maturity is that we have mature pools. we knew the first years -- >> the chair thanks it gently and not recognizes mr. omers for two questions -- ms. ellmers. >> thank you, mr. chairman. thank you, madam secretary, for being with us. i have some specific questions to ask about some of them a sense of the promises that the president made to the american people as he was rolling out the

idea of the affordable care act. one of those promises being if you like your doctor you can keep your doctor, carried. can you commit to the american people today that this is true and that they will be able to keep their doctor? >> congresswoman, i think that, as you well know in the private market, networks change on a constant basis. the president is not over taking the private health insurance market. there is -- >> you are correct. that was the promise, the promise that was made to the american people so that this piece of legislation which is now law was passed was that they would be able to keep their doctor. yes or no? >> most consumers by the opportunity to pick and choose a network that continued their doctor. there's nothing in the law that has their doctor lost for them. >> there is nothing in the lot with our networks that are now

very narrowed as result of the law, is that not true? >> insurance companies make network decisions day in and day out. [talking over each other] >> but that was not the promise the president made. did the president not make that promise of? >> private insurance market that changes networks basically -- >> why in the world, madam secretary, did the president make that promise to the american people? >> i think the president was trying to assure people that the law did not require them to lose their doctor. they have a networked -- >> no. i do believe that he was reassuring the american people that they would lose their doctor. i think he was reassuring the american people that if this law passed, they would be able to keep their doctor. so, therefore, today you're basically saying no, this is not the case of? >> i am saying that there is, again, this is the private insurance market where insurance companies develop networks and change them on a -- >> and the american people will

give the keep your doctor if they pay more according to ezekiel emanuel? >> they can choose the network whether doctor is available spent and play more? >> whether doctors not available based on the kind of premium, the kind of deductible, the kind of -- >> i see my time has expired so thank you, madam secretary,. >> the chair thanks the gentlelady. that concludes our questioning at the present. madam secretary, we'll have some follow-up questions were sent to you. we will ask that you please respond probably. we have a couple of unanimous consent request that i would like unanimous consent to submit to the record a letter from doctor julie welch, an emergency medicine physician and educator from indianapolis. without objection, so ordered. dr. burgess? >> thank you, mr. chairman. dr. gingrey referenced an offer from the health to the president to provide a platform for the