.

in the pacific islands, had an opportunity to hear a story and witness a video of this elder who was standing in the pacific ocean, up to his waist, and he had his children next to him, and they were probably up to about here. they were standing in the pacific ocean. as the lens zoomed back, they were visiting their elders in their graveyard. their graveyard has been in the same place since time in memorial. and now because of climate change, two times a day that graveyard is covered up by the pacific ocean. so it's amazing how the biggest impact i believe are up in alaska and near the equator, and we're all going to start feeling it. so i personally -- and now we have a couple of individuals on the climate change --

>> reggie and karen. >> yeah, reggie and karen were disappointed as natives to this climate change work group. so, yes, it will be a strong push me because my staff has ade it a top priority. one more question. lance? >> we are the last tribe to get federally recognized through the process in 2010, and the issue is a major issue within my community. it is really affecting our ability to do any kind of land trust. you have to employ congress to make this stick. i want to get some ideas from you as to how we're going to move forward in an attempt to get a fix.

this is in light of the decision that just came out the other day. it's really starting to impact not only the small tribes, but it's going to start to have this ripple effect to affect all tribes, especially with this decision. i'd just like to hear from you on the issue and where we are going to move forward with that. >> the decision from the supreme court was probably one of the worst decisions in a long time, because it impacted a lot of tribes across the nation. we are the first people of this ation, we are, we've been in our homeland since time in memorial, our roots go deep into that soil. our elders are in that soil. and because of bureaucratic red tape and bureaucratic screwups over the years and them making

the decision that, oh, you're not a tribe, and let me think about whether you're a tribe or not, it's ridiculous. and so what they've created is an era of uncertainty for tribes that have been recognized after 1934, even though they've been -- we don't move around. we don't get the luxury of, you know, using up all the resources in one part of the country and then moving to the other part of the country. and with this decision that just came down, the big lagoon, that really, really is scary for tribes that have had land in trust since 1934, 1944, 1954. i believe they've had this land since 1994. we have to work really hard. and it's unfortunate that many of these legislators are tying gaming to this, when it's only a small part of the big picture. so we need to educate them and

work with them. >> and that's all the time we have today, but we do have questions that have come online and other questions. if you can send them here, we also have many staff around here that will take your questions. we will respond to all the questions that we have. thank you for joining us across the country. we had many schools and organizations that partnered with us, a lot of folks on twitter, and our facebook, and thank you all in indian country and outside of indian country for joining with us today for the state of the indian nations. thank you. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2014] >> after "news makers," president obama's state of the union address and the republican response by washington representative kathy mcmorris-rogers, sunday at 10:35 a.m. eastern, also here on c-span.

>> c-span, we bring public affairs events from washington directly to you, putting you in the room at congressional hearings, white house events, briefings and conferences, and offering complete, gavel-to-gavet coverage of the u.s. house, all as a private service of public industry. we're c-span, created by the cable tv industry 35 years ago and funded by your local cable or satellite provider. watch us in h.d., like us on facebook, and follow us on twitter. >> today president obama and vice president biden met with the crew crew's of large and small businesses to talk about hiring people who have been unemployed long term. then president obama spoke at the white house about a new labor department initiative that would support partnerships and hiring by nonprofits and businesses. his remarks were about 20 minutes.

>> good morning. my name is erick varela. it is a great honor for me to be here at the white house today with the president and vice president, especially since, three years ago, i was unemployed and homeless. i am very happy to report that my story has a happy ending, but for a long time, my path forward was very unclear. i spent six years in the united states army where i proudly served my country as a combat infantryman. work was hard, the hours long, and the duty was dangerous. after my honorable discharge from the military in 2008, i returned home from california to begin a new life with my wife and daughter but was quickly met with the realization that there was no work for a skilled heavy

equipment operator and i was struggling to make the transition to a new career. i cannot find work in the construction industry, so i started to apply for fast food restaurants and retail stores. with no luck, i was motivated to work and i wanted to work, and i knew i could contribute to society like i had in my military service, but i felt helpless, lost, and more importantly, a disappointment and failure to my family. i was very fortunate to find online a new program started by pacific gas & electric company in california called the power pathway program that offered job training and skills to people who had no experience in the utility industry. i quickly applied and was accepted into a 16-week program in san francisco and i'm happy

to share that i graduated the pg&e power pathway program in 2009 and was hired in 2010, where i currently work as an apprentice electrician in eureka, california. i want to thank pg&e for giving me this opportunity, and the work they provided me restore purpose in my life and gave me sense of direction once again. i am glad that pg&e is expanding the power pathway program to address long-term unemployment and for signing on the president's initiative. let me end my remarks by thanking president obama for bringing companies together to help on work for thousands of americans who only want the opportunity to succeed. now it is my honor to introduce the president of the united tates, barack obama. [applause]

>> thank you. thank you so much. thank you, everybody. first of all, let me thank erick for being here and sharing his story for his service to our country. rick, everyone recognizes what a great success story this is, but also the notion that omeone with this kind of skill and talent was having this kind of difficulty finding a job indicates the challenges we face. i want to thank all of you, business leaders,

philanthropists, elected officials, all members of my cabinet and administration, not only for coming, but for committing to more success stories for more people like erick, making sure that everyone in this country who wants to work as a chance to get ahead, a paycheck, and the structure that a job provides to people. i said in a state of the union, while the economy is getting stronger, businesses like yours have created 8 million new jobs in the past four years. unemployment is at the lowest it has been in five years. we all know we have more to do to build an economy where everybody who is willing to work hard and take responsibility can get ahead. we have to do more to restore opportunity for every american. he opportunity agenda i laid

out the gains with doing everything we can to create new jobs here in america, jobs in construction and manufacturing, american innovation and energy, steps we can take to streamline our tax code, incentivize companies to invest here, things we can do to make sure that we are continuing to lead the world in innovation and basic research. we have a whole lot of infrastructure we can build that can put people to work right away. we have a couple trillion dollars worth of deferred maintenance in america and the ramifications of us taking that on would be significant. we have to roll faster and put more shoulders behind the wheel of expanding economic growth. step two is making sure every american has the skills to fill those jobs. step three is we have to guarantee every child access to a world-class education, from early childhood, to college, to a career. [applause]

step four, we have to make sure the hard work pays off, with wages you can live on, savings that you can retire on, health insurance there when you need it. today we are here to focus on hat second point, connecting more ready to work americans with ready to be filled jobs, so folks out of work can apply the skills they have already got. getting people back on the job faster is one of our top priorities, but i have to confess, last month, congress may not harder by letting unemployed insurance expired for more than a million people. each week congress fails to restore that insurance, roughly 72 million americans will lose their lifeline. for our fellow americans that have been laid off through no fault of their own, on implement insurance is often the only source of income they have got while they look for a

new job. when erick was out of work, it s a lot harder to look for work if you cannot put gas in the gas tank. if you are worried about whether there is food on the table for your kids. if mom is not making the rent and paying her phone bill, it is a lot harder for her to follow up with a potential employer. on implement insurance offers that security is about losing your livelihood does not mean that you lose everything you worked so hard to build. that is true whether you have been out of work one month or six months, but those that have been unemployed the longest often have the toughest time getting back to work. it is a cruel catch-22. the longer you are unemployed, the more unemployable you may seem. this is an illusion, but one that unfortunately we know

statistically is happening out there. according to one study, if you have been out of work eight months, you are likely to get called back for an interview only about half as often as if you were out of work one month, even with the identical resume. so we are here tonight to say that is not right. we know there are folks like erick all across the country who have enormous skills and talent and capacity, but they need a change. i invited him to -- a mother of two boys to my speech. she was employed since college, never collected on implement benefits, never dependent on the government. when she lost her job to budget cuts, she could not find another and turn to unemployment insurance to make sure she and her husband could eep the new home they just

spend their life savings to buy. as i said on tuesday, she wrote to me and said i am confident i will find a job. i will pay our taxes and raise our kids in the home that we purchased in the community we love. please give us this chance. i thought that spoke for so many americans out there, just give us a chance. they are our neighbors, friends, young and old, black and white, men and women, phd's and ged's. interestingly, the long-term unemployed are often times slightly better educated, in some cases better qualified, then folks who just lost their job. just because you have been out of work for a while does not mean that you are not a hard worker. it just means you have bad luck or were in the wrong industry or lived in a region of the country that is catching up a little slower than others in

the recovery. i have heard from too many of these folks that show up early -- they will outwork anybody. they fill out 200 applications, sending out resumes, still finding time to volunteer in their community or at a church. sometimes they have more education or skill then newly employed americans, but they just need a chance. someone that will look past that stretch of unemployment, put it into context of the fact that we went through the worst financial and economic crisis in our lifetimes, which created a group of folks who have to work longer than normal. they just need employers to realize it does not reflect on their ability or their value. it just means they have been dealing with the aftermath of this really tough job market. all they need is a fair shot. and with that shot, and out of work young person can get the critical experience he needs to

improve his employment rospects for the rest of his life. with that shot, someone with decades of experience could show someone with less experience the ropes. that is what today is all about. we really do not have an alternative because giving up on the unemployed will create a drag on our economy that we cannot tolerate. giving up on any american is something that america cannot do. erick made an important point in his remarks. often times, folks, no matter how skilled or confident you are, you get discouraged, and that affects people's physical health, it affects their mental health, and over time, you can have a negative feedback where it becomes harder and harder for folks to get back in the game because they are getting so many discouraging messages. that can have long-term impact, particularly, if it is early on in a young person's career.

so while congress decides whether or not it will extend unemployment insurance for these americans, we are going to go ahead and act. we know it works. we're going to go ahead and see what we can do without additional legislation to make some serious dents in the long term a plumbing problem. we know what works for employers and employees alike. i spoke on tuesday about the head of the detroit manufacturing system. she was with us at the state of he union, sitting with first lady. she worked with the local american jobs centers, early

funded, to hire people that were out of a job but ready to work. on average, they were out of ork for 18 months. today she says they are some of her best employees. greg is here today. greg has been working in sales for 30 years when he lost a job in december 2011 for the first time in his life, found himself struggling to capitalize on decades of work experience. after months of pounding the pavement, is on implement insurance ran out, and began, as erick described, darted to feel hopeless and useless. then last year he got hooked up with a program called skills for chicagoland's future, thanks to the work of our secretary of commerce and my former chief of staff rahm emanuel, and so this intermediary trains greg with the skills they need to be employed in a local company. two weeks later, he was back on the job helping people get signed up for health insurance they need. he said it made him feel relevant again, like i have something to offer.

so today, more than 80 of the nations largest businesses, over 200 medium and small sized businesses, are now making their commitment to set best practices like greg and misty and erick, can access, and feel as if they can have a partner in getting back on the job, making the contributions that we know they can make. so i want to thank all the companies who have made this commitment. [applause] with the support of andrew and --with the support of andrew and ursula burns chairing the business council, randall stephenson of the business roundtable, the society for

human resource management, we have engaged in companies all round the country, including here today, to commit to inclusive hiring policies, for aking sure screening practices do not visited it folks that have been out of work, to expand the open door policy hat encourages all qualified applicants, and of course, it s only right the federal government lead by example. today i am directing every federal agency to make sure we are evaluating candidates on the level, without regard to

their implement history. because every job applicant deserves a fair shot. i just had a chance to meet with some of the ceos who are making these commitments. some of them are already participating with what is going on in chicago. they have some great ideas of what works. one of the things we will need to look at is the impact of credit histories on the long-term unemployed. if you have been out of work 18 months, you have met -- you may have missed some bills. that cannot be a barrier of entry to you getting to work so that you can pay the bills. unfortunately, we are setting up, in some cases, perverse incentives and barriers, but in some cases, what i heard was, just pay attention to this. let's see if we are doing everything we can to look at every candidate on the merits. i was really grateful to all of them for stepping up in this way. i am confident that as a consequence of what we did, we will see progress across the country. going back to greg, his life was turned around because of a artnership, not just because he got a fair shot, but because he had advocates that helped

him earn the skilled than he needed to land a job that made sense for him. that is why we are excited to have programs like hicagoland's future platform to implement, and many others are presented in the room. as important as it is for the businesses to make this commitment, it is great to have these intermediaries and on profits who are also able to show success, even with folks who have been out of work for a long time. my administration will partner with the business community and the nonprofit sector. i have asked joe biden to lead an across-the-board reform of all of our training programs, working with secretary of labor tom perez, secretary of commerce penny pritzker, to make sure our job training programs have a single mission. train americans with the skills

employers need, and then match them to the good jobs that need to be filled right now. [applause] that is what we have to prioritize. today, i am announcing that the department of labor will put forward $150 million in the ready to work partnership competition, to support more partnerships that we know work. innovative collaboration between local governments, major employers, nonprofits, all designed to help workers get the steel they needed to build bridges to the jobs required. even though the economy is getting stronger, it will not be enough until those gains translate enough into better opportunities for ordinary folks like erick, who have kills and the desire, just need a chance. we are going to keep knocking down barriers to reemployment so more of the nearly 4 million long-term unemployed americans can regain the stability and security that a good job brings

their families. and by the way so they have more money to spend on local businesses, which will lift the entire economy up, creating a virtuous cycle, instead of a negative one. we will keep encouraging employers to welcome all applicants. you never know who will have the next great idea to grow your business. we will keep building ladders so that every american can join the middle class. we are stronger as i said on tuesday when america feels a full team. i want to thank you for the business commitments, the nonprofits here for the work you are doing on the ground. we are going to scale this up and make it happen. most of all, i want to thank erick and some of the other folks that have experienced success. before we came out here, i said, when folks see him doing well, that gives them hope, and

it reminds us that we cannot afford to let such incredible talent the wasting away. we have to get those folks back in the game. that is what i am committed to doing and i know joe is as well. thank you. i went outside the federal commitment. after this, i think you guys still have some more work to do. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2014] >> there we go. [applause]

>> the president's meeting, penny pritzker and thomas perez spoke to reporters outside the white house for about 10 minutes. >> well, thank you for being here today. we had a terrific meeting with a group of c.e.o.'s, a number of folks who've been long-term unemployed and a number of of providers of services to help our long-term unemployed find employment. what we're talking about here today is to make sure that all of the programs that we have are industry-led, and this is an issue that i am passionate about.

i've been working on this for years, long before i had this job. it's something to see programs that i've spent years working on being highlighted and the kind of enthusiasm that we see around the country for replicating efforts to bring, you know, solutions to folks who have not been able to find jobs, mostly because there's been a bias in hiring folks who've been unemployed, and that's what studies show us. so this is really encouraging. we had over 100 companies sign on to principle that is they would review their hiring policies to make sure that folks that have not had a job for six, eight, 10, 12, longer months, they wouldn't be discriminated against. so this is really an incredibly enthusiastic and exciting day for those of you who really care about making sure we all get up every day and make sure

that folks who want a job in this country should be able to get a job. >> thank you, secretary pritzker. it's been an honor and privilege to work with you. helping the long-term unemployed get on their feet is a top priority for the president. it starts with making sure that congress extends emergency unemployment compensation benefits. we continue to work with people on the hill across party lines to address this critical challenge, because people have gone from crisis to catastrophe in losing their benefits. we had a very productive meeting today, and this is an all hands on deck enterprise, and the president is using every tool in his arsenal to help long-term unemployed get back on their feet, and so today, in this meeting, we had an open and frank dialogue about some of the barriers that may inhibit the long-term unemployed from getting a fair shake, barriers such as the fact that their credit record may not be perfect.

their credit record isn't perfect because they can't afford to pay the bills. they need a job in order to be able to afford to pay the bills. so we talked about how we can eliminate those barriers. the president wants to practice what he preaches, and that's why the president signed the memorandum today making sure that federal agencies are eliminating any barriers and doing our level best to provide opportunity to this group of folks who have tremendous talent and simply want a fair shake. the department of labor will be issuing a $150 million grant competition so that we can help identify innovative practices across the country, and we heard them today in our session together. there are employers. there are workforce systems. there are private interimmediate airs. there are so many people out there who are doing promising practices, and so we want to take those to scale. we want to learn from those, and so the president is investing this money, this $150 million in this grant program,

and we're confident that this will help move the ball forward. we're going to continue working 24/7 on this issue, and we're very happy to take any questions that you may have. >> at your most optimistic, you have four million long-term unemployed, people that have been unemployed for more than 27 weeks. a program like the 300 businesses agreeing to these, making these commitments, what percentage of that huge number do you think you can reach and help over a period of time? >> well, this is certainly a down payment. you know, when you're talking about fortune 100 companies, you're talking about force multiplayers. when you talk about that, you're talking about helping thousands of people. we are engaged in a multifaceted effort to help the long-term employed. at the department of labor, wf a workforce system that helps over a million people get a job last year, and we're putting our resources to bear to help

even more with this particular focus on the long-term unemployed, with programs such as wage subsidies, so that we can subsidize an employer between 50 and 8 or 90% of the cost of the worker, and that's an incentive for an employer to take a fly other people. we've been able to help thousands of workers get back on their feet. so this commitment by employers -- and by the way, this is the beginning, it's not the end. there are other employers that i'm confident will be signing up, and secretary pritzker and i are going to be going around the country to do our level best to continue to increase this number. this is one part of a very wide-ranging strategy to address the most, really, vexing challenge that arises from the great depression, which is helping the long-term unemployed get a fair shake. >> what we learned from a number of employers we spoke with today, they went back because having been asked to review the principles, they

went back to their own practices and really were unaware of what was happening in their own companies to prevent the long-term employed being considered for jobs that they were very well qualified to fill. and so this is a very positive step, and i think it will go viral, because you're hearing leaders from different companies around the country saying, i'm going to be back to the other companies in my neighborhood and my city and my county, and i'm going to ask them to do the same, because frankly, this has been a good thing for helping our own company find good talent. >> once you convince the companies to this program, how do you hold them to that, and should the government take that role? >> i think what's so exciting about this program is that companies are pushing themselves. you know, finding good talent is really an issue for many of the businesses that we met with today, and frankly, from my own experience traveling around the country, talking to the

business leaders in my first seven months, i hear about shortage of skilled workforce as one of the top three issues facing every company, so we don't need to hold people accountable. we're offering them opportunity to find a workforce that they've been desperately, you know, seeking. >> and i'll say further, you look at the work that we have done in partnership with employers in veterans contacts, you look at the work we've done with employers in the context of hiring qualified people with disabilities, tremendous progress has been made in those areas as a result of commitments that employed have made and partnership with the federal government and other key stakeholders. it's really a model that we can replicate in this context. >> more than 100 companies have actually signed to the principle to this point? i want to clarify this. >> yes, i think it was roughly 100 that signed up for today, and they're now going back to

their communities and encouraging their fellow employers to sign up as well. and what's so fantastic about it is the c.e.o.'s would say, you know, i hadn't thought about this issue before and have gone and looked at their own practices and determined, for example, we heard from one bank, they said, you know, we're turning away someone who might have a chink in their credit, but of course they have a chink in their credit. they've gone through a long period or a challenging period to find a job. it doesn't mean they're not qualified to actually do the job that we have open. and, in fact, they're sitting there with open jobs and can't find people. so it's been a great revelation to many c.e.o.'s. >> on some of the retraining programs that were talked bout, will those be new skills that are thinking is perhaps they'll be a greater need going forward so people can update, or how will that work? >> again, the programs you heard discussed today are

programs that exist within our workforce system, and they exist within the partnerships that we have been working with community colleges. so i hope that as people out there see the success of these programs, one of our goals is for congress to see that same success, because for every person that we're helping get that ticket to the middle class, there are other people who want to get into these programs, and because of the unavailability of funds, we're not able to do that. so i'm confident and hopeful that we will see more success, because success begets success. >> one of the programs we talked to today, skills for chicagoland's future, which is something i know intimately, having worked with them, the training that they're doing is very much geared towards the jobs that are open. they secure jobs, opportunities first, and then do the training geared towards those jobs. so sometimes it's very specialized towards that

particular opportunity. >> time for one more. thank you. >> thank you. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2014] >> this is a situation where we're not going to be able to pay our bills, and shame on us as america if that's the case. we ought to make sure that bills we've already committed to are paid, everybody is responsible in their own family for doing that, and we need to do that as a country. to me it's pretty simple. the constitution requires us to do it, and we ought to make sure we're paying our bills. >> so no negotiating with republicans? >> i don't think you negotiate on paying your bills. we can negotiate a lot of things. i've been negotiating for three

years on agriculture and food policy, but when it comes time to pay the bills, i think it's our responsibility to pay the bills. >> could you tolerate some off sets or do you want to clean it? >> we don't negotiate about paying our bills. >> next, the challenges of implementing state health insurance exchanges with the officials running the exchanges. speakers included audrey haynes. after "news makers," president obama's state of the union address and the republican response by washington representative kathy mcmorris rogers, sunday at 10:35 a.m. astern, also here on c-span. >> he was someone, as i say, who grew in the office. he was badly burned by the cuban bay of pigs experience. he had listened to the experts, c.i.a., joint chiefs of staff,

to he said -- and he went see de gaulle in france. did he that trip in may, june of 1961, and de gaulle said to him, you should surround yourself with the smartest possible people, listen to them, hear what they have to say, but at the end of the day, you have to make up your own mind, and he, kennedy, remembered what harry truman had said, the buck stops here. and i think after that bay of pigs, he was absolutely determined to make up his own mind, hear what these experts had to say, weigh what they were telling him, but at the end of the day, he was going to make the judgment and he was the responsible party, and you see that, you see that, that was abundantly clear when you listened to all those and read the transcripts of all those tapes during the cuban missile crisis. he was his own man. he was the one who was making his own mind and only held the

joint chiefs at arm's length. they wanted to bomb, invade, and he didn't want to do it. >> an inside look at the kennedy administration, sunday night at 8:00 on c-span's empty q&a." >> next, the challenges of implementing state health insurance exchanges with the officials running the exchanges. speakers include audrey haynes, secretary for the kentucky cabinet for health and family services. she was a guest of first lady michelle obama during the state of the union address. and experts representing california, maine, massachusetts, new jersey, and rhode island. this is hosted by the robert wood johnson foundation on friday. it's an hour and 20 minutes.

good morning and welcome to our robert wood johnson foundation spons earned health reporters roundtable. today our topic is where are we now. the state of health insurance exchanges and enrollment. i'm susan dentzer. i want to introduce some of my foundation colleagues who are here today. cathy hem stead in the front row here. her colleague brett thompson who runs communication for our coverage team. and both of them will be available at the end of the briefing today also to answer any questions. today marks the end of the first full month, the 123rd day to be

exact, not that anybody's counting, of the health insurance marketplaces or the exchanges. as we all know, the start-up phase was very rocky for the federal marketplace. healthcare.gov. and for some of the state marketplaces. on the other hand, other state marketplaces fared much better. and in the aggregate of course the big picture is it now appears that millions of people have successfully signed up, either for private health insurance coverage, for medicaid or the children's health insurance program through the exchanges. today, we've gathered five people who have worked closely with some of the most successful state exchanges to report on their experience. none of these exchanges were without glitches. on the other hand, many things worked. and we're going to hear about both the challenges and the successes. we've asked all of our speakers to bring us up to date on the

enrollment. what outreach strategies worked. and which didn't work so well. and what they foresee between now and the end of open enrollment period on march 31st. as well as what plans they're making for open enrollment next year which, believe it or not, is only nine short months away. so let me introduce our speakers now. first of all, heather howard is with us. she's the program director of the state health reform assistance network. that's a program funded by the robert wood johnson foundation. and it's dedicated to providing technical assistance to states. she's also a public affairs lecture ur at the woodrow wilson school at princeton university and faculty affiliatety center for health and well being. previously served as commissioner of the new jersey department of health and senior services and worked before that in the u.s. senate, the house of representatives, the domestic

policy council at the white house and the health care task force at the antitrust division at the u.s. justice department. we're also delighted to have with us audrey heinoanes. she previously served as the senior vice president and chief government affairs officer for the ymca of the usa in washington, d.c. and then governor steve ba sheer who of course you saw at the state of the union address the other night appointed her to the kentucky cabinet, the cabinet and her office oversees the kentucky exchange. hanes served in the clinton administration previously as deputy assistant to the president and director of the office for women's initiatives and outreach. also with us, we're happy to say, is christine ferguson. she's the director of the rhode island health benefits exchange. previously, she spent close to eight years as a research professor at the george washington university school of public health and services.

she also has served as commissioner of the massachusetts department of public health. as the director of the rhode island department of human services. and formerly as counsel and deputy chief of staff to the late u.s. senator jon chaffee of rhode island. so we're very happy to have christy with us as well. mili kaufman also has joined us. she's the executive corredirect the d.c. health benefit exchange authority. and served as the superintendant of insurance of the state of maine from 2008 to 2011. she also has served in key leadership positions at the national association of insurance commissioners and was formerly an associate research professor and project director at the georgetown university health policy institute. and joining us on the line by phone from california we're happy to have peter lee who's the executive director of covered california, a sacramento-based insurance

exchange and these states insurance exchange for small businesses. he formerly served as the deputy director of the center for medicare and medicaid innovation at cms where he helped shape initiatives to implement higher quality care at lower costs. he also served as the director of delivery system reform at the federal health and human services offices of health reform and before that was the ceo of the pacific business group on health and executive director of the center for health care rights. so welcome to all of you. we're going to start with an overview from heather howard, setting the stage for what we have seen to date in the state-based health insurance exchanges. so health, welcome. >> thank you. thank you susan. thank you to the robert wood johnson foundation for your work on expanding coverage. i have a few slides to talk about some of the key takeaways.

so what are we seeing? despite the rocky start, we've seen that enrollment in state based marketplaces is generally outpacing the enrollment in thor if fed really facilitated marketplace states. it's also because we're seeing far more robust consumer assistance and marketing efforts. and really important also is seamless eligibility between the marketplaces and medicaid. it's worth noting too there is a success story in five states. this is just early on that have been doing what we call fast track expedited enrollment for snap beneficiaries. that's food stamp beneficiaries into medicaid. oregon, despite their ongoing exchange implementation challenges, have been able to enroll 121,000 people into

medicaid through that fast track enrollment. but also we're seeing that plan choice varies by state level across the state-based exchanges and we'll hear from our friends here today about what it locks like in their states. overall, we're seeing that 80% are choosing silver or higher level. and that age distribution also varies. overall, 24% of the enrollees are in the 18 to 34 age range, that coveted age range. consumer assistance varies. one really important distinct between the state-based exchanges and the federally facilitated marketplace states is active robust consumer assistance. this chart demonstrates how much more funding. we know how important it is, given the general consumer confusion about their options. as people are learning more and more, the state-based marketplaces have more and more resources to get the word out. also the consumer assistance partnership states. which are also receiving funding

from the federal government for outreach. now, we've seen these early successes. there are challenges. first up are the systems failures. some vendors have not been able to deliver. states have struggled with the i. i.t. implementations. those audits are really prompting decisions about whether and how to salvage what they've built thus far or whether to start over. it really demonstrates a commitment from the states to system repair and enhancement. i think that suggests that ultimately those state-based exchanges will be successful over time. there have been significant investments in i.t. if they can salvage or repair, they will be successful. not only their system failures but states have figured out work arounds. as states tend to be good at doing. first, paper processing. and then in several states,

states have been pursuing policy options to allow people to keep their previous coverage options during this transitional period. so while we've had some rocky starts in some states, states have been looking at transitional patches to allow people to keep their coverage. and of course it's very important to make sure we're effectuating the enrollment in the coverage. we're seeing that's getting better day by day. today, there was some good reports out about how many people have -- were paying their premiums. but something that's been a real focus for state-based marketplaces is effectuating that coverage and making sure they're able to transfer that data back to the carriers about enrollment and about payment to make sure that coverage is effectuated. overall, very promising news from the state-based marketplaces. as we look forward. and promising enrollment data. which we know we're going to be hearing more today. so thank you. i'm going to turn it over to audrey.

>> thank you, heather. and of course i'm very pleased to be here. thanks to the robert wood johnson foundation for hosting the event this morning. so i know folks have heard a lot about kentucky. which we're really pleased about. as you all know, our governor is really pleased about it. so this is sort of a little bit short version of our story. in kentucky, there were 640,000 uninsured in a state that's just over 4 million. we have about 300 -- it's actually the exact number is 308,000 that we expected to qualify for medicaid under the new eligibility rules when we expanded medicaid. and about 290,000 we anticipated to qualify for premium assistance through the exchange.

the way it happened in kentucky is the governor signed an executive order which created the exchange and its administrative structure. it is organized in my cabinet, the cabinet for health and family services. i want to mention this just a little bit. we find that this is -- has been part of what we call the secret sauce, i suppose. in my cabinet, you have the department for medicaid services. you have the department for community based services which has been doing all the eligibility for medicaid and also provides food stamps and the snap programs. snap benefits and child care, that sort of, those programs. also in our cabinet is the department for public health and department for behavioral health. our office of health policy. just to mention a few of the major departments.

we think this is rather significant because it -- we haven't had many of the structural barriers you would think, well, everyone works for one big administration it shouldn't be a problem. but we all know that sometimes organizational structures do get in the way. they become barriers. also, because medicaid is in the cabinet, and they work so closely and did work so closely with the exchange, we also have a really experienced i.t. department. anyone knows that medicaid has to have a pretty super i.t. department that supports it. but so do the other departments within our cabinet. so we had a lot of experience within the cabinet at bringing up very large i.t. structures. and then we also had a really great vendor in deloitte consulting that truly sent their "a" team to the game with us. we established an advisory

board. our advisory board was made up of all the stakeholders. as i'm sure it happened in the other states as well. one of the stakeholders, i want to point out, it's had varying degrees of success in other places around the country. the insurance agents have been really, really involved in kentucky. and we have over 2,000 agents that have become certified on the exchange and are helping both small business as well as individuals get signed up. and clearly they -- even though they still of course receive an insurance commission, when they help people sign up for medicaid and helped walk them through, they don't get anything for that. and so a lot of the insurance agents that are in lower income neighborhoods and communities where a lot of people that are uninsured would qualify for medicaid versus one of our qualified health plans, they

have been really terrific in helping them as well. and of course we have what we call connectors. those are navigators. to help as well all around the state. our exchange is known as connect, kentucky's health care connection. so why did we decide to do it? it's not something we're proud of but we're about the 44th sickest state in the country. and if that's not reason enough, then i'm not sure what is. because we all know that both education and health are such important building blocks for a state's economic development opportunities that are afforded to them. 50th in smoking. 41st in diabetes. 48th in poor mental health days. 49th in poor physical health

days. 50th in cancer deaths. 49th in cardiac heart disease. 43rd in high cholesterol. 48th in heart attacks. and 44th in annual dental visits. not something that any of us in our state would be proud of. certainly not something that if you were serving as governor, secretary of the cabinet for health and human services, you would be proud of. kynect and the affordable care act provided us tremendous opportunity. really an historic opportunity to begin to take advantage of the law and turn this around. our health statistics, we believe, could actually get worse before they get better. at least the reporting. the reason we say that is because there's going to be such a high demand for screening and so many people that have gone without insurance for so long. we actually think there's going to be possibly a lot of chronic diseases that are diagnosed that have just frankly gone undiagnosed and unreported. so we're trying to get everyone

to brace for the fact that, you know, we could go down a little bit before we go up. but we know that ultimately we will be heading into the right direction. so what are enrollment statistics? these are as of monday. i have new statistics hot off the press this morning. i think when you'll give them to you, it will probably give you some idea of how quickly, how our enrollment, daily enrollment has really picked up. for example, we, as of this morning, we have 195,502 enrolled in health care coverage through kynect. you can see what it was at the first of the week. we had 148,837 that have qualified for medicaid. that's about 76.1% of the overall enrollment. it started out as about 70% of

the enrollment was medicaid. it's gone to -- or 80%. it went to 70%. now it's suddenly at about 75% of the enrollment as medicaid. we have 44,160 individuals that have enrolled in a qualified health plan. 54,094 have been found eligible for a subsidy to purchase a plan. and some have just not yet chosen that. we have 647,186 folks that have conducted a preliminary screening. and our call center reported this morning 456,950 calls that have been answered. we've had just under 1 million unique visitors to our site. the other number that's not up

here that we're very, very proud of in kentucky is we have 1,471 small businesses that have begun applications and about half, 548, have now completed them for their employees. clearly, all numbers that in our state we're really proud of. and here's our cute little -- cute little call center person. and our number. so i'm happy to answer questions and turn it over to christine. >> thanks so much. i'm really happy to be here today to represent the leadership in the smallest state in the union. you're going to have the largest state in the union at the end.

on behalf of our leadership, governor chafee, lieutenant general roberts, legislative leadership in rhode island and my colleagues in the cabinet. we really like the idea of being the smallest state in the union and in the top two best exchanges in the country. in terms of our enrollment and beating our targets. likewise, we have similar statistics of the other states in the context of making our way through the uninsured. we're about a third of the way, moving up into half of the way in medicaid of new enrollees. and in the number of ininsured in the state with the tax credit. i want to talk a little bit about lessons learned. the numbers have been all over the paper. everybody's focused on