we have to rethink at the government side how we do these things. for us in rhode island, we've been very fortunate. our system's working really well. we're moving to system stabilization as opposed to -- as opposed to fixing -- we're fixing, but as opposed to having to redo. that issue is the core of all of our businesses. it's essential lesson learned. it's essential cooperation between state departments and state agencies and quasipublics and the state leadership. if you tonigdon't have it, it's difficult to make sure you accomplish your goals. third, there are really fundamental problems in the basic law of the aca that need to be cleaned up. if we don't clean them up in the

next year or so, there are going to be ramifications for that. they relate to implementation of the law. they tie everybody's hands because we can't get agreement on moving forward. we need to move forward and fix the things that need to be fixed. the problems in the launch at the federal level scared away a lot of early adopters, particularly in the business community. that's not a good thing. the federal government has done a great job recovering and they're moving forward really well. but we have to acknowledge that there was some damage done in the context of the marketing and outreach. and that marketing and outreach piece has to be addressed. and we have to redouble efforts in that area. it is real private sector kind of customer service that we need

to provide. because we're providing services to a range of people. you've got the medicaid population. you've got middle income and upper income individuals getting tax credits or buying as 100% of the cost. and then you have small businesses. essential that we look at those customer service pieces. the investment in marketing from a government view of the world, that's a very different thing than the way the private sector looks at marketing. and investment in sales. and i know that's not always the best word but the truth is that is what's happening now. so we do need to rethink how we look at and invest in those kinds of components. the small business for the

future. small business focus is essential. employee choice for small business. as we're doing in rhode island and many of the other -- my colleagues here and other states are moving toward. the way that change is going to happen, it's not just reducing the number of uninsured, it's also managing costs and looking at outcomes. small business is essential in that component. and we really need to understand what they want and how to provide the kind of data and information that their employees need to make decisions. finally, this is the most important investment in health care that's made in 70 years. i've been at this for 30. which is way longer than i ever thought i'd be at it. this is it. if we don't take this opportunity to invest in looking at what the data and the

outcomes are in addition to enrollment on cost, on quality, if we don't provide consumers with a transparency and businesses with a transparency of how insurance works, how do make decisions, it doesn't have to be as complicated as it's been. we can break it down, unpack it and provide people with information so they can make better decisions. not only when they enroll in the health plan but also when they're making provider decisions. providers will finally have the tools. if we do this right with the data. providers will have the tools to push back and start redesigning more from the bottom up how payments need to be changed and how they can practice medicine and work with consumers in the way that they've wanted to, which is holistically. so at the end of the day, if we can't all stand up here in a couple of years and talk to you about what the outcomes were on

worker productivity, health care, health care outcomes, and costs, if we can't do that, coverage is only one piece. the american people want to know where the investment went and they want to know what they got for that investment. we need the data analytics to make sure they get those answers. thanks very much. >> good morning, everyone. can you hear me? great. so my name is knemila kofman. it's been almost a year since i've been in my current job. i want to start off by saying if it wasn't early on for the rwj

foundation helping me get some support, consulting support, i would not be part of the success story. i was the first employee hired. i had one more employee working with me the first month. and the foundation stepped in to help. so thank you so much to the foundation. and thank you for having me here today. october 1 was a great day for d.c. health link.com. bloomberg news that day was reporting we were one of four states, one of four jurisdictions that was open on time and state opened and consumers were able to do everything from start to finish. shop for health plan options. make health plan selection. hit the invoice me button. that was a great day. it is still a great day, every day for d.c. health link.com.

you probably know we have full functionality on the shop side, which is the marketplace for small businesses. and we have full functionality for the individual side. we're very proud. in fact, we were the marketplace selected by opm for elected officials in congress as well as congressional staff to have their job based coverage. in december we also enrolled the president, so i thank him for his business as well. we have broad insurance company choices and product choices on the individual side. we have 34 products on the small group side. we have 267 different products. and we all have -- and we also have all of the major insurance companies participating. etna care, first blue cross blue shield, kaiser permanente as well as united on the group side. i want to skip through the group

slides. i wanted you all to have them to give you a sense of where the product offerings are. both on the individual and small group side. i want to talk briefly about employer and employee choice. this is something that christy mentioned earlier. how important it is for us to not only focus on the individual side of things, but also on our small business clients. from day one, we were -- d.c. health link.com, we were able to offer small businesses the types of choices they do not have currently in the commercial marketplace before we opened for business. in fact, now small businesses essentially have the purchasing power of large employers and can offer their employees the types of choices that were only available to large employers in the past. so a small business getting coverage through d.c. health link.com can choose a level. and then the employees all have

the carriers, all the products, hmos, ppos, zero deductible, and a particular meta level. that's a type of option that never existed before. or the small business can choose one carrier and allow the employees to choose the different benefit levels. i also included some slides for you to show you a range of prices. i just want to note that the prices are very competitive in the district. in fact, if you're a 27-year-old person, you can get a policy for $124 a month. with one of the largest carriers. if you're 55, you can get a policy for a little under $300 a month. so very affordable coverage. i also included the range for the shop side for you, which i'm not going to go through. but i think it's interesting to see where the pricings are in the marketplace.

i do want to focus a whole lot on our experience with enrollment and also share some challenges and lessons learned with you. so as of january 10th, and we release data on a monthly basis. in a couple weeks, we'll release more updated information. and we do that for a number of reas reasons, including the fact we've seen movement in when coverage becomes effective for a particular enrollee. so what we found initially is some people wanted january 1st coverage but online they signed up for february 1st coverage and what we've been doing is we've been accommodating consumers who wanted the earlier start date. so if we release numbers on a weekly basis, the numbers wouldn't be accurate in terms of who enrolled for january 1st coverage, how many people enrolled for february 1st coverage, et cetera.

so the monthly release time for us works better in being able to provide all of you with more accurate data on the enrollment in d.c. so as of january 10th, we had over 20,000 people enrolled. that includes both the shop side and the congressional enrollment on the shop side. it also includes individuals and families enrolling in the individual marketplace, in private qualified health plans, as well as enrolling through dchealthlink.com into medicaid. i have to tell you that exceeded all of my expectations. d.c. has one of the lowest uninsured rates in the nation. over the years, we've done a whole lot to expand coverage options for our residents and small businesses. and when we started this, the

old census data showed we had about 42,000 uninsured people in the district. we have more updated information and the most current information on uninsured shows we had about 35,000 uninsured. the district expanded medicaid right away, after the affordable care act was enacted. and people with up to 200% of federal poverty level income qualify for medicaid. so we believe huge drop in the uninsured rate is a result of the early medicaid expansion. so when we started to look at our goals and tried to figure out how many people we can enroll in year one, our numbers from the start were a lot lower than kentucky, i have to say. but i thought, with my team, i

thought, let's try to hit the target of 5,000 in the first three months before december 31st. that was a kind of target for us to set and still be realistic. in the first three months, we exceeded that target. we had 1,000 people sign up for february 1st coverage. and we were able to get 4,600, almost 4,700 people enrolled into medicaid. in the first three months, we exceeded our goal by a whole lot. and then we had almost 12,000 enrollees in the shop. and the numbers -- i just want to note for all of you. the numbers in the next week or so that we'll be releasing will include enrollment by effective

date for january, february, as well as march. so you'll have that breakdown once we release that. another interesting aspect of our enrollment is who we're enrolling. we can show you by age, categories, our highest enrollment by age is the age group of 26 to 34-year-olds. and some of you know that the largest percentage of our uninsured, in fact, 60% of our uninsured population is under the age of 40. so right from the start we were very focused on the younger members of our community. and we have a success story to tell when it comes to enrolling those younger members. we did some creative outreach. in fact, we have youth enrollment leadership council

that advises us. which are folks on the ground who help people with enrollment. they're young and provide us with creative ideas. so we've done outreach event s t dance clubs, bars, at air jordan when the sneakers were -- when there were lines outside the stores with young people try to buy the air jordan sneakers. we were out there trying to educate and enroll those people. midnight snacks at denny's. we were there trying to educate and enroll and our numbers on the younger age groups definitely show that. we do have a few events planned for valentine's day, as well as youth enrollment day in the middle of february, we'll be in ice rinks and doing all sorts of things with the younger

population. i want to talk a little bit about one of the challenges we've seen. that is the act population. people who don't qualify for medicaid but qualify for tax credits. i've been very disappointed in how many people have been enrolling. most of our enrollment in fact is full price coverage on the private side. about a third of those individuals we've determined to qualify for tax credits enrolled. so we are trying to engage in a new strategy in how to enroll the rest. once we tell you you are eligible for premium reduction, why is it that you're not selecting your health plan? so my team and i are reshifting gear, to try to be more strategic. we've lined up partnerships with tax centers around the city that provide tax advice during tax season. and we're going to have brokers

as well as imperson sisters there to help get those people enrolled as well. we think that kind of targeted strategy will help us a whole lot to reach the population that qualifies for tax credits but are for whatever reason not enrolling. i also want to briefly talk about some of the i.t. challenges. we are in the find and improve mode. and adding new functionality all the time. and by that i mean we discovered that our system wasn't built to include a feature that allows you to reset your own user name. we found that 60% -- more than 60% of the calls to our call center was consumers who forgot their user name and needed us to reset it. and initially our i.t. folks were handling that and so a

consumer unfortunately would have to call back several timings times to get that done. which was making the wait times for the call center longer. and it's an inconvenience to a consumer. i know myself, i want it instantly. so we added that feature recently. so now a consumer can avoid calling our call center and can reset their own user name. so that's the mode that we're in. we're learning a lot of lessons from our users, from our customers. we have feedback, very good feedback from them. whether a consumer has a good experience or less than positive experience. we take all of those lessons and we focus our i.t. strategy to always making the consumer experience better. i'm going to close by saying i do think i focus most of my remarks here on what's happening now and today's and yesterday's

emergencies and focus. this is going to take time. it's not an overnight sensation, right? this is the most fundamental effort to make sure that all americans, all people who live and work in the u.s. have access to high-quality affordable coverage. it took us a long time to get 40 million uninsured. it took us a long time to get to the reason for personal bankruptcies being a medical condition. it took us a long time to get to this irrational system of health care financing and delivery. and it's going to take us a little bit of time to get ourselves on a better path. to a path where the way we finance medical care is sustainable for all of us. not just as individuals but the nation as a whole.

so i asked the reporters here to keep that in mind and the public who is thinking about enrolling. if they're in a state that is not a success story like us, give the site, give the federal government another chance. we are all in this to improve everyone's lives, everyone's health. and to make sure that over the long term, people have access to the medical care that they need and the kind of financial security that families need. we are committed to all of you. we will work day and night to make sure every single person gets the kind of coverage they need. thank you. >> thank you very much. now we're going to hear from peter lee of cover california.

peter, welcome. >> great. good morning, great to be joining you and my colleagues from across the nation. i'm going to try to hit quickly the major points that susan queued up at the beginning and run through them. a lot of my points will echo remarks you've heard from rhode island, kentucky, district of columbia. first, how are we doing? partway through, we're now two-thirds of the way through open enrollment. we have a lot of data on the first three months and some on the last couple weeks. how we're doing is we have a lot of interest and a lot of enrollment. so in california, we've seen about 1.1 million people enroll. newly eligible in medical, about 600,000. or in cover california's exchange products, about 500,000. of our enrollment in the covered california exchange, we've actually seen 85% of them being subsidy eligible.

15% not eligible for subsidies. but, remember, a lot of people don't need to shop in our exchanges if they are getting a subsidy and we don't care where they shop. we'll look forward to sharing data on off exchange enrollment in february. because that's one of the stories that isn't really being talked about. is that the enrollment in coverage where americans are benefiting from guaranteed issued coverage, are benefiting from essential benefits, though not buying directly through an exchange. couple other things on the numbers. then talk about what they mean. is trends. so california's obviously a big state. on the marketplace side of enrollment, in the month of october, 30,000 people enrolled. november about 80,000. december, 400,000 people enrolled. importantly though, the momentum hasn't stopped there. in the first two weeks of

january, an additional 125,000 people selected covered plans. that means in the first two weeks of january, we saw more enrollment than we saw in the first two months of open enrollment. that's good news. so what's that mean in terms of what's working? we think we've generally done a good job getting the word out. people know that covered california is there. when we look at who is enrolling, we're seeing in many areas a good mix across the state. but in some areas, we think we have challenges. we enrolled in terms of proportion to those who are subsidy eligible. they're about 50% of our target. essential here in california. in some regions of the state, we're doing very well relative to some base projections. where three months in we've

surpassed the base projections of what the entire open enrollment would be. areas like orange county, san diego, bay area. in other areas, we aren't enrolling as strongly. the inlet empire. central valley. so what this means is we've actually pivoted right out of the gate to say what can we do to adjust our strategies now? and the two things i point to there is first, like i think many of the states, as well as things have gone, there's some areas where we have not provided the best service that we'd want to. some of this has been because of a much higher service volume than we would have expected. some because of the rampup on the in person assistance in communities, licensed agents, certified enrollment counselors, county workers, has been slower than we want. some of it's because we or our

health plan partners haven't been as effective as we'd want in providing notices to consumers. so they've needed to call back again and again. for issues we'd rather not to have to call back about. so what have we done? we've done six or seven things to improve customer service now during open enrollment. adding literally hundreds of customer service workers. many of whom will be bilingual. adding self-service tools for consumers. doing e-mail campaigns. following up on consumers that have started enrollment. improving our web functionality. supporting even better the agents and certified counselors in the field. second, we've been adjusting our marketing. the states had resources to do marketing.

in tv, radio, digital. we're actually adjusting some of those strategies as we go into the last two months to have new and expanded placements. in particular, spanish language and target the latino community. but also with a shift of methods. many of the consumers, in particular uninsured, have said they really need more of the details. why is it affordable? what are the benefits? and we're going to be focusing on those messages. as well as focusing on the fact that we now in california have over 25,000 people in communities to help people enroll sitting across the table. we think this is going to be vital as we go forward. and to communicate those. licensed insurance agents, county workers. it's free and confidential. and these are one of the things these are one of the things we think a lot of people uninsured

worry that if they go see someone or cough on something or they're worried about confidentiality issues, we'll be addressing those issues head-on as we pivot in our marketing. finally, on marketing, we'll be telling the story through the voices of people that have gotten insurance and how they benefited. we think that's going to be crucial as we go forward. finally, i would just reiterate a couple other remarks made by my colleagues, which is rather than talk about open enrollment in a year, and we're already thinking about that, as susan cued up, i think the exciting thing is we're at now we need to be thinking about it's not just about coverage, it's about health care. we're spending a lot of time working with the health plans to make sure that people enroll, get access to needed care when they need it, and the services that they are covered for. and we're looking forward to turning our attention not just to coverage, but to right care, right time, and a cost effective

manner and that's the next place we're going to be turning our attention to. thank you very much and look forward to taking questions. >> great. well thanks so much to all of you. i think what you've heard is a series of common themes. everyone faced some aspect of health i.t. challenge. some more successfully than others. you heard from audrey the shout-out to the team they had the deloitte and also drawing on the experience of the state's medicaid department in standing up i.t. systems. but you heard, again, across the board a common theme in i.t. you also heard a common theme in sort of understanding the customer. and what the particular different sets of customers needs and desires were. both in terms of functionality of websites, you heard mila talk about people wanting to be able to reset their usernames if they forgot it like most of us always do. et cetera. so common themes of finding out, learning as they go, about the challenges that arise, and

adapting to them. and essentially, of very clear story here that these challenges can be overcome, and surmounted, and that a lot of people are in the end getting coverage as a result. so with that, let me take the moderator's prerogative to just ask one quick question and then we'd like to open it up to all of you here in the audience. want to come back to christy's statement that one of the learnings here has been that there still are issues in the actual law, the underlying law, that preclude the smooth enrollment of individuals and families. i'd like to ask you, christy, just to briefly expand on that. what are the issues that you're identifying that in a perfect world congress and others would come back to, and revisit in potentially new legislation? >> there are numerous issues that relate to the back and forth between people who are on the cusp of medicaid and the tax credit. and some of the ways that they

get stuck on either side of that. the affordability standard is based on an individual, and this is -- this is what will qualify somebody from getting a tax credit, if they're -- if they have access to employer based coverage. the problem is that they have access to employer-based coverage, and the affordability standard is based on the individual, not the family cost. which doesn't have the same kind of employer subsidy. and so that -- that affordability standard excludes the family from accessing a tax credit that otherwise they would access. and then there are a number of other issues not so much related to eligibility, but related to

how this is -- how the small business side of this works. and some -- there are some areas where i think it could be -- it could be made more effective for small businesses. so, i'll leave it at that. >> and just briefly, are others of you finding that? mila? >> so the biggest issue for us is identity proofing. if you are young and you don't have a credit history. if you were not born here, born somewhere else, or if you're -- if you were in a traditional family where the wife, in most cases, didn't work, and didn't have credit history in her own name, and is now divorced, it's very difficult to get through identity proofing instantly. so what we have to do essentially is, in person, verify that you are who you say you are. and so that is one of the

biggest obstacles for us. i believe that we're losing many clients, many consumers, who, if they can't do everything online instantly, then they're not going to go to one of our service centers to in-person prove who they are. so that is at the top of my wish list to fix. >> okay, great. and now we'd love to open it up to those of you in the audience with questions. i'd ask you just to identify yourselves by name and affiliation for the benefit of our panelists. we'll start here with julia. >> hi, i'm julia appleby with kaiser health news. there's been a lot of talk in the last week or so about whether we know if the folks signing up had insurance previously or not. and i know that's a difficult question to answer. but are any of you tracking that? and do we have a way to track that? and what do we know about that? >> actually, we started having these discussions about a month ago, and we're beginning to discuss with our department of

insurance, as well as the insurance carriers that are participating with us, about how we track this. some of our insurance carriers do, and maybe one doesn't. so, we have been thinking about the same thing, because we want to get a clear picture. a lot of people can't afford insurance without the tax credit, and they have absolutely -- i mean, they can just go directly to an agent or to a carrier that they know and they're familiar with and they're not dealing with the exchange. so, we know that the numbers of people that are getting insurance for the first time possibly, or a better rate for insurance now going privately without the exchange is much higher than our overall numbers reflect. we just don't know how much. >> and i can add, so we have anecdotal self-reported information from our in-person assisters, about 50% of the people they help do not have any kind of health insurance whatsoever.

we do not collect uninsured status at the time the application is done online. it's not one of the questions. our plan is, after open enrollment finishes, we will do a survey of all consumers who are enrolled through the -- through the individual marketplace in qualified health plans to find out their insured status before they enroll. we'll also be asking other questions like if they had coverage, did it work for them, did it cover their medical needs, pre-x conditions, that sort of things. we'll also be asking them what motivated them to get insured, whether it was a tax penalty or something else. so we'll have a lot of information based on a survey we plan to do. >> i could tell you that one of the most interesting moments that i had in the past couple of months was at the moment that i realized there wasn't a clear question in all of the -- in all

of the eligibility and enrollment, and date that that we have which is massive, there wasn't a clear question. there are a couple of proxies that we can use, and we're developing that information, and there's some reports we can pull from the system, where we'll probably do a survey, as well. but we're looking immediately at putting that question in. >> okay. great. >> same for california. >> oh, sorry, peter, you want to speak to that? >> we're in the same boat. >> okay. great. >> from npr, one of the biggest glitches that i see popping up these days are people who are sort of incorrectly being sort of adjudicated into medicaid, and then being -- who clearly don't qualify for medicaid, then they can't seem to get out and buy an exchange plan until they get a denial from medicaid and i guess medicaid in many states is just so backed up that it can

take weeks and weeks and weeks to get that denial from medicaid, and in the meantime they can't go ahead and buy an exchange plan. is that something that you have ways of dealing with? i don't know if this is happening in any of our states, or if you know of this problem, but i'm getting now, tens, if not dozens of letters of this same thing happening in multiple states, where people are wrongly being told, you qualify for medicaid when they clearly don't. >> there are actually two components to this question that are interesting one is that there are people who may qualify for medicaid who don't want to enroll in medicaid and would rather buy a private plan. or their kids are getting put into medicaid, and there's -- so that's another piece of the law that needs to be fixed. because people should be allowed to do that. the second component is the

interaction between medicaid and the tax credit piece, and people getting caught. and i think all -- i won't speak for my colleagues, but my understanding is that many of the states are seeing that. we -- the state base exchanges, in general, can be much more nimble when things like that happen. in the federal exchanges, they can't be. so we're -- we are absolutely taking those cases and working them through as quickly as possible. there are certainly wait times that i don't think ultimately are acceptable. but, -- but that's -- that's being cleaned up. this is another one of those things that needs to be fixed and we need to have a 4ri bit more flexibility in how we can fix it. >> we've also had the issue of a person qualifies for medicaid,

but does not want mid cade. it's not a large portion, i think, i am aware of less than 50 cases. but, the bottom line is if that person doesn't take medicaid the person cannot receive tax credits. so in the 50 or so cases, we manually deleted the original application from our system, and that enabled the consumer to complete the short form, which is full-price coverage, and that's how those folks were able to enroll. but essentially, that is not something i expected to see that when folks qualify for the very comprehensive public program we have, the assumption initially was that they would get enrolled. >> what do you all think is causing that? is it the stigma that some people continue to perceive of medicaid? >> personally, i think that we have seen this with younger

individuals, maybe. that there is a stigma, they've grown up in middle to upper-class families. they've gotten out of college, they don't have a job. so maybe they still qualify for their -- to be on their family plan, they just haven't been added, so there's still confusion in that. one of the things i would like to add to that, though, is there is an impression that you can just choose medicaid. that's completely incorrect. i'm sure that's not the way it is in rhode island or in the district or in california, you just can't go on and press a button and say, i choose medicaid. so at least in kentucky, you fill out the information, and if you qualify for medicaid by the information you have put in and that we have been able to verify then that's how you are afforded an opportunity to sign up for medicaid. but to kind of build on what

christine has said, there is a process by which that if you have incorrectly enrolled, you don't choose to enroll, it's an unfortunate thing, and most of these i bet were all working manually when people call, but you know, there is a process that the federal government requires us, we send people information to get more information, from them, to try to confirm identity, or confirm their salaries, or whatever, and so there is a process by which time it takes to get you unenrolled. it is but it's not instant. >> so here's -- i hesitate to do this, but, i have no self-restraint on this issue. one of the core problems with the way that we developed this and the implementation of it, is the focus was on the eligibility

and enrollment system as the thing that solved all problems. the reality is, that when you go in to buying a product or looking at -- looking at a range of products, you get a lot of information before you get to the point where you actually sign up and buy. that component was not as focused on by the -- by the federal requirements, by the systems folks. so many of us have websites that were wrapped around or loaded on top of that system that allow -- that allow people to look at those things. but they're not anywhere near as sophisticated or developed, i think, at least in our case, as i would like them to be. so that people can draw those conclusions, have 80% of the

information that would give them an 80% clue that they were eligible for this, or that they would get this kind of tax credit or that they were in a small business or that medicaid might be an option. and from that information, once they go in to the enrollment system, if something's not matching up, that's what customer service is about. that's what our ability to move should be about. and that's where i think you're going to see many of us really put a lot more effort, and we're urging and encouraging the -- at the federal level, the help that we're getting from the robert wood johnson foundation, and others is critical in making that wraparound happen. so that's essential. >> great. let's see i think there was a question here. let's get a mic over to him. >> thanks. know up leave very with the los angeles times. i wonder if you all could talk a

little bit about what kind of feedback you're getting from the carriers on your various marketplaces about their plans for next year, potentially carriers who are not in your market place who may be expressing interest in joining or the converse if you're hearing anything. >> i can answer pretty quickly yes, yes, and yes. in kentucky we have a small group of carriers involved in the individual plans. we only have three in one of them, humana had a much more -- a smaller area to choose from. they're not completely statewide. anthem, on the other hand, they -- they made some adjustments to sort of narrow their provider network, and then we have a federally -- one of the co-ops in kentucky, and so we had a small -- a rather smaller insurance market than many have, such as the district,

or california. i know i'm not sure about rhode island, christine. but we have a smaller market to start with. so we have heard from our managed care plans that are owned by larger carriers, we've heard that they want to come in the market. we have a great relationship with our insurance carriers because it's a small group of people, we talk to them regularly. some of them have talked to us about some mistakes that they made, and from the beginning maybe in their network, or their -- going statewide or just a certain area, very quickly, so they, too, have been evaluating this all along. so we expect our number of carriers to certainly grow and our networks to become more robust. >> others of you want to comment on that? >> i have two components to the answer. one is, yes, we are definitely in conversations with other carriers and to come in.

and i think we'll be successful with that. the carriers have been fantastic to work with in rhode island. all of them have really stepped up in great ways. because this is a complicated exchange. but i want to point out that there's some -- another interesting component that's happening in the marketplace. there are three streams. there's the medicaid stream. there's the tax credit for individuals stream. and then there's the small employer stream. and recently both two of our carriers, one of which is a national for-profit entity, and the other which is a nonprofit, announced the formation of, and i hear that imitation is the sincerest form of flattery, so i'm actually, i'm happy that this gives us a chance to talk about this. but they've both announced that they're going to do private

exchanges within their own carrier health plans, for businesses. and i think that part of that is because carriers are nervous about what full employee choice, where employees can choose between carriers, real competition on the consumer level, as opposed as on the business-to-business side. that's raising some interesting dynamics, and it really will give us to this question about transparency, and competition, and consumer-based work. and i'm -- i'm delighted to have that conversation. but that's the interesting -- you got to look at all three streams. they're very different interactions. >> and i would just add -- >> peter -- >> hang on just a sec, we're going to get to you. mila will start and then we'll come to you. >> all right, thank you. >> so out of the gate in the district, we had all of the carriers who were in the

commercial market on the individual side and the small group side. in fact, i think one of our carriers is -- we're the only jurisdiction where they're participating both on the small group exchange marketplace, and the individual marketplace. so we were very pleased early on. we built a carrier portal to make it as easy as possible to load their products and rates into our portal. we had a lot of testing with the carriers. we worked very closely with each of them. each company is in a different place when it comes to how sophisticated their i.t. side is. over the years, different insurers have invested different amounts into their own i.t. so our approach from the start was we're realistic, pragmatic, just tell us where you are and we'll work with each of you in a different way and that's what we did. so we also have an excellent relationship with all of our

carrier carriers and i have to thank them publicly. on the individual side, two of the carriers allowing consumers until february 15th to pay their january 1st coverage bill, which is pretty remarkable. and so, there's a lot of there's as i very close relationship around the 834s as well as the 820s. >> 999s. >> just to clarify these are all different forms that have to be shifted back and forth to control. >> way more than anybody wants to know but it's essential. >> so the bottom line is, we're in the same boat -- we at the marketplace, we're in the same boat as the carriers, all of this is new, and the goal is to work with each one, and just get it done for the consumer. and i do hope that any carrier not in the marketplace that wants to come in to the

district, they're welcome, and i will work with every carrier who wants to come in. >> we just want to give peter lee a chance to comment on this question, as well. peter? >> yeah, somewhat different philosophy. we actually told the plans a year ago that if they wanted to be part of the individual marketplace, to step up and play first year around and not stand by the sidelines. we're not letting plans that were not previously in the marketplace come in next year. the plans that are in want to stay. the one exception is medical plans, plans in the medicaid market can potentially come in, obviously medi-cal extension is a big deal. all of the plans with covered california are really recognizing that this is a long-term play, and are looking at things like benefit design. how do we improve the benefits? but really how do we learn what's happening over the first two years to do then substantial

benefit design changes not next year but the year after? so the plans are recognizing with us that this is not a short-term play. but rather one that we need to actually base our growth, and changes for consumers based on information. >> peter just a quick question about narrow networks as we heard from audrey in kentucky there's a sense that maybe the networks were too narrow. >> for some. >> at least for some of the carriers. and this has obviously been a controversial question across much of the country. what is likely to happen in california? do you think carriers next year will go back to expanding their networks, or are they essentially wanting to plow ahead with a strategy of having narrow networks, agreeing on pricing, and high quality, and attempting to give people the best possible value for their money, as they enroll in coverage? >> well, a couple things. one, you know, across

california, almost 60,000 doctors are in one or more than one of the health plans that are contracted with covered california. that's a substantial majority of the doctors. the question is, or the reality is, every doctor is not in every health plan. and we've made sure that every health plan has enough doctors, hospitals, nurses, to serve everyone that enrolls. and it's really going to be our job to make sure that that reality comes true for consumers. the second part of our job and i think this cuts across all of our exchanges around the country is that consumers understand the implication of their choices. so having physician directories, and improving those directories over time, as we've seen in this last month, consumers say, well, i went to my doctor, who's in the directory, and they don't think they're part of the network. some of the doctors don't

understand that there isn't necessarily a separate covered california network, rather they're part of the anthem individual product network and that's it. so those are some of the issues we're going to be focusing a lot on, and assuring adequacy. i don't know that any of the plans are relooking at their strategies overall. >> this is also fundamentally why state-based exchanges can be so much more effective than a federal -- a federal completely federally run system. because, every state has a different market. so in our state, for example, the private -- the plans, the commercial plans that we're offering have extensive networks. everybody's covered pretty much. and so the question now is, how do you provide incentives to, and to rethink how you get really good integrated and innovative new products into the

market, with full employee choice as a core component of that, so that the individuals making the choice and not the employer on behalf of the individual, and so that they have the kind of information and metrics in terms of work productivity trends, and quality trends that matter to individuals that are making choices. and that transparency. it's a completely different conversation, it's not -- you started with narrow networks because of geographic issues or limitations in terms of how you were able to bring plans in. but, a completely different conversation in rhode island. so each of us is going to come at it from a slightly different perspective in terms of getting those innovative products online. but it's one of the reasons why the states, like ours, who chose to go the direction of the state-based exchange, are really going to be able to use this investment very, very effectively to be a catalyst for

the overall change that needs to take place in the health care system. >> and susan, i know we're wrapping up here but i just really want to underscore that. what christine said, and the differences, and the importance of the state-based exchanges. it is so important, and you know, we you are state-based, when our governor announced that we were going to go the state-based exchange route, what he said then couldn't be more true today. which is he was making the decision to do this state-based, even though it was not the politically more popular decision, however, he was doing it because he felt as though we knew our insurance market best, we have the personal and professional relationships with those carriers that most of them have been in our state for a long time, and they better understand our state, our demographics, and the market, and it is better for our people, whether it's medicaid, or whether it's in the private

insurance market, you're really looking out for the consumer in a much more intimate way through the state-based exchanges, and we're so much more nimble. as mila had said so many of these individuals that somehow i call it, they're stuck in i.t. cyberspace somewhere, they're stuck, you know, somehow their information is not connecting up, that's a great example of same thing in kentucky. we've had a few of those. and literally, they are worked by hand between our exchange staff and the insurance carrier. and the insurance carriers are manually working these by hand, as well. and that's not something that you get in a much larger system, and anyway, so i hope that others that didn't choose the state-based exchange will see this as a real consumer success story for their constituents, and their voters, and their citizens within their state, to

just help them get better coverage. >> well, on that note i think it's a perfect place to end, because it encapsulates, again, several themes. one is that this really has been a major learning process. it's been a learning process, particularly at the state level, in states that have now have the opportunity, as christy said, to make enormous differences in the health care delivery system going forward on the basis now of a much greater understanding of what consumers are going to want, what kinds of tools are going to be need to be made available to consumers, and how all of this can be brought to bear on really effect outing the ultimate goals of the affordable care act which is to create an affordable and sustainable health care system over time. so i want to say thanks once more to peter lee from covered california who joined us on the phone, to mila kofman from the d.c. exchange, to christy ferguson from the rhode island exchange, and to audrey haynes

overseeing the kentucky exchange as well as heather howard from the state health reform assistance network. thanks to all of you for joining us today. we'll look forward to seeing you at our next reporters roundtable. >> on the next washington journal, ron johnson will discuss republican's plan for the house on immigration. the program, a discussion about no nuclear weapons and materials are secured. we will be joined by william director. former beginning live at 7 a.m. eastern on c-span.

tomorrow, treasury secretary jack lew will be at the bipartisan policy center in washington dc, where he's expected: congress to raise the debt ceiling. secretary loop recently -- lew letter to lawmakers, and we will have that live on c-span to guide you can share your comments during the event on twitter by using #cspanchat. the center for the national interest is hosting the event, we will have it live at 12:30 a.m. eastern -- 12:30 p.m. eastern, on c-span two. someone who grew in the office. human badly burned by the

-- cuban bay of pigs experience. can listen to the experts, the cia, the joint chiefs of staff, gaul inent to see the france. said you should surround yourself with the smartest people, listen to them, and hear what they have to say, but that the end of the day you have to make up your own mind. what harry truman sent said, the buck stops here. he was determined to make up as mind, way-- his own with the experts said, but at the end of the day he was going to make the judgment, and he was the responsible party. you see that, that was abundantly clear when you listen to all of those, and read the

transcripts of all of those tapes during the cuban missile crisis. he was his own man, he was the one that was making his own mind. the joint chiefs were at arms length. they wanted to bomb, invade, and he would not do it. >> [captions copyright national cable satellite corp. 2014] >> after several years of wrangling, the house has passed a five-year farm bill. now it is up to the senate and that will be happening this week. join us on newsmakers is senator debbie stabenow. she is chairman of the agriculture committee. our panelists are alan bjerga of bloomberg news, and ed o'keefe of "the washington post." mr. bjerga, you may start the questioning. >> thank you. >> senator, you seem poised to see the passage of a piece of