witch the tone to realize that all living with increasing health care cost and whether we voted for affordable care or not, we have a major role to try to drive down the future increases in health care if be competitive around the world in commerce. so i thank you, mr. chairman, i your indulgence. >> i recognize the ranking committee, the full mr. cummings, and if you would please -- i'm sorry, the representative from maryland. >> you just moved me clear across the country. >> that's quite a shift. just shifted your time zones, i apologize. >> thank you very much, mr. chairman, and today is april 3rd, just three days after the deadline for americans up for health insurance under the aaffordable care act. happened in the the six months, since federal exchange has opened for

business. pretty.ot always been but we should take a moment to reflect on what we have accomplished. 7 million residents of our fores have signed up affordable health care, millions of people who could not afford health insurance and were one accident or illness away from financial ruin, now have health insurance. significant. this is something that we all of.ld be proud all.hat's not we hear talk about what it the't do, but under aaffordable care act, insurance companies are no longer allowed against people diabetes, or other pre-existing conditions. longer allowed to discriminate against women.

that's happening now. millions of our residents receive free preventative care, stay well. we all know that it's cheaper to keep somebody well than to treat sick.hen they're if you want to talk about driving down the cost of health care. millions of kids can stay on their parents' plans until 26.'re and billions of dollars in rebate checks have been sent to country. across the that's happened and it's happening now. gentlemen, put simply, the affordable health care act saves lives. prevents people from going through pain. it allows people to live longer, like the gentleman who is probably watching us right knowing colon cancer that he has a ways to be treated and he'll be able to walk his the aisle.wn or the person who just wants to

survive long enough to see their child graduate from high school. that's what the affordable care about, sometimes i think we get so caught up in the are going through picture.orget the big said dosaid it best, he not be pushed around by your fears and your problems. be led by your hopes and your dreams. that's what this is all about. hopes and dreams. so, to the witnesses here today and to the state and federal workings who are tirelessly to implement the law, you.t to say thank i look at dr. sharpsteen of healthd, the head of our department. this is a man who has given his tears his sweat, and his trying to make life better for commissionere was in baltimore and now with our

state. probably say that i doing the samee thing, and you don't do this for the money. because it feeds your souls. you do it because you want to make a difference. it because you want to affect generations yet unborn. we are allwhat about, we should be about. making a difference so that live the best lives that they can. to get heretook today was rocky for the federal government. for also been challenging some states, including my home state of maryland. i cannot fully express how frustrated i was with the troubled rollout of the maryland connection. in my state, as in many of desperateple have a for quality affordable health care. we needed the system to work. let me say it again. needed the system to work.

it.s depended upon and when it did not, unnecessary way,cles were put in the which was completely .nacceptable sometimes you c contractors that advertise more than they can produce. they sell you a bill of goods. maybe those are the folks we need to be looking at. clear.'s be this is not just about a website. about a website. this is about making a for people, so they can be the best they can be and theml that god meant for to be. the answer to the problem is not to decimate the affordable care act. the solution is not to eliminate oflth care for millions people, to gut the funding for

the a.c.a., or the return to the days when insurance companies could discriminate against us our medical conditions. i have said it before, and i'll say it again. we're better than that. let insurance companies do that to us. to remedy certainly is not scare people away from enrolling in health care they have a right law.der the when you scare them away from scared themou have having health care, for having insurance, for being their child care of when the child gets sick, or prevent a child from getting sick. we're better than that. unfortunately, our republican friends have voted more than 50 times to repeal, defund, and undermine the affordable care

act. friends, mr. issa, the chairman of the committee, i agree with him, we need to move not to common ground, but to higher ground. what this nation is all about, higher ground. where we come together to try to out what is wrong and correct it and move forward. so when the history is written, walkthat man is able to down that aisle with his daughter, when that mother is her child graduate from college, when that person enough to see their first grandchild born, they're about ag to be worry website failed. to bee not even going talking about that. they may not even know that it was the affordable care act that them. and gave them a life. them is will matter to

they had an opportunity to live dignity and have a moment of happiness. that, as we move forward, that this is -- by thehis is the law, way, that we move forward to make the law better, and not try destroy it. the only reason i mention these past efforts with regards to the hearings, is because i have not seen in these hearings to improve the law. not one. that, we could move to then we could move to higher ground. back.th that i yield >> i'd like to recognize our panel. please introduce your guest from well.nd as >> i thought i did. dr. sharfsteen is the head of

our health department in maryland. as i said before, he, by the way, he was a staff member on mr. chairman,, some years back, and then he came to baltimore and he was our health there,f kind of worked all innovative projects to baltimore and now he's the head of the health department for the state maryland and i'm very pleased to have him. to introduceted mr. peter lee, who is the executive director of cover who has had a storied career in health care, both in the private and public formerly was the deputy director of the center for medicare and medicaid innovation at c.m.s. among many other places. welcome, we're very glad you're here. >> you definitely have the longest time zone change here, we're glad you're here. executive director of the hawaii health insurance

exchange, jean yang, the directory of the massachusetts insurance exchange. mr. scott leitz, is that right? chief executive officer of the minnesota health insurance exchange. pelt, from the oregon health insurance exchange. beforeses are sworn in they testify, so please stand and raids your right hand. do you solemnly swear or affirm abouthe testimony you are to give will be the truth, the whole truth and nothing but the god? so help you let the record reflect all the witnesses answered in the affirmative. your entire written state, which all of you have submitted, will record.of the permanent mr. matsuda, you're batting off here, you're first up, you push the top button, we'll be glad to receive your for five minutes. >> thank you, chairman. ranking members and members of the subcommittees, my time is

tom matsuda, interim executive the hawaii health connector, peeking on behalf of board ofctor and board directors. hitch has long been a leader to havee that our residents access to quality affordability health insurance. enacted a ground breaking state law, the hawaii prepaid health care act. this most employersat in hawaii provide health care coverage to employees who work than 20 hours per week for at least four consecutive weeks. hawaii's prepaid health care act requirements are generally thecter than those of federal affordable care act. as a result, hawaii has a low estimated ate, about 8%, or 100,000 individuals. because the state law is so strongly supported by the people the allow a state -- the aloha state authorizationsed statetablishment of a based marketplace to harmonize

with the act affordable care act. hi written testimony provides the connector and i would like to focus on specific issues. ofst, enrollment, as march 31, 2014 we have 7,596 individuals enrolled in commercial plans through the individual marketplace. people enrolled through the andl employer marketplace, 24,641 completed applications in our system. connector does not handle medicaid eligibility or medicaidt for the population. that is handled through the department of human services, or d.h.s. d.h.s. had over 28,800 medicaid enrollments from last october this year, fory 36,661 of over enrollments across the entire hawaii marketplace. onlineched our marketplace on october 15, and

accepted the initial application forms between october 1 and 15. the system has been operating then, but it was very difficult to use at first. made now, we have significant improvements. the system is better today than it was back in october. our system is working from end to end, but more imappropriates made. sustain ability. as a state based marketplace we sustaining, by , 2015. last year the board approved a plans sold on for the connector. our bore is now engaged in a planning process. the key is to reduce operating expenses while supplementing especially in the shop exchange. the federal and state decisions employers the option to remain with their existing insurance plans through reduced the volume of

participants in shop. has received four federal grant awards. while hism is a small state, we same federalo the requirements as all other states to establish the infrastructure to operate these state based marketplaces. the establishment costs will be comparable from state to state to ensure that the structural components of the marketplace are compliant and secure. our small population and low uninsured rate mean that hawaii has a smaller market to support operating costs. as of december 31, 2013, the has spent about 57 million of the to the in federal grant monies awarded to us, and we system.operating for our priorities going forward, we have roughly 11,000 incomplete applications. enrollmentsdual these are not yet complete.

we have increased staff to process.this we are also working on extenting our outreach into island underservedthat are to help educate these populations about the services them.ble to on behalf of the hawaii health connector, i appreciate the to discuss these issues with you today. accomplish, left to but we believe in the mission of the connector. and your fully committed to part inting our hawaii's long history of affordable,cess to quality health care coverage to our residents. thank you. you.ank lankford,ou, chairman ranking members and other members of the committee, i opportunity to testify today. it true that i used to staff this committee, i used to be one sitting along the box wall. i can say that every staffer liker what is it would be to sit on this side of the

microphone. and after the hearing i'll be them.o tell as has been widely reported, has paid considerable i.t. challenges in establishing our state based exchange. the system barely work at all. for weeks we struggled with a range of software and hardware problems. but we did not give up. we now expect to hit our goals, in fact we expect to exceed it by 10% or more. we expect the number of in qualify held plans to come within 10% of what was predicted by inexperts and to exceed our expectations for medicaid enrollment. we the time the dust settles could see enrollment more than 300,000 in maryland. maryland's story includes we could makeish again, failures by multiple vendors and too many i.t. frustrations to count. but maryland's story is also about an exchange that is a lot a website. it's about a state that is looking back and is towards the future. i have submitted detailed

written testimony, so i'll just key points. first the exchange is a lot more than the website. our closed partnership with more than 2,000 brokers, it includes a very competitive market with four carriers offering 45 plans. we have some of the most competitive insurance rates in the country. including dental plans. we have a website that has a network for each carrier, and a community based navigator program that includes grass roots organizations. second, we did face serious website problems. we made a major misjudgment in adoptingt initially in a strategy of trying to buy commercial off the shelf software that could be configured for the purpose of the affordable care act, instead of building something specifically for this purpose. the products that were advertised as being ready actually were defective and deficient. this caused immense frustration for consumers and at certain wonder whether anyone would be able to enroll.

third, rather than give up in the face of these i.t. maryland tackled the problem head on. leadership,uded new including when the governor asked the secretary for i.t. to job and befrom her the single leader for all i.t. a generalt, hiring contractor, the same company fix the federal health care.gov, implementing fixes.s of could be rating closely with people who had trouble on the website. tok arounds which allowed us process certain types of eligibility by hand. elbow grease by the gallon, and the incredible tough work of hundreds of consumer assistance a strongand finally finish with as much enrollment in the last few days as in the so.t 10 weeks or

as i said before, we expect not but to exceed our enrollment goals. quality and affordability health coverage is providing peace of mind and access to life saving care to families across maryland is also going to reduce the hidden tax that all of us pay for poorly managed and uncompensated care. under our unique system in maryland of rate setting for hospitals, which not only i issa'so the chairman point, is going to reduce the for uncompensated care in that system, but also we're using across all pairs with no shifting to address the fundamental challenge of cost in health care. to me finally say that, talk next step. in addition to the significant work and the hundreds of fixes to the took to get us point where we could exceed our enrollment goals, our secretary of information technology has a process of figuring out

the future for the website. extensive analysis, the board this week voted to the connecticut i.t. order to upgrade our website. that has proven very effective and allows us to veryomething that works well in time for the second open enrollment period. thehe chair of the board of maryland health benefit exchange i deeply regret the frustration that many marylanders have experienced. i am also proud of the efforts of so many who have worked to overcome the i.t. challenges and help their friends, neighbors and fellow toizens gain access affordable and quality health coverage. thank you for the opportunity to testify, and i look forward to your questions. mr. chairman. chairman jordan, chairman lankford, ranking member cartwright, ranking member spear

and members of the subcommittee, good morning. tonk you for the opportunity testify about our experience implementing the affordable care massachusetts. as you know, massachusetts is very familiar with the framework the a.c.a. in 2006, former governor mitt with our state legislature to fashion and approach to expanding health drew ideas from both ends of the political spectrum. in 2007,ook office governor deval patrick worked to tong the statutory framework life, in close collaboration with our state's legislature, ourhealth care providers, business and labor leaders, our insurers, our consumer others.s, and countless we are extraordinarily proud of the results we have achieved the past eight years. virtually all of the commonwealth residents are now at 97%. 91% of our residents report a primary careo

seencian, and 88% having their physician in the previous 12 months. on a whole host of measures we meltier. at the same time, more employers than anding coverage our state's budgets have been consistently balanced. one of the most important lessons we have learned in the year since 2007 was that health time.eform takes we refine our plan as we learn new lessons in collaboration partners including the bush and obama administrations. easy. not always been but we kept our eye on the goal of getting people adequately covered. as governor patrick has remarked, we learned early that website.re is not a we support the affordable care act because it embodies the our massachusetts reforms and because i gives our ande new tools to sustain expand on our success. we know that it is already to put affordable

coverage and care in the hands country.ans across the in massachusetts itself, since the a.c.a. took full effect the over 200,000 more people have signed up for subsidized coverage. almost 30,000 people have purchased unsubsidized a.c.a. ourliant plans through health connector. the health connector is also for the dental policies first time with over 2300 plans purchased to date by individual shoppers. even so, while it plentying the experiencedve website challenges. these are mainly due to failures our system integrator. but with our new team in place live witha path to go a functional, reliable exchange website for the next open period.nt challenges with our system integrator and project shortcomings impeded our progress in achieving our full vision for the website by last year.f on that account, we decided to

deploy only parts of the new on that date. given these constraints, and encounteringple errors and wait times eve 2010 the part that were deployed, we alternativeed pathways to support enrollment. these mechanisms have enabled us to protect and expand coverage with strong cooperation from our insurers, pricers and consumer advocates. many residents of the experienced have difficulties with some of these processes and we fully share their frustration. we have not allowed website problems to prevent us from of the the ultimate goal a.c.a., getting people covered so that they can enjoy health economic security. though the website challenges an mainly the result of under performing i.t. vendor, we are holding ourselves them.table for fixing and we are making progress. systems,ablized our eliminated a backlog of paper

applicationings and substantially reduced call center wait times. we continue to maintain strong protocols that meet federal standards and c kept personal information of safe from data breach. and we have a detailed plan to the websiteparts of only when we know they are ready for users. meantime, through the creativity and flexibility of are gettingople covered. we have an unwaiverring commitment to ensuring quality affordable health care for the people of massachusetts. commitment that kept us moving forward through both the peaks the valleys of state reforms, a commitment that keeps us moving forward today as we to realize the a.c.a.'s full potential for improving lives.d improving thank you for your time. i look forward to your questions. you.ank

mr. lee. >> good morning. you chairman issa, jordan and lankford and ranking cartwright and cummings. i appreciate also the other distinguished members the having us here. i'm peter lee from covered california and i'm glad to share our early implementation lessons in california in launching the affordable care act. i think it is important that we california to across a whole range of bestituents, whether they insurance agents, county workers, health care providers, positions political who have come together in california to expand coming. of thateing the fruits effort today. california is one of 15 state weed exchanges and when started we looked at the data and said that somewhere around 4 million californians could benefit from federal support, expanded medi-cal --

in a very few years we've gone a 10-person organization to an organization of over 1,000 people. startup that fast is working to change history. so how is it going so far? of theheard some numbers. 1.2 million californians now have coverage directly through covered california. an additional 1.9 have coverage medi-cal and every single one of them went through our website. many were touched by humans in the enrollment process, and i too strongly, we've heard again and again, exchanges are about more than websites, littleant to talk a about what they are about. but i also want to underscore basede think about state exchanges, there are five exchanges out there that as of a had already covered more than 30% of those eligible. those states included

california, rhode island, vermont, washington, and connecticut. have done a very good job as well, kentucky, new york. as of three days ago, california had brought coverage to more 50% of those eligible in the exchange. that's a remarkable number when takes to about what it start.brand new so let me talk about what it takes to make a state based ects change work. we i would note that when say work, we do not mean perfect. it's been bumpy and it will be rocky and bumpy. this is historic, this is a very big change to the health care feelm but all in all we good about the progress we're making. it takes in our mine three exchange to work, it takes having affordable health plans delivering quality effectiveakes marketing and outreach, and it takes effective enrollment. in the area of affordable care,

has an act ofia purchasing, 33 health plans expressed interest in participating in our selected 11.we went throughornia a process of standardizing our benefit design to give consumers under what they were choosing between their plans. we ended up getting very competitive rates and we're optimistic those rates will stay competitive and affordable. right out gate we've been giving consumers information so they the right choice. second element of suck is effective marketing and outreach. cover california has been reaching out to californians demographics, across languages, through a tv, through radio, newspapers, but as or more importantly through over groups, anchored in local communities doing outreach and about thepeople opportunities of enrolling in california.

finally, effective enrollment. is about more than an i.t. system. the enrollment system like the other people testifying with me here, has to connect with more bases1 different data including the federal government, but also state systems. we have our system up and running, it's been up 91% of the time in terms of scheduled running time. it's working well, but more workingtly, than it well, the over 25,000 californians, these are county workers, licensed insurance agents, these are certified enrollment counselors, in every the state, have been helping literally millions of californians get enrolled. it largelywe think working in california because californians have stepped up. to theirped up to talk neighbors, members of their churches, their schools, to get them covered. have lessons learned, those are in my written testimony and i look forward to

responding to questions from the committee. thank you very much. >> thank you, mr. lee. youreitz, you're up for five minutes. >> chairman jordan, lankford, spear,ank member cartwright, cummings and members of the oversight and reform morning., good thank you for inviting me to come here today to talk about minnesota's experiences in establishing min-sure, our online health exchange. want to tell you about cory in kate who live minneapolis. cory is a teacher, four years insurance had health through his job, but over time the out of pocket costs grew. their third son into the family, they had to paying theirn mortgage or held bills. min-sure hern three boys qualified and she was able to purchase a plan for than $200 a is less mob without tax credits. in her words, i was thrilled.

mind that we are going to be able to be cared for and are not going to lose our house. proud to say min-sure is stable, secure, and successful. because of our efforts they are just a few of the nearly who000 people in minnesota now have access to affordable, comprehensive coverage because min-sure. nearly 88,0000, have enrolled in medicaid, over have enrolled in minnesota care, our state's basic health plan for people between 133 and 200% of the federal poverty line. other state these individuals would be in private plans with tax credits. over 47,000 have enrolled in private qualified health plans. that ino both noting minnesota, 95% of people enrolled in health coming have paid for it. as we continue to process applicationings we expect our higher.to grow even

it isn't news to this committee that min-sure's rollout was rocky. our initial launch in october was plagued by software and technical glitches. appointed interim chief executive officer on december 18 after the resignation of min-sure's first executive director. in recognition that more must be ensure minnesotans have access to coverage, i took action.e we made a number of enhancements to helpmer experience boost enrollment and improve customer satisfaction. working in close partnership our vendors we were able to stablize their system. eligibility software is now operating with over 99% success 70% inompared to december. and their online marketplace has been stable enough to process enrollments a0 day. december software problems caused our call center wait an hour,climb to over

and up to 70% of consumers were giving up before they could be helped. resolved this issue by more than doubling the size of our call center and by bringing software to our system. average way times for the month of march were dramatically less. forward, we are planning our budgets for 2015. i am happy to say that next year's calendar year budget is balanced and does not seek additional state or federal to operate min-sure. in the longer term, we under the selecting a lead vendor that will heaven sure the larger software issues that were identified in the report. make theis to not just 2015 open enrollment period diseurms, but to have a road map for improving and enhancing the exchange for in every open enrollment period to come. i had the opportunity to meet kate and her son recently, she told me that having affordable insurance has opened the door

family. health reform is more than a website. it's about getting real people affordable, into comprehensive health coverage. this is something we are doing well in minnesota. for the opportunity to testify and i look forward to your questions. mr. leitz.u, mr. van pelt, you've been patiently waiting, you're up. >> thank you very much. mr. chairman, ranking members and other members of the oversight and government reform committee. allowing me to speak before you today about oregon's health reform efforts. my graham is greg van pelt, i recently retired as chief executive officer of providence health and services in the oregon region. throughout my career i've had direct experiences with the challenges of expanding access to quality health care while costs.g last year the governor asked know step in to help navigate launchllenges around the of the state's health care exchange. currently i serve as the the oregon health leadership council and voluntary advisor to the governor and

dr. bruce goldberg, acting director of cover oregon, for whom i'm appearing today because recently suffered a broken leg. while the launch of the a.c.a. in oregon has been different hoped, over 300,000 individuals have enrolled in since insurance plans october 1. the governor two weeks ago an inassessment of cover oregon produced by the company first data. i all the, which included in today's record, was on 67 interviews with stake holders from cover oregon, and oregon health short employees to the governor and legislators from both side of the aisle, and review of more documentings. it assess tess technical problems with the development rollout of our health exchange website. wantrs of the committee, i to you know that in response to first data's findings the governor announced numerous steps he has taken or will take to improve performance, accountability and oversight.

steps are detailed in my written testimony, which also has been shared with you. know that some things have worked very well. we have used our tech not thantment to roll more 300,000 oregonians in health care coverage since october to cover oregon and the oregon health authority. we continue to be proud of the to improvedone oregonians' lives and we know that will endure. welcome your questions and the opportunity to scuts with you oregons ongoing health care transformation work as well as the progress that we've made to secure the public trust to make oregon's promise to enroll more oregonians in healthble high quality insurance. thank you very much. >> thank you, mr. van pelt. turn to questioning and start with the gentleman, vice chair of the committee, the arizona. from >> thank you very much. want to start with you. you talked about the rocky stat for your exchange earlier.

first question is in the three months leading up to the rollout, 14 managers of the site received bonuses for exchange.did on the is that accurate? >> congressman, it is. the state payuld people a total of $27,000 for a website? usually bonuses go to exceptional work. seem to meetn't exceptional. bonusesessman, those were approved by the previous executive director. >> i'm glad you said that, anythingave you done to call back those bonuses? no.ongressman, not to date, >> interesting. january, united health optimum division released a report stating that the exchange's current program management structure and process managementent and decision making is occurring via crisis mode. report also concluded that

the exchange might be so badly that min-sure might have to scrap all of it. you were quoted assaying we do take action, i thought i heard you speak about this in your comment, we intend to take as a result of the report. have you fired anyone in the state government for the bungled launch in the massive loss of taxpayer dollars? >> congressman, we have made with -- >> i asked you a question. anybody?fired >> personnel actions have been taken. >> people have been fired? >> congressman -- >> or have they just been reassigned and given a new title? >> congressman, individuals are no longer with the organization who previously -- the stateill in government? >> no. >> so you did make some changes? >> yes, congressman. week the los angeles times reported on how governor day ton referred to the blackota exchange as the hole. where he was referencing consumer applications that were

vanished. did you ever fine out where those vanished applications went? >> congressman, yes, we d. >> you have a to the accounting? identify anye a to applications that had previously been in the system that we then't able to track during fall rollout. >> will you provide that to the committee? a lot of the folks back in minnesota don't know that story. >> congressman, i'd be very happy to provide an accounting those individuals, in thing a regrat of course. >> thank you very much, now i'm to everybody. how many people did you have to hire to process paper applications because of the your exchange website? let's start with you, dr. matsuda. contact center recently we increased staffing thatndle the backlog mentioned in my remarks, by a people. 80 >> how much did that cost? >> i'll have to supplement that record, i can get the exact number for you. >> we'd like to know how it was paid for too.

next, mr. sharfstein? >> about 200 more people in the center, about $6 million. >> how was it paid for? our grants under the usual rules. >> through the federal government? >> federal and state government, right. >> miss yang? havengressman, we leveraged the work force of about 300 individuals through an thensive work period in past four weeks. and we are happy to report that backlogr application has been eliminated. >> how much did that cost? >> i do not know the precise for that period. we can get back to you on that. >> and how it was paid for. mr. lee? >> we have a customer service expanded by about 250 people that do both phone and mail, but we also shared the processing work with county partners throughout the state of california, and additionally did some extra contracting to remember doors to help us get through the paper

backlog. i'll follow up with you on that number, but it was paid for out establishment grants. >> congressman, approximately 50 added for thate purpose. we also paid for that out of the grant.shment >> mr. van pelt? >> thank you. leveraged work force from different state agencies, but i will have to get back to you on the precise number and source. >> i'm going to come right back pelt, quickly, mr. van because when did the state first alert c.m.s. that the exchange operational? to be >> that's all in the first data have tont, and i'd defer to that report, congressman. address the -- >> my particular role was such that i was called in shortly after the governor and the, determined that this was not working or going to work and that being the case my time

onsetting up the paper application process and steps going forward. was that c.m.s. had very poor oversight, in your predecessors were talking in regard to later lackluster questions and how impressed c. m. s. with unimpressive answers so i'd like to have a detailed report on that. >> i'd be happy to do that. >> i yield back. >> the gentle lady from california is recognized. >> thank you, and thank you again for your outstanding testimony. tribute to you as executives in each much your programs that you've turned what into --nade you've turned lemons into lemonade. quoting thestart by speaker, when he referenced the horrendous and a launch was anything but smooth. barton called it a huge undertaking and there's going to be glitches.

those were comments made by congressmanand by barton on the rollout of part d, medicare part d, which was seen theull of problems with initial rollout. and yet republicans at that time about fixing it. was in president bush's administration. i would like to see the same kind of frankness and the system to fix now that it's in president obama's administration. we're undertaking a much, effort.ger now, what's good about everything i've heard here this morning is that you have fixed the initial problems. you are all optimistic about the perhaps.f your can i just have each of you indicate whether or not you are, have metou

your goals or will meet your goals? >> thank you, we do believe we're going to reach our goals. our system is working, as i testified yerl, and really our goal now for the short term is to improve the functionality and the use ability of our system. succeeded oates enrollment goal. >> miss yang? you havesswoman, as heard in my testimony, we are proud of the fact that we're fundamental goal of the a.c.a. which is to expand coverage on top of an already i ground in massachusetts. our work is not done, but we're solid path. >> mr. lee? >> well, we actually have never we'veecific goals, exceeded all expectationings and all independent projections. ensure everyto single californian, so we've still got work to do. >> congresswoman, minnesota is solidly on track and we feel very good about the future of

us.'s ahead of >> mr. van pelt? >> thank you, oregon is very achieving itsy to enrollment goals and feels confident in the steps we've technology.rove our >> great. mr. lee, california is a great here, and we're proud of that. would you tell us what some of the reasons for the success were? >> congresswoman, i'd be happy to. and some of these are my testimony, and i'd highlight this very briefly five things. one, leadership across the state focused on consumers. politics aside and said let make this work for consumers. collaboration, both between state agencies, the medi-cal agency, but also with the regulatory agencies, this changed the entire insurance market. exchanges,st about

it's about changing the marketplace. that coordination is critical. partnerships, this has worked ground it worked on the in communities, with community clinics, with counties, with thatance agents partnership collaboration has been fights. and finally that we've had a culture of transparency and learning. we've had bumps along the way our coursedjusted and will continue to do that. this is the beginning of a very long road, we look forward to learning and improving as we go forward. >> dr. sharfstein, you're going to implement the connecticut solution. i don't know how many other states are, but they seem to well. y it work very what do you think the key is to system?ecticut push your button, please. >> sure. there are several things that very attractive about the connecticut solution, first of all there's a very simple and el both for consumers on the consumer assistance workers.

it also has very good functionality for insurance brokers and we have a lot of insurance brokers that we're working with in maryland, so was very good. it also uses some of the same for the, not the specific software for the affordable care act, but some of the general software piece mass. licenses to, and it runs on the same kind of computers that we've already purchased. lot of overlap and allows you to reuse some of the initial investment. thehose are some of and we were able to demonstrate it at our board meeting recently, we've gotten a feedback onive that. >> thank you all. >> we will now go to the from michigan. >> thank you, mr. chairman and thank you for holding this at a programok as ans being penned exceptional opportunity to, i guess, carry on approach that away freedom, competition, opportunity and i think great

health care continuation for our country, simply because we were the cost to deal with and increase that competition. but let me ask a question of mr. lee. thank you for being here. auditors report that called the covered high risks plan a new entity. and that was the auditor's statement. you said the report stated that all enrollment scenarios, cover california will not have revenue to cover its operating cost in fiscal year 2015-2016. it said it would be losing. >> 73 million. you told state finance officials quote,mber that, and i the long-term sustainability of the organization, end quote, is its greatest weakness. what did you mean by that?

>> well, a couple things. are very appreciative to receive federal funding to get going. california, after we are going, we will be running 100% on our own steam. by premium dollars, by state law we cannot go to the for generalifornia fund. so making sure we are fiscally well managed is an important factor for being an ongoing organization. the auditor's report also noted, believe, in our budgeting has always planned to have a couple years of with a are called deficit spending to then be offered in the black. be2016-17 we plan to operating in the black. >> you still believe that you will be? >> absolutely. we are actually in the process of developing our next year, our budget revised budget now based on our current enrollment figures that we'll be taking in to our board this next month and we'll be able to adjust every year our operations the revenue and the expense side to be fiscally well

managed. >> let me follow up on that with again, the state awe for's inort noted that premiums both individual and shop quote, generally would provide the revenue required to operate the exchange. shut down the shop market earlier this year. congressman. not, >> you didn't shut it down? >> absolutely not. our shop market is running, we have more than 6,000 individuals enrolled and over 600 businesses. we turned off the online enrollment functionality, which is generally not used by the shop market. that's generally not how small businesses enroll any way. but we are enrolling people continue to. >> so you don't plan any future? bailout in the >> absolutely not. by state law in california, i want to be clear, we cannot be general fund money and we expect that we'll be to --ting >> federal taxpayer bailout as well?

>> we've been support bid the federal support to get launched -- >> but you don't expect any more bailout.upport or we'll hold to you that. i hope that's the case. >> me too, congressman. >> now, let me move onto ask you questions. withtal, let me start dr. sharfstein. in total, how much has been paid to your state to develop and exchange?s your microphone, please. has spentour exchange for all costs including the website about $129 million. >> that's what's been paid in to the for your state to operate this exchange? so our federal grant i think in total, if i'm correct, are about 180 million. no, i'm sorry. let me get the exact number for

you here. >> miss yang, you can get prepared for that same question. >> it's about 180 million in grants, we haven't spent all that though. been paid tot's you thus far? >> those are the federal grants awarded.e been >> who are the contractors and how much have they been paid? >> there's a long list of contractors. so i could submit that for the record. >> i'd appreciate that. were they bid competitively or sole sourced? >> for the major i.t. we did a procurement. >> any other contracts, sole sourced? a couple much smaller contracts that were sole sourced. theow would you rate contractor's performance under contract? our primee let go contractor, we did not think they performed well, we were how some of with the software worked, it was sold to us as out of the box, it lot ofe able to do a things that it in fact did not do out of the box, and we wound sameth some of the

problems that minnesota had. >> mr. chairman, if i could ask the record if i could get thathe information to us would clearly state whether you will seek further federal fund to fix your mistakes. expired., my time is >> the georgia from pennsylvania mr. cartwright is recognized. >> thank you and thank to you all the witnesses who have joined us today and for your tireless efforts to get people signed up for affordability care. unfortunately i come from a its ownat did not start exchange. pennsylvania. failure to dothe that in pennsylvania was an abdicationn of the the governory of on behalf of the citizens. over the last five years we've

seen 1hospitals in close, and i see the a.c.a. and enrollment as a way to strengthen america's hospital system and that includes pennsylvania. the governor's decision back in to establish an exchange was announced in a way.iar it was first celebrated in a fors release by americans koch brotherse funned enterprise. 20 minutes later the commonwealth of pennsylvania itself made the same in a press release. the timing of that announcement raised questions coch brothers influenced that decision in the place. the governor's decision not immediately to expand medicaid than 520,000 pennsylvaniaians, who could be covered under -- the federal government would have paid 100% of those costs

first three years, phasing it down to 90% by 2020. we've had a health care c.e.o. in my district in northeastern pennsylvania confide to me that if the pennsylvania doesn't accept the medicaid expansion, close one to have to of his two hospitals. that's how important this is. of accepting federal funding to expand a highly program, theaid governor in pennsylvania submitted a waiver proposal that would improse premiums, work search standards and limits to benefit for medicaid recipients. familyng to the kaiser foundation, the governor's delay will cost pennsylvaniaians hundreds of millions if not in med okay dollars this year and will leave lowreds of thousands of income residents without health ine coverage in 2014 pennsylvania. it's unconscionable to me, it's playing politics, as ranking member cummings has pointed out, with people's

people's health. i urge governor corbett to reconsider his wrong headed decisions. and with that i'd like to turn to the panel today. the citizens you represent, ladies and gentlemen, are fortunate that all of your states have made the decision to expansion.medicaid mr. lee, i want to start with you. enrolled more than 1.5 million new applicants october 1.id since am i correct? >> that's correct. committeeou tell the about what the medicaid expansion means for those and for theesidents state as a whole? >> absolutely. i appreciate the question. been in california in very close partnership with our agency. people don't know what they're eligible for. we've had literally thousands of tears ateak down in the idea that they have for the first time in their lives

affordability coverage, both for medi-cal and subsidized coverage california. i've talked to many of them personally and people on the whether they're service agents -- touching many lives. >> what will you, mr. leitz, can you describe the impact of medicaid expansion on residents in your state? >> congressman, we know in that will 60% of our uninsured population is eligible the medicaid program, so as our numbers have grown we know unsuredre reaching the by enrolling them into medicaid and that's allows them to access services, oftentimes for the first time, to get preventive screenings, to care for issues that they might not have cared for in the past, so it an a very them ast thing both for well as the care givers that they seek. you.ank what about you, dr. sharfstein, same question.

expansion isid extremely important in maryland. we've done analysis that there over $150 million in uncompensated care reductions that we expect as a result of expansion. and it matters a great deal. onea pediatrician, i met would mom who said that her daughter got, was telling me the story about a very sick baby who heart surgery that the medicaid paid for and then me ag the daughter to give hug. they're real people, in maryland, my patients when i see clinic, that the medicaid expansion changes their lives. >> thank you, sir, and i yield back. >> thank you, gentlemen. ranking member of the gentleman from florida is recognized. >> not ranking member, i'm on your team. right.all >> you've been called worse i'm sure. >> thanks, i appreciate this hearing. i got to tell you, when i hear

things like that this law is causing premiums to decline sharply for americans, i don't after havingsay dealt with so many disappointed in my district. the question is who are you going to believe, those who are defending this law or your own eyes? i think the american people will make that determination. some i think the american people will make that determination. said arehings that are expansion for 3 million young adults. it is probably less than one million. the numbers back and forth are fine, but the essential promise -- that central

promise has been broken. i have not had anyone come to me and say that their premium has declined by $250. people are paying higher can we put the slide up ? you have a lot of those things. so what was the promise? everyone now has health 37% ofe but the cbo -- americans.

now they say will be closer to .0% the actual number is 12.5%. that's including dedicated expansion and the age 26 rule. 12.5% of the uninsured that have been covered at a great cost. we are seeing the amount of money that has gone into creating these exchanges. we are seeing people on medicare advantage. it hasn't even produced what they said in terms of expanding coverage.

i think that is something that has made a lot of folks frustrated when they see numbers like that. i have a couple of quick questions. i read a news report where a couple had signed up for a plan, and then they got a voter registration card sent to them that had the party already checked. are you familiar with that report? >> i am. >> how did it come or there would be something that would be pre-checked. is that something you have control over, or is the election office sending this separately from cover california? >> every voter registration form at cover california has been designated a national voter registration agency, so it's a requirement under law that we send these out in california. every voter registration form is provided by the secretary of state's office. >> thank you. i also read another report about whether they are advertising to people in the country unlawfully. i don't believe they are lawfully allowed to get obamacare subsidies. how are you approaching that? are you trying to get folks who

don't have legal status to get signed up on cover california? >> absolutely not. we are trying to communicate clearly how a family who has mixed status -- there are many who might have one member of the family who is not a documented resident and another family member who is. we want to make sure those who are eligible for coverage get coverage. it clearly indicates the rules on how a family should come forward. we greatly appreciate of the guidance from the federal government to make it clear that the guidance provided is only used not to discourage individuals as families coming forward to get coverage if they would be worried that would be used. >> if someone could not get status that would mean -- >> absolutely not. >> any cancellations has oregon had on the individual market - >> how many cancellations has oregon had on an individual market? >> i don't know. >>, and people have enrolled via the individual market in oregon

as of april 1? >> approximately 65,000, and another 140,000 in medicaid or oregon health plan. >> of the 140,000 medicaid, do you know how many would be eligible for medicaid anyway? >> approximately 100,000. >> it seems to me there were more canceled and have signed up in the individual market, and if you were going to control the medicaid numbers a lot of states have seen increases in states that didn't even expand medicaid. i think it's important we are able to determine those. i am out of time, so i will yield back. >> the ranking member of the full committee, the gentleman from maryland. i believe the gentlelady from new mexico is recognized.

>> thank you, and i also appreciate the panel today and spent some time working with our state legislature and our current governor to enact legislation that got passed by our legislature. we had to pass it three years, three times in order for new mexico to get started, so you are pointing out trials and tribulations. one thing we haven't discussed is that many state waited until the last minute, and that exacerbated the issues you have identified today. i am interested in some of the education and outreach efforts and would love to have each of you talk to me a little bit about that going forward,

targeting those folks that are still uninsured, really clarifying these numbers, looking at folks and businesses and those trends, working with your navigators and brokers, if each of you would talk to me a little about moving forward. >> our outreach program we have arranged sub grants of federal funding to about 32 nonprofit organizations on all the islands, and with those grants organizations are hiring people to go into the community to work with people from many different cultures and different language groups to work with them face to face to help them understand health insurance and then the affordable care act, and if they are interested in looking into applying, they will assist them with going to our application process for enrollment. >> in maryland we work with more than 2000 and insurance brokers.

in addition we have an entity program where there are six regions, each with a connector, each of these working with local agencies. when i was way out in western maryland i was meeting for another reason with a group that is the sole mission to help people get health care. for many years they work with the medical community. they said, we are part of the coalition that got funded, so we have some great organizations across the state. it's one reason we have been able to hit our goals despite the i.t. problem. >> i think that is important. i appreciate the reference to your partners. tell me what you would do differently going forward. some states are still really struggling. we could do a lot better in new mexico. although we did a good job we could do a much better job for example in medicaid out reach.

>> i appreciate this question because one thing i can say based on massachusetts experience of the last eight years, outreach and education is one of the most critical efforts. it is one of the most important outreach area. particularly the lowest income is hardest to read. if you look at massachusetts reform records we have 97% remaining are primarily low income, and we are very proud to see the fact that we were able to break in 200,000 new people into subsidized coverage, and that is a major step forward relative to where we were. >> we have a lot of learning still to do. we look forward to it, but it's going to get harder and harder. the people who are not insured often have never had insurance. they don't believe it could be affordable.

that's a core outreach message we have done with both advertising and also on the ground. the other thing we are continuing to develop, this is complex stuff, and having person to person support in english -- >> i have only got 45 seconds left. we know that eight out of 10 hispanics are likely eligible for one of the medicaid programs or coverage, yet we have half of the hispanic population is not going to be insured. i worry we have too many steps. >> there was a very big and important latino community. 18% were latino. we have doubled the rate of ensuring latinos. it takes education.

>> if the chairman will allow we will do a quick answer. >> we have certainly seen the importance of working with agents and brokers on the ground. they are with every community. they know the community is very well. the other area we have been focusing on is working with communities, helping them understand the importance of coverage and working in their light which is. -- in their languages. >> thank you very much. similar to other states working with community partners to help get the word out and walking citizens step-by-step through the process. >> i really appreciate all that. i am very grateful for those

responses. i would love for everyone to consider, maybe at a future hearing. in my state i went to several different enrollments, and they varied, and this notion of waiting for appointments and having it more in depth in depth than going to an appointment with a sister -- we lost 50% of the folks in that line. i think that is too much. thank you, chairman. >> i think earlier, you received 180 million in taxpayer grant dollars in the state of maryland. >> yes. >> you have spent approximately two thirds of that -- 120

million? >> i think we have spent 100. >> you had to hire 200 more people to work in call centers? but that's correct. >> you said the state of maryland is meeting our goals. i think a lot of people disagree with that. >> i was referring to the enrollment goal. i would agree we don't meet our goal with regards to the website. >> my understanding is that the enrollment target number was 150,000 for the state of maryland, and you have enrolled 60,000 people. >> it was approximately 260,000.

for the individual markman we had an individual assessment, and they estimated around 75,000. >> i thought you said the enrollment number was 150,000? >> no. >> we have a document that says that. >> if that's the case i haven't seen it. >> where is the 75,000 coming from? >> it comes from the university of maryland in baltimore county. we could provide a letter that explains that. >> that your target goal? >> our goal was for a qualified

health plan, but insofar as how we are doing in terms of health plan enrollment -- >> our understanding is you took what hundred 80 million of taxpayer dollars, the federal agency involved in implementing, and they said the enrollment should be 150. you can take the money but you get someone independent to tell you what your goal really is. what was that number given to you? >> that was the estimate given. it was a revision of a report they did in the last couple months. >> what was the initial number? >> the initial number was 150 thousand. >> imagine that. the number i just said. when did you get the revision? you are close to that, and you get a revision. how convenient. suddenly we are close. it is bringing the standard down.

>> you can look at the letter they gave, but i don't consider medicaid to be invisible. >> suddenly when you are not coming close the standard gets revised by some independent maryland goes to to get the number it likes. i'm not the only one who thinks you are doing the job. you have a democratic congressman from your state. i have four letters from congressman john delaney from the state of maryland, where he says this is such a mess, we encourage you to switch to the federal exchange. it's not republicans sending the message. we think with all the problems associated with the federal

exchange you have a democratic congressman from the state of maryland saying you are such a mess we should tag this and go to federal chains. -- the federal exchange. >> i don't disagree we had a major i.t. problem. >> you haven't hit your goal. you were supposed to be 150. that is markedly short from your goal. >> that was an estimate, not a goal. it was in error. when did you let the federal government know you were going to come far short of this 150,000 number? did you have to give periodic reports of where it would be? >> we have been working closely with the federal government the whole time, so we have been providing weekly public updates on where our enrollment is. >> let me ask a couple questions. i am over my time.

how many people in your state lost insurance because of the affordable care act? >> i think very few. there weren't that many cancellations. there were notices of nonrenewal. the carrier allowed them to renew for 12 months if they wanted to. >> according to our reports, 73,000 individuals in maryland were going to lose their insurance because of the

affordable care act, and what you are telling me is your revised goal is approximately the same number. 75,000. your revised goal of people you are going to sign up is we are going to sign up the people who were kicked off of the affordable care act? >> the problem is there is also a market outside the exchange. we are going to see it in and out of the exchange including the people who renewed the policy to be far more than 2013. you have probably as many people outside the exchange as in the exchange, plus you have people who renewed early and are still in those plans, so our carriers predict significantly more enrollment. >> you may predict that. 73,000 marylanders are going to be kicked off their plan because of the affordable care act, and you are telling me the goal you were supposed to meet by april 1 was only 75,000. >> you are comparing apples and oranges. >> i am comparing people who got

kicked off because of this law and the number you said you were going to sign up because of the exchange, which is roughly half of what the team gave you. >> i think apples and apples would be the size of the individual market before and after. whether people had coverage before versus after. we are seeing not only the exchange enrollment, the outside exchange enrollment, which is going to be at least that, but the fact that people could and roll early. >> i think you are leaving out the fact that your calculation is those who were kicked off. they were kicked off the plan. >> they were in the individual market report. apples to apples would be you were in the individual market before. you are in the individual market after.

>> the number you are saying is your goal, 75,000, you have lots of people kicked off. you had people who didn't have insurance before you were supposed to shine up -- sign up, and we are back to the original point. they said here is $180,000. your goal gets revised in the last few months down to 75, and we have a congressman from your own state in the other party who said this is such a mess you should have switched to the federal exchange a long time ago. back in january he was calling for you to switch. >> we investigated that possibility. there is no disagreement about whether our website works like we wanted. it didn't. >> the president said in late september -- he gave a speech in maryland days before the launch promising obama care will be

"smoother in places like maryland where governors are looking to implement it rather than fight it. what are you saying that would give the president the assurance this was going to work great when it didn't work well? how can the president make that statement where we have a democrat member of congress saying this is such a mess, go to the federal exchange? what was he basing that on? were you saying everything is going to be fine? >> i think it was well known there were going to be glitches. the federal government was communicating that. >> the president didn't get the memo. he just said it would be smoother that they were working to implement this rather than to fight it. >> we were surprised by the scale of problems after april 1. >> i want to go to this slide. a whistleblower gave us this.

this was a report. we will give this to you. this is difficult to read, but we think this is important. what it says is the red our problems associated with significant delay or risk. this was a report given to you back in february, 2013. it shows you knew a year ago there were going to be big problems, and you didn't communicate that with the federal government who is giving you 120 million in tax dollars? >> the federal government received our report. >> the president had access to this report before he made that

statement just days before the launch of the affordable care act? >> we are communicating with the agency we work with. i would say subsequent to that we were able to make progress. >> of course you were going to make progress. when it is this bad you have no place to go but up. >> in june of 2013 we passed an important test. i think it probably gave us more optimism than was deserved at the time. >> i am way over. i appreciate the chairman's indulgence. >> i would like to have my 12 minutes, just like mr. jordan. let me go to you. i listen to mr. jordan.

i wonder how many people he helped enroll under the affordable care act. i know it has been difficult. as you know, the last three saturdays i spent all day helping people who were trying -- i sponsored two events all day to get people enrolled under the affordable care act, and the website -- and i'm glad that if the website had a problem that we wouldn't throw our hands and say throw everything out. i stood with people who waited all day to enroll.

i don't know what you say to people when they said this is the first time i have been able to get insurance in years because i had a brush with rest cancer. -- with breast cancer. i don't know what you would say to this person. don't apply to the affordable care act when it is the law? i'm not sure. we can nitpick and go ring around the rosie, but i go back to what i said in the beginning. this is not just about a website. as i understand it, the figures were adjusted. i am going to refer to a february 2013 article. i'm just going to read from it. it said the new number is 70,000.

after it was corrected at the university of maryland and baltimore county, a nonpartisan health research organization that discovered its error weeks ago and sent the letter dated february 21 to the health secretary of the exchange board. it was a footnote to one chart that included open enrollment beginning next fall for 2013 coverage. does that refresh your recollection? do you have that letter? >> i have that letter here. >> did you go seeking that? how did that work? what happened?

you found you have a problem. people have problems every day. they don't just throw up their hands and get upset and say, i cannot do it. they find a way to get it done. sometimes we make adjustments. we make adjustments every day of our life. review the reason i have that attitude is my mom and dad had a second grade education. they were former sharecroppers and worked like slaves. we believe in the can-do attitude. i am hoping we believe in the can-do attitude in maryland. would you explain that to me? that mr. jordan made such a big deal out of this? >> they said a more reasonable estimate of combined enrollment would be 160,000 including

approximately 70,000 in the exchange. people said, now you're probably going to lower that goal, but we didn't, even though we were way below 200,000 at that point. the governor wanted us to shoot for 260,000. even though the overall estimate has been lowered by the people we hired to do an independent analysis, we are not changing our goal. we wound up exceeding it. >> i was all day trying to help people get insurance.

i had a chance to speak with the organizers. these are people not making a lot of money but giving their blood, sweat, and tears because they wanted to touch somebody's future and change the trajectory of bed. one of the things that was very interesting -- we had so many people trying to get health care, and correct me if i am wrong -- that we had to basically put the people in the queue and say, there are so many we can't even get to them all. we are going to have to get back to you in the week. is that what is happening? >> we expect the numbers to be higher than they are now. right now our call center is getting calls from people who were not able to enroll in march. it could be several thousand more.

we were able to suppress 300,000 against the goal of 260,000 in the face of incredible i.t. challenges. >> the can-do attitude. let's talk a little bit more about the contractors. when i served as the ranking member of the subcommittee of the transportation committee, we had a situation where we had contractors that were building boats for the federal government, and the boats didn't float literally. sometimes i think some contractors have moved to a culture of mediocrity. it's so very unfortunate.

if we continue down that road, we will be in a situation where i think about a trip i made to israel years ago, and there was a saying, if we are not better we will not be. if we are not better, we will not be. can you talk about the contractual situation here, what happened? you said you had some bad situations that happened, and could we have foreseen some of that? >> i think the major in retrospect -- although it was hard to know at the time, the

states based the decision on whether it was better to build a computer system from scratch or to rely on existing products, and we thought it would be less risky to rely on existing products. we procured a system that had an ibm software for eligibility, and it was portrayed as out of the box being able to work. we would just be able to configure it very easily. this has been a big point of discussion in some of our state discussions. we have shared with the state legislature parts of the bid

that related to this, and the software did not work as advertised or even come close. it created a whole range of problems we had not anticipated. i think the states that did more of the building themselves were able to be successful, particularly in california and new york, and in the end because we can reuse a lot of the software and hardware, we're going to go with particular solutions in connecticut. >> does the state of maryland plan on recouping some paid for the development? >> we do intend to seek a recoupment of the funds. absolutely. >> now you are going with lloyd. is that right? >> correct. >> what are the plans? >> the plan is to take the system developed in connecticut and has been successful and move it into maryland with minimal changes and basically plug it in. you have to build the interfaces and change certain elements of the website and use it in maryland for the fall open enrollment session.

>> who is going to fund that? how will maryland fund this? >> we will be putting our plan in a corrective action plan for the federal government, and we will be seeking to have the same partnership funding we have had so far. >> i want to say, and i said it in your introduction. i know what you have done for maryland and what you have done for baltimore, and i know the dedication of you and i'm sure all the other people sitting there. when we had medicare part d, we had problems. when you go back and look at some of the comments made back then, we had folks who said on both sides of the aisle, we have got a problem.

we are going to work through it. we are going to get there, and we got there. now you don't even hear about glitches. it's like ancient history. i can recall medicare. we held the same kind of events. members of the congress went to all kinds of meetings, town halls. and you voted for it, but it was the law. we wanted to make sure that it worked. i hear all of this, and i do wonder. i really wonder, and i know there are problems with the affordable care act. nobody has denied that.

i wonder what it would be like if we could join in together to address those issues. as my father used to say, when you're dead, you are gone. so what we are talking about is trying to save people's lives. we are trying to make sure we keep people healthy. we want to make sure we give people a piece of mind. i want that for my colleagues constituents, and i wanted for mine. i think we have one life to live. this is no dress rehearsal, and this is that life. i did we ought to be about the business of trying to help each other live the very best life we can, and i will yield back on that. >> will you yield to mr. jordan for just a moment? >> it's really simple. what happened is the federal government enters into a

contract with the state of maryland. the initial terms were 150000 and role he is in the market and 180 million dollars going to the state of maryland. they were going to go after some of the contracts they felt didn't will fill their end of the deal. if you get 180 million dollars if you sign up 150,000 people, and we say, we made a mistake and we're only giving 75. the plan is simple. are you going to return some of the money? >> inc. you, and i will consider that. having looked at this document i am not exactly sure who this document was shared with. >> i am going with you. a number you gave was 140,000 people. >> i was referring to the

document handed to me. i wanted to be clear. i thought it was a different document. we will follow all the applicable laws and to the extent we are able to recoup funding i hope it will be you refunded. >> are you going to return federal taxpayer dollars? 150,000 enrollees, you get 180 million dollars. you didn't meet that. you changed it. are you going to return all the money? >> we are going to follow up with double laws. >> you're going to go after those who you feel didn't fulfill their part of the contract related to the functionality of the website. >> that's correct. >> it's ok to go after them but the taxpayers don't get their money. >> i think the taxpayers should get back their money. >> unanimous consent for one minute. >> i noticed mr. lee was shaking his head. why are you shaking your head?

did you have something you wanted to say? >> the document prepared was prepared not as a document with us, but they pulled from a range of things, and i will note the california estimate in the document and towards the end of open enrollment, i thought that was the goal for open enrollment. we had independent estimates developed. we have talked about those. those are open enrollment, high-end estimate was 800,000. at the end of two rounds it was 1.2 million. i think you are alluding to a september internal memo that was never part of our contract, but they got the numbers wrong. >> i didn't say anything about california.

i was focused on maryland. he said it was revised down to 73. i would ask unanimous consent to look at the letter from congressman john delaney suggesting they switch to federal. >> i would ask unanimous consent that the article dated february 23, 2014 at the hilltop institute letter to the interim executive director of the benefit exchange, dated february 31st, 2014 be entered into the record. >> without objection. >> thank you, mr. chairman. as a schoolteacher i thought the students there were three branches of the government. legislative, judicial, and executive. checks and balances. they should have taken my class because they keep writing checks and the constituents get the balance.

i also told my constituent bills were brought to the floor, went to committee, and brought to the floor again for debate and considered passage. but the aca was passed before congress can read and debate the bill. shame on congress for allowing this to happen. seems on those who circumvented the congressional procedures that allows open and respectful debate before a passage of a law. the billions of dollars spent and the divisions it is costing this country is inexcusable, because congress passed a bill before it was read

and debated. this is shameful. it seems here, listening to all these debates, the good, the bad and the ugly, the money that was spent, and all we have is billions spent and division in this country. i keep hearing -- well, let me say this, in congress we are the fiduciaries of the public's interest rate today, after hearing your testimony and reading this testimony, all i see is more money wasted for failed system, coverups. that is what i anticipate. lawsuits will be filed, and every citizen knows, somehow, something that someone is going to be swept under the rug, and more money spent. how many uninsured people are in the state of california? i look forward to knowing at the end of this year -- >> to know the population? >> 35 million people.

>> how many people in california have enrolled to the state exchange? >> 1.2 million in california exchange products. >> 35 million people in the states and 1.2 million people signed up. well, if it was a good product, you think -- you think people would be the pastor door. door.t a path to your of those who have enrolled in the state exchange rate paid for their insurance and those have not paid for it, -- 85% of those are paid a premium. >> to not many people are going to receive it -- insurance through that exchange? >> absolutely. >> thank you very much, mr. chairman.

i want to ask a question of the contractors. i don't think there has been in all the hearings that we have had, enough of a focus on the contractors. congress is so busy fighting off the affordable health care act itself. i must say that the number of state exchanges is had problems. when you combine that with the problems we have in the federal exchange, it really does show that technology is overrated. i must say it also shows that since this has not been found just in the federal exchange, this rollout problem, this problem with technology just in the state of that state, but rather through a wide

cross-section of states, that we are dealing with a new problem. we ought to approach it that way. that means if it was new to the government, state and federal alike, it certainly looks like what we did not anticipate, is how new it would be to these contractors. that was perhaps overreliant faith put in the contractors. i know one of them, see gr, had its fingerprints on a number of the states as well as the federal exchange. i can't believe that that is accidental. let me just ask you who used cgi. did you see what its record was with massachusetts? i see that massachusetts no

longer uses cgi. those of you who used cgi, and there were several of you did, would you speak up and indicate whether you checked to see what cgi's experience had been in doing precisely this kind of work, at least in massachusetts? >> thank you, congresswoman, for the question. first of all, let me say that they see has many components. i.t. implementation is one of them. we work with a wide range of different contractors, and some of them have been delivering excellent performance, ensuring our overall success. >> i'm asking you about cgi in particular. >> cgi was involved in massachusetts aca implementation, specifically with website development.

we engaged them through a competitive procurement process consistent with guidelines applicable to us. unfortunately, cgi's performance has been disappointing. they were behind schedule in delivering a required functionality. >> did you use them from the beginning? >> i am sorry -- no, the health connector was engaging cgi for the first time with this contract. >> when he rolled out your own program, did you use cgi? >> no, we did not work with cgi. it was a much simplified, very different website development and we work with a local vendor. >> what led you to use cgi? >> why did we use them? we went through a competitive procurement process to identify -- >> what about cgi led to its

selection? >> it was selected through a procurement. >> everybody was selected through a procurement. >> i'm sorry. i am just turned answer why we ended up. >> to the have experience or some other factor that made them stand out among those who competed for -- >> it was the best vendor among the respondents. >> in what way? >> they demonstrated experience. >> in this kind of work? >> yes. >> mr. matsuda, you used cgi. what made you use his company that had that experience across a number of states? >> i was not with the hawaii health connector time the decision was made. but my understanding is that we went through a procurement process and they had been selected for the federal

exchange. >> do any of you know whether cgi had experience doing this kind of work before? did anybody else at the table you cgi? had cgi had experience operable to this experience that you engage them to do? to your knowledge, ms. yang and mr. matsuda? >> as you know, aca implementation is a new project for all of us. i would not say cgi was engaged in identical projects, but in terms of comprehensive system integration, cgi -- >> mr. lee, did you consider cgi? >> i actually don't think, as i recall, cgi did, or it was not one of the finalists for us. i don't know if they were a bidder, but the folks who did the did not have direct experience. you have to look at general track record, cost, staff they provided, before you could endorse a selection.

>> the district had a heavy burden, because congress in a spite amendment, made numbers of congress and their staff go to the exchange and took them out of the federal program. it worked pretty well. i have to go back and make sure they did not use cgi. we will have to look at these contractors and see what was the difference in the experience with the contractors in particular. when you're doing something entirely new, which congress has not taken in consideration, it does mean that you're probably asking contractors to do something they have not done, either. the problem with this is, we assume that contractors do something much bigger. we talk about the big parts of the private sector. we assume that these must be sent contractors who have done, who have handled things in the country so surely they could do

the health care exchange for a particular state, or for that matter for the united states. mr. chairman, if i could say one thing, this is a note for the record, that mr. desantis from florida put up a graph, which he said showed, and question witnesses, on the theory that it shows that these contractors and others, including the federal exchange, had in fact performed below cbi expectations considerably. please note for the record that his state, and now a great many other states, are directly responsible for that, because they have failed to allow poor and middle class and disabled people to get health expansion of the medicaid exchange. if that had happened, i had -- i would have no doubt that the goals would've been met.

if you don't take responsibility for why there is a reduction in the uninsured americans, takes a lot of chutzpah. mr. chairman. >> in my state, we also have that. some of those individuals were covered by our ensure oklahoma program prior to that, and a loss that. part of the waiver issue was, we had to remove that as a safety net. >> chairman, that doesn't take care of those when you have an expanded medicaid. did you have expanded medicaid? >> we did not have expanded medicaid, but we did have coverage with our ensure oklahoma program. >> my remarks were limited to those who failed to expand medicaid and had no other way, obviously, of assuring them.

>> i just asked this question of the whole panel. who are in charge of your exchanges in your respective states. i will go down the line. yes or no, have you enrolled through these exchanges that you are in charge of? >> yes. >> mr. sharp stain. >> no. i'm a state employee. >> are you enrolled through the very exchange you are in charge of enrolling others? through state coverage. >> i need to apologize and correct a statement made earlier. mr. desantis asked about the enrollment of our qualified health plans on april 1.

the correct number is 57,000. with respect to your question, congressman, i am not an employee of the state. i'm self-employed, and did not apply for insurance to cover oregon. >> ok, so the question, and i ask this because this is one of the questions that my constituents ask about the laws that we live under. so i would ask you, there is a concern i have about personally identifiable information, and folks are putting information into the exchange, and the safety of that information. you know, would you personally guarantee that personally identifiable information is safe

through your exchanges? >> what i do know since i've started in this position is that i have verified the exchange was given full authority to connect to the federal after passing all necessary -- >> we have concerns with the federal hub as well. you are sharing perhaps some concern? >> no. >> to me ask you again. we guarantee that personally identified information is safe to your change? >> i believe so, yes. recognizing that nothing is 100% safe, maryland is very safe. there are a lot of things i can happen. no known incursions. to your point, my personally identifiable information is in there. i did start an application.

i put in my social security number. at no qualms about doing that. >> were you able to complete your application? >> i did not completed because i have coverage. i was just testing it. >> this is one of our highest priorities in terms of protecting people's private information. we have not had a data breach. i would not be comfortable, i wouldn't be letting the exchange operate without knowing that her so information was protected. >> so the safety of personal information is our top priority. we are certain the data is secure. we have had no data breaches and no incidents we know of of individual, financial or personal health information being breach in any way. >> security is a top priority for us. we do everything we possibly can to protect the information that goes in.

>> we guarantee that? it is much a top priority and we do everything we possibly can -- >> cover oregon also meets a cms security requirements which have been validated by cms. we're not sure -- we are not aware of any security breaches. >> i wanted to at least ask that. in terms of lost applications and incorrect subsidies, it is not an error proof system we have. obviously. there have been faults and failures. i got a story for you, mr. sharp stain. in your system in maryland, i have a staffer whose mother was given a notice by our ensure that due to the affordable care act her insurance was discontinued. she had to go into the exchange.

she began a three-month long process to enroll in your exchange. i know that you have about 4000 applications in your state that were given incorrect subsidies or lost applications. is that about the right number? >> we reported a number similar to that. >> her experience is one that i know very well. your daughter and threw her telling the story. when you are talking about the first roadblock for her and filling out application was a question of for citizenship, which she could not verify, she called the health line -- he called the helpline. it is obviously helpful in all your states, as you will attest to. people have problems with the website. they have been noted. i don't have to recount the spirit in her situation, she was told to the hotline to fax her,

i believe it was her driver's license and social security number, to this open fax line. she asked, do i put it to your attention? >> i would hope not. there is a fulfillment center. they have an approach to secure personal information. we have to verify things like whether people are able to purchase coverage under the law. >>