we look forward to bringing about some much-needed reform. if there is no further question, senator, you may submit additional questions. this committee stands in recess to call the chair. the next hearing will be on , and which we:00 will take testimony from , thetary pritzker secretary of commerce. >> thank you. >> next, the hostile many looks at the implementation of health insurance exchanges at the state level. after that, q&a with author matt about his book,

"the divide." after that, you comments on "washington journal." tomorrow, the lights in support of afghan people looks at this past weekend's elections and what happens next. live coverage begins at 2:00 eastern on c-span3. >> we are really active. we are involved. news is where you really make you money in the local market. that news operation cost us almost $800,000. it is not cheap. this is often the faint of heart. because this is what people wanted and needed to get them back to her station, back to ww m.d., billy huggins, who is my general manager, we put that back in place without sinclair.

i, alone could not afford these figures. there's an ice storm in south carolina about a month ago. i still stored our generator. we were off the air from a 16 hours. to get a generator was $400,000. these are the kind of expenses that you cannot calculate. i don't care what kind of wealth i may have been blessed with, with's no way with my two three television stations can survive this without these joint services and shared services agreement. >> the fcc rule that owners cannot control more than one station in the same local market . using joint sales agreement and shared services agreement. find out more tonight on the communicators at 8:00 p.m. eastern on c-span2. >> on thursday, a house oversight and government reform subcommittee held a hearing focused on state health insurance exchanges. witnesses included officials

from hawaii, massachusetts, maryland, minnesota, california and oregon. hearing came just three days after open enrollment ended. this is 2.5 hours. >> the committee will come to order. >> americans have the right to know that money washington take some them as well spent. our duty is to protect his rights. our responsibilities hold government accountable to taxpayers. we will work tirelessly in partnership to deliver the facts to the american people and bring genuine reform to the federal bureaucracy. good morning, everyone.

this is a conversation about the affordable care act and about the state exchanges. four years ago, the health care law was passed. the president made several promises. over 5 million americans ever see cancellation notices from the insurance companies. millions more find out there were no more -- they are no longer covered. just this week the bureau of economic analysis reported that spending growth was at a 10 year high. that it would be good for the economy. in order to minimize the negative exposure to the taxes, employers are forced out -- were forced to lay off some workers and reduce some workers to pay time -- to part-time.

this automatically increases government spending. according to ceo, the obamacare spends nearly $2 trillion over the next decade. there are 20 new taxes and significant cuts to this medicare advantage program. 80% of the people who are uninsured before obamacare are still insured to -- are still uninsured today. the administration has implemented actually go fashion, 21 different changes to the law. for example, in response to public anger, the administration allowed entrance to renew, not grandfather policies for an additional year. administration -- while i welcome policy changes that reduce the burden of obamacare's

, the administration set a dangerous precedent by going around congress to rewrite parts of the law that are politically troubling. administration's rerouting of the law and lead to higher premiums in 20 15 and beyond. recently, wellpoint, one of the educators indicated double-digit increases in renames. while there are many issues we can and will explore in the days ahead, the topic of today's hearings or state exchanges. representatives from those .tates are here today residents in the states are forced to use an error ridden website. residents are working

through the same issues that are on the federal side. while states have worked incredible hard, and we're grateful for your service, you are also struggling with some of the federal regulations and some of the delays are coming down as well. how is it possible, after 3.5 years and spending hundreds of millions of dollars extra many different exchanges that they is problemsh a building websites. where was federal oversight of the projects? how could so many exchanges have so much difficulty at the same time? , and more taxpayer dollars will be requested to bailout exchanges in the years ahead. commerce has an important oversight role. here and the witnesses

i do appreciate you coming, being apart of this conversation. you have things to contribute to this conversation at we cannot know until we have a chance to hear from you. glad to have a conversation with you. includemillion does not enrollment surges that took place in the states, including

california, running their own exchanges. republicans won't be focusing on the successes are conceding that their predictions have been as reliable as a fortune teller at a carnival. any republicans have voiced her certainty that the aca would fail. they said that the 7 million goal was impossible. ever months ago, chairman issa said it is time for the president to find make knowledge obamacare is not working and to delay the law, in fairness to family and individuals. today is the committees 26th hearing of the aca. this week come on the floor, we voted for the 52nd time to repeal it. all historic and transformative pieces of legislation, the rollout of the andhas been challenging, far from smooth. republicans have contended from the beginning that there is no meaningful role for the federal government in health care. the marketber how has handles health care in the past.

the market allowed insurers to resend your coverage if you get sick. deny you coverage if you had a pre-existing condition. market alsoted allowed insurers to charge women more just for being women. let's remember how the market determined premiums. before the aca, with the exception of the recession, premiums grew by double digits year after year. into a lot has gone effect, we have seen dramatic declines in the riser premiums. this is the real story of the impact of the aca. i ask you to look at this chart. profound. if anything speaks to the importance of the aca, it is that williams -- that premiums have declined dramatically. ongree with my colleagues this side that the aca should be the subject of scrutiny by congress and the oversight of this committee, but the

consistently partisan and one-sided approach has been all about tearing the program down, not fixing it. the preparation for this hearing only provided the latest example of how this committee seeks to undermine the efforts of states administration to implement the law. we will hear testimony from executive director of the massachusetts health insurance exchange. massachusetts has experienced its own set of website issues. requested to send miss yanks have a qualified calling to this ms. yang, soad of that she could stay in massachusetts and continue to ,ork in fixing the website however, upon hearing about the changing witnesses, the chairman of the full committee threatened to issue a subpoena. i'd like to apologize on behalf of this committee to you, ms. chang. what this committee should be focusing on is what we have to do in the future to contain

costs. how he can share the best practices by successful states are california, connecticut, kentucky, and new york with the states that are still struggling. a truly balanced hearing would've looked at more than just one story of state this exchange success. if someone from kentucky's exchange had been invited to testify, i'm sure they would've wanted to tell the committee that a preliminary analysis found that approximately 75% of the enrollees were previously uninsured before signing up through the exchange. are under enrollees the age of 35. ordered by the end of enrollment. , over 370,000 kentucky citizens now have health insurance that did not have before. to that end, i'm so glad to have testify as minority witness and to bring some good news and balance to this

discussion. at the end of march 31, over 1.2 million californians have signed to the exchange. the number greatly surpassed california's a sign suggestion of 580,000, and enhance projections for the entire open enrollment. california enrolled 1.9 3 million an additional 800,000 were found likely eligible. this brings a total of all californians enrolled through medi-cal and exchange to almost . million people i look forward to hearing more from you today about the improvements that california plans to make and

. in for-profit hospital chain allegedly rick crawford taxpayers for more than $600 million. that should be the work of this committee. i look forward to hearing the testimony of all witnesses present today and thank you for being here. >> i like to recognize the chairman, mr. jordan, for his opening statement. we have several witnesses. i want to thank you for happens

hearing. let's remember, all the false claims that are made about the aca. it is good to go back and put some context on this. if you like your plan you can keep it, false. if you like your doctor, you can keep them, false. premiums will go down, false. humans will go down an average of 25 hundred dollars, the it ministration said, false. the website will work, false. hearings totless dispel all these claims made by the administration. today, we will hear about the dismal performance of the state changes. again, underscoring how poorly this law is operated, how bad it is, and why we need to change it. i want to thank you for putting this hearing together. i look forward to hearing from our witnesses. a look for testing questions from our witnesses about these six state exchanges area the overall impact is law has had on

the american people. with that i yield back. >> thank you, chairman langford and chairman jordan. this marks the 26th hearing this committee is held on the aca. over the course of 25 hearings you would think that every member on this committee on both sides of the out would have been working tirelessly to guarantee that each and every one of their constituents had access to affordable health care. i would also think that these hearings would have consisted of a bipartisan effort to find ways and actualthcare.gov oversight would eventually take place. this is the oversight committee. in 25dens me to say that hearings, none of these things actually happened and i'm afraid that today is not going to be any different. in this committee and throughout this congress, health care has become a divisive, partisan

issue. instead of offering solutions to ensure that constituents have health care,versal this house has instead held 54 votes to repeal the affordable care act. some of my colleagues have also run misleading and often times outright false designed tot frighten their constituents from signing up on mixed asians -- on the exchanges. i am proud that congressional democrats have held more than 400 events in their districts at home in an effort to educate constituencies on the aca. i've had five of them myself in my district. i would also like to commend my fellow democrats for all their ensuring that their constituents are afforded the same kind of information. this hearing has been called in order to examine the state health insurance exchanges under the aca. california has one of the most

successful state exchanges with more than one million individuals having signed up her private health insurance plans through its exchange. other states such as new york, connecticut, and have also experienced success with implementing the state exchanges. i'm grateful that mr. peter lee is here with us today to speak regarding california's state exchange and provide much needed balance to this hearing today. york, rhodeat new island and connecticut were also included today so that we could hear about their best practices. i also wish that pennsylvania had its own state exchange so that my constituents could've had the same tailored access that the states have. why were still governor of pennsylvania had originally accepted the administration's generous offer for medicaid expansion, it is my hope that the two sides disagree on a plan and expand medicaid for the more than 520,000 people --

pennsylvanians that would benefit from that kind of expansion. the high demand for the quality and affordable health care available under the affordable care act is real. it is evident by the recently released enrollment figures haveng 7.1 million people signed up for the private insurance plans using both the federal and state exchanges, beating both administrations own goal and popular expectations. , thee market demands it health-care bill is more popular than ever. about half of all americans now support the law, despite the misinformation and disseminated over the last four years. on the same glad that many more people in places like oregon, maryland, as jesus, hawaii minnesota have health insurance than they did prior to october 1. i'm interested in hearing about how the states did this, despite

glitches with the rollout in each of the states. i look forward to hearing about the best practices from the state of california, from which i think we can all learn a lot. i welcome our witnesses and thank them for taking the time >> i like to recognize the chairman of the full committee, mr. issa. >> i want to thank you for the work you've done, mr. langford, the details of these laws in healthcare.gov and in the overall legislation. i ask unanimous consent that my entire opening statement be placed in the record. >> it is important as a californian to have california representative here. the best and the worst will be seen in looking at the largest eight in the union.

we often turn divisive, partisan legislation into divisive, partisan oversight. as to cartwright, mr. spear have made that clear by talking about republicans this and republicans that. i called, or authorize many of those hearings they alluded to. i am probably did it and i'm only sorry we didn't do more and sooner. ultimately, about half of america's federal spending will be related to health care, medicare, medicaid, medicaid to eligibles for our seniors and obviously the growth related to subsidizing the affordable care act. they represent the largest single bulk of the budget today, and that over than $1 trillion is an area over we have no real control over the rise of those costs unless we implement changes that drive the cost of delivery down.

long before president obama became a senator, we had problems with health care. i think republicans and democrats need to recognize that medicare and medicaid have been part of the problem, not just part of the solution. just a few days ago by voice vote, almost a cowardly act in many ways, we did what was called the doc fix. it is based on a decade of old mandates that somehow we were going to lower costs through some congressional magic and fiat. every year we recognize that it does not work, and that if we don't suddenly come up with billions of dollars of new money, our doctors will be underpaid by about 25% of what apparently we believe is fair. the user is an example of a clinton era, republican house and senate attempt to regulate

health care. this committee has a solid responsibility to do in real facts and real costs and real savings. that is not been the case for people on both sides of the aisle for decades. the affordable care act is well intended, i believe. but it has had many flaws. one that we will see today is fairly straightforward. instead of doing a single website in which everyone fed in, spending $700 million, $800 million, one alien dollars, $2 billion, some enormous amount of money to create a network, what we did is issue out large grants. in the case of california, the number i have in front of me is one billion -- is $1.6 billion.

let's understand something here today, whether you voted for the four noble character you didn't, redundant programs throughout most of 50 states that issued hundreds of millions of dollars per state to do the same thing again and again, sometimes with success, or the case of maryland, i believe today, some would say failure on the website. that alone was billions of dollars of unreasonable, unrest -- unnecessary, redundant in the planning. for the states all come together and use a common platform, a common software, was common sense. too divided into contracts into which each state may or may not have chosen the same good vendor, or in some cases the same bad vendor that the affordable care act federally used, is self evident today. let's get past the petty arguing

about who voted for it or against it, whether we voted to repeal it or change it. publicans and democratic members are in fact today regularly talking about necessary change. i know the 7 million figure is big as of yesterday. i know as a republican i'm told to say that very clearly that figure represents a great many people who lost a plan and in fact simply picked up and got the 7 million. mr. lee will undoubtedly, quite frankly, have to tell us that because california mandated to get onto the exchange, that you get off of programs that was necessary and delivered cancellation of all kinds of programs in california, because vendors had to choose whether to keep their old program or participate in the exchange. i'm not holding anyone accountable. it probably seemed like a good idea at the time.

but the fact is, we have not driven down the cost of health care to the individual, except when the taxpayer picks up the tab. all of us today should begin looking not just at mistakes like 30 some different websites all paid for with federal dollars, all essentially asking many of the same vendors to simply duplicate the software, but bill is twice, three times, four times, for reinventing it. we also should look at the question of since we have not succeeded in the past and driving down the cost of health care through cms's efforts, rather repeatedly have simply said we will pay less and cost shift as the ford will care act is implemented and more and more people are under a federally subsidized program, where do we cost shift to? we are running out of people we can cost shift to, which means by definition, everything we do will be something we have to pay

for. mr. chairman, this is long, and i apologize for going over. but i, like you, am passionate about efficiency. not just affordable care act, but all the federal spending has to really be looked at. i have taken note of the fact that corruption by vendors using federal dollars is rampant. i believe that we do need to go after it. i look forward to holding a hearing in which we look at both sides. offenders who socked to enrich themselves by getting more than they deserved and government oversight agencies that let it happen until it child up to hundreds of millions of dollars. mr. cartwright, i want to thank you for something you did that you may have forgotten. you voted for a bipartisan basis for a major change in how we procure i.t.. when that becomes past, senator

udall has a companion bill, and that becomes passed, we will become more efficient on a bipartisan basis in this committee. i know we started off on a partisan basis. hopefully we can switch the tone to realizing that we are all living with increasing health care costs. 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 we are going to be competitive around the world in commerce. i thank you, mr. chairman for your indulgence. i yield back. >> i recognize mr. cummings for his opening statement. >> you just move make clear across the country. >> i apologize.

>> thank you very much, mr. chairman. today is april the third, just three days after the deadline for americans to sign up for health insurance under the affordable care act. a lot has happened in the past six months since the federal and state exchanges opened for business. it has not always been pretty, but we should take a moment to reflect on what we have accomplished. more than 7 million residents of our states have signed up for 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. this is very significant. this is something that we all should be proud of that is not all.

we hear talk about what it didn't do. under the affordable care act, insurance companies are no longer allowed to discriminate against people with cancer, diabetes, or other pre-existing conditions. there are no longer allowed to discriminate against women. that is happening now. millions of our residents receive free repetitive care so they can stay well. we all know it is cheaper to keep somebody well and to treat them when they are sick. if you want to talk about driving down the cost of health care. millions of kids can stay on their parents plan until they are 26. billions of dollars of rebate checks have been sent to consumers across the country. that has happened and is happening now. laserjet omen, put simply, the affordable care act saves lives,

and it prevents people from going through pain. it allows people to live longer, like the gentleman who is probably watching us now with colon cancer, knowing that he has a way to be treated. he will be able to walk his daughter down the aisle. or the person who wants to survive long enough to see their child graduate from high school. that is what the affordable care act is all about. sometimes i think we get so caught up in the things that we are going through, that we forget the big picture. emerson said it best, he said do not be pushed around by your fears and your problems, be led by your hopes and dreams. that is what this is all about, hopes and dreams. so, to the witnesses here today, and to the state and federal employees are working tirelessly

to implement the law, i want to say thank you. i look at dr. sharp steen of maryland, the head of our health department. this is a man who has given his blood, sweat and his tears trying to make life better for people when he was a commissioner in baltimore and now for our state. i can probably save as i knew all of the people there, i know that you are all doing the same thing. you don't do this for the money, you do it because it feeds your souls. you do it because you want to make a difference heard you do it because you want to affect generations yet unborn. that is what we are all about, we should be about, making a difference so that people can live the best lives that they can't. the road we took together today was rocky for the federal government. it has been challenging for some

states including my home state of maryland. i cannot fully express how frustrated i was with the troubled rollout of the maryland health connection. in my state as in many, people have a desperate need for quality affordable health care. we needed the system to work. let me say it again -- we needed the system to work. lives depended upon it. when it did not, unnecessary obstacles were put in the way, which is completely unacceptable. let me say this, sometimes you have contractors that advertise more than they can produce. so they sell you a bill of goods. maybe those are the folks that we need to be looking at. let's be clear, this is not just about a website. this is about making a

difference for people so that they can be the best they can be and be all that god meant for them to be. the answer to the problem is not to decimate the affordable care act. the solution is not to eliminate health care for millions of people, to cut the funding for the aca, or to return to the days when insurance companies could discriminate against us based on our medical conditions. i have said it before and i will say it again, we are better than that. to let insurance companies to that to us. the remedy certainly is not to try to scare people away from enrolling in health care they have a right to under the law. when you scare them away from

enrolling, you have scared them away from having health care. for having insurance, for being able to take care of their child when the child gets sick, or prevent the child from getting sick. we are better than that. unfortunately, our republican friends have voted more than 50 times to repeal the fund -- repeal, defined, and stopped affordable care act. i asked chairman ison that we -- chairman issa that we move to higher ground. when history is written, when that man is able to walk down the aisle with his daughter, when that mother is able to see her child graduate from college, one that person lives long

enough to see their first grandchild born, they will not be worried about whether a website failed. they're not going to be talking about that. they may not even know that it was the affordable care act that saved them and give them a life. all that will matter to them is they had an opportunity to live in dignity and have a moment of happiness. and as we move forward, since this is the law, by the way, that we move forward to make a lot better and not try to destroy it. the only reason i mention his past efforts with regard to numerous hearings is that i have not seen in these hearings one effort to improve the law, not one. if we could move to that, then we could move to higher ground. with that i yield back.

>> i would like to recognize the panel. please introduce your guests from maryland as well. >> this is the head of our health department in maryland. he was a staff member on this committee, mr. chairman. some years back, he came to baltimore and he was a commissioner of health there. he brought all kinds of innovative project to baltimore, now he's ahead of health department for maryland. >> i'm delighted to introduce mr. peter lee, who is the executive director of cover california, who has had a storied career in health care, both in the private and public

sector. he was formerly the deputy director for the center for medicare and medicaid innovation at c m s, among many other places. we are very glad you're here. >> you definitely have the longest time zone change of anyone here. mr. gene yang is the executive director of the massachusetts health insurance exchange. mr. scott leitz's interim chief executive officer of the minnesota health exchange. all witnesses are sworn in before they testify. can you please stand and raise your right hand? >> do solemnly swear or affirm that your testimony will be the truth, so help you god? i ask you to limit your testimony to five minutes.

you'll be a part of the permanent record. mr. matsuda, you are batting off at the beginning. a little spring baseball conversation. push to talk at in and we will receive your testimony for five minutes. >> thank you, chairman, ranking members, and numbers of the subcommittee. my name is tom matsuda, interim executive director of the whole i health connector, speaking on behalf of the connector and its board of directors. hawaii has long been a leader to ensure that our residents have access to quality affordable health insurance. in 1974, hawaii enacted a groundbreaking state law, the hawaii prepaid health care act. this law requires that most employers in hawaii provide health-care coverage to employees who work more than 20 hours per week for at least four consecutive weeks.

hawaii's prepaid health care act requirements are generally stricter than those of the federal affordable care act. as a result, hawaii has a low uninsured rate estimated at eight percent, or 100 thousand individuals. because the state's law is so strongly supported by the people of hawaii, below low estate authorized the establishment of a state based marketplace to harmonize the aca with the hawaii prepaid health care act. my written testimony provides detail about the connector and i would like to focus on some specific issues. first of all, enrollment. as a march 31, 2014, we have 7005 hundred 96 individuals enrolled in commercial plans to the individual marketplace. 265 people enrolled through the shop small implement marketplace, and 24,006 and 41 completed applications in our system. the connector does not handle medicaid eligibility or enrollment for the medicaid population.

that is handled through the department of human services, or dhs. dhs had over 28,000 enrollments from last october through february this year for a total of over 36,000 enrollments across the entire hawaii marketplace. we launched our online marketplace on october 15 and accepted the initial application forms between october 1 and 15th. the system has been operating since then. it was very difficult to use at first. as of now, we have made significant improvements. the system is better today than it was back in october. our system is working from end to end, but more improvements can be made. sustainability. as a state based marketplace, we must be self-sustaining but january 31st, 20 15. last year, the connector board approved a premium assessment, a

two percent premium assessment for plants sold on the connector. our board is now engaged in a sustainability planning process. the key is to reduce operating expenses while supplement enrollment, especially in the shop exchange. federal and state decisions to give small employers the option to remain with their plans has reduced the volume of participants in shock. hawaii has received for federal grant awards. while hawaii is a small state, we are subject to the same federal requirements as all other states to establish the infrastructure on the state based marketplace is. our small population and low uninsured rate mean that hawaii has a smaller market to support our operating costs.

as of december 31, 2013, the connector has spent about $57 million of the total 204 million dollars in federal grant money is awarded to us, and we have an operating system. for our priorities going forward, we have roughly 11,000 in completed applications. these individual enrollments -- the individual enrollment is not a compete. we have increased staff to complete this process. we are also working on extending our outreach into the communities that are underserved to help educate these populations about the services available to them. on behalf of the connector, i appreciate the opportunity to discuss these issues with you today. we believe an issue of the connector and are fully ready to contribute our part in hawaii's long history of dividing access to affordable quality health care coverage to our residents, thank you.

>> thank you members of the committee. i appreciate the opportunity to testify today. it is true that i used to be one of the people sitting alongside the back wall. i think -- i could say that every staffer wonders what it would be like to sit on the staff -- on the side of the microphone. after the hearing i will be able to tell them. i as has been widely reported, marilyn has faced -- maryland has faced significant issues. on september 1 the system barely worked at all. we struggled with hardware and software problems, but we did not give up. we now expect to hit our enrollment goal, in fact we expect exceeded by 10% or more. we expect the number of enrollments and qualified health-care plans to come within 10% of what was predicted by independent experts and to exceed our expectations for medicaid enrollment.

by the time the dust settles we could see enrollment of more than 300 thousand in maryland. maryland's story includes decisions we could -- we wish we could make again, failures by multiple members and to many i.t. frustrations to count varied but maryland's story is also about an exchange that is a lot more than a website very it is about a state that is battling back and is looking towards the future. i have submitted detailed written testimony, soil make some key points. first, the exchange is lot more than a website. it includes our art in a ship with more than 2000 brokers, it includes a competitive market with four carriers offering many plans. it includes dental plans. we have a website that has a physician network for each carrier and a navigator program that includes more than 30 grassroots organizations. second, we did face serious website problems. we made a major misjudgment in retrospect-ish and it -- initially in 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 actual effective and efficient. this caused immense frustration for consumers. at certain points it made us wonder whether anyone would be able to enroll. third, rather than give up in the face of these i.t. challenges, maryland tackled the problem head-on. changes included new leadership, including when the governor asked the secretary to step aside from her job and be the single leader for all i.t. development. having a general contractor to help fix the system, implement hundreds of critical i.t. fixes, collaborating closely with carriers to allow for special types of enrollment for people that had trouble on the website.

manual workarounds which allowed us to process applications by hand. the incredible tough work of hundreds of consumer assistance. finally a strong finish with as much enrollment in the last two days as in the first 10 weeks or so. as a result, we expect not only to meet, but to exceed our enrollment goals. quality and affordable health coverage is providing peace of mind and access to families across maryland. it 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 speaks to chairman isis point, is going to reduce the cost of care within that system, but also we are using -- to address

affordable cost of health care. let me finally say that -- in addition to the significant work in the significant work in hundreds of fixes that it took to get us to the point where we could exceed all enrollment goals, the secretary of information technology have led a process of figuring out the future for the website. after an extensive analysis, the board this week voted to leverage the connecticut i.t. solution in order to upgrade our website. this is a model that has proven very effective and allows us to use something that works very well in time for the second open enrollment. here it is the chair of the board of the 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 tirelessly to overcome i.t.

challenges and help their friends, neighbors and fellow citizens gain access to affordable and quality health coverage. thank you for the opportunity to testify. i look forward to your questions. >> thank you, mr. chairman. chairman jordan, chairman langford, ranking member cart right, ranking members. and members of the subcommittee, good morning. thank you for the opportunity to testify about our experience implementing the affordable care act in massachusetts. as you know, massachusetts is very familiar with the framework of the aca. in 2006, former governor mitt romney worked to fashion an x broached -- health care. once he took office, the governor worked to bring the statutory framework to life in close collaboration with our state's legislature, our health care providers, our business and

labor leaders, our insurers, our consumer advocates and callous others. we are extraordinarily proud of the results we have achieved together over the past eight years. virtually all of the commonwealth residents are now insured, at 97% varied 91% of our residents report having access to a primary care physician, and 80% having seen the physician in the previous 12 months. on a whole host of measures, we are healthier. at the same time, more employers are offering coverage, and our states budgets have been consistently balanced. are most important lessons we have learned in the years since 2007 was that health-care care reform takes time. we refine our plan is to learn new lessons in collaboration with our partners, including the bush and obama administrations. it has not always been easy, but we kept our eye on the goal of getting people adequately covered. as governor patrick has

remarked, we learned early that health care is not a website. we support the affordable care act because it embodies the principles of our massachusetts reforms and because it gives our state new tools to sustain and expand on our success. we know that it is already helping to put affordable care -- affordable coverage and care in the hands of americans across the country. massachusetts itself, since eac took full effect, over 200,000 more people have signed up for subsidized coverage. almost 30,000 people have purchased unsubsidized aca compliant plans through our health connector. the health connector is also offering dental policies for the first time with over 2300 plans purchased to date by individual shoppers. you and so, while implementing the aca, we have experienced website challenges. these are mainly due to failures of our system integrator.

with our new team in place, we are on a path to go live with the functional and reliable exchange website for the next open enrollment period. challenges impeded our progress in achieving our full vision for the website by october 1 of last year. on that account, we decided to deploy only parts of the new system on that date. given these constraints, and with many people encountering errors and wait times, even with the parts that were deployed, we have developed alternative pathways to support enrollment. these mechanisms have enabled us to protect and expand coverage with strong cooperation from our health insurers, providers, and consumer advocates. many residents of the commonwealth of experience difficulties with some of these processes, and we fully share their frustration. we have not allowed website problems to prevent us from

meeting the ultimate goal of the aca, getting people covered so that they can enjoy health and economic security. though the website challenges are mainly the result of an underperforming i.t. vendor, we are holding ourselves accountable for fixing them, and we are making progress. we have stabilized our system, eliminating a backlog of paper, and stanched -- and substantially reduced cost and away times. we continue to maintain strong data security protocol that meets federal standards, and has cap personal information safe from data breaches. we have a detailed plan to open up new parts of the website only when we know they are ready for users. in the meantime, through the creativity and flexibility of our team, people are getting covered. we have an unwavering commitment to ensuring quality, affordable health care for the people of massachusetts.

it is a commitment that kept us moving forward through both the peaks and valleys of state reforms. it is a commitment to keeps us moving forward today as we strive to realize the aca's full potential for improving care and improving lives. thanks for your time. i look forward to your questions. >> thank you, ms. yang. mr. lee. >> good morning. thank you to chairman issa, and ranking members spear, cartwright and cummings. i'm glad to share with you our early implementation lessons in california in launching the verbal care act. i think it is important that we are excited in california across a whole range of constituents whether they be health care providers, workers, and a range

of political positions. we are seeing the fruits of that effort today. california is one of 15 state-based exchanges third when we started, we looked at the data and said somewhere around 4 million californians could benefit from federal support, either extended medi-cal or from cover california. any very few short years we have gone from being a 10 person organization to one of over 1000 people. we are a very very fast startup that is working to change history. how is it going so far? you have heard some of the numbers. 1.2 million californians now have coverage directly through cover california. 1.9 million have coverage through medi-cal. this is close to 4 million californians. every single one of them went

through cover -- covered ca.com. many of them work processed by humans. i can't stress enough, exchanges are about more than websites. i want to talk a little more about what they are about. but it also want to underscore that when we think about state-based exchanges, there are five exchanges out there that as of a month ago had already covered more than 30% of those eligible. those states include california, rhode island, vermont, washington and connecticut. other states did a very good job as well. kentucky, new york. as of three days ago, california had brought coverage to more than 50% of those eligible in the exchange. that is a remarkable number when you think about what it takes to grow a brand-new, start program. let me talk briefly about what it takes to make a state-based exchange work.

i would note that when we say work, we do not mean perfect. it is been rocky, it has been bumpy, and it will continue to be rocky and bumpy. this is historic. this is a very big change to the health-care system. overall, we feel good about the progress we're making. it takes three things foreign exchange to work. it has to have affordable plans delivering health care. marketing and outreach and effective enrollment. in the area of affordable care, cover california has been an active purchaser. 33 health plans expressed interest in our marketplace. we selected 11. cover california specifically went through a process of standardizing our benefits to give consumers the tools to make choices and understand what they were choosing between other plans. we ended up getting very competitive rates and are optimistic those rates will stay competitive and affordable. right out of the gate, we gave him -- we give consumers information to choose. second element of success is effective marketing and outreach. cover california has been

reaching out to californians across demographic sections through tv and radio and newspapers. more importantly, through over 250 groups anchored in local communities doing outreach to inform people about the importance of enrolling in cover california. finally, effective enrollment. it is more than an i.t. system. it is a complex i.t. system. enrollment system we have has to connect with more than 11 different major databases, including the federal government, but also the state system. we ever system up and running. it has served more than 12 million unique visitors. it is working well, but more importantly, the over 25,000 californians, these are county workers, these a licensed insurance agents, these are

certified enrollment counselors heard every community of the state has been helping literally millions of californians get enrolled. that is why we think it is largely working in california because californians have stepped up. they stepped up to talk to the neighbors, members of the churches, members of the schools, to get them covered. would you have lessons learned we can share their dozer in my written testimony and i look forward to responding to questions from the committee. >> mr. leitz. >> chairman jordan, trevor lankford, chairman issa. ranking members and members of the oversight and reform committee. good morning. thank you for inviting me to come here today to talk about minnesota's expenses in establishing our online health exchange. i want to stop it telling you about two people who live in minneapolis. cory is a teacher. for years the family had health insurance through his job. but over time, the families out-of-pocket costs grew. after welcoming their third son

irving into the family, they had to choose between paying the mortgage or paying their health bills. last fall, whenminnsure opened, the boys qualified with no deductible. she was able to call phifer plan for less than $200. she was thrilled. today, i am proud to say the company -- the system is secure and successful. because of our efforts, his family are just a few of the hundred 70,000 people in minnesota who have access to affordable coverage because of mean sure -- minnsure. over 88,000 have enrolled in medicaid, over 34,000 have enrolled in minnesota care.

in other states these individuals are enrollees would be in private plans are tax credits. the remaining four 7000 have enrolled in private, qualified health care plans. it is also worth noting that in minnesota, 95% of people enrolled in health coverage have paid for it. as we continue to process applications, we expect our numbers to grow even higher. it isn't news to this committee that the rollout was rocky. our initial launch in october was plagued by software errors and technical glitches. i was appointed interim chief executive officer on december 18 after the resignation of the first executive director. in recognition that more must be done to ensure minnesotans have access to a functioning website and comprehensive affordable health coverage, i took immediate action. in january, i commissioned an interview of our exchange by active health. they recommended we make a number of enhancements to customer experience to help boost enrollment and to improve customer satisfaction.

working in close partnership with our vendors, we were able to stabilize our system. our eligibility software is now operating within over 99% success rate compared to 70% in mid-december. our online marketplace has been stable now to process more than 2000 enrollments today. december software problems caused are call-center wait times to collect to over an hour, and up to 70% of consumers were simply giving up before they could be helped. we resolve this issue by more than doubling the size of our call-center and bringing stability to our software system. average wait times for the month of march were genetically less. moving forward, we are planning our budgets for 2015. i am happy to say that next year's calendar your budget is balanced and does not seek additional state or federal funds to operate minnsure. and a longer term, we are in the process of selecting a lead vendor.

the goal is to not just make the 2015 open and roman. a better experience for consumers, but have a conference of roadmap for continuous improving and enhancing the exchange for consumers in the open enrollment periods to come. i had the opportunity to meet kate needleman and her son irving recently. she told me that having affordable insurance has opened the doors for her family. health reform is indeed more than a website. it is about getting real people and families into afforded -- into affordable health coverage. thank you for the opportunity to testify and i look forward to your questions. >> thank you, mr. leitz. >> thank you very much. mr. chairman, ranking members and other members of the oversight and government reform committee. thank you for allowing me to speak about organs efforts. i recently retired as chief executive officer of providence health and service in the oregon region.

throughout my career i have had direct experience with the challenges of expanding access to quality health care while managing costs. last year, the governor asked me to step in to help navigate the challenges around the launch of the state's health care exchange. currently i service the president of the oregon health leadership council and fallen cherry adviser to the governor and dr. bruce goldberg, acting director of cover oregon for whom i am appearing today because he recently suffered a broken leg. while the launch of the aca in oregon has been different than we hoped, over 300,000 individuals have enrolled in health insurance plans since october 1. governor kitzhaber for released an independent assessment of cover oregon produced by the company's first data. the report, which i also request to be included in today's record, was based on 67 interviews with stakeholders in cover oregon governor -- and health employees and legislators from both sides of the aisle.

a review of more than 3200 documents. it assesses the technical problem -- problems with the enrollment and rollout of our health exchange website. members of the committee, what you to know that in response to first data signings, the governor announced numerous steps he is taken or will take to improve performance, accountability, and oversight. these steps are detailed in my written testimony, which also has been shared with you. we do know that some things have worked very well. we have used our technology investment to enroll more than 300,000 oregonians in health care coverage since october thanks to cover oregon and the oregon health authority. we continue to be proud of the work we have done to improve oregonians's lives and we know that that will endure. i welcome your questions and the opportunity to discuss with you oregon's ongoing health-care transformation work, as well as the progress to secure public trust and make good on cover oregon's promise to enroll more oregonians in affordable,

high-quality health insurance. thank you very much. >> thank you mr. van pelt. we will now turn to questioning. let's start with a gentleman, vice chair committee, the gel men from arizona. >> mr. leitz, i want to start off with you. we talked about the rocky start for your exchange, earlier. my first question is, and the three months leading up to the botched website rollout, ebbers of the websites receive bonuses for the work they did on the exchange, is that accurate? >> it is. >> why would the state pay people a total of $27,000 for a botched website? usually bonuses go to exceptional work. botched doesn't seem to mean exceptional. >> congressman, those bonuses were approved in the previous executive director. >> i'm glad you said that. have you done anything to call back those bonuses?

>> congressman, not today, no. >> interesting. in january, united health optimum division released a report stating that the exchanges current program management structure and process is nonexistent. management and leadership decision-making is in crisis mode. that report also concluded that the exchange might be so badly flawed that it might need to be scrapped. you're quoted as saying we do intend to take action, in fact i thought i heard you speak about this in your comments. we take action as a result of the report. have you fired anyone in the state government for the botched launch and the massive loss of tax-free dollars? have you fired anybody? >> personal actions have been taken. >> purses have been fired? >> -- persons have been fired?

>> you did make some changes? >> yes, congressman. >> last week, the los angeles times wrote about how the exchange was referred to as a blackhole. he was referencing consumer applications that were frozen or vanished. did you ever find with is that -- was vanished applications when? >> congressman, yes we did. >> your total accounting? >> yes, were able to identify any applications at a previous the been the system that we were not able to track during the fall rollout or a >> we provide that to the committee? >> out to folks back in minnesota don't know that story. >> congressman, we will be happy to provide an accounting of those individuals very >> thank you very much. >> will try to go fairly quickly. how may people did you have to hard to process paper applications because of the problems with your exchange website? will start with you, dr. matsuda.

>> recently, we increased staffing to handle the backlog that are mentioned in my remarks by total of 80 people. >> how much of the cost? >> i will have to supplement that for the record. >> we like to know how that was paid for, too. >> about 200 more people to the car center -- through the call center. >> house paid for? >> through our grants under the usual rules. >> to the federal government? >> federal and state governments. >> ms. yang? >> we have leveraged a workforce of about 300 individuals through an intensive work. in the past four weeks. we are happy to report that the paper application backlog has been eliminated. >> how much to the cost? >> i do not know the precise number. we can get back to on that.

>> hausa paid for, mr. lee? >> we have a customer service staff that we expanded by about 250 people that do both phone and mailable. we also share a preprocessing work with county partners throughout the state of california. additionally did some extra contracting with vendors to get through the paper backlog. i'm not sure the number, i will happily follow up with you in a number. it was actually paid for out of our federal establishment grants. >> mr. leitz? >> approximately 50 individuals were added. we paid for that of the establishment grant. -- out of the establishment grant. >> oregon leveraged a workforce from state agencies. we will have to get back to on the precise number and payment source. >> i will come back to you quickly, mr. van pelt. when did the state first alert cms at the exchange was not going to be operational? >> is all in the first data assessment.

i would have to defer to that report, congressman. >> so you can't address the oversight? >> my role was such. you are all in the first data assessment. i would have to refer back to that report. >> the gentlelady is recognized. >> thank you, and thank you for your outstanding testimony. i would like to start by quoting

the speaker when he referenced the rollout as horrendous and the launch was anything but smooth. for the rollout of medicare part d, which is seen as full of problem's it was all about fixing it because it was in president bush's administration. i would like to see the i would like to see the same frankness or willingness to fix the problem now that it is in

president obama's administration and we are undertaking a much larger effort. what is good is that you have fixed the problem. i have trouble figuring out whether or not you have met your goals or will meet your goals. >> we are going to meet our goals. our goal for the short-term is to improve our functionality and the usability of our system. >> they have exceeded enrollment. >> as you have heard in my testimony, we are proud of the fact we are achieving the fundamental goal to expand coverage on top of a solid ground. our work is not done, but we are

on the solid path. >> we have never had specific goals. our goals are unsure. we still have work to do. >> minnesota is solidly on track, and we feel good about the future of what's ahead of us. >> oregon is on its way to achieving its enrollment goal and feels confident in the steps we have taken to improve our technology. >> california is a great sunshine story, and we are proud of that. would you tell us what some of the reason for the success was? >> i would be happy to. some of these are highlighted in my testimony. i would highlight briefly five things.

one, leadership focused on consumers. we put politics aside and said let this work for consumers. we have very effective collaboration between state agencies, the medi-cal agency which i partner with but also with the regulatory agencies, the department of insurance. this has changed the entire insurance market. it's not just about exchanges. it's about changing. this has worked on the ground. the partnership collaboration has been vital. we have had bumps along the way. we have adjusted our course and will continue to do that. this is the beginning of a long road. we look forward to learning as we move forward. >> you are going to implement the connecticut i.t. solution.

i don't know how other states are, but they seem to have made it work very well. what do you think the key is to the connecticut system? >> there are several things very attractive about the connecticut solution. first it's a very elegant design for consumers and consumer assistance workers. it also has good functionality for insurance workers. it uses some of the software pieces we already have licenses to and runs on the same computers we have already purchased. there is a lot of overlap that allows us to reuse some of the initial investments. those are some of the reasons. we were able to demonstrate it recently.

>> we go to the gentleman from michigan. >> thank you for holding this hearing to look at a program being panned as an exceptional opportunity to carry on an approach that takes freedom and opportunity, and i think a great health care continuation for our country because we weren't able to deal with the cost. let me ask a question. july 2013 auditor's report called the cover california plan and new high-risk entity, and that was the auditor's statement. the report stated that under all enrollment scenarios cover california will not have sufficient revenue to cover operating costs in fiscal year 2015-2016.

specifically it said it would be losing $73 million. you told state finance officials in september that the long-term stability of the organization is its greatest weakness. what did you mean by that? >> a couple things. we are very appreciative to receive federal funding to get going. we will be running 100% on our own steam. we cannot go to the state of california for general funds, so making sure we are well managed is a critical, important factor for being an ongoing organization. the auditor's report also noted, and are budgeting has plan to have a couple years of deficit spending. >> you still believe you will

be? >> absolutely. we are in the process of doing our revised budget. we will be able to adjust every year our operations on the revenue and expense side to be fiscally well-managed for california. >> let me follow up. the state auditor's report noted that premiums generally would provide the revenue required exchange, but you shut down the market earlier this year. >> no, we didn't. >> you didn't shut it down? >> we have over 600 businesses. we turned off the online enrollment functionality, which is generally not used, but that's generally not how small businesses enroll anyway.

>> you don't plan a taxpayer bailout in the future. >> state law in california ought to be clear. we cannot be dependent on general fund money. >> federal taxpayer bailout as well? you don't expect any more federal support or a bailout? i will hold you to that. i hope that's the case. >> we both do. let me ask several questions. let me start with dr. sharp steam. how much has been paid to

develop an operating exchange. your microphone please. >> so far our exchange has spent for all costs about 120 $9 million. that is what has been paid in total? >> our federal grants in total are about $180 million. let me get the exact number. >> you can be prepared for the question. >> it's about $180 million in grants. we haven't spent all that. >> that is what has been paid to you thus far? >> those are the federal grants we have been awarded. >> what are the contractors, and how long have they been paid? but there is a long list. >> where they bid competitively

or full source? >> we did competitive procurement. >> any other contracts. >> there were a couple. >> how would you rate them? we let go our contractor. we were disappointed with some of the software work i mentioned before. it was sold to us that out-of-the-box it would be able to do things it could not do out-of-the-box. we wound out with some of the same problems minnesota has. >> for the record if i could get information to us that would clearly state whether you would seek further federal funds to fix your mistakes. with that my time has expired. >> thank you, and thank you to the witnesses. thank you for your tireless efforts to get people to sign up for affordable health care. i come from a state that did not

start its own exchange -- pennsylvania, which i think the failure to do that in pennsylvania was in abdication of responsibility of the governor on behalf of the citizens. we have seen 12 hospitals close. i have seen enrollment as a way to strengthen our hospital system, and that includes pennsylvania. governor corbett decision to decline to establish an exchange is in a peculiar way. it was first celebrated by americans for prosperity. 20 minutes later the commonwealth of pennsylvania itself made the same announcement in a press release. the timing of that announcement raised questions as to how the koch brothers influenced the

decision in the first place. even more disappointing was the decision to expand medicaid for more than 520,000 pennsylvanians who could be covered. the federal government would have eight 100% of those cost for the first rigorous, phasing it down by 2020. someone confided to me that if pennsylvania does not accept medicaid expansion, he is going to have to close one of his two hospitals. that is how important this is. governor corbett in pennsylvania submitted a waiver proposal that would impose premiums and limits to medicaid recipients.

this will be hundreds of thousands of low income residents without health care coverage in 2014 in pennsylvania. it's unconscionable to me. it's time to quit playing politics with people's lives, with people's health. i urge governor corbett to reconsider. the citizens we represent are fortunate all of your citizens have made the decision to accept medicaid expansion. california has enrolled more than 1.5 million new applicants and to medicaid since october 1. am i correct? >> that's correct. >> can you tell the committee what the expansion means for

those california residents and for the state as a whole? >> i appreciate the question. we have been in close partnership. people don't know what they are eligible for. we have had thousands of people break down in tears when they have affordable coverage provided to them. i have talked to many of them myself, and the people on the front lines relate these stories constantly. >> what about you? can you describe the impact of medicaid expansion on your residents in your state? >> we know about 60% of our uninsured population is eligible, so we know we are reaching the uninsured by enrolling them in medicaid. what that has allowed them to do

is access services, often for the first time, to get preventive screenings, to care for issues they might have had not cared for in the past. it has been an important thing as well as for the caregivers. >> thank you. what about you, same question? >> the medicaid expansion is extremely important in maryland. we have done an analysis there are well over $150 million in uncompensated care reductions as a result of the expansion, and it matters a great deal. i met one mom who says her daughter was telling me a story about a sick baby who needed a heart surgery that medicaid paid for, and out came the daughter to give me a hug. they are real people in maryland. i see the medicaid expansion changes lives.

>> the gentleman from florida is recognized.>> you have been called worse. >> thanks to the chairman. i appreciate this hearing. when i hear this law is causing premiums to decline sharply for americans, i don't know what to say after having dealt with so many disappointed constituents 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 their own determination. we keep hearing this has led to the expansion of coverage for 3 million adults, but people have debunked that and said it is probably less than one million.

some of the numbers back and forth are fine, but the central promise for this law was that if you like your arrangements, this law would not negatively affect you, and it would benefit you at lower cost. at central promise has been broken. if people like their plan they may not be able to keep it. i don't have any constituent who has come to me. we don't talk about the increase in deductibles. people are paying higher premiums and seeing their deductibles, up. people are paying way more on premiums than they used to. you have all of those things which we were told were not going to happen, but then we see a lot of people have seen their existing arrangement undermined or changed in a way they would not have chosen to do it.

we have constantly said everyone now has health insurance, but if you look, when the law initially passed, they said it would be 37% of americans who are uninsured would be covered. then they said it is going to be closer to 40% of the uninsured by this point in 2014 and the actual number is 12.5%, and that is not just including these exchanges. 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. this is something we report, and it's being investigated. >> 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. >> 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 $180 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 150,000. >> 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 agency 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 exchange. >> i don't disagree we had a major i.t. problem. >> you haven't hit your goal. you were supposed to be 150,000. 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. cms said here is $180,000,000. 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 october 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 $180 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 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 -- 2015 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. 90,000 in medicaid. 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 navigators. 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 may be able to surpass 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.

-- deloitte. 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 150,000 enrolles 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 emma 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 147,000 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 21st, 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

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. losses 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 beat a path to your door. 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 selectlecthr 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. >> to 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 bitter, 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. >> states 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

we assume that contractors do something much bigger. we assume they have handled they could doely the health care exchange for a particular state. note that the census from florida put up. this is from a theory that showed that these contractors performed below expectations considerably.

state and athat his great many other states are directly responsible for that because they have failed poor and middle class and disabled get expansion of the medicaid exchange. how'd that happened, i have no doubt that the goals would have been met. to use such a graph without takes aesponsibility lot of chutzpah. thank you, mr. chairman. >> i would only say one thing to that. in my state, we also have that. part of the waiver issue was

that we had to remove that as a safety net. >> that does not take care of those within expanded medicaid. >> we do not have expanded medicaid, but we did have coverage there already. limited.arks were i asked this question of the whole panel. you are in charge of your exchanges. have you -- are you in charge of the exchanges? >> yes. >> no. me personally? no. >> are you enrolled through the

exchange you are in charge of? >> thursday coverage. -- through state coverage. >> i need to apologize. >> you can use somebody else's time for that. desantis asked about the enrollment of our qualified health plans on april 1. the correct numbers 57,000. question, i to your am not an employee of the state. .'m self-employed >> this is one of the questions mike and -- my constituents

-- i would ask you, there is a concern i have about personally identifiable information. the safety of that information in the exchange. personally guarantee that personally identifiable information is safe through your respective exchanges? >> what i do know since i have started in this position is that i have verified that the exchange was given full authority to connect to the federal hub after passing all necessary -- so i know we start -- >> there were concerns with the federal hub as well. is the information safe through

your exchange? >> i believe it is secure, yes. nothing ising that 100% safe, i believe -- >> 80% safe? 90% safe? >> there are a lot of things that have -- can happen. my personally identifiable information is in there. we have had no breaches. >> were you able to complete your application? i did not complete my application because i already have coverage. i was testing it. our highestne of priorities. we have not had a data breach. i would not be letting the exchange operate without having confidence that personal information was protected. personal information is our

top priority. we are confident that that information is secure. we have had no data breaches and no instances that we know of of information being breached in any way. >> similarly, security is a top priority. we do everything we possibly can to take the information and protected. >> will you guarantee that? >> it is very much a top priority. i will take that as a modified, possible yes. oregon meets the security requirements. we are not aware of any security breaches. >> ok. i wanted to at least ask. applicationsost and incorrect subsidies, it is not an error proof system we

have -- obviously. there have been faults and failures -- obviously. you.e a story for i have a staffer whose mother was given notice by herrin sure that due to the affordable care act her insurance was discontinued. she had to go to the exchange. she began a three-month long process to enroll in your exchange. you have about 4000 applications in your state that were given incorrect subsidies or lost applications. is that about the right number? >> we reported subsidy problems of about that number. right. >> her experience is one that i know very well. through her daughter and threw her. her.oughrough

her wast roadblock for a question of citizenship which she could not verify. the helpline is very helpful in all of your states, as he will testify. hotlinetold through the to facts her driver's license and social security number to this open facts line -- fax line. she asked, do i put it to your attention? it to that number. is that concerning to you? >> it is not a fax in the corner that people wander by. >> i would hope not.

not at a local truck stop. >> it is a fulfillment center and they have an approach to secure personal information, too. hathave to verify things th people are able to purchase coverage under the law. >> are the people privy to the fax machine, are they vetted? is there some safety and security that i can tell her that there was for her information? >> yes, you can. >> describe that for me. >> we work with a company that secures lots of personal information. brokerre an enrollment for medicaid program. they are a very big company that has top quality at protecting

private information. they are staffing the fulfillment center that those faxes go to. ,> the final question i have you all have the number of enrollees in your metrics. measurement ofe success of your exchanges, do you have a cost per enroll he? -- enrollee? has spentof maryland $150 million to build a website and exchange. is that about right? >> so far about $129 million. ee.about $2000 per enroll >> again, we have an role 295,000 people. it would be a lot less than that if you were to divide it. we are looking over several years. >> this is an individual market. not -- and medicaid are

noteople in medicaid are invisible. they have all banned coverage since february 1. >> this is about individual -- the individual market getting access to insurance. is that not a fair measurement for this? >> i don't think so. it has also help people get medicaid get insurance. they could not previously have had insurance under medicaid. >> i thought medicaid was actually an insurance. >> the vast majority of people in maryland, single adults for example, did not have coverage. vast majority of adults in maryland did not have coverage? >> did not have medicaid coverage in maryland, even if they were very poor. , i want to make

sure equal time is granted. 's mr. connolly been unfair before? >> can i just ask one final question? here to seeeman was mr. cummings, i was being a little less greedy than he was at the time. esther cummings is coming back in. was appropriately useful with this time. >> with the gentleman yield? >> i used the exact amount of time -- >> how about this? i will yield back. mr. chairman, thank you so much for your generosity. i appreciate the kindness of my

colleague and i will show you the same kindness. >> i was not objecting. i was trying to make sure the minority was granted equal time. >> i will do something out of order. you have been seated for two and a half hours. would you like a moment to stand and stretch? would you like to stand for just a moment? we will take a very short recess to be able to stand.

>> thank you. i would like to thank the members of the committee. the people of hawaii were very concerned about the reports of the money spent on our connector. i know you have inherited this. in julyinto effect 2011. you came on board in november. to the extent you can address these concerns i would appreciate it. quite he is truly different. i know everybody says that, but it is.

hawaii has the prepaid health care law that went into effect in 1974. that is part of the issue. . saw the letter sent let's begin. how much money did the state actually is? we spent $57 million. extende was a request to so that you could spend the -- but themount state has been denied that, is that correct? >> that is correct. >>