263 trillion cubic feet of gas. using up 1 billion cubic feet of gas. we can do quite a lot there. but i think we need to pay ttention to power. >> most of the small and medium enterprises aren't going to work unless we have power. it's something we need to do. it is very important and critical. secondly, with this interaction between africa and united states, i believe it is very important and paramount to renewing our exim bank status. lot of countries they have

what is called credit to buy equipment. the cheap energy that you have. it is very, very competitive, because component in manufacturing is not much, it is the energy. american equipment -- if that is not renewed i think that will be a bit of an issue. >> first of all, we are having a vigorous agreement, i find it amazing. economics and if you are running a country, you have to create an opportunity for your businesses to be competitive. and that's all the exim bank does. and i have heard more ridiculous things said about the exim bank in the last six months than i heard in my lifetime. i need to do that in a way to encourage more economic

diversification in africa. and i wish that not only our african panelists, but others here would give some thought to that. right now, we want to get it extend it and how to craft the extension so we can support the development aspirations of the various african nations and what the people really need. look, we are out of time. we haven't talked nearly about education and training and the equal inclusion of women and girls in the economic plans for the future. there are so many things that need to be said about finance infrastructure, energy, that presumably will be said later. but i hope that everybody who's here because you are interested, though not yet involved is now more interested and more determined to be involved. and i hope that all of our

african friends who are here will accelerate the opportunities we have to do things together. i think the united states and its business community need this relationship as much or more as africa and its business community. this is a very important part of our future. and i would just like to say one final thing. there was a panelist up here talking before we came out and i heard about his story and i thought of all the people driven out of uganda. and the amazing stories so many of them had made, it reinforced something we shouldn't forget here. intelligence, dreams and ability to work is distributed. investment opportunities and citizens that reward smart

behavior are not. that's really what this is about. all of us are being given a chance to either do our work like the gates foundation and i do or to make a lot of money out of the fact that this gap has occurred which should now be closed. and i see the world bank president out there, he's going to help us do it. the american government is committed to help us do it. remember his speech. that may be the most important thing that occurred on this stage this morning. he drops out of school at 15 and done what he has done in the last 18 years and should never have had to leave home a single day to do that. we want to create the african home as a place of opportunities for africans and for those who want to work with them. we should give our panelists, especially our african panelists, a big hand. [applause]

[captions copyright national cable satellite corp. 2014] [captioning performed by national captioning institute] >> it's primary day for several days including kansas, michigan, missouri and washington. earlier today on washington journal, we got a preview of the races in kansas and michigan. here's a look. >> let's begin with this senate primary, pat roberts, the incumbent is facing a tea party challenge. who is challenging him and what's the prediction? >> well, this u.s. senate race has been a slug fest and the incumbent senate pat roberts is defending against wolf. it has been an interesting race and i would imagine that roberts will win this primary, but one interesting thing to follow is whether or not that margin is thin. and if it's thin, it might

suggest that roberts is vulnerable. >> so the role of the tea party in this race, i want to show our viewers, tea party citizenship fund that invested $75,000 to oadcast a kansas cable television link to senator pat roberts. here is the ad and get your take on it. >> senator pat roberts does president think he should have to live under the same law. he takes a special exemption. yes, he wants special treatment. when congress realized when obamacare was, he took it. that's wrong. on august 5, vote dr. milton wolf to send a message. repeal obamacare. tea party patriots citizen fund is responsible for the content of this message. >> tim carpenter, are the issues

that are being debated in washington and being advertised in this race, having an impact on voters? >> i think so. if you did some polling, you would learn in kansas that the affordable care act is highly unpopular. so one thing republicans can do in kansas is run against barack obama barack obama and the a.c.a. and they'll get tracks. that's why this campaign ad has come into the mix. factually that is challenged. and perhaps misstates what roberts' experience with the a.c.a. is. >> in what way is it not correct? it averts that roberts took an exemption to obamacare and that's, in fact, not true. the senator and his staff have received their health insurance through the affordable care act, through the exchange as they're

required to do. the ad is wrong. >> this race has been described by the "washington post" as one of the most colorful in the nation. what's been happening? >> yes. so roberts has been emphasizing that he wants to convince voters that wolf's character can be defined by the fappingt that he posted to facebook x-ray images of dead people accompanied by undignified remarks that were described by wolf as humor. there is an ongoing ethics medical investigation of wolf. on the other hand, wolf who is a distant cousin to president obama, since that roberts, 47 years in washington transformed him into a defacto senator in virginia. legal resident of dodge city, kansas.

>> and as you said, though, the voters going to the polls today in kansas prime player, it is looking though right now that senator pat roberts could beat back this challenge from tea party challenger wolf at this point? >> the thing you have to remember in kansas, republicans have won every u.s. senate race since 1932 and it's very difficult for challengers, republicans or otherwise to take on these incumbents. >> why is that? >> i think congress generally is unpopular, but people like what they know. they like their guy, their person in the house or senate. than and you would have to lean from day one to the incumbent and senator roberts has been around for a long time. has made a lot of friends and a few enemies. i would have to assume anything can happen today.

the voters decide it's the greatest poll that we have, but i have to assume that senator roberts would prevail. >> there are a couple of house primaries that people are watching. the 4th district and the 1st district. the 4th district, who is running? >> you have the incumbent mike pompeo and he is being challenged by former representative todd tiahrt. they have experienced name recognition and deep pockets backing them up. it has become a very vicious race. what is interesting, it has become a bizarre grudge match. tiahrt is being funded by a wichita oil man who lost the previous congressional congressional campaign to pompeo and formed a superp.a.c. >> and what about the 1st district?

>> u.s. representative tim huelskamp is the incumbent that. in 2012, he had no opposition. this year he has a primary and general election foes and lules camp reversal of fortune when the farm bureau declined to endorse him. there are upset with his votes on farm policy. he was kicked off the house agricultural committee by speaker boehner. so the opponents of huelskamp have aired uncomplimentary ads against him. this is bounce to a republican lapolice. uy named he taught school and dabbled in movies. >> those are the races to watch in kansas and one of the four states holding primaries today. the governor's race there. what's the latest for governor

brownback? >> i think national political writers have been drawn to this race because a year or so ago, they would have never predicted brownback's campaign would have been a strug. jennifer winn addition into his hide. but this election sets the stage for the fall when brownback goes up against paul davis, who is the house democratic leader in kansas. the polling isn't very robust here, but a layman would suggest this is a toss-up three months out. >> thank you for your time. >> my pleasure. >> joining us on the phone is fritz klug out of michigan to talk about that primary in that state and there are five races watch, according to fritz

klug. the republican primary in the 3rd congressional district. >> that race is very interesting and it has been for a while. a lot of the stories that we've heard in recent years about primaries have been incumbents who have been challenged by tea party challengers, but this is la reverse where we have amash and he is being challenged by an area businessman named brian ellis. >> and then you have number 2 on the list, you have the race to replace representative dave camp who our viewers will know a republican from there and chaired the ways and means committee. who's running? >> we have state senator who has been backed by both men who

preceded him and dave camp endorsed him and the attorney general has endorsed him. but more unknown businessman, paul mitchell when camp said he is not going to seek re-election. he has spent his own money into that race. someone who is well endorsed and well backed. the polls have shown that mitchell has had a large lead but seems that there is a close in the gap. >> 8th congressional district, open seat there. >> that's where another congressman viewers would know, mike rogers announced he is not going to seek re-election and head a syndicated radio show. we have two well known

republicans who are running for that. so they are running against each other for this nomination. democrats could still have a chance. in november. it is an interesting race because polls have shown that they are both well liked by constituents. but it seems that according to some polls that bishop is leaving but primaries you never know until people vote. >> and in the 11th congressional district you have a race that's similar to the amash-ellis race as well. >> it is interesting, bentvilleo who has been called the cidental congressman, and he was the only republican on the ballot after mccotter resigned.

he didn't have a chance running against mccotter but after mccotter resigned, he won that election. he is being challenged by an area foreclosure attorney and put a lot of money in his campaign and ran a strong campaign from the beginning. it appears that bentvilleo may lose. all the polls are pointing that. .ut this is the incumbent >> and the 14th congressional district, who's running there? what are the issues? >> we have a wide range of candidates right in the 14th. that is the seat currently held by gary peters, who is not running for re-election but trying to replace carl levin in the you senate.

and districts were merged through redistricting. you have state republic hobs who is well known and well connected. and brenda lawrence who is well liked and then you have another candidate, foster, who is running a lower level campaign. but between the three, they are pulling in their respective support. sea it's going to be a competitive primary and the city of detroit. and whoever is representing this . >> what are the issues, what are the top issues that are impacting these races in michigan? >> four of them are republican primaries, so a lot of them are in the third congressional district. who best represents their constituents.

he is often one of the others in the g.o.p. delegation. lipper tarian leaning but we know on a lot of bills, he is suspending. that is a big issue, who better represents michigan. who is going to be the better conservative voice for these republicans. who is going to be the one who is going to better represent them. the affordable care act. and in the state legislature or have done in their business careers. >> there is not many clearer sites because in those races, none of them were in washington to vote for those bills. >> news buzz reporter. you want to learn more,

reporting live at the web site. >> just to note, later in our schedule, we'll bring you the victory and concession speeches between pat roberts and tea arty challenger milton wolf. tomorrow on "washington journal," william chris toll of standard." then melissa harrison of the natural resources defense council action fund discusses the algae bloom in lake erie and left half a million people without tap water over the weekend. after that, "national review" correspondent on the debate over weather congress should re-authorize the export-import bank. your phone calls.

we are live wednesday at 7:00 .m. eastern on c-span. earlier today the kaiser family foundation and the alliance for health released the results of a new survey looking at navigateors and brokers during the last health care open enrollment period. the next open noelment starts november 15. this is an hour and a half. >> if i could have your attention, let's try to get started. i'm from the alliance for health reform and welcome you to this program on behalf of senator blunt and our board of directors. it's a briefing on the people and programs in place in each state to help consumers

understand their health insurance options, help them apply for assistance if they are eligible. each of the stathe marketplaces has these programs that are more than 4,000 of them in the first open enrollment period and the affordable care act provides some funding for them. traditional insurance brokers and agents are part of the picture as well. now there were more than 10 million people helped by these navigateors and other assistors during that six-month open enrollment period last year and early this year. today we are going to look at some of the challenges that were faced by those consumer assistance programs, how they responded to them and what the outlook is for the next open enrollment period, which begins less than three months from now. our partner and co-sponsor in this briefing, the kaiser family

foundation is the source of a lot of the best and most relied health policy analysis around. d we are pleased to have jennifer tolbert who is the director of the state health reform project at the foundation. that's part of her duties to monitor the implementation to the affordable care act, particularly the efforts to set up insurance exchanges in each state. and you will hear from jen in just a moment. i will take care of the logistics and move through the discussion as little discontinuity as possible. if you are tweeting and we would assist tors. # there is a sheet that tells you how to do that and the credentials are on the screen behind us. there's a lot of important

information in your pacts, ackground -- pakistan ets -- packets. if you crank it up on your computer screen, you can click on. there is going to be a video recording available in two or three days followed by a transcript, both on our web site kaiser h.org and on the family foundation web site. kff.org. you will find the speakers' slides and if you are watching on c-span right now and have access to a computer, you can punch up those slides and the rest of the background materials that the folks in the room have in front of them at allhealth.org. questions at the appropriate time, there are three ways to do that.

there is a green card in your materials. you can write a question on. there are microphones you can use to ask your question in person. and if you want to tweet the question, we will snatch it up from the twitterversus and bring it forward. so prepare for that and we will look forward to your questions. and the final little bit of overhead is that there's a blue evaluation form in your kits that we would very much appreciate your filling out so we can improve these programs r you in the future and to tailor the topics to your needs as well. i turn to jennifer tolbert. thanks for you being here and look forward to your presentation, too.

>> do i need to do introductions or -- >> why don't you go ahead and do that. >> thanks. welcome to everyone. and thanks to our panelists for participating in this briefing today and what i anticipate will be a great discussion and programs and the role that they played during the first open enrollment period and kind of throughout this first year. i am going to provide a very brief overview, just to make sure everyone in the room is oriented to these programs and the role that they play and the variety of programs that participated in this first year. so there were a variety of programs that provided a consumer assistance and outreach and public education during the first open enrollment period. you probably heard about the navigateors. those were programs that were

established by the a.c.a. and required to participate in all marketplaces. they provide outreach and public education. they help consumers apply for coverage and they facilitate the selection of qualified health plans in the marketplaces. now in person, assistors played a similar role to navigateors. they participated only in state-based marketplaces and the main distinguishing factor between the assistors and navigateors is how they were funded. assistors were funded through grants 1311, established in the state marketplaces and in consumer assistance partnership states. certified application counselors re another group of assistor programs. they were recognized by the marketplaces but were not funded

directly through the marketplaces. the training and other requirements for the c.a.c.'s were somewhat less extensive than navigateors. primarily they were not required to do outreach and public education, though many of these programs did. federally qualified health centers played a really important role in helping consumers sign up for coverage. most of these participated as c.a.c.'s, though some functioned as navigateors or i.p.a.'s. and then finally, there were two organizations that contracted with c.m.s. to provide supplemental enrollment assistance in select communities in federally facilitated marketplace states and in partnership states through the federal enrollment assistance program and as mentioned, through our survey of programs,

we estimate there were about 4,400 assistor programs that were established and participated in the first year of helping people sign up for coverage. i should also note that agents and brokers played an important role in helping consumers apply for coverage and enroll in plans. they were not included in our survey, so i can't document their role but i will talk about in a minute about what they did. health care providers including hospitals, as well as nonprofit community-based organizations sponsored the majority of the assistor programs. probably isn't surprising because these entities have had a long history of serving low-numb and uninsured populations. but importantly, other entities

supported assistor programs including local and state government agencies and local health departments, legal aid organizations, churches, colleges and universities as well as trade associations. and we estimate that there was over 350 million in federal funding that was available to support the establishment of these programs during the first year. that funding came primarily through federal navigator funding as well as the section 1311, exchange establishment grants. and as i mentioned that contract that they announced through the enrollment assistance program. the health resources and services program which provided funding provided about 44% of the total federal funding. now importantly, this only represents federal funding to

support these programs. we know there was a great deal of funding through private foundations and other private organizations as well as funding at was repurposed from organizations own budgets to support these assistor programs. one of the critical issues that i anticipate we will discuss on the panel is future funding for these assistor programs. c.m.s. has issued its funding f.o.a.'s, funding opportunity announcements for the program at $60 million. that represents $7 million less than what was available last year. c.m.s. has not made a decision whether it's going to extend its contract with the federal enrollment assistance with the two entities that participated in the federal enrollment assistance program. states can continue to fund their assistor programs with section 1311 grant funds this

year, but beginning next year, they will have to identify other sources of funding for their programs. and i will note that they indicated they will continue funding at the same level for this next open enrollment period. and then finally as i mentioned, while we couldn't document the role of agents and brokers during the first open enrollment program, we know they played an important role in helping consumers sign up for coverage. both agents and brokers have traditionally helped people find and enroll in plans in the individual market and many registered with the new marketplaces and were able to sell products and help consumers find plans in the marketplaces. and in talking to assistors, one area that i hope we discuss today has to do with collaboration between agents and brokers and assistors and in

talking to assistors out in the field, some expressed some waryness working with brokers, because they felt the missions were different because the brokers do receive commissions from the insurance companies for the plans that they sell. however, a number of other assistors found collaborating with brokers and agents to be quite useful because of the expertise that brokers have with understanding the health plan choices available to consumers. with that introduction and overview, i will turn it back to ed. >> thanks. and let me just very briefly introduce our panel. we are going to start with karen pollitz, senior fellow at the kaiser family foundation, one of the leading experts and she will be sharing with us the results of kaiser family foundation

survey of the marketplace assistors that jen was referring to. and we will hear from two speakers who are working directly who are trying to figure out and use the marketplaces to get the best coverage. jodi ray is the director of florida covering kids at the university of south florida. she has won a host of awards of enrolling families into health care coverage. lisa stein is vice president at cedc, a nonprofit that enrolls people into coverage in several states, some with state-based exchanges, some with with the federally-facilitated ones and she will describe how the assistors operate. and jessica waltman. she has been with her company with 15 years or so and is going to give us the important

perspective of the more than 100,000 brokers and agents that are affiliated with the association and who are as jen noted, deeply involved in most of the activities involved in getting people enrolled and signed up for coverage. so without further overhead, karen, could you take us through the findings of the survey and how that looks to you from your years of experience in this field. >> thank you, ed and good afternoon everyone. and thanks to the alliance for hosting this briefing today. i will just take a few minutes to summarize some of the key findings of our foundation survey of health insurance marketplace assistors. we feel that this survey just as open enrollment was concluding this spring to lorn more about the assistor programs, their experiences and the kinds of help that consumers sought.

we asked c.m.s. and state-based marketplaces to provide us contact information for the directors of their assistor programs, who were certified to work in the exchanges and as jen mentioned, for due to some technical difficulties we couldn't survey the brokers this year but we hope to do it in the future. our first finding of this viewer survey were the numbers. 4,445 assistor programs that ere established in the marketplace. they employed 48,000 full-time equivalent staff and volunteers. more people than that. and we estimate 10.6 million consumers sought help from these programs during the first open enrollment period. many who sought help ended up enrolling in qualified health plans, most of those with subsidies.

many enrolled in medicaid and chip and some people didn't enroll in anything at all. if they lived in states that didn't expand medicaid eligibility and went to an assistor program and found out they were not eligible for any help to obtain coverage. i'm going to show you this slide just to briefly point out that the marketplaces are required under the a.c.a. to set up navigator programs. there wasn't money to set up navigator programs per se so these work-arounds got established. this slide shows you that only about 30% of the assistor programs that were established in the first year were actually funded by the marketplace or with marketplace implementation funds. the other programs, these olunteers that were funded comprised most of the programs in the first year and helped

most of the people during the first open enrollment. it will be interesting to see if that changes in the coming year. and it's not moving. id i do something wrong? assistance was unevenly distributed across types of marketplaces, not surprisingly because c.m.s. had limited implementation funds to support navigateors in the 29 federal marketplace states while the state-run and partnership marketplace states could apply for these unlimited exchanges development grant funds. there were twice as many assistors relative to the uninsured population in state and partnership marketplaces compared to the federally-run marketplace states and the number of people helped relative to the unshurd population -- uninsured population was half of

that in the first year. these assistor programs were busy. for the entire open enrollment program, one in four programs said they could serve most of the people but had to turn some away while 12% said they were swamped most of the time. at the end of the open enrollment. half of all people that signed up signed up during the last month. half of the assistor programs said they had to turn people away. there we go. providing enrollment assistance was a time-intensive activity. 2/3 of the programs reported that they spent on average one to two hours per person setting up an account, going through the i.d. proofing process, entering the household information necessary to apply for subsidies, reviewing the plan choices and picking a plan. why do people go to these

navigateors programs? overwhelmingly, they didn't know where to begin. far more than web site glitches, the assistor programs report that people sought help because they do not understand the a.c.a., what they are supposed to do, they don't understand health insurance and needed help to understand their plan choices and simply lacked confidence to apply on their own. interestingly, 41% of assistor programs told us that most to nearly all of their clients who sought help lacked internet access. so in-person health will continue to be very important for years to come. after that, programs tell us that it was the details of the application process that prompted people to seek help. remember, to apply for subsidies, you have to report information about your income and who is in your household, not now, but what you expect

that to be in the coming year and what you expect your tax filing status to be in the coming year and for most people, they needed help walking through that. so these reasons i think shed some light on why it took on average one to two hours to walk people through the application process. about 90% of programs told us that most to nearly all of the people who sought help were uninsured. and about three-quarters of programs told us that most to nearly all of the people who sought help had significant insurance literacy. they needed help understanding like deductible. hy is the assistance was intensive. assistor programs tell us that plan information provided to consumers on the web site sometimes didn't answer all the questions that consumers had.

40% they tell us this was often or always the case. our survey asked the programs what happened. some of them developed partnership with insurance brokers and programs tell us that they hope in the coming years marketplaces will provide better plan information, better plan comparison tools and some also think that insurers should be required as a condition of offering coverage on the marketplace to provide briefings for the assistor programs on the products they are offering and provide a dedicated customer service line for the assistor programs. one other note, findings had to do with how these programs coordinated with each other. 45% said they did coordinate with other assistor programs in their region and helped them work more efficiently and effectively. they used a central scheduling

system so consumers could be directed to a program that had available appointments instead of one that was overbooked and help each other solve complex cases, like a super navigator emerged, that helped provide technical assistance to other programs. we have programs that initiated this coordination. this was something that the assistors did on their own or maybe that was facilitated by a third party like a foundation. it would be interesting to see if marketplaces act proactively to help programs coordinate more in the future. one other important observation. marketplace assistor programs are there to get people into coverage and do outreach and enroll them. but even one week after open enrollment closed, most programs, 90% of programs told us clients were already coming back with host-enrollment questions and problems. they didn't understand how to use their coverage and couldn't find a doctor in network and had

a claim denied and didn't know how to appeal. they provide state ombudsman programs to provide full range consumer assistance including post-enrollment problems and it is supposed to help everyone in the state. those programs were left funded in 2012. the marketplace assistors are being asked to pick up some of the slack. one word about the learning curve. 70% of the programs that help consumers in the first open enrollment had prior experience before this year. mostly they had prior experience in enrolling. 16% of programs in the first year report they previously helped consumers evaluate private health plan choices and enroll in private coverage and less than 10% had prior experience with tax issues. this first year represented a

steep learning curve for the assistor programs as well as for consumers. most assistance programs say that it is very likely they will continue in this role for another year. that experience will surely help programs to work more effectively and efficiently and it will be especially important because millions more people are expected to sign up for coverage in the second year at the same time that the folks who signed up last year are coming back to re-enroll and the second open enrollment period will be half as long and that will be lots of fun. i will stop there and turn it back to jodi. >> i don't know how to do that thing. >> you don't have to. >> i think i have my mike on, too. so as you already know, in florida, we participated as part of the federally-funded

marketplace and so we had navigateors. university of south florida was awarded a grant to provide navigator services. we covered 64-677 counts. we needed to look at what our coverage -- 64-67 countyies. we wanted them to be ready to enroll folks in the marketplace and be in a position of connecting them to any available coverage options like med i had cade and chip and we did have county health plans. but we were faced with a significant gap, because we didn't expand medicaid. so we were able to make a concerted effort to identify where resources were. in each of the service areas that we were working in. those that didn't qualify for coverage were still directly connected to services that they may be in need of, even if they

weren't able to obtain coverage. so this is what our outreach effort looked like gee graphically. covered 64-67 counties. only counties we didn't have were broward, miami-dade and monroe, which is the keys. we broke the state into geographic regions and we designed our outreach initiative to be from the ground up, grassroots. instead of university of south florida sending in troops to each of these areas, we worked a consortium of partners in each of the areas. we had 100 navigators on the ground. we had 208 project volunteers and each of these folks reached within their own community to identify a coalition of partners to enhance efforts that they were putting together in the community. one was intended to be reflective of the community.

the outreach efforts were comprised by the community, reflective of the community and knew who their target populations were. some of the challenges that we knew we had to be able to address particularly with the structure that we put into place was the fact that a, florida is a very large state. pensacola and key west, they are demographically and geographically very different. and even though we didn't go as far as key west, but counties like palm beach county. effectiveness had to be -- had to address the geography in this state and they are very diverse. florida -- we had to be able to reach out hard-to-reach populations in each of the geographic areas. and you have to have a certain

level of trust. you have to build public support for directing people to the health coverage. and the way we did that was to design the outreach initiative being that it broke down the state into regions. we had a very large uninsured population, so our target was pretty significant. and among those that are unsnerd, we see a huge deficit in their understanding of what having health insurance means. post-enrollment we are addressing questions like how do i use my insurance? do i go to a hospital to get my care. the most basic of questions are now being answered in follow up to the open enrollment period so we can provide a certain amount of health literacy to the consumers who now have health insurance so they can use it appropriately. we had large rural areas.

transportation is a significant issue. our outreach efforts had to include a lot of mobile navigators. this couldn't be just by design for folks sitting in an office. we had to go to them and be convenient in terms of hours and physical location so they could connect to the consumer assistance they needed. we were dealing with trust issues. among hard-to-reach populations and because they are so wide in terms of their diversity, we had to make sure we were working with the right trusted stakeholders who could speak the language and understand the cultural issues when we are communicating with someone like health care coverage. i have already addressed in the previous slide amongst the lowest income populations. while we have lots of people coming in, there were always those that fell in the lowest

income range that couldn't obtain coverage under this effort. a key element of the outreach efforts that we put into place under this initiative was engaging community partners. they weren't only there to provide navigator services. community partners played a significant role in referring folks to enrollment assistance. so part of the navigator duties centered around the education and outreach component and consumer piece. it was real important that our navigator initiatives took into account that we needed to engage, the larger community even those that weren't providing navigator services so we were general suring that populations were getting directed to the right places for navigators. the community knew who they were and so building those referral

networks and those community partners was real important. we utilized partners that we spent 16 years building. so it was to our advantage to be able to take those community coalitions and collaborations and say, you know we have been enrolling these children overall these years and now we can go back and enroll the parents, too. and up until recently, we haven't been able to do that. so it was a real advantage for us to go back to those existing networks and existing partnerships, looking at how we can expand them to meet the newly eligible populations and we were able to get this up and running pretty quick. so here's some of the outcomes of the grant to date. we have been able to assist through the outreach and education events and one-on-one navigator events, 78,000

individuals and attended outreaches throughout the state and held more than 17,000 navigator appointments and those appointments include things not only doing the application but then they come back and pick a lan and enroll and so that doesn't always happen with every consumer in that order, but consumer appointments include all of those activities. we had almost 100 navigators trained at any given time through the state. those navigators not only completed the 20 hours of training that h.h.s. required, but in florida they were required to be fingerprinted, background check and registered with the state. so those 100 navigators covered the 64 counties that were our target region. we were able to assist consumers in a wide range of languages.

top five languages are here which includes, english, spanish and creole, but in addition we have languages like arabic, chinese and so many more that we had to address and we utilized not only folks who spoke the languages and were part of the communities, but we also made sure we had access to translator services. and reaching folks through media was real important to be able to get the message out to large numbers of folks throughout the state. the outreach efforts are one thing. the one-on-one assistance help you get a lot of information to a consumer and help them through the process but we needed to get the message out, that a, the program is available. they needed to know things like deadlines and we found that that was one of the most effective ways to do it in some of the larger areas particularly.

again, this just gives you a picture of the outcomes of the work that the navigator initiative under the university of south florida was able to achieve during the open enrollment period to date and able to reach more than 200,000 onsumers throughout the state. thank you. >> thanks very much, jodi. we are going to turn now to lisa stein. >> can folks hear me? great. good afternoon. it's a pleasure to be here with you today. we had the honor of serving as a

navigator entity in four states. we worked in maryland and new york, which were state-based exchange states who also chose to expand medicaid and we also worked in georgia and tennessee, which were federally-funded exchange states but did not choose to expand medicaid. i thank the u.s. department of health and human services, the maryland health benefit exchange and the new york state health benefit exchange. they have been great partners and supporters of our work and we are excited to be part of this history. nonprofit national organization which answers economic tupt for people, communities and businesses in need. we are based in new york city and have offices also in maryland, georgia and tennessee. we have three program area of focus, work force, working family support and technical assistance. similar to the slide that karen

shared, our relevant experience prior to open enrollment was chim contracts in all four of our states. we currently hold snap contracts in all four states where we operate and in new york we participated in facilitated enrollment programs with helping people to enroll in medicaid. in addition, this last statistic -- i do. sorry. >> this last bullet on the slide is the result of our signature tool, earned benefits online known as e.b.o. it is a web-based multiple-benefit screening tool. staff can assist individuals to accept multiple benefits in one sitting and can determine eligibility, fill out application forms and provide individuals with check lists and resources to greatly facilitate their enrollment into benefits. as a result from 2005 up until

the beginning of open enrollment we have assisted over 18,000 households to receive $300 million worth of benefits. so in all four states we are both navigator-funded and also a certified application counselor-sponsoring entity. we choose to use an intermediary model and we worked with partners lgbt and immigrant population and i would like to take this moment we had very excellent partners in all four of our states and we are grateful to them and they are too numerous to be mentioned here today. in new york we worked with a group that serves the southeast muslim population. in maryland, we worked with two local county health departments. in georgia, we worked with a partnership between the health

initiative and georgia equality, which focuses on lgbt communities and we worked with s.o.s. and in tennessee, we partnered with the appalachian mountain project and easter seals. you can see from my slides that the differences in terms of resources available in each state, for example in maryland statewide, there was 306 navigated by funders. the variance in resources is at the heart of my next two slides, because the resources really dictated our strategy for deployment of the navigateors. so in new york city, where we ere concentrated in the five burroughs there was a lot of one-to-appointments and not just sitting in an office but going

out to points in the community, not just health sites, work force sites, food banks, churches, libraries. in georgia and tennessee, because there were far fewer resources and much more geographic distribution to cover, we took the show on the road. we would go to regional centers and partner with medical centers or libraries. a lot of church-sponsored events and we would do large-scale enrollment events. the resources also dictated education and outreach. in the state-based exchange states of maryland and new york, there were extensive advertising campaigns well in advance of enrollment. tv ads, radio ads, every subway, every bus, something in your electric bill, consumers typically had much more awareness of the marketplace and much more important association. in georgia and tennessee because

they were federally funded exchange states, it was a big part of the navigator outreach, so a way to learn something through the marketplace, and in both georgia and tennessee, we were both successful in getting over one million media hit, and those stories would then be reviewed on the internet. people were really hungry for the information. so we sort of had our own lab. yet exchanges, federally funded exchanges. and we had urban territory and and we took the opportunity to take advantage of that, and we contracted with the university of georgia's center for risk, and they conducted an

evaluation of all of our projects in all after your states, and this included an evaluation of the data we were allowed to collect in each state, and they interviewed navigators, and they interviewed navigators interviewed by the people. to comeat is starting out of the research, and they are focused on the navigator interaction. there is generally a low awareness of navigators. they have heard about it, but they were not as aware that there was free and unbiased assistance available. thatmers really appreciate assistance. oftentimes, navigators were the only interaction someone might encounter as they enrolled into an insurance product, and finally, the interaction between navigators and consumers could negative preconception. a lot of individuals that came negative ideas or

beliefs regarding health care, regarding the marketplace, so much more positive and engaged, and they said they would go out and tell somebody about their interaction. so there are some challenges. earth shocking news. there were some technology issues. in all after your states, there was some amount of technical difficulty with either the online portal or the call center, however, in new york and maryland, which were state aid exchange portals, navigators and a sisters had access into the portal, so they could he what was happening within application and really make sure to assist the consumer all of the way through in roman, and, furthermore, they had direct contact and regular contact sometimes daily with the exchange leadership so that they communicate and get real-time results back.

operating a call center for 34 states, that was a huge task, and there was not a special backend access into the portal, and there was no special backend access into the call center. our primary lines of communication were through our officers and regional offices, and they were terrific and responsive, but the information had to travel through different levels to get to the folks who were working the call centers. and the number two challenge that my colleagues have also complexityt is the of choosing a health plan. it is the greatest challenge and navigator faces. of thenavigators in all states, both the state-based exchanges, received some combination of trading that was required, and they felt committed that their navigators needed more, so we provided additional training on

communication techniques, both in advance of open enrollment and continuing through open enrollment, as well as additional one-on-one training immigration status and verifying household income. so finally, the challenge was around privacy concerns are you there was a history of maintaining privacy standards, and we were very committed to meeting the challenge in the health care marketplace in all of them. we conducted site visit with our partners to make sure they were observing straight hip a protocol, andpaa we had a very strict policy to make sure we were providing quality services to consumers. and we had some really great successes. my colleague from florida, fast implementation. while maryland was an early in the limiter, and we began

process in april, but the other totes, we had about 10 or 11 get them ready to go, and in georgia and tennessee, there were additional requirements, which may that links the year, but we did it, and our partners were great, and we are looking forward to doing it again next year, this year. think it really great success was our community relationships. there were diverse partners that diversity,e required and in our experience, word-of-mouth is the most effective. it quickly establishes trust to begin the enrollment process, and results from our research study, all states demonstrated effective outreach with a culturally diverse population. finally, i think our infrastructure was really successful. the model allowed local

flexibility to respond on the time, the at the same national coordination allowed us to share best practices and to course correction where needed. and looking ahead, similar to what karen indicated, open enrollment is 50% shorter this year and only overlaps with ever your weeks of the free tax preparation season. this is a really strategically strong opportunity to reach people. they come prepared with their information, and this will be the first year that they will face the tax implication of making a choice or not making a choice. finished a just strategic planning process with all after you are of our teams, and we are working really hard to make sure we can take advantage of every day of the next open enrollment. the renewal process will be a first. there is some uncertainty regarding the online

functionality as well as communication with consumers. the end, this is also a tremendous opportunity to benefit from last year. as i indicated before, we also indicated a study, and we look forward to having that information in september. thank you. >> great, thanks. jessica? >> thank you. good afternoon. i am jessica, and i am here on behalf of the national association of health this represents about 100 thousand health insurance agents and brokers from all around the united states. independent agents have been helping people get coverage and stay covered through both private coverage programs and also in a wide range of public assistance programs for over 100 years. our members serve everyone, from individual people accessing the

fortune 100to companies, and they own or they work for their own independent businesses, not health insurance plans, and using an agent does not cost any additional money. in fact, it requires consumers be charged the exact same amount regardless of which they use, but instead of receiving grants, like other organizations, if an agent in roles someone in the exchange plan, his or her identifying number, which we call the national producer recorded,n, should be and then the agents pay a small monthly fee that goes for the health insurance carrier, so, remember, that is going to come back again. ok. and health insurance agents have been around for decades, so they do know a lot of information and as karen

indicated previously, they may not be publicly available. clans have witch good cost controls, or which plan in the marketplace is best, things like that, and they are also good with helping with claims problems, so the business model is a little different than all of the other sister models also because they have been around for a long time. also to provide year-round service, so they help situation isre that you need authorization for surgery or you get a wacky bill that you do not understand, and then the next year when you need to renew, they are there to make sure that your health plan still fits your needs and enroll you again, and the good news is that there is really no limitation from the law on how many different types of assistance that you use. agents and brokers can work in concert with other types of assisters, but we do

have some suggestions that can make this a little bit easier to facilitate the partnerships for consumers, and i think it would also benefit the brokers and the assister groups, and i will get to them in a second. just a little more ground. because they have been around for so long, they are very highly regulated. there is data security laws that apply, and they may not apply to the other groups because they were not around when those laws were passed, and in addition to the exchange certification, and all of them require broker certification, they also have to be licensed in every state that they do business, and they have additional course of continuing education each year, normally about 24 hours, and there is insurance.

they are all legally and financially accountable for the advice that they give. to report to the commissioners, and all will tell you they have people who work for them that do. so last year, the agents were very excited about helping people in exchange-based and as they indicated, it does not give complete information about how many were certified, but we have cobbled together a couple of sources, and we estimated there were about 100,000 that are helping people with exchange coverage. not all exchanges have published their data about how many exchange consumers use an agent, but we do .21, which is a recent urban institute study, which showed about half of all people

who used the exchanges had some sort of assistance, including agents and brokers, and agents and brokers had the highest customer satisfaction rate of it9%, so just like everyone, agents did have a few bumps in the road last year with open enrollment, and one of those big bombs had to deal with the agents identifying number. for a variety of reasons, often those numbers were included in exchange numbers, and to make a long story short, they really did not have a good way to fix that. the repayment problems for the broker, but it also created a liability program, because if their number was not included, that could affect the insurance, and it was also a consumer protection issue, because we think any interaction should be recorded, and then finally, it was a problem for partnerships between agents and brokers and assister groups.

there were only spots to report one number, so if they were together, somebody's number was not being recorded, so we think that should be corrected for the year ahead. and agents can also better serve consumers if they had a backend portal, an exchange for year-round case management. that is how non-exchange coverage works and in most data exchanges, and we think the exchange could benefit if they can catch up. also, there was no list of certified agents and brokers on the healthcare.gov website, which would be an important tool for others to have access to and also for them to partner with agents and brokers, and we have long called for a good way to report and follow-up with my hotline, and the we were looking at him prove

brokers,or agents and so it would help agent support their clients throughout the year. and a lot of those are specific to the marketplace. some are more nimble and had better broker resources, but even with those exchanges for problems,d have a few a lot of times from identifying numbers. do feelews is that we that broker participation in the exchange next year will be high. we do not how high, but anecdotally, we are getting good feedback, and recertification is ongoing right now. it looks like and may be a little lower than last year due to the bumps in the road, but overall, it is looking good, and we see high participation rates. and we were also looking to help them in the year ahead. and othersy landrieu have introduced two bills which

would require them to a dress most of these concerns, senate bill 2175 and also 2173. additionally, there is a bipartisan coalition of more than 75 house members that have ,ormerly called on the issues and many other senators and house members have also caught have these items on the priority list on a separate basis. so looking ahead, we do see some great opportunities for 2015. and the exchange will be online soon, and it appears it will contain many of the broker leveles that the federal does not currently have available and may not have available for the open enrollment season ahead, but we are hopeful for the exchange that it will at least have some of that functionality.

we also see new market entrants and new products being put onto the market, which will help to better meet the needs of our clients, and this will be for open enrollment. some that we do see, and i would like to discuss in the question and answer period -- we're running out of time, it includes the new enrollment process for existing clients. in particular, we really want to make sure that all exchange toollees do have ample time really review their new options for the plan year ahead and just are not redirected into the same plan from last year if that is not necessarily the most appropriate for them anymore, so we want them to be able to check out their choices, and then also, we do have ongoing concerns about subsidy determinations and making sure that they are applicable for all applicants, particularly those who are being we determined and redirected into policies from last year, because many of them may have been offered employer

coverage or will be offered employer coverage in the year ahead because of the responsibility requirement, and so getting that coverage offer for the first time can affect your subsidy again. are some challenges that i see, so thank you very much, and we will start with the q&a. >> rates. thank you very much, and let's start with something that you actually raised. i should say let me remind you that you can't tweet a question -- you can tweet a question or voice your options, so i urge you to get involved in the conversation and also encourage to offer comments back and forth. it is something that you have heard, if it has raised a question or has made you want to make an observation. you were talking about

and welment, jessica, have some number, whether it is 8 million or 6 million or 10 million people who have signed up for something and are going to have to sign up for something in what they have, and we have a prediction that there will be even more people who will be attempting to enroll this open season as compared to last, and what does that say about the workload of navigators, brokers, assisters, and what kind of difficulties can we anticipate and maybe try to ameliorate? >> well, from the agent and broker perspective, of course there is always going to be some whose plan from last year is still a good fit, and it is important for them to be able to

renew that coverage, but we believe that your health insurance purchasing decision is one of the most important, profound decisions that a family can make. it deals with financial security and health security implications, and we think that every year you should take a look and see if it fits, particularly to make sure it is the right choice for you and still affordable and just check out the marketplace and see if there are new entrants out there that might be a better fit. >> karen? >> i think we did not ask this exact survey when we looked at how long it takes to help people. we did not ask the sister -- look at howgrams to long it takes to do the id proofing and to establish an determining your eligibility for subsidies, and how much it was planned choice,

so i do not know nationwide. i did spend a little bit of time in northern virginia. just watching the actual process and just that morning, i did realize it took about an hour and a half, so that was validating for us when we found that, but most of that time was in the application process, not in the plan choice process, and, in fact, one thing we did ask our navigators and our assister s, did you even get to that, or did you see the plan choice, and most of the time, they didn't, so by the time they got through figuring out their income and who was in their household and whether or not they had availability, job coverage, and that was not very well explained, this took a lot of time. plus, sometimes the website was the plano i think choice is absolutely important.

that is the cherry on top. that is what completes the enrollment, but all of this resented a was what lot of difficulty and required a lot of assistance for people, and that is why the sister program spent a lot of time doing that. and i think with reenrollment we are going to learn what the research has told us for years, and that is that there is a lot of volatility in the lives of low income people. their incomes change. their families that if changes. and some struggled a lot when they were helping women who were expecting to get divorced, so i think today i am filing married, filing jointly, but maybe by the end of the year, that may not be the case, and how do i know? i do not really know, so i think a lot of people are going to be coming and not only to reevaluate their plan choice but to reevaluate what they are eligible for in terms of assistance.

and i think we are going to see more about how much of that goes on, and then a really difficult process because there is guesswork involved when you are looking at this going forward for another year, and then recognizing what was done a year ago. >> ok. go ahead. i should ask the folks who are standing at the microphone to address themselves, both personally and institutionally, if there is such a apex i am a primary care division, and my questions are a follow-up to what you were talking about. karan, ands are for a follow-up survey that you did. it looks like more than one third of the people thought they picked the wrong plan, and a large number of people were helping with the co-pays and deductibles. so one question, there was supposed to be a standard form in which the plants were supposed to fill out so that it

was easy to compare one plan to another, whereas before this, when you pick an insurance plan, it was 50 pages long, and there was no way to compare one to another, because they all talked about different things. question has to do with affordability. i mean, when the subsidies were set up, they were looking at affordability but how much the federal government was going to have to spend come as opposed to how much the people were going to have to spend, and i wondered what your post enrollment survey told you about either one of those. >> we did not ask specifically about the summary benefits and coverage, but the first thing you mentioned is standard, the kind of format that describes in simple terms and no fine print and consistent terms what a plan

covers and how it works. >> do you have a sense though of whether it was useful? >> we are actually in the process at kaiser at looking at some of these, and i know some other groups are trying to do this, as well, so like a lot of things in the first year, they were not all perfect the first time, and there are inconsistencies, and they are not produced in a consistent way. in addition, i think there were technical, i.t. problems with clicking on the link and it not coming up or them clicking on the link for the provider directory, and that not coming up, or does not match the plan that you thought you were clicking on, so i think many, many, you know, factors were at it trickiero make in the first year, and then a lot of these plan designed we were noticing the marketplace, really innovative cost-sharing designs. you know, a deductible is not always a deductible.

sometimes you get some stuff, and then you hit the deductible, and you get some more stuff, and sometimes it relates to these services but not other, and i am seeing things i have never seen before, and it is interesting to see if we can catalog yet, so for many reasons, it was evaluate for people to planned choices, even if they knew a lot about health insurance coming in. assisters about the kinds of things they would like to have training on, more training on the choices, and, in particular, why is it that there are five plans offered i one company, and what is the difference between plan one through five, and that is the kinds of things that the assisters went to get more briefing on. a do not want to be part of the salesforce of the company to get access to that. they just want to be able to see it. that should be more transparent,

so i think that is one of the things that is still definitely evolving. another reporte before the next open enrollment period? but i worked on reports every day. >> following up on why people did not like the plants and why some felt they did not like their plans. >> we do not have anything planned on that, but just as the survey came out, we did another survey on individual market participants, and and that was more the telephone survey, and that is on our website, as well, and we were looking at coverage they purchased on and off the exchange, some of the policies that they were conforming that well,t conform as although interestingly, on that survey, when we ask people questions, like what is your

deductible, we had very high rates of don't know, not sure, so on and off the marketplace, i still think insurance is a bit of a mystery to people, more than a little bit. i am actually working on another thing on insurance literacy, so this is a complicated feature. your second question had to deal with affordability, and i would refer to my colleague in real time, and this is something we asked about in the individual market survey, but the subsidies are not comprehensive in the aca. people do have to contribute a significant amount of money to the premium, which is pegged to a level of your income, but the cost-sharing, that surpasses what people will have to pay in premiums in many instances, and these are mostly high deductible plans, even silver and gold having a thousand dollar , and goldadeductible

sounds like everything should be covered, but not so much, so there is still a lot of cost-sharing that people have to pay for services, and i think there are consumers who maybe and not used to insurance they paid all of this money for a premium, and i still owe $150, and i think that is a wake-up call. >> jodi, any comments? what i would like to add is i think it really depends on where you lived in your community. if you were in a rural area versus an urban area, your chances are far fewer. you may be choosing one carrier or a couple of plants from a carrier, and additionally in the some states, there are a lot of porous borders, so in maryland, going into delaware, and in georgia and tennessee,

folks are used to crossing the border, and that is more difficult this go around. and i think those are also at play because the map is so crisscrossed, and the reality is very different. >> ok. >> i just want to say around affordability, we spent a significant amount of time talking about these individual health plans, and we have spent a lot of time on that because the consumers did not come in necessarily being literate around the idea of coinsurance versus deductible versus a co-pay, and how many of those things are coming out of their pocket before the insurance kicks in, and when you look at those plants, and i think you mentioned this, and you called it a doughnut hole, but you really have to go into the details of the plan with the

consumer so that when they walked away, they were actually making a decision that they were really well informed about making, and on its surface, the information was not necessarily glance, so ia think talking about -- when you talk about affordability, you had to factor in all of those pieces that are actually going to comprise the peace for the consumer, and not just the premium as one factor to look at, because if they started adding up some of these other pieces, it was very possible and very likely that it became -- you know, some plants became completely unaffordable. the other issue of portability we encountered a lot was the family might have, obviously, someone who was employed, and that individual is employed and has virtually no rhenium

payments, but for the whole family, it costs $10,000, but it did not allow them to enroll in a plan with cost-sharing and tax credits. they can only enroll in the marketplace in most circumstances without attaining those additional discounts, so that was a real challenge we saw a lot around affordability. >> all right. yes, go right ahead. governor&r block relations. absent a change or a push back of the open enrollment date, perhaps lisa and jodi can talk about this -- we're very concerned, and we see a scenario where we have a client who comes in to do their taxes, being somewhat proactive and not waiting to the last minute, and they are hit with a small penalty for the first year, and then they say, well, how can we fix that, and now, they can not. it is three times as much.

case management issues are you working with, and how are you addressing this with your current enrollees, and what do you think about essentially marketing plans for those who did not enroll the first time around and took the $95 penalty? >> well, i would say from our perspective, and we saw this even during the last open enrollment period, the talker was the penalties and pushing forward, to come in for assistance, or to sign up, so i think it is going to be really important that we are putting in effort forth about getting that message out widely and clearly. it is obviously even more pressing because it is not going to be quite as simple to take the penalty because it will be a lot more painful. it is going to be real important that we are working with a lot of our partners, a lot of business people in the community, to make sure they are

equally and foreign. i think that is going to be really key in getting information out to folks. and h&r block and partners like that who have been helpful in the past when communicating with consumers about coverage issues and you have been involved, so i think that is really going to be something we're going to have to spend a lot of time on. >> so the emphasis we are taking it to really take advantage of the time we have now. and we are out there doing education, doing outreach, trying to reschedule people for enrollment, developing an even more extensive referral network to get people in so that the real focus -- i think, in the first open enrollment which took six months, with outreach and enrollment, i think the focus switched to the mass enrollment. this time, all the outreach is being done front then did so we can till he -- really take advantage.

we share your concern. we found this to be a very beneficial point of contact, and if anybody is thinking about what may need to happen, a greater overlap, it is significant. >> does that mean, by the way, that there is any kind of consensus in the community that it would be a good thing to try to align the open enrollment period to the tax season? >> yes. >> ok. >> i totally -- i think this is may be a problem with this whole concept of delivering subsidies through the tax system, and i'd totally take and agree with all of these concerns, that people need to -- february and march is when people start gathering information, and they can make a better guess what they are still

guessing about what they will do next year. opennk if we moved to the enrollment to april, and if everybody always is at the end, we run the risk of building a , because theiral coverage will run out, and then they will not sign up again until next spring, and if the answer to that is to realign the plan year, now you have just moved around the calendar, so now you have to estimate the tax liability for the coming year, 2015, and a quarter into 2016, which i think will be even harder for people, so i think the problem is guessing what your eligibility will be a year in advance, because the tax system cannot give you kind of a real-time take on your eligibility, and so i am a little nervous about proposals to move it around the calendar for fear that it will uninsured people for several months on a regular basis. >> that is a really good point,

but people do not focus during the holidays. december, there was a little bit of a spike to meet the january 1 deadline for folks who had pre-existing conditions, who were really waiting for this opportunity, who wanted the coverage on the first, but due to the weather, due to holidays, it was very difficult, especially in our states where we needed to do the large-scale enrollment event, so i do not speak for the whole community, but there is all sorts of timing factors to take into account. >> jodi? >> i would say that the challenge is still a mental disconnect between the concept of having health care coverage and my taxes, and those two do not generally interlinked for the average individual. is allnk taxes, and that in one bucket, and my health

access falls in another place, and generally in people's minds, those two do not connect, and we are trying to do that, and i think that is just going to take for theto overcome average person who has to live their everyday life. >> ok. is brian, and i am with technical frontiers. i have some general questions about the follow-up being done with all of the activity in the field. i know you're all doing follow-up. i am wondering, is this process going to be ongoing as this process continues to evolve? and, i guess, one of the other do youns that i had, have any information about what the beneficiaries themselves, the people who are receiving all of this help, are saying about the quality of their experience, whether they are being served by brokers or by assisters, or by

navigators? you what you mean by ongoing follow-up question mark >> yes, i guess i was thinking, do you do these every year? do you do these in the months following the open enrollment system? >> well, this was our first survey, so we have not yet decided whether we will do an annual survey, at least for a while, because i expect this will be an evolving process for several years, but we do not have any immediate plans. i know my call the, jen, has been out in the field, doing a lot of sites and focus groups to find out what is going on, so i think we are looking for other ways to constantly monitor what is going on with outreach and in roma, but we are still figuring this out, as well. >> if i could ask before barons of the folks who are at the microphone -- excuse me.

we do not want to completely dis people who have written things on cars, and we have a couple of tweets, as well, so, jen, i am wondering if you can look at a couple of these questions will we have about 10 or 12 minutes left. >> ok. so karen began to touch on this issue. we got a couple of questions related to the training for , and, in particular, how adequate it was and what the plans were for improving the training going forward, so i do not know if -- >> i cannot speak for the exchange entities, because the states dictate their training curriculum, and hhs is currently updating the federal curriculum. and we continue to maintain a and we will train any

employees, and we will do some and weng, partnering, will continue to do the quality insurance monitoring during -- monitoring to make sure the folks that there aren't equipped .o do the job >> and we have a question. i would point you to our survey. we did ask them what types of training they would want, and 92% said they did what additional training. they found the training helpful, but they wanted more training, not only at the outset when they get certified but throughout the like helpingcs people with their post in roman questions and problems, tax immigrationes, issues. they wanted more training in insurance literacy. they wanted a lot more insurance

on the qualified health plans. they also wanted more training on just using the online application and the paper application and how that and they said they appreciate the training both marketplaces offered throughout webinars, conference calls, to provide updates and to like an role america and the center on budget priority, and georgetown university i know worked with a number to provide additional, in-depth training on particular complex projects. >> and i would say that one of the things that we hope to see and the training going forward would better -- i guess would more directly relate to the kinds of -- the kinds of priorities that consumers have when they are trying to select plants. it is one thing to walk through the key terminology, but when

the consumers are actually sitting there, and they are making plan decisions, they are really focused on how they will is health care, and that really key, very often, to their decision. it is not solely around cost area a lot of them need health care for tubular services. they need particular providers. they need particular prescriptions, so you really have to get into the nitty-gritty of what the health plan provides and really take the time to understand what the consumer's health care needs are going to be said that they can make a planned choice that will effectively provide for them the access of care that they are really going to need after they get covered. >> agents and brokers in addition are required by state continuingensive

and i thinkeds, this need for additional training is great, but another way to address that also is to further encourage the community is given their extensive plan knowledge and also the focus of agents and brokers throughout the plan year, and there are some issues with that, and they are in place and ready, so i think if we could further the partnership between the two, we could really help to provide better information to the consumers, better plans, and better advice to the assister community. >> one tiny thing. the state of illinois was a partnership marketplace, and they put together a new plan ,omparison tool or consumers

and based on what a lot of you would be familiar with, because consumer checkbook does a lot of these, and they compare plans for federal employees and their health plans, and you can go look at that but, but it has a andmore information different kinds of scenarios. if you are going to have a baby, and so forth. a satisfaction survey. more quality information about the doctors in the network, so i would commend you to take a look at the marketplace with the comparison tool. it is interesting. >> ok. can i ask folks as we go through these last few minutes of questions to pull out the blue evaluation form and fill it out so we can get the feedback that you want, and we are particularly interested in the opinions of those of you who are on congressional staff. yes, go ahead. you have been very patient.

>> yes, hi, everybody. thank you for sharing your expertise. given there is a proposed rule to auto enroll people, i know that was talked about earlier in the panel, and i am just curious if anybody -- i guess jody or lisa, if there are any plans to segment marketing or outreach to folks who have been enrolled, , versusauto reenroll people who may be newcomers in the system. >> sorry. yes. we are certainly going to have to focus on the renewal and recertification process as part of our education process, and i say that because of the experience in doing this. we tend to see -- it is high -- retention becomes a challenge, and we certainly do not want folks losing coverage. gettingt want folks

confused and making decisions that they are not happy with, so we are really going to have to -- and we are doing this now, even as we are still doing special enrollment. -- special enrollment we are fully aware that this will happen. they will have to take steps one way or another, that this is going to involve them actively in some way, so that they are not caught by surprise, that they know where to get help if they have questions, so we are really taking a lot of time now to focus on that so that people have sort of a heads-up up that this is coming down the pike and that we are able to keep the enrollment gains that we were able to do during the first open enrollment period. >> but it is important to understand that we are not in control of the process. we have been talking about our ability to follow up, and if

you're operating in a federal exchange date, i cannot follow-up. i was not allowed to keep identifiable information. be able get consent to to follow up with the consumers through in role meant and only for the purposes of enrollment, so we do not -- there is no cold calling, there is no knocking on doors, there is no list, so it is our relationship in the community, and people seeing our partners as a trusted source that they are coming in with their letters, and i think it is also important to understand -- i guess it is my understanding at this point that folks will get a notice from the insurance company which will have the full cost, 100% of what the plan was, and if they received a subsidy, they then get a second letter with the amount of the subsidy from the government, so imagine having this literacy, and maybe one letter comes first, and maybe one is a little bit delayed in the mail, and you can imagine the heart attack you have at your kitchen table, so

those are all challenges that are very real and beyond the control of the navigator entities. >> and we want to point out that a key difference between these and the broker community, and, again, brokers have been around a long time and are regulated differently, so brokers actually could keep that information, and they do have their existing client base that have been helping all year round, so they are able to reach out and clients, and that is why a partnership can be very beneficial, because at least it can help them, and then that person has the year-round support, and then the year-round support with enrollment, so when they get the two conflicting letters, and they do not know how to get back in touch with them, our members can, and they can help them work out their process. unfortunately, not everyone has that benefit, so we are concerned about bb determination

ascess to make sure, because karen pointed out, it is very volatile. things could've changed, their income, and what have you, and we want to make sure that they understand those letters, and even if they are just looking at the coverage options, and making sure that it is the right fit for them. >> we have three folks who are standing at the microphone, and we have one substitute standing at the microphone for someone else, and we will try to get to you. i am sorry that the gentleman behind the microphone is not going to be able to get his question asked, but i will ask you to keep your questions as brief as possible, and i know as panelists will be insightful as possible as quickly as possible, and we will try to get through this if it takes us, in world cup time -- terms, into extra time. hello, i am from a senator's office. so what was presented kind of

indicates there is a lack of coordination among b's sister groups, so if they're going to be some type of federal or third-party coordination to incentivize, like coordinating a dialogue between the sister groups, or is it purely a recommendation? >> i am going to take a little difference with that comment. especially with the federal states, we had no choice but to coordinate, and we just did it ourselves, and in georgia and tennessee, we were in regular communication with the qualified health centers, with in role america, with the other funded entities who are either 's or have federal resources, because we had to, because we were making sure there was extensive coverage. now, in maryland, the state broke it out to geographic wasons, and so one entity responsible for a territory and a partnership and network in that, but it was very, very well

coordinated, and in new york, new york was maybe the most interesting scenario in that there were 20 to entities funded , so there was a bit of stepping over each other's feet come but with that said, there were weekly calls. there were other forms and formats, so while it may not have had -- there was coordination. it was more informal, and while that is a friend, it is not less valuable, and i think that is an important statement out there. >> and i would just say in florida, just representing the university of south florida initiative, we actually have more formalized efforts around coordination, because, you know, there is a limit with what the navigators can do and how many navigators were on the ground, and in the state of florida, 100 navigators are only going to go so far, so in the tampa bay area, for example, which was one of our largest regions, they

brought together all of the regular basis in a coalition formats, and they tracked the efforts of where they were reaching consumers, and they also coordinated efforts to get out and do outreach and education events, because one man cannot do it all, so in an effort to make sure nothing was left uncovered, they worked with the entire aope of the assisters, colluding the partners, so i would say they were all rot to the table. so not only did they coordinate, but they actually track the efforts of the coordinating. yes, iquestion were >> am with the center for health solutions, and my question was related to the outreach. i guess my question is more what did you guys learn when outreaching to the specific population question mark what were your specific challenges?

and the other is if you have collected information, did you find any data on maybe the rate at which the outreach to you programs,assister assisted other demographics? >> i can answer the question about the outreach, and it was interesting. because we were a university, it made sense that we were reaching out to the population, first and foremost, and so we really worked with the university and the local colleges, both community colleges -- we started realizing that from those massive enrollment events, some are the most effective at getting some of the younger population, and that, specifically, to those who were enrolled, obviously, into classes, so we worked with student help her's and student and we were able to get into coverage,ts

and i think one of the challenges with that is if you have students with part-time jobs otherwise supported by student loans, they are obviously at risk for not all a fine for sharing and tax credits because they do not have enough income to qualify. in sun communities, we were able to make sure that they did not. and getting to larger numbers of students, and they were in that 18, 19, to 34 range, and they are all over the university, and they are enrolled in classes, and they work part-time, and they work full-time, and we utilize those. so that was effective for us.

>> yes. thank you. go ahead. quick comment. >> we found in all of you are of our states that about 25% of the people we assisted fell into the age rate -- range, on par. >> all right. the last question. >> hi. i will keep this brief. my name is michael, from the american institutes for research, and my question for jodi, were there particular interventions that florida took that were veteran and other interventions, especially because resources were strict, because medicaid was not expanded? >> i am not sure what you mean by "intervention." approaches? >> yes, approaches, enrollment, and taking different approaches wer others. >> well, definitely found that partnering

with hospitals was effective. clearly, that is an easy way to so oury the uninsured, enrollment at the hospitals was definitely very effective. now, we coordinated with health planning councils throughout the state, and that also allowed us access to a wide range of we saws, and, you know, the results from that, but i think there were certain aspects of each of their initiatives that were specific to their community. i think the partnership of a hospitals in the college and universities were very effective. the other thing is recognizing that we did have that medicaid gap, knowing where the county health plans existed, so we were able to connect people in certain counties to some coverage if they felt in that togetherell as we put an actual concrete resource manual of where all of the resources were in the community, so the folks could access services that they needed despite not having coverage, so that meant working with the urald health centers -- r

health centers and the mental health centers and all of those resources, so we were still connecting folks directly with resources. >> ok, thank you, and how about approaches that were to successful? successful?s sorry to bridge on the spot. e, i'm not sure i can answer that question quickly. think, going back to the work at the universities, i think it took us a while to get that off of the ground, and, initially, how we designed those efforts were not initially successful, and we certainly had to circle back and figure out how to make were effective, and which the right partners to work with

in a university system or a community college that connected us better to more students. we initially started off -- we saw a very small response to what we were doing, so we were able to revise that and change who we worked with within the colleges, so, i don't know, maybe that is more specific. >> ok, thank you. >> jess? >> well, thank you. thank you, panelists, for a wonderful discussion. i think we learned a lot about what worked and what didn't in the open enrollment period in the first year, and i think we talked about some ideas for and goingthe process forward, but we also know that, i think, there are a lot of challenges that lie ahead for this next open enrollment. keeper and beyond, but i think this has been a great discussion, and i thank you all for attending, and i thank our

panelists for participating. >> and i ask you in joining us in doing so. [applause] [captions copyright national cable satellite corp. 2014] [captioning performed by national captioning institute] >> american history tv on c-span three this weekend, friday night at 8:00 eastern, watergate 40 years later, with a cbs report and president nixon's address to the nation. a live call-in program with author and journalist john ferrell about nixon's life,

legacy, and the watergate scandal that ended his presidency. and gerald ford becomes the 38th president of the united states. this weekend on american history tv. month, sarah palin called for the impeachment of president obama at the western conservative summit. that conference is next. former president clinton talks to business leaders at today's u.s.-africa forum. we will hear from president obama and a number of african leaders. primary voters go to the polls in kansas, missouri, michigan, and washington. we will have election results as they come in. one contest we are watching is the kansas gop senate primary race. facingnt pat roberts is tea party challenger milton wolf, a physician