>> on news makers, indiana governor mike pence talks politics and issues facing indiana and other states and governors. governor pence is frequently mentioned as a potential presidential candidate in 2016. here is a portion of his remarks. >> i think it would be a mistake for our party to continue the look the washington, d.c. it is a place where we're going to solve many of the intractable problems facing our country. i think it is less about where that leadership emerges from than it is about the focus. i really think to some extent, our party in the last quarter century has become, as washington centric as the democrat party. in my short tenure here as governor in the state of indiana and other republican governors and the results that they have

produced, my message to my party and policy leaders on capitol hill is very simple. when republicans regain the senate this fall and when republicans regain the white house in 2016, it will not be enough simply to cut government spending in washington. i think it is incumbent on our party to promote policies that will permanently reduce the size and scope of the government and restore to the states the resources and a news survey on navigators and brokers. navigators and brokers help people sign up for health care

on the exchanges. the next enrollment for beginsing -- purchasing november 15. .his is one hour 40 minutes >> if i could have your attention, let's try to get started. >> 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 state 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 navigators 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. and 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 encourage it, #assistors. 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 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 or health.org and on the kaiser 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 twitterverse 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 for 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 navigators. 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 navigators. they participated only in state-based marketplaces and the main distinguishing factor between the assistors and navigators is how they were funded. assistors were funded through section 1311, established grants in the state marketplaces and in consumer assistance partnership states. certified application counselors were 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 navigators. 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 navigators 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 that 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 cedco, 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 learn 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 were established in the marketplace. they employed 28,000 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 volunteers 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. did i do something wrong? assistance was unevenly distributed across types of marketplaces, not surprisingly

because c.m.s. had limited implementation funds to support navigators 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 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 navigators 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. why 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 post-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 navigators. university of south florida was awarded a grant to provide

navigator services. we covered 64-677 counties. 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 uninsured, 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 plan 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 consumers 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. so we are a national nonprofit 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 navigators. so in new york city, where we were concentrated in the five burroughs there was a lot of one-to-one 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 role to provide that education and outreach. so the most extensive opportunity for the public to hear something positive and to learn something about the marketplace was through earned media.

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 rural territory, 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. it is what is starting to come 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. consumers really appreciate that 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 overcome negative preconception. a lot of individuals that came to us had had 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. this is not 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 enrollment, and, furthermore, they had direct contact and regular contact sometimes daily with the exchange leadership so that they could communicate and get real-time results back. they were 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 talked about is the complexity of choosing a health plan. it is the greatest challenge and navigator faces. all the navigators in all of the 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 regarding 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 hipaa protocol, and we had a very strict policy to make sure we were providing quality services to consumers. and we had some really great successes. similar to my colleague from florida, fast implementation.

while maryland was an early implementer, and we began process in april, but the other states, we had about 10 or 11 to 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. and also, i think it really great success was our community relationships. there were diverse partners that achieved the required diversity, 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 ground and at the same time, the 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

-- four 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. however, we just finished a 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. but in the end, this is also a tremendous opportunity to benefit from last year. as i indicated before, we also

conducted 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 underwriters. 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 marketplace to fortune 100 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 enrolls someone in the exchange plan, his or her identifying number, which we call the national producer number, npn, should be recorded, 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 about plans, and as karen indicated previously, they may not be publicly available. things like witch clans have 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 assistor models also because they have been around for a long time. their goal is also to provide year-round service, so they help you when you're situation is 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 to complete an 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. and they have 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 coverage, 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 point to one, 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 83.9%, 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 created a payment 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 other types of 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 problems with the hotline, and we were looking at him prove minutes for agents and brokers, 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 brokers did have a few problems, a lot of times from identifying

numbers. the good news is that we do feel 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. senator mary landrieu and others 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

formerly called on the them to fix these issues, and many other senators and house members have also caught on to 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 services that the federal level 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 concerns 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 enrollees do have ample time to 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. so those are some challenges that i see, so thank you very much, and we will start with the q&a.

>> thank you very much, and let's start with something that you actually raised. i should say let me remind you that you can tweet a question or voice your options, so i urge you to get involved in the conversation and also encourage our panelists 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 reenrollment, jessica, and we 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 else or renew 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 people 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 assister programs to look at how long it takes to do the id proofing and to establish an account, 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 assisters, 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 clunky, so i think the plan choice is absolutely important. that is the cherry on top. that is what completes the enrollment, but all of this other stuff was what resented a 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 family status 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. my questions are for karan, and 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 plans 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. and the second 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 work there to make it trickier 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 difficult for people to evaluate planned choices, even if they knew a lot about health insurance coming in.

when we asked 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. >> will there be another report before the next open enrollment period? but i worked on reports every day. >> following up on why people did not like the plans 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 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 did not conform as well, 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. and 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 plans having a thousand dollar per person deductible, and golda 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 were not used to insurance and 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 plans from a carrier, and additionally in the states, 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 plans, 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 all their at a glance, so i 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 plans 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. >> with h&r block government 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. what 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 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. i think if we moved to the open enrollment to april, and if everybody always is at the end, we run the risk of building a structural portal, because their 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. you think taxes, and that is all 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 a while to overcome for the average person who has to live their everyday life. >> ok. >> my name 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 questions that i had, do you 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? >> can i ask 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 enrollment, but we are still figuring this out, as well. >> if i could ask before the folks who are at the microphone -- excuse me. we do not want to completely diss 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

assisters, 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 priority and we will train any employees, and we will do some mentoring, partnering, and we will continue to do the quality insurance monitoring during -- monitoring to make sure the folks that there aren't equipped to 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 year, on topics like helping people with their post enrollment questions and problems, tax related issues, immigration 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 differs, and they said they appreciate the training both marketplaces offered throughout the year, webinars, conference calls, to provide updates and to refresh, 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 plans. 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 use health care, and that is really key, very often, to their decision. it is not solely around cost 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 law the extensive continuing education needs, and i think 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 comparison 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 lot more information and 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 jodi or lisa, if there are any plans to

segment marketing or outreach to folks who have been enrolled, who may auto reenroll, versus 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. we do not want folks getting 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 periods, and 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. i had to get consent to be able to follow up with the consumers through enrollment 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 process to make sure, because as 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 our panelists will be as insightful as possible as quickly as possible, and we will try to get through this if it takes us, in world cup 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 enroll america, with the other funded entities who are either sponsoring cac'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 regions, and so one entity was 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 assisters on a 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 scope of the assisters, a

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? >> yes, i 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 guys, the assister programs, 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 helpers and student things, and we were able to get a lot of students into coverage, 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 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." you mean our approaches? >> yes, approaches, enrollment, and taking different approaches over others. >> well, we definitely found that partnering with hospitals was effective. clearly, that is an easy way to identify the uninsured, so our 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 partners, and, you know, we saw 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 with 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 gap, as well as we put together 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 rural 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 weren't as successful? sorry to put you on the spot.

>> um, gee, i'm not sure i can answer that question quickly. i 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 those effective, and which were 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 improving the process and going forward, but we also know that, i think, there are a lot of challenges that lie ahead for this next open enrollment period 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]

and he is mentioned as a presidential candidate in 2016. a newsmakers is today at 10:00 and 6:00 on c-span. >> special primetime programming on the c-span networks. anday on c-span, from glasgow debate on scottish independence. issues of spotlight on iris targeting conservative groups. wednesday night, the principle of hartford connecticut schools on educating children from

disadvantaged backgrounds. thursday, a budget committee hearing on an eye poverty programs. friday night, native american history. on c-span 2, a discussion about school choice. night, writer john hope right. wednesday an interview with the author of a biography about neil armstrong. night, a tour of simon & schuster. former congressman ron paul. , the reconstruction era. on tuesday, the atomic bomb. wednesday night, the follow the berlin wall. ithursday, how world war attitudes change to the war.

nasa documentary on the apollo 11 moon landing. find our television schedule one week in advance at c-span.org. let us know about the programs you're watching. join the c-span the conversation. like us on facebook and follow us on twitter. the white house drug chief and two judges discuss alternatives for treating substance abusers. it two options were discussed. the heritage foundation hosted the discussion. it is one hour and 15 minutes. >> >> thank you to everyone who is watching.

we are pleased to renew this program today. we have some very distinguished panelists. let me say that for some time been bedeviled by three problems, crime, alcohol abuse, and drug abuse. the intersection it magnifies the adverse affects of each one. state and local officials in south dakota and hawaii have found some creative ways to try and address those problems through to very innovative programs. sobriety and hawaii's hope. programsms -- those achieve three olds in the criminal justice system. to reduce incarceration, the

programs place offenders on probation. abuse,ce recidivism and they frequently drug test for inohol or other substances order to determine what he stayed sober and clean. both programs have through very successful in achieving the goals set for themselves. both programs have also proved very cost efficient. they deserve our consideration. they are reasonable and humane to addressys problems in the criminal justice system. we have three experts on these programs here. first, is the honorable larry long. judge long as a native of the mount rushmore state. graduated from south dakota

state university and the university of south dakota law school. a bannock county state attorney and prosecuted hundreds of felony cases. chief deputythe attorney general for south dakota. south elected to the dakota attorney general. he is served as a circuit judge in the second judicial circuit. the 24/7g created sobriety program you will hear about today. it is a zero tolerance program for alcohol abusing offenders that gives them a chance to dry out and walk right without going to prison. been recognized as being effective and efficient and humane. it was awarded and innovations award. the institute for behavioral health awarded the john p mcgovern award in 2009.