>> my name is ed howard, i'm with the alliance for health reform. i want to welcome you on behalf of senator cardin, our board of directors to today's program on the affordable care act -- the aca. we are joined in bringing you this program by the kaiser family foundation, one of america's most trusted voices in health policy. i want to give a special thanks for braving the elements and trouble uncertainties to get here. if you decided that staying home was the better part of your valor and you are watching from c-span, welcome to you too. glad you are safe.

every new congress in recent years, the kaiser foundation and the alliance have sponsored a series of briefings on a number of the most important health policy topics that are at the center of debate in congress. after today's briefing on the affordable care act, we will be conducting three more of these primers next month, not next friday, but the two fridays following that, and on wednesday april 1, on medicaid, medicare and health-care costs respectively. mark your calendars. we will see you back here. as for today's program, one might ask, why there is a need for a primer on outlaws, a few

weeks of being five years old, and has been in the spotlight virtually every day since it was signed into law. well, there are two fairly large reasons, one being this is a fairly complicated law, as some of you have found. with many different provisions and even without congressional action to amend it, many of those provisions have changed since its enactment. secondly, bright people come and go. and sometimes come back here on the hill. even when they stay, their duties shift. all of a sudden instead of the usda, they need to understand something else. we are helping them to understand the new language. we will dig into the affordable

care act, patient protection and the affordable care act to be proper. sketching out the main parts of the law, the ones you need to know about. we will not give arguments, for or against, the law or its provisions in its totality, but we want you to be better informed about what the law actually says. the briefing comes at a timely juncture, we have just concluded the second open enrollment period. and we just heard arguments that could radically reshape the aca. we are pleased to have as a cosponsor, the kaiser family foundation.

co-moderating with me today is diane rowland, the executive vice president of the foundation, and herself one of the leading health experts in the country. diane. >> thank you and welcome to all of you. i want to share with at my appreciation of you braving the weather to be with us today. we weren't sure if the audience would all have to watch via media or be with us today. i noted, and he just said that we would talk about what the law actually says. we will not talk about the supreme court debate over state-based exchanges. those topics will come up much later. what we want to do today is make sure the basic framework of the law is clear and you have an

understanding of where to dig deeper when you want to talk about other issues. with that, let's start. we have a lot to cover in a very short amount of time. all of the speakers have been given a short timeframe to talk of a very complex set of changes that have really revamped much of our health care system. >> terrific. thank you, diane. a little bit of housekeeping if i can. first of all, if you're in the mood to tweet, you can use the #aca101. feel free to make use of it. in your packets, you will find important information, including speaker bios, more detailed than what we will give.

you will also notice, our mc today. charlene frizzera's flight was delayed this morning. since she was scheduled to cover the aca's changes to medicare and ship, we are very lucky that we have another person, one of the world's foremost experts diane rowland. she has graciously agreed to fill in for charlene. there will be a video recording of this briefing available monday or tuesday on the kaiser website. thanks for a much to the foundation taking care of the important aspect of our work a few days later there will be a transcript that you can look at

on the website. those of you watching on cspan you may, if you have access to a computer, go to the website, it has all of the speaker presentations, you can follow along as we go. for those of you in the room you can go back to the materials, the presentations the bios, and biographical sketches as well. those of you in the room can ask our panel of presenters by filling in the card, it can be brought forward, or you can go to the microphone and ask or -- orally. at the end of the briefing there is an evaluation form, we would appreciate if you would fill out so we can continue to respond to your needs. we have a great panel and are very pleased to start with jennifer tolbert. she is the director of state health reform at kaiser family foundation and associate director of the kaiser commission on medicaid and the uninsured. as such, she has been paying close attention to how the states have been implementing the aca. we ask her to layout the major

provisions of the law with emphasis on his coverage provisions. thank you for joining us today. >> it's on. thanks and thanks to you all for coming. it's a pleasure to be here. i'm going to start with just a broad overview of the main coverage provisions of the law and my fellow panelists will dig a little deeper on each of these issues. starting off. one of the main goals of the aca is to expand coverage to the uninsured and to improve the quality of coverage for those with private insurance. it does this by building on the base of our current system which is supported primarily through the employer-sponsored insurance.

it fills in the gaps in the current system. namely, it expands medicaid to cover more low income adults by raising the eligibility threshold. just to know. the federal poverty level is around $11,770. it also creates a new health insurance marketplace, where people can go to shop for and an role in private insurance. through these marketplaces premiums of these are available to people without access to other coverage, who have incomes between 100% and 400% of the poverty level to make that coverage more affordable. all of these expansions are made to work by health insurance market reforms that prohibit insurers from denying people coverage or charging them more because they are sick. it also imposes new requirements on individuals to purchase health insurance with some exceptions, and for large

employers to provide affordable coverage to their employees. turning to the marketplaces, these are online market places where consumers can apply for, shop around, and learn what plans are available to them using standardized information. actually enroll in coverage. as i mentioned, the premium subsidies lower the cost of coverage for many. in addition, cost reductions are available to people with incomes between 100% and 250%. that lowers the out of pocket costs. the envisioned that all states

would establish marketplace, but it created a fallback where the federal government would establish a marketplace in any state that did not set up its own. mexico, and oregon are state-based marketplaces but partnership marketplace where the federal government is ultimately responsible for the marketplace but the state shares in the responsibilities. that leaves 27 states that have default into a fully fund really -- ru federally run marketplace. they have taken on a renewed importance as a result of the new legal challenge to the aca

as ed mentioned. in the king versus burwell pays in the supreme court, plaintiffs are ruling that subsidies can only be provided to states running their own marketplace. i think sabrina will talk a little more in detail about this case and its implications during her presentation. turning to medicaid. again, the idea of the law, when it was enacted was that all states would expand medicaid. however, some court rulings on the law in 2012 effectively made the decision whether to expand

medicaid a state option. currently, 29 states, including the district of columbia, have expanded their medicaid program. now, importantly, states can add dots and expansion at any time. that means big tension -- the expansion is actually under discussion in many states. while most of the 29 states that have adopted the expansion have done so under the traditional state plan amendment process which is standard process for making changes to the medicaid program, there are actually six states that have received section 11 waivers to implement the expansion it go be on the flexibility that was provided in the aca. notably, arkansas is enrolling their medicaid expansion population through qualified health plans in the marketplace. i think that diane will talk a little more about this as well. turning now to the impact of the aca and what we know to date. the aca does provide affordable coverage options for many.

according to analysis of data on the uninsured from 2013, about 55% are estimated to be eligible for either medicaid, chip, or subsidize coverage through the marketplaces. again, over half of those who were uninsured in 2013 would be able to access affordable coverage options as a result of the implementation of the coverage provisions in the aca. however, the decision by 22 states not to expand medicaid has left many poor adults in those states without access to affordable coverage. we estimate that about 3.7 million people in the states that have not expanded medicaid, that have incomes that are too high to qualify for medicaid in their state, based on current eligibility levels, yet they are too poor to qualify for subsidies in the health

insurance marketplaces. as a result, they have remained uninsured. now, we refer to this as the coverage gap. you can see, this is the orange slice on the fly. in addition, undocumented immigrants are not eligible to enroll in medicaid, nor are they eligible for coverage at all through the marketplace. they are left out of of the coverage expansions as well. millions of people have gain coverage through these coverage expansions. as of february 15, 2015, which was the official end date of the second open enrollment. over 11.6 million people have signed up for coverage. this number has increased already because of extensions that were granted to people who were in line as of february 15 and we expected to increase even

further due to announcements by the federal government, and most, if not all, states to grant a special enrollment. to people who found out they are penalty for insurance when filing taxes this year. i should note, over half of people who signed up for coverage during the second open enrollment period were new to the marketplace. about 40% renewed coverage from 2014. growth in medicaid has also been quite strong. there were 10.8 million people who gains medicaid coverage -- gained medicaid coverage from a baseline. in july through september up to 14, before the expansion went into affect.

not surprisingly, enrollment gains were stronger in states that expanded medicaid. growth expanded by 27% in states that expanded medicaid, as compared to 7% in states that did not expand. one of the most important measures of the aca is its impact on the uninsured. while we will not know for a while the complete picture because of lack and available data on the uninsured, and data from the national health interview survey, which provides data through june 2014 indicates that there has been a significant drop in the uninsured rate. while the drop has occurred across the board, the most important drop has been among the poor or near poor, along hispanics and blacks, and in states that have adopted the

medicaid expansion. just very briefly, we are focusing today on the coverage expansions in the aca, but the aca was much much rotter than just its impact on coverage. -- broader it contains a number of provisions that attempt to reform the delivery system and how providers are paid, as well as to expand the capacity of the health care workforce to accommodate the new people who are getting coverage. one of the things that the aca did was to create the innovation center at the centers for medicare and medicaid services and this office is charged with testing new delivery system models, such as accountable care organizations, providing coordinate care to individuals

with high medical needs, as well as weighing providers based on quality, as opposed to volume of services. and testing innovative payment methods, such as a bundle payment for services, including hospitalization. again, on the capacity side, it does a lot to increase payments to primary care providers, as well as community health centers, to increase the capacity, and it makes investments in training of new health care providers. again, to grow the health care workforce, particularly among primary care providers. so, with that, i will turn it over to sabrina. >> thanks very much, jen. sabrina, in this case, being sabrina corlette from the center on health insurance reforms, and in her spare time, an adjunct at georgetown university's health policy institute.

emphasizing protective for consumers. we have asked her to share with us her observations on requirements that jen mentioned that individuals have coverage and subsidies to make it more affordable. sabrina. >> thank you. as ed mentioned, i will talk about the three pillars of -- three essential legs. the responsibility requirement or mandate. and the financial assistance available for people to buy the private coverage and make it more affordable. first, the insurance market reforms.

generally, when you look at polling on these reforms, as taken individually, they tend to be very popular and very popular across the political spectrum. they were implemented in two primary phases, the first phase was implemented just a few months after the law was enacted in 2010. it included as we but reforms that include -- a suite of reforms that include allowing young adult up to age 26 to stay on their parents policies. a ban on lifetime and annual dollar limits on coverage. and appeal rights for people whose health plan has made the wrong claim.

january 1, 2014, was when we saw the heavy lifting take place. significant insurance reforms that really ended the widespread practice of risk selection. in other words, trying to keep away the people of high risk. in other words, that had health problems or issues, and only keep healthy people on. first and fourth most -- for most health insurers are not able to denied based on status. that is called the guaranteed issue provision. they are also not allowed to impose any more pre-existing condition exclusions on your policy. this was fairly common practice before the affordable care act. you would sign up for a policy and the company would say, we will cover you, but we see you have asthma, so we will not cover anything related toa a respiratory condition. those kinds of exclusions are no longer permitted.

the provision also requires companies to issue a package of essential health benefits. there are 10 categories including hospitalization, doctors visits, lab tests, drugs, maternity care, and is designed to be modeled on your typical employer-based plan, and the idea is that everyone can have a basic standard of health benefits. insurers are also not able to charge more based on health status or gender. they have to cap out-of-pocket costs over the course of one year . about 6000 $700 is the maximum out-of-pocket cost that someone can pay. they are also required to pay coverage levels that are commonly called the precious metal tiers -- bronze, silver, and platinum. bronze being the least generous and platinum being the most generous at 90% of cost.

but, of course to get these insurance reforms and ensure that we have a sustainable market with affordable premiums, the law included this individual mandate. the second leg of the stool. you have to maintain coverage, or pay a penalty or tax. for 2014, the penalty was the greater of $95 or 1% of your household income minus the tax filing threshold. h&r block came out with an analyst saying that on average the penalty is $75. -- $175 because the law says the greater

of $95 or 1%, in fact, most people's greater of is that 1%. people can get exemptions from the mandate. you can get an exemption if there is no coverage that is affordable to you. affordable is defined as a percent of your income. if you are not a citizen, and therefore not eligible for subsidies. and if you fall into coverage gap. if you are going to require people to maintain coverage, you have to have a place for people to buy it and a place for them to get it at an affordable price. jen already talked a little bit about the exchanges or the market place, so i will not go into great detail. the marketplace is designed as a way to have or managed competition so they can compete on price and quality, and people can really see very clearly the

differences between plans on dimensions like benefits and costs. the marketplaces are the only place these and get the financial assistance that the government provides. first therefore most is the premium tax credits and these are sliding scale subsidies based on your income between 100% and 400% of poverty. the slide shows how they are somewhat progressive and how they allocate. subsidies are paid to the second lowest cost silver plan available in your area. you can take your tax credit either by, or by, pay a little more, or by down to perhaps of bronze level plan. and garner more savings. however, if you choose to do that, you need to be careful

because for people between 100% and 250% of the federal poverty level, they are eligible for something called the car sharing reductions or subsidies. -- cost-sharing however, you only get to take advantage of those if you sign up for a silver level plan. if you buy down to the bronze plan, you lose the advantage of these subsidies. i think that we is they boost up the value of the silver plan by lowering the deductible and cost sharing so you have to pay less out-of-pocket during the year than you otherwise would. the federal government reimburses ensures for the cost of those subsidies. unlike the tax credit, which if you missestimate your income when you sign up for coverage, you have to pay back any extra tax credit that you receive, the cost-sharing subsidies do not have to be reconciled at text time -- tax time.

you do not pay those back. lastly, i would just say a couple of words about king versus burwell, which is on everyone's mind this week as the supreme court heard oral arguments. in case you have not been following the litigation so closely, the crux of the issue is that there is a statute that says the federal government can provide financial help to people who buy coverage established by the state. the king plaintiffs are arguing that because 34 states have exchanges run by the federal government that the tax subsidies provided through those

exchanges are illegal. it is important to note that almost 90% of people that have purchased insurance through the exchanges armor s are receiving subsidies. if the king plaintiffs prevail and subsidies through the federal exchanges are deemed to be illegal, you have vast majority of people buying policies through these exchanges, they will no longer be getting subsidies. according to one study, these individuals will face on average a 255% premium increase. the government, of course, in its argument to the court is saying that if you look at the full text and context of the statue, it's pretty clear that congress intended for all eligible individuals to receive the subsidies, no matter who is operating the exchange. that affects the way the statue is structured.

if you're eligible for subsidies because of your income, it does not matter who runs the exchange. the bottom line here is that if the plaintiffs prevail, it knocks out the third leg of ours stool, making financial assistance not available in 34 states. importantly, it significantly weakens that second leg of our stool, the individual mandate. that is because most people who are currently getting subsidies, once those are taken away, coverage will be unaffordable for them and they will qualify for an exemption from the individual responsibility requirement. if the plaintiff prevail, we lose two legs of the stool. with that, i will turn it over to paul, i think. >> thank you very much, sabrina.

paul fronstin is in fact our next speaker. he is a researcher at the employee benefit research institute. he is here to remind us that most working age americans get coverage through their jobs. the aca effects that coverage too. >> you have already seen two basic presentations and mine will be -- i will talk about the basics of employment base health benefits and how it is affected by aca. i was at someone else's presentation on wednesday and i sat through their presentation which was two hours long. there's just so much to cover on this which we do not have the time to do it justice, any of us. there are some extra slides in the packet for you to see during

your own time. one of the things to keep in mind is the environment before the aca passed and that is the percentage -- as jennifer showed on her first slide, and employment-based coverage is growing on. before it passed, that was falling. by 2010, it was down to 69%. when you look at where workers get their coverage from, we're at the point now where only 50% of workers get coverage through their own job. i don't know if that some psychological level that we made a breakthrough, and what it means if we do, but i think it is important to point out. what's happening now with the labor market now employment being at 5.5%, you should not be surprised if you see this downward trend reversed itself in the near future. the other thing to keep in mind is what's happening with benefits being offered.

what workers were seeing when they were offered health benefits. you saw increasing deductibles increasing copayments, increased use of 4-tiers. there were some exceptions of this cost shift onto workers whether it was on wellness programs, what medicine, lots of changes going on with benefits offered to workers. some of this was already covered. the next slide goes through a timeline of all the different things that affect employment based coverage. you have the slide so i will not go through them individually. you see 2010 was the year -- a big year. 2014 was a big year.

now through 2018, you have the tax on high-cost plans, also known as the cadillac tax, which we will talk about more and a few moments. just a couple of items to go over. one, the employee shared responsibility provision, i'm assuming you are all familiar with this, either the employer offers coverage or they offered $2000 per full-time employee penalty. that's the piece to really focus in on. an employee that does not offer coverage does not have to pay a penalty if none of the employees receive a tax credit. that has implications for the supreme court case as well which

we will talk about in a minute. currently, employers must offer coverage to at least 70% of their full-time employees. in 2006, that goes up to 95%. employeesrs with 49 employees are fewer are excluded. only employees with 40 plus hours are included in the assessment. in cases of employees of businesses with -- there is a provision to look under whether or not businesses are under common control and if businesses would be subject to the penalty. this was moved to this year for employers with 100 or more full-time employees and next year, it takes effect for employers with 59 to 99 full-time employees.

keep in mind the environment before the aca past. in 2009, when you look at employers affected by this mandate, those with 90 to 99 workers, 95% of them were already offering coverage. in some ways, this provision isn't necessarily a mandate to offer coverage, but a mandate to give an incentive for employers to continue offering coverage if they already were. it also affect employers in that not all of them offer coverage to all of their employees, or their dependents, and then you have all the other provisions, such as the requirement to offer affordable coverage. that took effect as well. and those are some of the qualifications here. for example, the definition of a full-time worker change.

it is now effectively 30 hours or more per week. employers must offer coverage to not only employees, but also dependents. dependents include children up to the age of 26. dependents do not include spouses. they must also offer affordable coverage. one of the things to keep in mind is this family glitch. basically, affordability is determined by the premium for employee only coverage. it is not determined by the family premium. so, an employee may not able to afford the family premium, despite the fact that the employers are providing an affordable package. when the employer offers coverage to the family that is not affordable to the employee spouse and children are not

necessarily eligible for a tax credit in the market. they may be exempt. they may be eligible for medicaid or chip as well. it has been estimated that between two and 4 million sauces and children may be affected. -- spouses there is a $3000 penalty that takes effect when the employer does offer coverage by at least one employee off out because coverage is either not minimum value or not affordable, and goes to the exchange and get subsidized coverage. if no one opts out, there's no assessment. when it comes to king versus burwell, if the supreme court rules that subsidies are not allowed in federal exchanges that affects employers. employers only have to pay the assessment when an employee gets a tax credit.

if it is deemed that that employee in these 34 states cannot get a tax credit, then essentially be an employer does not have to offer coverage because there is no penalty because their employees cannot go out and get a tax credit. there are all kinds of other issues that,, especially for employers, the operating across state lines and what this may mean for them. there's the small business health program, the shop exchanges. one of the advantages of this is that it increases choice of carriers and plan options for both employers and workers. it allows employers to set a fixed or defined contribution. it was delayed until this year. in 2016, it will cover businesses with up to 200 employees.

in 2017, states may allow employers with 100 or more employees into the shop exchange, but that is at the states' discretion. there are tax credits available to small businesses. if a business has less than 25 employees and an average wage under $50,000, those tax credits can cover up to 50% of the employer's contribution. if the employer contributes at least at least 50% of the premium, credits are available. there are wellness programs in the aca. and allows employers to provide financial incentives, as much as 30% of the total cost of average when tied to participation in a wellness program. hippa allowed for 50% of interventions designed to

prevent or reduce tobacco use. financial incentives can come in the form of premium discounts, cost-sharing reductions or other benefits. finally, the cadillac tax takes place in 2018. it is a 40% excise tax on the cost that exceeds these levels. there are higher threshold for plans that cover, adjustments for age and gender, and the mix of workers -- well, we have not seen exactly how that will take affect, as far as calculating the tax, it takes an account reimbursements, as well as employer contributions.

note, released last week, there was information from the irs saying that if the worker contributes to the reduction that is largely considered an employer contribution for tax purposes. as a result, that would be counted towards the threshold. there's all kinds of questions that still have not been answered yet because we have not seen regulations on this. the effective date is 2018. >> when talking about the threshold for applying the cadillac tax, if they exceed 10,200, how does that compare to the cost of individual policies through the employer at this point? >> at this point, i think the average from the kaiser survey

is 6600. if i'm not mistaken. obviously there are people up here who could correct me. 15,000 or so for family coverage. certainly there are some plans that are going to trigger it. it's not as straightforward as looking at the premiums. if you're counting if it is a contribution, that will boost up how many plans may be above that threshold. i think the issue is that premiums have been increasing faster than inflation, though the gap has shrunken recently. the cadillac tax is indexed to overall inflation. after the first year. the expectation is while there may not be any plans affected by the tax initially, over time more and more plans will be affected if they do not make changes to avoid it. >> paul is exactly right. diane's organization is a cosponsor of the definitive

survey of employer-based coverage. the kaiser survey. a renaissance woman, diane is stepping in to pick up the thread of questions about medicaid and chip. i should say, we do not have her slides in the packet. we will have them on our website after the briefing. diane, thanks very much for being so flexible today. >> you do not have the slides because they were done at 10:00 a.m. this morning. [laughter] medicaid clearly, as jim's overview noted, is the key building block within the affordable care act. one of the program is that if then around for 50 years. it has a lot of other changes that were embodied in the affordable care act. today, i will just go over some very high level changes.

i urge you to come back for the medicaid 101 to go into greater depth. clearly one of the main things it was doing was extending coverage to young adults. it was also seeking to water it was also seeking to water nice the way that eligibility happens. to streamline the way determination was made, and the way income was counted. it also provided substantial federal funds to the state to help them put in place the expanded coverage. as well as supported a wide range of changes in the delivery system, not just in care, but long-term services. the key piece that the affordable care act was seeking to do was fill in the gaps of eligibility that had occurred for medicaid, especially for adults. one of those key provisions was

that medicaid was never available for adults without dependent children, unless they qualified on the basis of disability. the affordable care act change the way medicaid eligibility would be set to be based solely on income and not the characteristics of the individuals. and it was going to try and put in place a uniform standard across all states to eliminate some of the variations and who was eligible on the basis of income to 138% of the poverty level, or around $11,000 for an individual. that was because of the tremendous variation that occurred and who was eligible for the program by income, as well as category. here, you see the medicaid program together with chip. it provides very broad coverage for children across the nation

virtually all states cover children at at least 200% of the federal poverty level, as well as pregnant women. there was a great disparity in the income eligibility. the affordable care act sought to fill that, but the supreme court, not in the king versus burwell case, but in its previous case, decided it was course of on the states to require them to expand coverage, even in the early years. there was a full federal dissipation, and it gave states the option to not provide coverage to the expanded adult situation so that would have been some of the working parents

above the old eligibility level, as well as the childless adults. this creates a coverage gap between medicaid eligibility standards and eligibility in the marketplace. as one of the glitches that occurred when the supreme court intervenes and did not change other aspects. individuals under the federal poverty level would all be covered, so they were therefore left in a eligible for gaining access to coverage in the marketplace subsidies that have been talked about earlier. anyone below the federal poverty level, who was not already eligible for medicaid by the old standards, was left without coverage. those between 100% and 138% of the federal poverty level could gain coverage in the

marketplaces in the states. what you see is that in the states that expanded medicaid, there is a very nice flow -- childless adults get coverage through medicaid and then they face into getting coverage from the marketplace if their income goes up. parents are covered equally. children have higher coverage. in the states that did not expand, those who are childless adults below the federal poverty level have no coverage option. those who are parents can be covered if they meet their states very stringent, early income eligibility levels. sometimes it is 70%, 25% of poverty. many states they did not a fan had the lowest coverage levels.

if they were a childless adult they were in eligible. then, they fall into the coverage gap, and once they earn enough to be over 138% of poverty, then they can go into the exchange, or between 100% and 138% they can gain exchange coverage. children, again, because of coverage with chip and medicaid, remain covered at much higher income levels. nationwide, as a result of the trade to states that not expanded coverage, we see about 3.7 million low income adults fall into this coverage gap where they are too poor to go

into exchanges. many of them fall into the southern states. you see in states that have the highest uninsured rates, some of the highest poverty rates. they are the most limited coverage for the poor. now, an addition to the coverage, which has gotten all of the attention in terms of medicaid's choices, every state did have to modernize and improve its application and enrollment process, and try to coordinate that with the federal or state-based exchanges. you see, i great deal of effort put into replacing paper

applications, in person applications, places where there was no data exchange about eligibility to try and have this vision of no wrong door, anyone can go and apply. simplify the way in which they get through, try and really get the doors open so the emerald and processes more available. as a result, even in some of the states that did not expand medicaid coverage, the process has become more consumer friendly for people already eligible. we have seen increases in coverage in those states of the people who were previously

eligible, but not enrolled largely due to many of these improvements in the way the process works up front. second, most of the states have been seeing -- that have expanded coverage, have seen real benefits to the population. reduction in the number of uninsured. these have been particularly important among the low income population and expansion states have seen greater reductions in the uninsured, then obviously occurred in non-expense and -- non-expansion states. increase state savings in the expansion states, as they began to provide less uncompensated care, move some of the other services that had been provided to the indigent population to medicaid coverage, and increase stay economic activity. in addition to trying to really focus on getting the coverage right, and making the process seamless to gain the coverage that they need, the aca also thought to improve what happened after you get coverage to improve access to primary care

services, to improve the way the health system works for the low income ovulation, and to try and develop other ways to provide services, especially to the population in need of home and community-based services as an alternative to long-term care and nursing home facilities. a two-year booth has unfortunately expired, though some states have kept them in place. it had invested heavily in expanding community health centers so there would be facilities to take care of the new lely insured population. and they try to develop, within medicaid and medicare and the private sector, more patient center is an accountable care models being tested in many areas. and you options for the elderly and disabled population to be able to control more of their home and community-based services and options for care.

we are really seeing at the end of the day, both a coverage expansion and medicaid, but a real reform of the ministry of structure, especially for determining eligibility and determining how to get people connected to manage care plans and other health system reforms. so, medicaid may be 50 years old, but it is entering the next 50 years because of the aca as a much more modern and change program that is much more responsive to some of the ongoing changes in our overall health care system. outstanding question is what will happen to states that are still on the offense of providing expansion or not. many are seeking exchanges or waivers to come in with a different tilt to the affordable care act provisions so they can provide coverage to their citizens. the story is still out on where we will finally end up. i would only remind us that medicaid is health was phased in over many years. not everyone took up the arson when it was first passed in 1965. >> thank you, very much diane.

one quick question for you too if i can. you mention the standardizing that the aca brought. what happened to the asset tests that were in place for medicaid recipients from the time that the law was enacted? >> as the children's asset tests were expanded, -- medicaid covers a substantial number of individuals who are elderly and have disabilities who qualify some through the supplemental security program, and others through their provisions in the medicare program that still require the

tests. >> i should also say, if i am over my time, i will say it anyway, the other provision that is one clearly coming to congress in any affordable care act was the children's program that has actually boost the coverage of children and the income eligibility levels for children. that was funded through the affordable health care act for the end of 2015, which is fast approaching. the requirements that states operate those programs and continue the eligibility were

intended to go through 2019, but congress is going to have to make a decision fairly soon, very soon actually about whether to extend the funding beyond 2015. as they extended, are they going to extend it is a straight up program the way it is currently structured or will they make other changes to it. we at the mac pack commission have recommended a two-year extension of the program just as it is, and has -- have also said that is important over the next few months, and in the next two years, if that is the length of the extension, to figure out how to integrate coverage for children into either the exchanges and to the medicaid program, or whether to continue the program as it is can -- currently structured as a middle ground program. >> thank you very much. as you can and for from that response medicaid itself is one

of the most complicated programs that we have going. let me reiterate, diana suggested that you plan to be here on the 20th of march for the specific primer on medicaid. if you have questions that you would like to have addressed by one of our panelists, you should either go to one of the microphones, or take out that green question card, write it down, hold it up, and we will bring it down for you. let me just take advantage of how long it takes you to position, spoke too soon. we ask everyone at the microphones to identify themselves and to keep their questions as brief as possible so we can get to as many questions as possible. >> tony hauser, formally with cmf, last few years volunteer the affordable care act.

one of the things i have seen over the past year or so is budget and policy priorities that have made it more clear for me. both consumers and advocates have comparisons to make in both deductibles, different co-pays there are quite a few different. i was overwhelmed by how many things they have to compare. i have seen one tool simplify that. i am wondering what solutions the panel has for that kind of dilemma that is confronting consumers who are signing up for the affordable care act. >> we will turn to sabrina. how many in the audience know what a navigator is? good number, but nowhere near a majority.

you might remedy that. >> sure, the affordable care act requires exchanges to establish a navigator program. navigators are responsible for conducting outreach and education activities to let people know what is available to them, and know what their rights and obligations are under the law. they also helped enroll people. they help figure out what they are eligible for, and what the gentleman indicated, it sounds like he is been serving as one help them figure out what is available to them, and what is their, and optimal plan choice. although the law does include some new standardization for health plans, and other words they have to cover the essential health benefits, there are still some and norma's amounts of flexibility for the carriers

particularly around cost-sharing, but also services. as a result, it can be overwhelming for consumers to figure out what is right for them. . the consumer checkbook has helped develop tools help people figure out their choices. we are hopeful, in addition to illinois more will employ those tools. other states are looking at greater standardization of help -- health plan options. narrowing even further, the kind of flexibility the insurers have, for example buried copayments or deductibles for specific services. that may be something to look to

the future. some states did it in the first year and the second year, but are looking to do it going forward now that we are past some of the hurdles. >> thank you. >> high, i'm dr. coplin, mi primary care physician among other things. one follow-up to his question, has there been any studies looking at whether the carriers are deliberately structuring their choices in such a way as to attract healthy people, and push deliberately away six, costly people since they are getting the same premiums for the healthy as the sick. my question was about employee sponsored insurance, and the requirements of the aca, how does the benefit package compare

because they have to cover the same benefits, or is it, can make employer get away with a much compare because they have stingier, less useful package. >> good question. >> i can cover the benefit design issues, and then turn it over to paul. one of the shortcomings as having 10 minutes to present three and i did not get a chance to cover all of the provisions of the affordable care act. one of them is a provision that prohibits insurers from using benefit design to discriminate against high-risk individuals. that said, there is not a lot of clarity about what that discrimination looks like, and there has been early evidence that some insurers have been doing what you suggested, which is trying to design benefits to discourage people from ensuring. some insurers were recently sued because they put all of the aids

drugs and the highest cost formulary tier, even the generic ones. it is really incumbent on the federal and state regulators to put out clearer guidelines about what benefit design is and then actually provide the oversight to prevent land -- plans from doing that. then i will turn it over to paul for the other question. >> yes, i think your question is about the essential health benefits and whether it applies to other plans -- >> and one other thing out-of-pocket costs. >> ok, we will get to that. it depends on the employer. for employers purchasing insurance through the exchange by definition may have to comply it depends on the employer. with the essential health benefits. for those outside, they have to comply with a. for large self-insured employers, they still have to provide minimum while you --

value coverage. they have to cover 65% of something and there are guidelines which basically make sure they do not not provide hospital coverage, which i think was the big issue. if you look at what they were already providing, they were for the most part in compliance. i am not sure that that was a concern that needed to be addressed. as far as out-of-pocket, they have to comply with the same out-of-pocket as all the other plans do. >> the exchange plans? >> i believe so. or maybe it was the lifetime limits were removed and the annual limits as well. >> can i ask also -- it seems to me we have heard a lot about what people call the three r's. is there and after the fact adjustment if you end up with a risk pool that you have sicker

or un sicker -- unsicker than average? >> i do not want to hog all the time, but yes. that is a point. the health law provides a risk adjustment, a risk corridor, and reinsurance program, and all our three risk mitigation programs to help insurers take on more risk than they anticipated in the first years. the risk adjustment is a permanent programs, so if you get sicker people than a competitor, it is a rob peter to pay paul program. and the hope is it will encourage insurers to take on secure people, chronically ill people, but if they can manage their care really well and keep them out of the hospital, they actually end up winning under a risk adjustment system.

but that has not gone into full effect yet. and there's a lot of questions about how it will work. >> yes, ma'am. >> hello, i am a senior scholar at academy health. and i have a question about the funding schemes that were -- funding streams that were available before the aca, the 334 federally qualifying health planners and disproportionate share payments to hospitals. i believe that those were reduced or cut off because the presumption was everyone would be covered. i am wondering what the status was and what is happening in the state, and what might still be happening for these uninsured? >> currently, the schedules have not gone into place in the administration is charged with

trying to develop a formula for how they would be reduced over time. clearly, those provisions were put into the law with the expectation that all states would be expanding the medicaid program, and now that it remains a safe choice, it throws that kind of provision a little bit down the road to be fixed or look at -- looked at. the availabilities of community kind of provision a little bit health services and health centers, the 330 program, was substantially expanded by the affordable care act, and that is irrespective of which states have expanded or not. there has been a real infusion of assistance into many areas where the low income population live. >> and, diane, you have dominion over the numerous cards that have been sent forward.

>> so, sabrina, one of the first questions i would like you to explain in depth is the difference between cost-sharing subsidies and premium tax credit. just to clarify how those work together and what they are? >> sure, i will give it my best shot. the premium tax credits are designed to make your premiums more affordable. those are the upfront monthly payments you pay for your health plan. they're available for people at 100 and 400 percent of the federal poverty level on a sliding scale basis. basically you get your tax credit. you can get it on an advanced basis or you can wait until the end of the year and collected at that point. most people will get it on an advanced basis, with essentially reduces the amount of their monthly premium payment. the cost-sharing reductions or subsidies, often you will see

csr's, are available to people between 100% and 250% of the federal poverty level, and they are only available if you enroll in a civil lever -- silver level plan. these are designed to increase the value of that silver level plan by reducing deductibles and copayments. and again, with the tax credit they are provided on a sliding scale basis. it is 100%, 150% of poverty when you sign up for that silver level plan. it boosts the value of that silver level plan to, i think, 97% -- 94% actuarial value. that is really covering most of your copayments and deductibles, between 150% and 250% of poverty

poverty, it covers to 80%. so, again, making it a little bit more than a gold level plan and then between 200% and 250% it is slightly increasing the level of that plan to, i think 73 percent. thank you for keeping me honest. 73% actuarial value. it is actually -- you're eligible for the premium tax credits. your premium payments are reduced. when you enter into service, going to the doctor or the hospital, you're also paying less of your out of pocket costs . if that covers in-depth. >> jen, maybe you can comment, since this will be occurring in april, on the reconciliation process? >> yes, another key difference between the premium tax credits and the cost-sharing reductions are the premium tax credits have to be reconciled because they are a tax credit.

people who accept advance payment of those premium tax credits, they are based on what people project their income to be for the coming year. people who sign up in january project their income for 2015, what they thought they would make, and then come tax time in 2016, the amount of the premium tax credit they received gets reconciled against what they actually made over the course of the year. so, if they made more than they projected, they may oh some of that tax credit back, and they would pay it in the form of additional tax when they file their taxes. if they in fact made less income than they anticipated, than they would get an additional refund on their taxes. and so, importantly, the cost-sharing reductions do not are not required to be reconciled in the same way as the premium tax credit.

>> to follow up on discriminatory health packages -- to your knowledge, is there any data on the prevalence of those packages, particularly with drugs, and are there any lawsuits in either the states or the providers to prevent these discriminatory packages? health resources. >> thank you. >> to my knowledge there is no data on how widespread the potentially discriminatory benefit design is. hhs, i think, and has tried to put out some guidance for insurance companies about what they would think would be

discriminatory benefit design, but it is still pretty vague. to date, what has happened is you have individual organizations looking at these health plan benefits designs. and those can be pretty tough to get a hold of if you are not enrolled in the planned. so, we are aware of some lawsuits at hhs. -- at hhs, alleging the benefit designs are discriminatory. i believe some of those lawsuits have been settled, but my personal opinion is ideally, you would have the feds or the states giving clearer guideposts for insurance companies to prevent the practice in the first place, as opposed to waiting for it to be litigated. >> this has been a particular issue in the state of florida and there has been some on depth

-- in-depth look there at plan availability and some of the researchers at kaiser family foundation are looking at case studies that look particularly -- in-depth look there at plan at the drug benefit offerings for different plans inside different states to see of there are any patterns there that might be discriminatory. >> al millican, a.m. media -- depending on how the supreme court decides, how many people would you estimate are going to be affected by the decision? i was curious that all of you have -- if all of you would have similar opinions about that? >> when we look at the states in the federally run marketplace there are 7.5 million people receiving subsidies in the state .

so, the subsidies for those people would immediately go away. many of those people would then know longer be able to afford that coverage. the expectation is they would so, the subsidies for those immediately drop the coverage. but the implications go beyond that, because, as sabrina pointed out, when you take away the legs of the stool, the requirements that insurance guarantee, issue, and restrict rates based on health status remain in place. so, what you're likely to have happen in the state is what is referred to as a death spiral in the individual market. in other words, many of those people, young and healthy adults leaving the market, the people who are going to stay and do what they can to afford coverage are those who need it the most those who are sick or. so what you will see an insurer's doing to the extent

that they can is increasing premiums and possibly eventually without any changes made to the law, everyone are most people would be priced out of that market. it affects not only people receiving subsidies, but everyone purchasing coverage in the marketplaces in the states. >> and from the low income perspective, in those states that elected not to expand medicaid coverage, many of the individuals between 200% to 38% of poverty have gone into the marketplace and most of those are federal marketplaces. we estimate 2 million people who would be covered by medicaid if the states had expanded are benefiting by being eligible for coverage in the marketplace and most of them would lose that coverage as well.

>> and one other aspect, jen -- i'm thinking if you are in insurance executive in your trying to figure out what to do for rates you are going to file in 2016, you are facing a strange timetable, are you not? >> yes -- >> oh, i am sorry. >> yes, that is one of the difficulties. you have to file for 2016 five may 15 of this year. that will be before the supreme court hands down its decision. the rates have to be filed like current law, so the insurance companies cannot build into the rates the favor of the plaintiff. there is real concern they could be locked into a rate that does not represent the risk status of their pool for all of 2016 which i can tell you is making a lot of these executives

extremely nervous. >> one of the questions from the floor would be what is a possible plan b if the plaintiff prevails in king versus burwell, and "be realistic." [laughter] one plan would be for congress to clear the ambiguity and say that subsidies are available in the exchange, whether federally facilitated or state faced, but i will let my fellow panelists come up with a different plan b if they have one. [laughter] >> there is no good plan b. the problem is -- i am not a budget expert, but i understand it -- cbo will almost immediately readjust the baseline. if congress goes back to fix the language, that costs money in the budget, right? so, not only do you have a congress that is probably not inclined to make a quick fix you also have the budget problem, right? it is also not easy for states

at this point to on a dime establish a state-based exchange. there are significant costs involved. the cost to have state authority , which means getting it through your legislature, or even those that could potentially do it through executive order, there are questions about how you could raise the revenue, rate the exchange area there were a lot of unanswered questions. i do not see an easy or simple plan b at this stage. >> hello. my name is daniel. i wanted to ask a little bit about -- have you all studied what the aca does in terms of cost savings and specifically you had numbers about how states have seen savings as a result of medicaid and these insurance plans, but how much is really from savings as opposed to the government giving them money and the states claiming that as savings, in that they are not

spending the money and it is more the federal government spending the money? >> actually, some of the state income from programs that they have been operating for the indigent population, once that population gets insurance company -- coverage, they do not need to continue to operate that program. so, they are able to go to a hospital and have their care paid for through the program instead of the state having to come in and provide uncompensated care. some of the community health centers have been able to stretch grants that they get to operate care for the uninsured to now have more people with insurance to provide additional revenues for the health centers. we need to remember there are still going to be uninsured populations because of the fact

that many were excluded -- the immigration issues excluded some from coverage. there are others who will not have signed up for coverage, who need to continue to rely on some uncompensated care. but states have seen improved revenues from the fact that it generates economic activity in the state, and that gives the states better revenues, which helps offset some of the budgetary costs. >> thank you. >> hello. this is for jen told burke. thank you for presenting so much. i am curious whether you have any estimation what percentage of rural residents were enrolled in 2015 plans? >> yes, so, i have not actually looked at this, but -- in depth,

42015, but there is data available from hhs by zip code and when we did do analysis of 2014 enrollment, enrollment in rural areas did lead behind enrollment in urban areas. i think there are a number of reasons for that. a lot of people signing up for coverage, especially for the first time, needed the help of the sisters, and the sisters are easier to access and the urban areas. i think there were efforts in place during the second open enrollment period. it is possible that when we analyze the data we will see an increase in rural areas, but i think it is an area where we need to focus attention. not only are the coverage error

-- coverage rates lower, but it is a problem in rural areas. >> thank you. >> we have only about five minutes left, so i would ask while you are waiting -- listening to the last couple of questions, if you would pull out the blue evaluation form and start filling that out, that would be very helpful. >> this is a question for paul -- if the government wants to encourage enrollment, why would it include the cadillac tax under aca? what is the harm of employers providing coverage exceeding $10,200 per employee or 27,500 for a family? >> that is a good question. employers have benefited from preferential tax and if it, in the sense that the amount

employers pay is not included in worker income and the amount that workers pay reduces their taxable income. the concern is that because one dollar of health insurance is not subject to taxes and one dollar of wages is, workers prefer health insurance over wages to some degree or increases in compensation in the form of more generous health insurance, and we know that more generous help insurance -- health insurance results in more use of health care services. some may be good for people to be getting, and in some cases people may be over in short to some degree. there has been interest as far back as the reagan administration in changing the way health benefits in the workplace is taxed. and this is one way from the top

down it addresses these plans, although not always, but often associated with generous benefits. you rate -- you may remember summer 2009, the poster child was goldman sachs where they were spending $30,000 per executive for their health benefits. it is a crude way of going about it. there's some issues with it. there are some things we have not seen in how it will be addressed, but the intent is to reduce these very, very generous benefits or at least find the source of revenue to pay for all of their provisions in the bill by taxing these benefits. >> the last question here is really about the value of having health insurance coverage and asks if we can speak to the cost-benefit or cost avoidance

by more people having coverage and eliminating cost by preventing conditions for becoming worse or preventing people from getting care in low-income environments. and i think this speaks to the spirit of the -- the purpose of the health care act. people often will delay care postpone care, and up in many cases sicker, and when they arrived for care, they are often more expensive because of delayed care. we know that there are real consequences in cases like the early detection of cancer, can make all of the difference between being alive and being prematurely put to death by the effect that your condition was not treated when it was responsive to treatment. so, that said, with those issues came the need to move more people into the state of having

health insurance coverage and especially with the big focus on the affordable care act on early access to primary care and to preventative services and preventative services being available without cost-sharing -- and there were also -- and we will get into that -- i know in the medicaid section, the mayor -- the medicare section, and the cost section, all of the efforts to restructure the way the delivery system works, to change the way the payment policies were, to try to prevent -- provide for more incentive to use the system in less costly settings, but also to pay and reward care, performance for value. that an advertisement for the fact that the next >> perfect segue. it gives me the chance to say thank you to first of all you

for providing a rich background of questions to eliminate number of positions -- illuminate a number of positions and provisions in this law and for showing up. thanks for the kaiser family foundation for not only cosponsoring but also contributing so richly to the discussion. i'd like to ask you to join me in thanking the panel for giving us so much progress on this. [applause] don't forget the evaluations and is diane said, see you in a few weeks to talk specifically about medicaid. thank you. [indistinct noises]

members in the house are on a break this week. today's senators will meet.pm to talk about president obama -- will meet at 5:00 p.m. at 5:30, senators will vote on the intellectual property enforcement coordinator. other actions awaiting the senate are bills to prevent trafficking. >> the political landscape has

changed with the 114th congress. not only are there 43 new republicans, 50 new democrats in the house and 12 new republicans and democrats in the senate there are 108 women in congress. keep track of the members of congress. the congressional chronicle page has lots of information including voting results and statistics of each session of congress. new congress. best access. >> each year at c-span, we talked to you about our studentcams documentary competition. the goal is to challenge middle and high school students to think about issues that affect them and their community. the theme for student cam this 2015 year was the three branches and you. we asked students to tell us a story that demonstrated how a policy, law, or action has affected them or their community.

and in addition to telling it through video, we asked them to use c-span programming in their video and explore alternative points of view. before we meet one of the grand prize winners and watch a portion of their grand prize video, here's a little bit more background on the competition. there were five top themes among entries we received this year. they were education, health, the economy, equality and immigration. we received more than 2,200 entries from 45 states and the district of columbia. students were able to enter as a team of up to three or individually. and there were four categories in which they could enter, broken down by regions at the high school level, high school eastern states, high school central states and high school western states. middle schoolers competed separately. in the end, 150 student prizes were awarded totaling $100,000. now it's time to announce the

grand prize winner a team of , eighth graders from lexington, kentucky, were named the grand prize winners in 2015 for their video on the minimum wage titled "the artificial wage." their cable provider is time warner cable. here's a small clip from the winning piece by anna, katie and michael. ♪ >> sydney jones is a single mother with a 4-year-old child. she has to make tough choices every week since she has to make ends meet on a minimum wage job. $7.25 an hour. she said $15,080 a year isn't enough for her to get by. >> it is hard because sometimes i have to decide like, if my son needs underwear, i'm going to have to be late on the bill -- on a bill to buy underwear or i'm going to have to ask people to borrow money. so it is hard, sometimes. >> sydney is not alone. according to the bureau of labor statistics, 3.3 million americans make minimum wage or

below. that's 2.6% of all u.s. workers. most minimum wage workers are employed in fields like food service, retail sales or personal care such as day care. rosemarie gray makes minimum wage as a custodian. >> we want to be able to take care of ourselves, pay our bills and pay for housing and we can't do that on minimum wage. we just can't. so they have all these programs like food stamps, you know. they're going, why do you need food stamps? because you've got to eat. when you don't make enough to feed yourself and pay all your bills. you just don't. >> the push is on to raise the federal minimum wage from $7.25 an hour to $10.10 an hour, which would provide a little over $21,000 a year if the individual works 40 hours per week. it's been six years since the

minimum wage was raised. some in congress say now is the time to raise it again. >> things are getting better. the problem is, they're only getting better for some. we know that corporate profits have continued to break records while americans are working harder and getting paid less. >> but some, like kentucky congressman andy barr, say raising the minimum wage will cost jobs, citing a nonpartisan study by the congressional budget office. >> if we mandate a higher minimum wage in those entry level jobs, then we would lose 500,000 to a million jobs immediately, those low-income jobs. that's the last thing we want. we don't want to create more unemployment. we want higher employment. >> representative barr says more education and better worker training are the keys to improving the lives of minimum wage workers like sidney and rosemarie, not an artificial wage.

>> now it is time for us to meet one of the students that's on the grand prize winning team her name is anna gilligan and she's joining us from lexington, kentucky. hi, anna, congratulations to your team. anna: thank you so much. host: where were you when you heard the news you'd won? anna: i was in my principal's office with my team and a few teachers and i got the call and for the first time in my life i didn't have anything to say. host: isn't that terrific. were you surprised when you won? did you feel when you sent it in that it was a winner? anna: my team and i, when we were making it, we said, let's show so and so. we wanted to get the word out and let people know. we had no idea. there's always somebody better out there and we didn't know that this was a possibility. host: how did you choose the topic "the artificial wage" which deals with the minimum wage? anna: we were looking through

the clips you had available and we're all passionate about human rights and i was like, oh, let's look at, minimum wage, you know, hey, for the people. give them more money, help them out. and you know, right there, we're like, yeah, that's what we're going to do. we want to help people. host: it's interesting, when people watch your video, and i hope they'll take time to find it on our website, you have a decided point of view the three , of you, that you speak through. was it your opinion when you started out the piece? anna: no, our opinion changed. when we first started researching, we saw the top layer. if you give people more money, they'll be happier and they can buy more things. but you know, we started to dig a little deeper, found out the cost of inflation and people can just send work elsewhere and put people out of a job, so we decided no, it is not best for the workers and our community.

host: how did you find the people you interviewed particularly those who were working on minimum wage, to interview for the piece? anna: my father had a job connection he, found them through a job fair and we were able to coordinate those interviews through a program called jubilee jobs so they were like, all right, we have three people, if you would like to interview them, they are happy to tell you their story. host: were you surprised they were willing to share their lives with you? anna: we had one interesting view, one of the gentlemen said, no, i don't think this is a good idea. and that just shocked us. so just everything about it, it was very interesting. absolutely. host: is have you worked with video before or is this your first documentary project? anna: this is my first time, michael is very experienced and he helped out with the technical aspect of that.

host: how did you put your three-member team together? anna: it was originally katie and i, because we've been friends since fourth grade and i was like, how are we going to put this together, who will help us make this a story and not just facts and i was like, michael, hey, why don't you come help us out. he was like, great. so we all worked well together. we are friends. we are all on speech team. we get along very well. host: closing question, how will you celebrate your win, both at school and what will you do with your prize-winning money. anna: starting out, we didn't think this would happen so i haven't made any plans. invest in the stock market, do something worthwhile and maybe learn a little bit. host: do you know how your school will celebrate? anna: we'll watch this on tv and -- >> we're going to have an assembly.

anna: we're going to have an assembly and all sorts of fun stuff. host: i'm sure all the other students in your school will be happy to cheer you on. congratulations to you for your big win this year. we're very proud of you. anna: thank you so much. host: in addition to the grand prize winners, there were first prize winners in each category. here they are. a team of ninth graders from sandy spring, maryland, who produced a video on school lunches. their cable provider is comcast. first prize in high school central went to a senior from oklahoma. her topic, public access to natural resources. another cox communications company team won in high school west, a team of three seniors from phoenix who focused on the individuals with disabilities education act. and here's our first prize in middle school. two young ladies from silver spring, maryland, with their cable service provided by comcast.

they chose medical research funding for their video. finally, one more prize. mckinley lare, our first prize winner in the high school central region also won our first ever fan favorite prize. this was student cam's first time allowing the public to preview and cast votes for their favorite documentary. you should know that all 150 main prices were decided independently of the public vote but during a week of voting with 325,000 votes cast, mckinleigh's documentary received 195,000 votes. she'll be recognized as the th year's fan favorite and win an extra $500 cash prize. congratulations to all the student cam winners and all the students who entered this year. you can watch the winning entries on our website at studentcam.org. >> next a house armed services

committee on u.s. operations in afghanistan. after that, q and date with author david o stewart. live at 7:00 a.m. your calls and comments on washington journal. >> today independent senate -- senator bernie sanders of vermont will be at the luncheon. he is expected to talk about his priorities and plans for the upcoming floor debate on the budget. live coverage at 1:00 p.m. eastern on c-span. >> tonight on "the communicators," the founder and ceo of media, on the challenges facing media companies in the follow from the latest fcc decision facing the internet. >> i have no doubt this will

increase rates for the consumers. >> why is that? >> if they will impose regulatory fees and additional rental fees, taxes at the local level, utilities and regulatory utilities in the states will get into the act, i have not found one government that does not want to raise more money and this would give them an true opportunity. tonight at 8:00 est on "the communicators." >> on wednesday afghanistan general john campbell testified before the armed services committee and gave enter update on the military. including troop drawdown, counterterrorism operations against afghanistan and the islamic state and the training of forces. this is two hours 15 minutes.

mr. thornberry: the committee will come to order. today the house armed services committee meets to discuss the conflict in afghanistan. week of been engaged in military action in afghanistan for 14 years. the predictions that this would be a long conflict have proven accurate. while there have been setbacks in recent years, there's also cause for cautious optimism. the united states and its allies, especially the afghan forces, have made some meaningful gains. counterinsurgent is one of the toughest types of war a democracy can fight. while this conflict has been a difficult one, it's not impossible. both our future security and the future of the afghan people depend on our success. the people of afghanistan currently have, in my opinion, the best opportunity for a stable, relatively peaceful country that they have had in over four decades.