inaccurate or as mr. hoyer said yesterday not precise enough, it does strike me that millions of individuals who by listening to speeches like yours voted, believing one thing, now found themselves without coverage and are now scrambling to find coverage in a marketplace that offers more expensive plans with fewer options. in response to my constituents' calls for help, i created a portal on my website, no patches or fixes needed, that allows those who have experienced problems to reach out and tell me about their personal experiences. in just the last few days, my office has received dozens of complaints regarding increases in their monthly premiums. i received one such notice from a mother in her early 50s who just received a notice that not only will her insurance premiums double but she will also have to switch insurance to keep her doctors due to the fact of the

affordable care act. can you imagine receiving notices like this? i can tell you that just in my district the 11th of georgia many more are experiencing this situation. madam secretary, this is akin to telling seniors that in a few weeks their medicare coverage will be dropped or their premiums would double. now, i know that neither you nor the administration would ever advocate for such a policy, yet here you are subjecting those currently in the individual market to such government intervention and i would hope that you would agree with me in recognizing that these increases are a heavy hardship on my constituents, on all of our constituents, republican or democrat. now i'll get to my questions. you know the health care law included a hardship exemption from the individual mandate. yet the administration has failed to finalize the application form for the hardship exemption three and one-half years after we passed

this law. as of today, can an individual apply for a hardship exemption from the individual mandate on healthcare.gov, yes or no? >> i don't know. >> i do, it's no. on october 15th, politico reported that if the online system for getting into obama care coverage is rickety, the system for getting out of the mandate doesn't even exist yet. hhs says it will take another month at least for the administration to finalize the forms for the hardship exemption from the individual mandate. why has it taken three and one-half years to finalize a simple application form for an exemption from the individual mandate? >> well, sir, as you know the individual mandate is not in place until next year. we have made it very clear that if somebody is medicaid eligible in a state that doesn't choose -- >> my last question an my last second. an estimated 16 million people

in the individual market have or will receive cancellation notices stating their health insurance coverage does not meet minimum coverage requirements of the affordable care act. the bill specifically grants you, madam secretary, the power to determine the criteria for hardship exemption. will you provide all of these individuals a hardship exemption since the affordable care act has taken away their plan? will you do that? >> no, sir, and i think those numbers are far from accurate. 95% of americans who have health insurance will be in a continuous plan, medicare, medicaid, employer based, va. 95%. 5% who are in the individual market, a portion of those 5%, a portion of them, about 12 million people, a fraction of those 12 million will have a plan that doesn't meet the criteria an has not been grandfathered in. they are indeed receiving notices.

many of those individuals, half of them, will be eligible for financial help getting a new plan and they have many more choices in the marketplace. so we will not have a blanket exemption. >> sounds like a hardship to me -- >> the gentleman's time is expired. miss christianson. >> thank you, mr. chairman. and thank you, madam secretary, for being here and thank you for all that you and your staff at hhs has done in implementing the affordable care act to ensure that it would provide the many benefits to children, to women, to medicare beneficiaries and to insure security to those who already have insurance as well as lower costs. of course the biggest complaint has been about the application and the enrollment website, but we have heard over and over from you that those are being addressed. but you would recall and i know my colleagues would recall that congressman rush and i have always been concerned about those who do not have internet

access, those who are uncomfortable using the internet and would not use it. so i just wanted to just remind everyone that there are other avenues for enrolling, either by telephone or by paper, either alone or with the help of a certified application assistant. but my question goes to one of the rumors that's been circulating. there are many rumors about how the affordable care act has affected part-timeworkers, and some of my colleagues on the other side claim that the companies are moving workers to part-time jobs because of the health care reform law and low wage workers are being detrimentally affected. i understand why these claims are being made, as just another part of the ongoing effort to undermine the law. would you take a few minutes and just set the record straight on the part-time issue. >> certainly.

95% of businesses in this country are small businesses, under 50 full-time employees. and there is no responsibility that any of those employers have to provide health coverage for their employees. on the other hand, there are now tax credits available for some of the smaller employers who want to offer coverage to actually come into the marketplace. for the other businesses, the businesses hiring 50 or more, there is a standard that says an employee is considered full-time if he or she works 30 hours a week and that really came from a market snapshot with help from the small business administration of where employee benefits were in the private market based on hours of work, what was a part-time or full-time employee. what we know about the economic

data is the high point of part-time workers was in 2008 and 2009 at the height of the last recession. it has been decreasing each and every year. there is no data to support the fact that there is an up tick based on the impending affordable care act. i am sure that there may be some individual employers making some business decisions about how many workers they want full time and how many part-time, but i can tell you there is no economic data or employment data that supports the notion that this is an effect of the law. >> true. in fact it's my understanding that part-time workers are at the lowest percentage of workers in many, many years right now. >> well, and for the first time, as you know, congresswoman, part-time workers will have options for affordable health coverage. they have never had that before. they have never had options in the marketplace. they have never had some help

purchasing coverage for themselves and their families. their full time colleagues have but they have not so they will have options. >> and just to be clear, i had another really long question, but the last part of it, it would be fair to say that at every point along the way, you expected this website to work based on everything that you had been told by the contractors up until that point? >> well, i expected it to work and i desperately want to get it working. >> more than anyone else, i am sure. >> we are committed to fixing it. the only thing that i think builds back the confidence of the public is fixing it. >> thank you. >> the general lady's time has expired. mr. scolese. >> thank you, mr. chairman, for holding hearing and thank you, secretary sebelius for being with us. last week when the contractors were here i asked them all under oath if they had actually delivered the system they were contracted to build and all four of them answered yes. so i want to ask you, did the contractors deliver the system that you contracted them to

build? >> i don't think i can accurately answer that question. what we know is we have a system that doesn't function properly. >> we definitely know that. >> as we fix things, we will know more about what is broken along the way and i'll be able -- >> so somebody in your office oversaw the implementation and received the product. >> that's true. >> they either said this is the contract and paid hundreds of millions of dollars to build or it wasn't. does anybody in your office have the ability to get us that? >> i think we can say that the products tested individually, verified individually -- >> but clearly it was an integrated system. >> they don't work well together. >> but, i used to write programs for a living. i developed software products for a living. if you're developing an integrated system, it's irrelevant if one isolated program works by itself but you plug it together and it doesn't work, that's a system that doesn't work. one of the questions i had and others had, somebody in your agency made a decision literally

weeks before the deployment to change the system. instead of going from a browser ability from somebody just like on kayak or amazon.com could shop for products, look at prices before they purchase, which is how consumers are used to doing this, you decided to gather all their information first before they could see prices. was that you that made that decision? >> no, sir. >> was that miss tavenner. >> it was miss tavenner and a team -- >> did that team make the decision because they knew once people actually saw the prices and we're getting reports of dramatically higher prices than what they were expecting, did you make the decision because you knew that when they saw the prices they might not want to buy the product so you wanted to gather their information first? >> sir, first i did not make the decision. i was informed about the decision. >> did you agree with the decision? >> we rolled off a number of features and clearly they can see the products. there is no requirement to buy anything.

>> i spent two hours trying to get into the system. i did get kicked out many times and got some of those blank screens other people got. i do want to share some stories from some of my constituents because we started a page on facebook and on twitter we are collecting what's called share with scalise. we're getting lots of stories. randall from mandeville said my health care premium went up 30% to over $350 a month increase. michelle from slidell, our insurance premiums are going up $400 a month and our deductible has increased. then shawn from covington who said my current plan through united health care is no longer being offered in 2014 due to obama care. in fact i received a letter stating that the new health care law was indeed the reason for the removal of my current health care plan. madam secretary, what would you tell shawn, who liked his plan and now has lost it? and he was promised by you and the president he'd be able to keep that plan. what would you tell shawn now

that he's lost his plan? >> i would tell shawn to shop in the marketplace and wouft marketplace -- >> do you think that's an acceptable answer to shawn? >> if shawn -- again, if united chose not to keep shawn's plan in effect for shawn -- >> because of the law. >> sir, the law said if you keep shawn's plan in place, if he loi liked his plan, then the plan is still there. >> you and i may disagree who you work for. i work for shawn. you work for shawn. shawn lost his plan that he liked and there are thousands and millions of shawns throughout this country that lost the plan they liked because some bureaucrat in washington said we think your plan is not good enough, even though you like it, even though you were promised you could keep it. you're now not able to keep that plan. i think you deserve to give shawn a better answer than you have to shop for something else even though you lost your plan. >> the gentleman's time has expired. mr. mcnerney. >> thank you, mr. chairman. thank you, madam secretary, for

coming today. i'm going to follow up on mr. doyle's line of questioning. one concern i have with the fallout from the website is that many users who tried to sign up and were discouraged because of the problems will now be too discouraged to come back once the site is fixed. what do you plan to do to get those folks to come back? >> well, sir, we tend to invite them back formally by e-mail, by message, but we don't want to do that until we're confident that they will have a different experience. so fixing the site is step one. and then inviting people back to the site to make it clear that when our timetable is fulfilled, they have four months to shop for affordable health coverage on a fully functioning site. we know we're going to have to spend special time and attention on young and healthy americans who don't start out thinking they need health insurance, aren't aware of the law,

certainly don't want to use a failed or flawed site, so we'll have to spend some particular attention on them. >> thank you. have the software specifications for the website and its related software elements, including the test specifications, has that changed since the initial rollout? >> i know that there certainly are some changes because -- since october 1st. >> since the rollout, the specifications. >> the specifications haven't changed. we are certainly fixing, as i say, speed and reliance is one of the issues we're taking a look at. that's the performance side. but there also are some functionality sides that things do not work as they can, including the enrollment passed on to insurers. so we are fixing functionality and i don't think that's a change in the specs, i think it is actually making the system work the way it should. >> well, are you -- or is the

department doing a prioritization? >> as of last week when jeff zients joined us, we asked him to lead a management team. we have pulled in all of our contractors as well as additional talent that they may have available. we have talked to tech folks in and out of the private sector and insurance, some of their tech experts to get all eyes and ears, made a full assessment, developed a plan for fixes along the way, have a punch list for going after those fixes and we are doing a daily tech briefing and blog to tell people what we have found, what we have fixed, what's coming next, what the functional is, and we intend to

do that until it's fully functional. >> thank you. madam secretary, looking past the initial problems with the aca rollout, do you think that the affordable care act will be successful in bending the health care cost curve and reducing the fraction of our national economy that goes for health care? >> well, i think that we have already had some success. i think the goal is to continue to achieve that. a fully insured population arguably with preventive care, with an opportunity to see a primary care doctor and not go through the emergency room will in and of itself reduce costs. having people identified earlier who may have serious problems and managing those problems will reduce health costs. but i think the delivery system also needs some considerable help in paying for number of procedures, number of tests, number of prescriptions but paying for health outcomes.

>> thank you, mr. chairman. >> mr. latta. >> thank you very much, mr. chairman. and madam secretary, thanks very much for being with us today. appreciate your testimony so far today. what i'd like to do is i'll get these to you because these are questions that we've received from our constituents back home, specifically about what's going on with the website and for them. and so what i'll do, i would like to get those to you, but there's a lot of questions here and a lot of thought has gone into a lot of these questions. but if i could start with last week's testimony when four of the contractor were here. and in one of the questions that i had posed to ms. campbell from cgi, in her testimony she had stated that they had delivered the medicare.gov and federalreporting.gov and i asked were these sites more or less complicated than this site that we're talking about here today. she said of course this site

today was more complicated. in the questioning and from her testimony, you know, we've been hearing about this end-to-end testing that wasn't happening that we had individuals out there saying about two weeks had been done, but i'd asked her was there sufficient enough time when they had medicare.gov and the response that she gave me back was on medicare.gov, which was a less complicated site. and she stated that we had sufficient time to test the system before it went live. and i asked her in a follow-up then, what was that sufficient time and she said we had a number of months before the system went live at that time. and then i just want to make sure, because again, sometimes things don't get reported accurately. but in the u.s. news there was a report on october the 18th of this year and there's some questions going back and forth. i just want to make sure that you were quoted properly.

it said after two weeks review the hhs secretary concluded we didn't have enough testing specifically for high volumes for very complicated project. the online insurance marketplace needed five years of construction, a year of testing, she said. we had two years and almost no testing. is that correct? >> i don't know the quote. i never suggested that we needed five years. i don't know what that's from. >> that's one of the things i wanted to check. >> we clearly did not five years. the law was signed in 2010. >> and then last week when you were down in texas, you were being asked by a reporter about the system and the launch. one of the parts of the question was at what point did you realize the system wasn't going to be working the way that you envisioned before the launch and why didn't we stop it before the launch. and again this is what was reported. we knew if we had another six

months we'd probably test further, but i don't think anyone fully realized both the volume caused such problems but volumes also exposed some of the problems we had. now, going back, though, to miss campbell's statement that they tested more extensively on a system that was not as complicated but hhs, cms decided to go forward with only a very short period of testing, do you think that was acceptable? >> clearly looking back it would have been ideal to do it differently. we had a product that, frankly, people have been waiting decades to have access to affordable health care. medicare existed well before the website. medicare is a program that started 50 years ago. the website was an additional feature for consumer ease and comfort, and so they were not launching medicare. they were not delivering health benefits to seniors.

they were putting together an additional way to enroll in medicare. i would suggest, sir, that we had deadlines in the law that people had benefits starting january 1st. we wanted a extensive open enrollment period so that a lot of people who were not familiar with insurance didn't know how to choose a doctor or choose a plan had never been in this marketplace or people who needed to understand fully what the law offered had ample time to do that, so the date that i was, again, required to select for open enrollment, that's again part of the statute, how long would open enrollment be, we picked that date. all the contractors that began early in this process in the fall of 2010 when we issued -- i'm sorry, 2011 when we issued the initial contracts to cgi and qssi knew the october 1st date.

that was not changed. it wasn't added to. as we got closer to the system, one of the reasons again that we pared down what needed to launch on october 1st was an attempt to minimize the risk to the system, to get people to their ability to see clearly what they were entitled to, what the plans were and if they chose to, to enroll. clearly the testing should have been longer, should have been more sufficient. >> the gentleman's time has expired. mr. braley. >> thank you, mr. chairman. m madam secretary, people who are watching this hearing might be under the asusumption there's some sort of political debate over the affordable care act. people in iowa don't care about who's winning the debate. they want these problems fixed and they want them fixed now and i think that's the responsibility of everybody in this room to make sure that happens. i tried to go into the marketplace on october 7th and i

encountered problems immediately dealing with the security code questions which required you to select dates. one of them was type a significant date in your life. today is my birthday so i put that in. i tried three different ways of entering that date and got a message each time, important, this is not a valid answer. same thing for the third date entry. and a lot of times when you're registering online for anything and you have to put a date in, there will be a little prompt that tells you what the format is you're required to enter. do you know, have we solved this problem in the security code area? >> yes, sir. one of the initial issues was just getting people into the site and the i.d. proofing, which is a two-step process. one is that you give some preliminary information and you set up a password, but the second to ensure that your personal data can't be hacked,

can't be interfered with is the second step where some personalized questions which only can be verified by you are indeed part of that. again, that was a -- an initial hold-up in the system. we focused a lot of attention on that in the first several days. it was fixed only to then discover that there were system problems throughout the application and that piece has been fixed but i would suggest it also was a function of trying to make sure we had the highest security standards, that we were not cavalier about someone's personal information being able to be addressed and attached and it was a functionality that didn't perform properly but does now. >> one of the things that keeps coming up in this hearing because you are from kansas is references to the wizard of oz. people went to see the wizard because of the wonderful things that he did.

the affordable care act is doing a lot of great things in iowa. the "des moines register" wrote io iowans will face some of the lowest premiums in the country. it's increasing competition in our state. iowa consumers are able to choose from 40 health plans in the marketplace. you have mentioned the growth of health care spending is at the slowest rate in 50 years. 50,000 iowa seniors have received prescription drug rebates. bans on pre-existing conditions are allowing people to get coverage and switch carriers and now insurance premium increases are subject to review and can be rejected by the people reviewing those plans. but all of these good things don't mean anything unless we solve these problems. and what i need to know is how confident are you that the problems will be fixed by december 1st. >> well, again, congressman, i

have committed to that date because that is the assessment of both inside and outside experts have analyzed and i think they kicked all the tires and looked at all the system. i know there's no confidence in that date until we deliver on the date. i am well aware of that and that's on me. >> since americans were supposed to have six months to sign up, would you support insuring they still have six months by extending the open enrollment period for two more months? >> at this point, congressman, they will have a fully full months of fully functional all ways to sign up and again there are alternate ways and the website right now that people are getting through. the open enrollment period is extraordinarily long. it's about six times as long as a typical generous open enrollment period. and it's important for the insurance partners to know who is in their pool so, again, they

can stay in the market next year and know who they're insuring, so we think that the timetable will allow people four months' time to fully use the website. they can use it right now, they can use the call center, they can go to navigators, they can enroll. >> the gentleman's time has expired. mr. harper. >> thank you, mr. chairman. thank you, madam secretary, for being here today. i'm sure there are other things you'd rather be doing but we welcome the opportunity to have this conversation. i'm going to ask the clerk to bring you a document for you to look at so i can ask you a couple of questions. if you can go to page 8 on that, i have highlighted an item there. but this is a copy of a cgi slide show from october 11th discussing technical issues that must be addressed within the website. on page 8 of what i've handed you, cgi recommended that cgi and cms have a review board to

agree on which issues can technically be solved and which should politically be solved. was such a review board convened? >> sir, i cannot tell you. i've never seen this document and i'm not aware of this recommendation. >> but cgi is responsible for the website, correct? >> cgi is responsible for the application. >> for the application of this. >> yes, sir. >> does it surprise you that in a slide show that they gave october 11th they acknowledged political reasons for trying to solve this? >> sir, i've never seen this document. i have no idea what that means. did you ask cgi when they came last week? >> can you find out for us if such a review board was done and if any decisions were made on political reasons or on the other reasons and find that out for us? >> sir, that question needs to go to cgi. but i can ask them to report to you. >> if you would do that. >> this is their document, if i

understand it, this is not our document. >> yes. would you turn to page 9. and it states challenges on page 9 in this presentation by cgi. and it says under challenges. unable to determine at this time whether low enrollment counts are attributable to system issues or due to users choosing not to select or enroll in a plan. so those are two completely different issues, obviously. if it is a system issue, that's something you have confidence at some point will be resolved, correct? >> yes, sir. >> and if it's a user selection issue, that's an entirely different story, is it not? >> yes, sir. >> okay. now, you know, when you use the phrase earlier about a punch list, that's like having somebody move into a house. someone is buying a new house and they go through and they have been told this house is going to be ready for you to move in on october 1st. they load up the van, they come in, they get in and it's not finished. part of the plumbing is not right, the wiring is wrong and

they go in. this creates the situation where, you know, health care shouldn't be a zero sum game. i mean we want to be fair to everyone. we want to help people who are vulnerable. but at the same time we shouldn't have to hurt folks. we've got people in my district, in my state who are getting notices of cancellation. they're being told of higher premiums that they're having. these are great concerns that we have and how do we work through that. i want to say i appreciate you accepting responsibility for these initial rollout failures that we've had. but who is ultimately responsible? it is the president, correct? >> for the website? >> the president is ultimately responsible for the rollout, ultimately. >> no, sir. no, sir. we are responsible for the rollout. >> but who do you answer to? >> i answer to the president. >> okay. so is the president not ultimately responsible, like a

company ceo would be? >> sir, he's the president of the united states. i have given him regular reports and those -- i am responsible for the implementation of the affordable care act. that's what he asked me to do and that's what i'll continue to do. >> so you're saying that the president is not responsible for hhs? >> sir, i didn't say that. >> okay. so the president ultimately is responsible. while i think it's great that you're a team player and you're taking responsibility, it is the president's ultimate responsibility, correct? >> you clearly -- whatever. yes, he is the president. he is responsible for government programs. >> my time has expired. >> the gentleman's time has expired. mr. luhahn. >> mr. chairman, thank you very much. before i begin, i'd like to ask unanimous consent to submit some articles from new mexico publications, the albuquerque journal and business journal, the first entitled small business owner health exchange will save me $1,000 a month. >> without objection. >> thank you, mr. speaker. i see my time did begin there so

i'll try to get through this, mr. chairman. madam secretary, i was intrigued boy a line of questioning by congressman green asking questions about the individual marketplace. how volatile was the individual marketplace before the affordable care act became law? >> i would say it wasn't a marketplace at all. it was unprotected, unregulated and people were really on their own. >> madam secretary, the kaiser family foundation reports that over 50% turnout of individuals that have coverage in the individual market, either lose coverage, they're priced out or drop it. is that consistent with what you're aware of? >> that's an accurate snapshot. about a third of the people are in for about six months and over half are in for a year or less. >> so individuals that were in the individual marketplace before the passage of the affordable care act did not have the same protection as those that were in group coverage? >> that's true. >> and would those individuals in the individual marketplace

sometimes have higher co-pays? >> higher co-pays, unlimited out of pocket costs for often coverage that was medically underwritten or excluded whatever medical condition they had in the first place. >> so these were typically one-year contracts. if they used the plan because they got sick or were in a car accident or a victim of domestic violence, sometimes they would be thrown off their plans or their rates would go up? >> yes. >> i think that's important to know, madam secretary. i'm intrigued as well that my understanding is last month hhs conducted an analysis that found nearly six out of ten uninsured americans getting coverage through the marketplace will pay less than $100 per month. >> they will have a plan available for less than $100 if that's their choice, yes. >> and that number would be even higher, would be better if more states chose the option of using federal funds to expand medicaid to cover their low income population? >> very definitely. that's just a marketplace snapshot.

those are people who will be in the marketplace. >> madam secretary, i don't think that i've heard anyone from the other side of the aisle today, my republican colleagues, ask you how can congress work with you and support you in fixing this website and fixing this problem. i hope that we all agree that we want this website fixed. i would yield to anyone that would disagree. seeing no one accepting that, i'm glad that hear that we agree with this. madam secretary, what can congress do to work with you to fix this website? >> well, i'm not sure that there is hands-on work that you can do. maybe we have some technical expertise, but i would say getting accurate information to constituents is helpful. letting people know that they can check out the facts and the law, that they may be entitled to some financial support. that cancellation of policies means that the policy that they had may not exist but they have a lot of choices of new policies and a law that now says they

must be insured in a new policy, that they don't have to be insured by their company at a higher price. >> i appreciate that, madam secretary. going back to the individual marketplace, madam secretary, did this congress in previous years before the affordable care act make it illegal for health insurance companies to raise rates on someone after they submitted a claim for going to the hospital or becoming sick or getting rid of pre-existing conditions? >> no, sir. >> madam secretary, one last note here. it seems that we have received some horrible news that there are bad actors already taking place of fraudulent websites to imitate the health care exchange or misleading seniors into disclosing their personal information. i've signed on to a letter to you led my by colleague, raul ruiz, to request that you prioritize fraud prevention efforts. what has the administration done to protect these fraudulent acts and protect personal information? >> i can tell you that the president felt very strongly that that needed to be part of

our outreach effort, which is why the attorney general and i convened representatives of state attorneys general, insurance commissioners, the u.s. attorneys and the justice department and the federal trade commission, which has jurisdiction to make sure that we first got out ahead of some of this developing consumer outreach. no one should ever give personal health information, because personal health information is not needed for these policies any longer. that's a red flag. we want to make sure that people turn over potential fraudulent acts. we have put training in place for navigators. we have our law enforcement -- >> the gentleman's time is expired. i would just note that we -- with the indulgence of the secretary, we're hoping that we can have all members ask some questions but we also know that with four minutes we're going to have a little trouble so i'm going to ask unanimous consent that we try to limit our questions and answers to no more than two minutes and i've talked

to mr. waxman. is that okay? because otherwise we will -- there will be a lot of folks who will not be able to ask a question at all. >> three of us? >> mr. chairman, if the questions get submitted, we would be happy to provide timely answers also. >> so can i do that? so with that we'll try two minutes. mr. lance. >> i guess i've won the lottery on the two minutes. madam secretary. >> time has expired, okay. >> 20 seconds, mr. chairman. on the website, madam secretary, the contractors testified last week that they needed more than two weeks for end-to-end testing. why in your opinion was there not more than two weeks? >> again, we had products -- the insurance policies themselves by companies were loaded into the

system so we could test up until then but it wasn't until september, mid-september that that was done and again the contractors said we would have loved more testing time but we think we're ready to go ahead. >> i believe that will ultimately be a dispute between cms and hhs and the contractors, and if there's anything we can do regarding that, because obviously that didn't work and i had thought given this as the signature issue of the president that the website would be ready. number two, in my judgment the president's statements were overstatements. the four pinnochios is an indication of that. there's a report in the new jersey newspapers this morning that 800,000 people in new jersey who purchased their policies in individual or small employer markets will be affected by this. in a previous question mentioned the fact that in an individual market you would be able to keep your policy grandfathered yet

regulations issued by hhs say that grandfathered status would not be continued for so much as a $5 change in a co-pay. is that accurate and do you believe that that is a significant change? >> sir, we gave i think in the grandfather regulations a guide for how pricing could change, medical inflation and i think it was in most cases plus 15%. there were some individual consumer outfacing issues that were more rigid than that. but i would say that in terms of having companies being able to collect a profit margin, that was certainly built into the grandfather status. >> i think that's too little a change personally. >> the gentleman's time has expired. mr. tonkel. >> thank you, mr. chair. welcome, honorable secretary. thank you for fielding our

questions and for responding when you were extended the courtesy to offer a response. as a strong supporter of the affordable care act, i'm frustrated and i think it's fair to say that the american people are frustrated as well. i heard you here many times this morning say you're frustrated. i think boy ay and large peoplet this law to work. when i talk to folks back home where i represent even people who opposed the law initially aren't rooting for the failure of the affordable care act. instead they want congress to come together to fix these problems so we can move on to real issues that matter like creating jobs and growing the economy. my home state of new york, which also experienced website problems, has now completed enrollment determinations on 150,000 new yorkers with more than 31,000 having signed up for quality, low-cost health insurance. given that many states have had success in overcoming these initial website issues, has hhs

looked at what these state websites are doing as it searches for solutions to fix healthcare.gov. >> absolutely. we shared a lot of the information going in. i think that the hub feature that we have in our website that all states are using, including the state of new york, is fully functional and that's good news for new york and california and others who are running their own state websites. but we are learning from them. we've shared information with them and we are eager for all the help and assistance moving forward. >> thank you. similarly, many states made the illogical choice of rejecting medicaid expansion contained in the aca that would help some of their poorest citizens get access to the health care situation. this is despite the fact that medicaid expansion is almost entirely financed by federal dollars. can you comment broadly on hhs' plan in the future to encourage more states to run their own marketplaces and expand medicaid so that the law can function as designed?

>> well, absolutely. most recently last week the state of ohio did move into the medicaid market and we now have 30 governors, i think 27 states have fully completed the process. another three are in the process. republicans and democrats who -- some of whom sued us about the constitutionality of the act who are now deciding that for the scitizens of their state they want to be part of the expanded medicaid. we will continue to have those conversations. it's not just about the marketplace, it's also about medicaid. >> thank you very much. >> the gentleman's time has expired. mr. -- dr. cassidy. >> you said that only if -- an individual policy is only cancelled if it changes significantly, but to be clear, after may, 2010, if coinsurance went up by any amount, even by a dollar according to your regulations, that would not qualify as a grandfathered

clause. just to have that out there for the record. i gather even by a dollar. that said, i get a letter from someone in my district, adrien. she says she lost her coverage. she lost her coverage because spousal coverage is gone. she's gone on the exchange, she doesn't qualify for a subsidy. but that her premium and out of pocket cost under any plan is $10,000 a year. she feels -- she writes this. she feels betrayed by her government. now, she has to sit there asking herself is this fair. if you were she, do you think that this would be fair? >> dr. cassidy, i want to start by the amount that you gave is not accurate. i was told $5, not $1. >> that's for the co-pay, not for the coinsurance. for the coinsurance it's any amount. but i have limited time. do you think that it's -- if you were she, if you were adrien, do you think this is fair? loses her spousal coverage, now it's 10k, no subsidies? >> sir, i don't have any idea

what she's looking at. i can tell you that, again, based on what we've seen in the market, what we've seen in the plans, people will be getting full insurance for the first time at a good price. >> again, this is what she reports. if what she reports is true, do you think it's fair? >> i can't answer fair or not fair. i don't know what she was paying or what she was paying for. did she have full insurance? >> richard writes that his daughter received a note that his premium is going up because she's being lumped with older costlier patients. now, it's possible that the only people that sign up will be those that are only more costly. does hhs have plans on what to do if only those who are more costly sign up and premiums rise for everybody? >> i think, sir, that's what we're trying to do to make sure that -- >> but if only the costly sign up, do you have plans? >> that's the importance of the individual mandate that you've just outlined. getting rid of pre-existing condition -- >> but if only the more costly sign up, do you have backup

plans? >> we will encourage others to sign up. that's why there's a penalty in place -- >> does this assume that there are no backup plans? >> the gentleman's time has expired. mr. yarmouth. >> thank you, mr. chairman. madam secretary, nice to see you come to this hearing with a little bit different perspective. kentucky is doing a great job with our exchange. as of this morning we had 350,000 people that have explored the website. 59,000 have started applications. 31,000 are now fully enrolled in new coverage and 5,000 just in the last week. i think very importantly, more than 400 businesses have begun applying for their employees as well. so the idea that somehow this is going to be bad for businesses is not born out in kentucky. would it be safe to say that if 36 states had done what kentucky and new york and california had done instead of 14, that the rollout would have been much smoother and the website would have been much easier to construct? >> i don't think there's any

question that the -- in january of 2013 we knew how many states were not running their own websi website. in mid-february we learned about partnership so it was not until that point that we learned that 36 states would actually be coming through the website. having said that, we should have anticipated, we should have planned better, we should have tested better. i don't think that's any excuse but we clearly are running a very different vehicle for enrollment than we thought we were going to run in march of 2010. >> on the subject of cancellation of policies, isn't it true that, first of all, the federal government can't require insurance companies to sell insurance? >> that they can't? >> the federal government can't require insurance companies to sell insurance? >> yes, sir. >> and in fact insurance companies all over the country are making very difficult decisions now about where they want to participate and where they don't. and in some markets, they're actually trying to get out of the market cancelling people because they want to play in

other markets and so forth. they're all making those decisions now. >> and we know we have more insurers. 25% more insurers in the individual market than we did prior to the law being passed. >> so a lot of dynamics are going on here that are not necessarily an indication that the president misled anybody. there are business decisions being made all over now. >> cancellation of policies, again, that one-year contract notice is a routine in the individual market. it has been in place for years and for a lot of people, they are policies now, they're being cancelled because they're being notified you can no longer be medically underwritten. we can't charge you more. we won't ever have the kind of limitation on what your policy can pay out or charge you exorbitant out of pocket rates. those policies will cease to be offered in the marketplace. >> the gentleman's time has expired. mr. guthrie. >> thank you, madam secretary, for being here.

last week mr. lau was here and the president talked about the alternatives to the website, his phone calling or using paper, paper application. what he said an i think you've said it with the phone, they take the paper applications but enter them into the same web portal. so i know you get around the issue of getting on and getting logged off but there's still issues with data within the web portal. you can't even get reliable data who's even signed up. he also said because of the surge in paper applications, it's like six to eight weeks to process. so if november 30th is when this will be ready that they can use, even if you do it now, eight weeks are getting close to january 1st. and somebody does lose their insurance so they're signing up to this and they get to january 1st, even though you have a march 31st open enrollment, is there a contingency plan for these people to continue their insurance? >> sir, i think that we have improvements every day on the

speed of the site. sirco was giving you early snapshots of difficulty of accessing the site. >> they said just processing the paper actually. >> i understand. but it is the site for -- they put the application into the site and get a determination. that's part of what the process is. so the site is part of the portal all the way through. this is an integrated insurance vehicle. so that will improve and we, again, with four months of continuous service, which is far longer than most people had. some of these cancellation numbers mr. gerety pointed this out from florida blue cross but it's true of everyone else, these are not january 1st numbers. they are year-long numbers. so over the course of 2014 when an individual's policy is due to expire, that individual -- >> somebody's could expire january 1st and not be able to get coverage if the website -- and the vendor said they needed months to test.

they would have liked to have months and months of what they'd like to test. even if it works november 30th -- >> i would say we're testing as we go. this is beta testing going on right now. that's how we're fixing how to identify things. people are getting know a lot m >> but the paper process, if it does take even four weeks, then it's november 30th and people's cancel january 1st, there's needs to be a contingency for that person. >> again, typical insurance is two to four weeks within signup. they'll have two full months. >> gentleman's time has expired. ms. schakowsky. >> thank you, madam secretary, for bringing to millions of americans access to affordable, comprehensive health care coverage that's going to be there when they need it. i want to thank you especially as a woman. women can no longer -- being a woman can no longer be considered being a pre-existing condition. women can no longer be charged more than a man for the same coverage. women have access to comprehensive benefits like

prescription drugs and free preventive screenings and free contraceptive coverage and maternity care, which is often left out of coverage. and the days of complicated pregnancy or diabetes are domestic violence being a pre-existing condition, those days are over. you know, i want to say to my colleagues, after a 3 1/2-year campaign to repeal, to discredit, to even shut down the government over obama care, i want to say, get over it. we all agree that there are problems, but these are problems that i see being fixed. so i want to ask one -- oh, and i want to say that what we did under medicare part d can be an example of how we can work together. in fact, chairman upton and i both sent a letter asking for more money for community-based groups to help implement the

program and make it work. we can work together. so if you could just briefly say, how are the navigators, how important are they in making this system work for the american people? >> well, what we know, congresswoman, is a lot of people are not web savvy and are not frustrated by the website because they don't have a computer, they don't want to use a computer, they don't trust a computer. they need a live human being to ask questions, get questions answered, talk about the plan, talk about insurance. so the navigators play a hugely important role. we have about 2500 trained navigators on the ground right now. we have thousands more community assisters ready to go. about 45,000 agents and brokers have gone through specific affordable care act training. but those individuals working with their clients, customers, and in the case of navigators and community assisters, just the public at large, they're not paid by a company. they're not collecting a fee.

they just want to help people get coverage. they're hugely important. >> mr. olson. >> i thank the chair and welcome madam secretary. >> thank you. >> i'd like to open with a quote from an american icon. i'll hold up a poster. it says, if the user's having a problem, it's our problem. i'm glad to hear you embrace this philosophy during your testimony today, ma'am. obama care was signed into law 1,256 days ago. and since then, there's been user problem after user problem after user problem. regarding healthcare.gov, your deputy administrator for consumer information gary cohen testified one month ago right where you're sitting that, and this i quote, cms has worked hard to test the infrastructure that will allow americans to

enroll in coverage confidently, simply, and securely, end quote. yet, according to "forbes" and "the wall street journal," you told them that you needed five years of construction and one year of testing. the program has crashed and burned at least three times. the user is still having problems. it's been down the whole time you've been testifying. the system is down at this moment. my question, ma'am, is very simple. when did you know these changes were going down, a month, a day a quarter? and did you tell the president what you knew? >> sir, i was informed that we were ready to launch on october 1st. the contractors who we had as our private partners told us and

told this committee that they had never suggested to delay and that is accurate. our cms team felt we were ready to go. i told the president that we were ready to go. clearly i was wrong, we were wrong. we knew that in any big, new, complicated system, there would be problems. no one ever imagined the volume of issues and problems that we've had, and we must fix it. >> yes, ma'am. an incredible journalist said you knew you needed six years to get this -- >> sir, that quote has been repeated. i can guarantee you i would have never stated that because the law was passed in march of 2010. i chose the open enrollment date. i don't know where that quote comes from, but that is not from me. >> gentleman's time has expired. mr. barrel. >> thank you, mr. chairman. thanks for attending today. i suspect that deep down most people on this committee sport the concept of reforming insurance markets so more people have access to better insurance

coverage. we have disagreements about the means used to get to those ends, which is why i have voted against the affordable care act. seems every day we're hearing of something new going wrong. i'm concerned these short-term enrollment problems could become long-term insurance market problems. my constituents are already losing confidence in the federal government's ability to pull this off. ic -- i think we need to delay the individual mandate to restore that trust. it's not fair to customers when it's not their fault. right now i'm less concerned about who's to blame and more concerned about what went wrong and how to fix it and ensure it doesn't happen again. nearly all of our constituents want and need health insurance. it would be a huge mistake if we were so blinded by our love or hatred for obama care if we miss opportunities to address its flaws. to the subject of technical problems becoming market problems. can problems of folks getting into the system snowball into risk-pool problems where those

who choose not to enroll can actually affect the cost of those who do choose to enroll? >> certainly, a risk pool needs a balanced market, so you need people who are older and sicker to be balanced with people who are younger and healthier. that's how a pool works. >> at what point are we going to see a problem vaccihaving the r pool if the tech problems are entering? >> well, again, sir, we will be monitoring during the six months of open enrollment as will our insurance partners, who is coming into the pool. that's why we want to give this committee and others reliable, informed data about not only who it is but what the demographics are and where they live. that's part of our target. >> if things aren't better by the end of this next month, at what point are we going to start thinking about further delays and imposing penalties? >> again, i think that having a defined open enrollment period is one of the ways that you then make an assessment if you have a pool that works or not.

you cannot have an unlimited open enrollment period with any insurance company because that really doesn't work. >> thank you. >> mr. mckinley. >> thank you, mr. chairman. last week the cgi representative campbell said she had met her contract obligations and met specifications. she said the only problem she had was with pace, but the pace wasn't part of the specification. and we asked her what you would testify to. she said you would testify that she did complete her contract in accordance with the specifications. would you? >> sir, i don't think until the product is working the way it's designed to work that anybody has finished their job. that's really my -- >> i'm sorry. with time, they've shortened our time. so if she hasn't met their

specifications, but yet we're still using her, so is the american taxpayer still paying the money to fix the problems that she didn't do -- her company didn't do -- >> none of our contractors have been paid the amount of their -- >> will she be paid for this work into the future as we go to correct this problem? >> we'll make that determination as the work goes forward. i would tell you, sir, that as we learn what needs to be fixed, how long it takes, we'll know more about whether they delivered. >> i'm sorry about the time frame. they cut it down. who owns the software? now that this has been developed with taxpayer money -- >> it is owned by the centers for medicare and medicare services. >> so it's all owned by us. will they be able to use it by a license for other clients? >> not to my knowledge. i think it is specifically designed for the marketplace with these products in mind. >> then last question -- >> and the clients are the american public. >> under iv&v -- and she testified she thought that's something we should have done.

under hhs, you recommend -- or the hhs recommends that for software development, that they should have independent verification program. it wasn't used in this case. can you share with us in the time that's gone why we didn't use iv&v? >> again, i don't think that's accurate, sir. at every point along the way, there's independent testing. >> independent? >> yes. >> not someone within your staff. >> pardon me? there's a level of company self-attested testing. there's a level of cms testing. then there's an independent test on each piece of the contracting. independent, not cms. >> gentleman's time -- >> it needs to be done independently. people -- >> h-- has expired. >> i'll get you the information. but there are three levels of testing. one he