>> i guess i would say that this is a very strong priority for hhs right now both cms and the national coordinator and we're actively part of that strategic planning effort in terms of how do we accelerate the path disorders interoperability. that would make it much, much easier. right now what community partners do they send a report, pc3 makes this a little bit easier because it's a condition of their getting paid and that gets attached into the vista record essentially as a portable downloadable file. >> would this incentivivizing through pc3 if we can incentivize them. >> i think so. >> disir, dr. lynch, the stlarv on the waiting list -- how many were contacted and spoke to a very person. tell me what the contact was. did they have an actual conversation with them? >> we don't have that breakdown yet, congressman. we will. there were attempts made to contact all veterans, the process is that there were three attempts made. if we could not contact the veteran they then received a certified letter. we will be developing the data as we collect it and we should be able to provide you w

that is where we find cm cm with -- christien kafton. >> reporter: right now fire investigators are still trying to figure out how this fire started in the first place. here's what firefighters are telling us. it started shortly after midnight. they believe the fire started outside one of the homes and spread to the neighboring building. in all we are hearing two buildings, three units in all have been damaged by this fire we know one has been treated at the scene. the cause is under investigation. >> it's under investigation at this point. at this point we are not sure. >> again we are now hearing that in all seven people displaced by this fire. red cross is still here on the scene and we have learned that some of the residents still trying to find a place to live at this time. coming out, you can see how heavy the damage is between these top buildings. it's believed the fire started somewhere in that area. you can see how it spread from one building to the other. at this point the cause of the fire is still under investigation. the fire started shortly after midnight and began outside t

one was the federal centers for medicaid and medicare services, cms. they actually came in and did an on site review at sfgh. then mayor lee thought it was important to have an external review and asked the university of california of san francisco medical center to come in and do a review of security systems at the hospital. and then finally director garcia had her staff, and i was a part of that, develop a corrective action plan that we delivered to the sheriff and he graciously accepted and has been a partner as we've gone through trying to put together that action plan. the summary i'm going to share with you is a couple four mayor areas. those are leadership, patient safety, contractor services and facility improvements. you can follow -- you'll see the legend actually at the top. it shows the organization that made the finding and/or recommendation and so those are cms for the medicaid federal survey, ucsf from the medical centers review and those items in the corrective action plan, the cap for the sheriff's department. in terms of leadership, t

does not get money from cms. we are compliant with all the standards.the private health-care providers who were given incentives to digitize their records -- as a standard set forward by cms, will that provide interoperability with vista? guest: it should. in some cases, we are starting to explore this. with some pilot projects on allowing veterans to get immunizations in a walgreens. we can exchange that kind of information. there is a difference between people meeting the same standards and being able to share freely across platforms. >> you are saying it should. , physicians who have been incentivized under the aca to digitize, the standards by cms should provide the platform for interoperability with vista? >> it provides the foundation for it. >> part of being able to facilitate this ability to arena care in the private would be to facilitate interoperability. maybe part of the answer would be that, if there were further incentives for our physicians to part of, this would be the solution. >> this is a very strong priority for hhs right now. both c

both cms and the national coordinator and we're actively part of that strategy i can planning effort in terms of how do we accelerate the path toward inoperability. but what the community partners do is they send a report, pc 3 makes this a little bit easier because it's a condition of they're getting paid. and that gets attached into the vista record, essentially, as a portable, downloadable file. >> would this incentivizing in through pc 3 be helpful if we put in an incentive for them to digitize? >> that might be an option down the road for sure. >> great, thank you. >> mr. -- you're recognized for five minutes. >> thank you, mr. chairman. the 70,000 veterans contacted that were on the waiting list and the point is to remove them from the waiting list, how many were contacted and they actually spoke to a person, a va person or -- tell me what the contact was? did they have an actual conversation with them? >> we don't have that breakdown yet, congressman. we will. there were attempts made to contact all veterans. the process is that there were three attempts made. if we could not

>> i guess i would say that this is a very strong priority for hhs right now, both cms and the office of the national coordinator. we are part of that strategic cunning effort in terms of how we accelerate the path to its inner operability. right now, with community partners do now is, they sent a makes it easier because it is a condition of their getting paid. that is attached to their vista record as a portable, downloadable file. is helpfulentivizing . crexendo i can option down the road. >> thank you. >> you're recognized for five minutes. >> i appreciated very much. -- i appreciate it very much. first of all, how many were contacted and actually spoke to a person, a v.a. person? the contact was, did they have an actual conversation with them? >> we do not have that breakdown yet, congressman. there were attempts made to contact all veterans. the process is there were three attempts made. if we could not contact the veteran, they then received a certified letter. we will be developing the. as we collected, and we should be able to provide you with information that would tell you h

it took us a decade to get that approved and it's finally approved through cms. it took a $200 million study and 50,000 patits and smokers have the ct scan and show that t ct scan is a 25% more preventable death over justuitting a lobe and that proved 50,000 patients in nine months. >> you mentioned bonnie now, for folks that don't know bonnie, she's from the cancer foundation. you walked into my clinic and you fixed r. >> stage three lung cancer. >> she had 3b in a trekkie spot. she's a fighter and we're a can-do team and we built a program and she was in the thoracic oology program and she realized she could do more on herown and started foundation that i helped her start and the rest has been history and she's been trying to change the perpective on lung cancer and drive awarene and build novel clinical trials and novel approaches because, you know, it's never a good time, obviously, to have cancer but it's alst a good time because we're on the cusp of what i think areramatic changes. >> in just a moment, we do is to >> in just a moment, we do is to take a bre

commissioners, we left off on the regular calendar for 2012, cm, a request for use authorization. >> good afternoon, president wu and members of the commission. you have before you a conditional use authorization to allow development on a lot larger than 10,000 square feet in area in the haze golf and ct district. the project is acorn lot with 100 feet of frontage and 120 feet of frontage on lagoon in -- of laguna. it's construction of a mixed use building of 8,000 square feet of ground floor retail space including up to three restaurant uses and a basement level parking garage with 15 residential parking space and five commercial parking space. the project utilizing a modern design. contextually related to older buildings in the sur rounding neighborhood in terms of rhyme and massing. the residential entry on haze street has color and a different pattern. this is articulated with windows, and balconies. the department believes that the project complies with the intent and the design principals of the area plan. this is an upper floor setback that has the mass on the narrow street. i

. >> reporter: her story also cm& inspired other kids living with cancer.telyn cress was diagnosed with lymphoma last year. >> i'm going to be having my own alex's lemonade stand. and all of the money is going to support of pediatrics. >> reporter: today alex foundation is going strong, raising more than $80 million helping fund hundreds of research projects. alex's parents, liz and jay scott, said alex would be proud of all they have accomplished. >> this is an incredible day for us as a family. and i'm just amazed. i'm just amazed. so thank you. >> reporter: this is alex's legacy, and it will live on, one small cup at a time. rehema ellis, nbc news. >> that's "nbc nightly news" for this sunday. brian williams will be here tomorrow. i'm lester holt reporting from new york. i'll see you shortly for tonight's "dateline." in the meantime, for all of us here at nbc news, good night. >>> what precipitated this event, we do not know. my officers were simply having lunch when the shooting started. >> five people are dead in las vegas following a shooting at a bus

that is the importance of cms. where those dollars come from for most medical centers where there is a mission not an option to invest in other places but that's the mission to do the research and education. those dollars primarily come from clinical revenues. a little bit from philanthropy but if you do the math is a huge amount that would be required to make up that gap and that is why the decisions on funding that are made from cms which type of privates are so critical to this research enterprise. it's not just nih budgets that supplement that every academic medical center put sand to research enterprise where it's the mission to look for the cures. it's not an option. >> i just want to say this exceeded my expectations and i want to thank everybody for coming today. i really want to thank -- most of the members have left but i can't really remember a more robust discussion among members of congress that we have had either about looking at a visionary way to the future so thank you all for participating in our

he took our cm our chum bag. he ripped our chum bag right off. >> was it worth it, though? bag. that was amazing. >> they said the shark hung around for 20 minutes and swam away after the food was gone. >> really wanted that chum bag. >>> and finally, we thought this next story was just a hoot. >> it's a hoot because it involves an owl that somehow got stuck in somebody's kitchen. the guy got it to sit on the swiffer sweeper and slowly, delicately lowered it towards the window and got it out. >> oh, it's okay. please don't give me that look. oh, oh, oh. >> that is the look of death. that is cruel look the owl is giving. >> looking away. >> it's brilliant. >> it's pretty good. >> and he managed to shoot himself the entire time. >> we'll be right back. stick with us. th us. without angie's list, i don't know if we could have found all the services we needed for our riley. from contractors and doctors to dog sitters and landscapers, you can find it all on angie's list. we found riley at the shelter, and found everything he needed at angie's list. join today at angieslist.com o

cms will sometimes do that. there's something called coverage with evidence development where they say we will take it as it comes but there's additional information. at least you are getting reimbursed for it. i think that is a critical area to be looking at how we can provide that greater payment predictability. >> thank you mr. chairman. >> thank you. let me thank chairman upton and congressman to get for putting this together. i think it's very beneficial and everyone who has participated. i just want to ask a general question. i guess mr. dr. collins or any one really can answer it. i constantly hear and listen away paper and dr. collins mentioned it. and mr. waxman mentioned about funding. obviously there is not as much money available here to nih as it used to be. you mentioned a researcher that went to china because he thought they were better opportunities fair and mr. gray mentioned the technical infrastructure you know that we are falling behind. i'm just trying to get a handle on we are constantly to

estuvo a 2 cm de salir eliminado por la selecciÓn chilena.r. felicidades, fÉlix el afortunado desde rÍo de janeiro. >> el afortunado jorge. tiene razÓn. >> ahora pasamos a costa rica mÉxico perdiÓ pero costa rica ganÓ y eso es precisamente lo que hay que ver. nuestro corresponsal en recife. marÍa antonieta impresionante el partido hasta el Último momento por penales. costa rica y sÓlo que mÉxico no pudo hacer. >> jorge buenas noches efectivamente si hay que describir es agÓnico y cardÍaco e inesperado a la vez la gente querÍa que costa rica se uniera al bloque de colombia y brasil. probablemente de argentina para seguir representando esos minutos en los penales fueron muy importantes antes del partido sino vamos a ir a penales sabemos resistir la tensiÓn. si estaba viendo estarÁs de acuerdo conmigo la precisiÓn y la colocaciÓn. dicen que para que un penal sea buena necesitando solo tener la fuerza. sino la colocaciÓn perfecta decÍan tambiÉn que si lo penales y se tiran hacia arriba son mÁs fÁciles de parar. los penales de costa rica siempre f

that would be helpful but then specific question to elizabeth in a march letter that cms sent out they mentioned they would scrutinize network adequacy in 2014 and i don't believe any additional information has come up. who would like to speak on that? is anybody? no takers. >> i do want to put it in a commercial we're holding a briefing july 21st? we're doing a program on july 11th where we've looked at some results from a survey of the commonwealth fund will put together about the exchanges and what is going on there. later in the month we will join the explicitly focus program some stay attuned. >> bravo. as the one who represents putting together the networks i will try in with my fellow panelists. i think a lot of the focus around provider networks for tickets and they from blue cross blue shield where you are used to a broad network. what i would say in terms of pricing is we would never artificially price anything. we feel strongly we have to price on the information and that we have, appropriately and accurately with the policy as the company do not go after quote-unquote marke

to tamp this down and restore any order is if madame nhu just leave so this had been something that cmand his brother had not been willing to do but finally they said okay madam knew you have got to go now. where did she go? she comes to united states and goes on a press relations to her and she doesn't understand the difference. she's invited to speak about harvard and columbia and georgetown and she is also invited by "meet the press" and all of these press organizations and she doesn't understand why she feels like the government hasn't rolled out the red carpet for her. wasn't she invited and she just doesn't get the separation between the press and the government because in her country of course the press can only say what the government wants them to say so for her it was totally befuddling to the end of her days. i can understand why they invited me to come and then say go home. why don't they want me here? she goes to new york and she goes to washington d.c.. she comes to chicago and stays in the blackstone hotel. one of my favorite moments of the trip as she goes to dallas and

we have cm e-trader andrew keane. set the table for us. serious is this situation and what do you think happens from here? >> melissa, pleasure to be with you. it is a very serious situation. as professional analysts, three of us and you as professional journalist we'll analyze this situation. keep in mind this humanitarian crisis of epic proportions. next five taste you will see several hundred thousand refugees, as many as a million, internally displaced persons. keep in mind what isis is. they are the world's worst terrorist organization in terms of viciousness and brutality. they are trying to establish a safe haven state for islamic fundamentalist terrorists. people that disagree with them get decappy tated. they can't be reasoned with. they can not be negotiated with. they will do what they are going to do. in terms of -- melissa: wow. let me bring john in. the show is "money." we'll look at it from the money issue. president says no major sis are up shun to the supplies. is the market prepared for that to change. >> the market was u

i will apologize by dancing and little bit around it, because i have my colleagues at cms, but you're raising an important point which is if i'm a developer avid technology, what i need is predictability, not just to get the market, but to get reimbursed. as a physician, but i care about is also patient access. we know patients to not have real access in many cases unless there is also reimbursement for the technology, particularly if we deal with more extensive technologies or part of an expensive procedure. many are disenfranchised because they would not have the coverage and money for it. we need to think about others circumstances were we can provide that more streamlined pathway and more guarantees if you're getting actually through fda, are there circumstances where the you should get paid for. where yous atie-in are paid for and there is additional data collection. they're sometimes called coverage with evidence development, so we will take it as it comes, but there is additional information but at least you are getting reimbursed for it. to that is a critical area be looking a

and medicaid, child care enforcement, cms and medicaid.out the work rk requirement aspect of tanf. >> at this can just comment on that as well. the federal government has give encouraged states to go out ande get food stamp recipients measured as a percentage of everybody that's potentially pot eligible.eli this isgi a counter productive policy and i think it contributes to the increase in a the nonworking food stamp caseload excluding aged and d. disabled -- >> i'd add on -- >> -- from the able bodied from 2.3 to 8 point -- >> ms. moore. >> thank you, mr. chairman. i have half the time that they . had so i would hope that you would answer my questions very s quickly. how are you? >> very, very goods. g good to see you, representative moore. >> it is. it is.re.t we do have a history and so i know that a lot of your a experience and you've done you'e fantastically m your career was based on your work with tommy thompson at a time when i was a state senator.icies t i'll get in there. are you concerned that the policies you are promoting real

greater extent for 2015 than 2014 and i don't believe any additional information has come out from cms unless there is somebody here. who would like to speak on that? anybody? no? okay. no takers. >> before you go, i would want to put in a commercial. we are actually going to be holding a briefing july 21st, is that right? no, different, we're going to be doing a program on july 11th in which we look at some results from a survey that commonwealth fund had put together about the experience in exchanges and what's been going on there. and then later in the month we'll be doing an explicitly-focused program on narrower networks so stay tuned. >> bravo. >> so, as the one who represents those who is putting together the networks i'll chime in but please feel free, i invite my fellow panelists to add on. i think that a lot of the focus around provider networks is that for many people value networks are something new, particularly from a blue cross-blue shield plan where you're used to a very, very broad network. . . scrutinized very heavily through the regulatory process" in having our netw

mark second shun in the pits of the cm-e. we begin with mark. what drove it? was it merger monday? any lack of negative headlines here? >> you know the path of least resistance is up. there is no catalyst to send the market lower. so until we see some sort of a catalyst, if the, if the choice is up or down, it always will be up. that is just kind of the tenure of the market right now. you know, i want to make some comment, there has been talk in the media about market complacency and low vix and everything going on. talk how much the s&p 500 actually is moving right now. if you look at the last 20 trading days, the s&p 500 is moving at rate, call it 6 1/2 to 7%. when you look at vix, it is over 11%, that is a nice insurance hike up in options right now. so, when i look where the vix is pricing, how s&p is moving i think you will see this slow grind up continue. potentially through the 4th of july. who knows, maybe through the whole summer. adam: mark, pick up something you said. i want to go to jason, he says don't worry about complacency. weir seeing real estate investors come in

insurance industry as a whole we did have ongoing conversations with the secretary and with the hhs and cms. we felt very good about the tools that we were developing as a company as and as an industry to make the individuals as they were and we referenced it whether it was the communities where the churches that were best known to humankind in kentucky. we felt very good about that. what we were the most concerned about frankly, and this was before the glitches in the website, we were concerned about the next of the members and i'm speaking to you as a business person i have to be honest we were concerned about the mix of folks coming in. if we were not able collectively to get the young and invincible since the program, we were fearful that it woul they wouldk the bank on the program and the federal government at a traffic job. we referred to the risk adjustments and the reinsurance. they were in place. we were not sure that they would be enough to sustain the progr program. i would say that we were less panicked when all of the outcry over the problems in the website because we were in c

well, just last week one of our favorite cm e-traders, mark sebastian, said investors need to be -- andsed -- aggressive with their stop orders. here's what he said. >> you know, in a slow, grinding market like this, the key to kind of trading is is really having patience with your winners and having aggressive, aggressive stop orders to get you out of the ones that are really losing. liz: we said bring him here. now! and so he flew here. great to have you. thank you so much. >> thanks for having me. liz: we love the train and teach our viewers sometimes. we don't, like other business networks, assume that people know everything already. but when you said be aggressive with your stop orders, we thought let's get you in to explain exactly how people do that and why they should do it. right off the bat, what should they be doing every time they buy a stock? >> yeah. before you even buy a stock, you've got to figure out your entry and exit points, okay? where am i looking to buy, where am i going to get out? not just on winners, but losers. that's where stop orders, stop loss orders and st

you have a nuclear commitment mnc, cm and see, cgm -- c nuclear power in europe.ould like them to invest in nuclear power. for me, the magical issue is this, probably because i come from a markets background. this is a critically important issue for the city of london and financial markets. this is the second biggest bank in china. there are many ways to skin a cat, as they say. what may be used to be the prime business of the city of london migrates and changes. today it looks east. >> manus cranny, thanks so much. > london's cloud world for um, there are a lot of myths about what is and what it isn't. our european business correspondent caroline hyde is clear thingsto up. good morning, caroline. >> get this, adventure capital firm north ridge did some research. apparently, more than half the people in the united states say -- that they took data from say that car -- cloud computing could be affected by stormy weather. they don't exactly know what cloud computing is at all. the levels of money going into it is quite phenomenal. more than $800 billion could be flo

cms uses medicare billing records.f the hospitals submit the bills and then they analyze them. fairly archaic method. one of the problems with tracking all of these is anyone in the hospital knows how google or netflix is better organized technologically than the hospital. so we do not have very good access to patient charts. not a lot of standardization. it is hard to get accurate information. cms uses the best thing for them. host: new york. republican line. caller: hello? ok. ofive on the south shore long island. i see the urgent care centers popping up all over the place. open from saturdays and sundays, most days of the week" 9:00 at night. they open early in the morning. i believe they are relieving the emergency room. it is because of the affordable care act? do you have any information on that? i do not think most of that change has to do with the affordable care act. i do not think most of that change has to do with the affordable care act. emergency rooms are extremely expensive. weights can be hideous. a lot

leaders this morning are first energy, north ooegs utilities, public service, and enterprise group and cmsl, the utilities index for the s&p 500 up over a percent today, scott, a nice day, assumed and still have the leadership role in the year to date performance for all sectors in the s&p. back to you. >> domm, thank you so much. >>> fedex trading at an all-time high after beating estimates by 10 cents, and the company says the fiscal year has been good, but 2015 will be even better. donald bratton, managing director has an outperform rating on fedex and a $165 price target. good to have you on the show. >> good to be here. >> a good read, snap back from the cold winter. >> oh, absolutely, absolutely. everybody's glad to see phil gone, but the bottom line is the outlook is rosy indeed. i was looking for $9 a share, consensus was $8.75, a range of 8.50 to 9, and when they get good momentum, set targets that are reasonable, spen in the next year or so beating and raising. mart interpreted it correctly. >> this was ground doing well, freight doing well, but what about international. still re

second stage of the so-called meaningful use, this is the series of stepped incentives, right,ing that cms has put in place incentivizing is private sector providers to adopt electronic health records and the like not just to buy the stuff but to the actually use it in such a way as to improve quality of care. that second stage of meaningful use actually requires the providers be able to share some information with other providers. so you're right that meaningful use is actually a path to getting us to a place where we can share all the information. i think it's fair to say that many providers are finding this challenging. so dr. ban i check is also correct when he says give me a break because if you're thinking about actually just uploading all information from one to another, that's actually much, much steeper and likely a bit far off. i think your original an sherrion that in fact the incentives put in place by the hi-tech act are setting us in the right direction. i wanted to make the point vha is complying with all of those. >> my understanding having spoken to some physicians who do

in some programs, shot enforcement, cms and dedicated, food stamps, there was a significant involvement in new york city and i have not seen that in the tanf good attitude of chart to the extent to which states that any penalty status as a result of failing to meet and i do think any state has been in penalty status in the united states in five years, which just shows there may be less evident to csm about the work requirement aspects of tanf. >> if i could comment as well. the federal government has encouraged states to go out and recruit food stamp recipients can they give bonuses for the increase in food stamp recipients the 10 states have measured a percentage of everybody that's potentially eligible. this is a counterproductive policy unit tribute to the increase in the nonworking flute stamp caseload, excluding aged and disabled. from the able-bodied from 2.32 mike 85 million. >> thank you, mr. chairman. >> ms. moore. >> thank you, mr. chairman. i think the witnesses for. you i have half the time they had, so i would hope you would answer my questions very quickly. how are you, mr

>> go to the cms website and you'll see one of the metrics that the private sector is paying a lot of attention to right now, readmissions. we know a tactic like a post-hospitalization phone call has the ability to reduce readmissions. and yet what we don't do is we don't measure the post-visit phone calls they make. in the publicly reportable website you would find the readmission rates for folks within certain disease categories. >> thank you. within the va, there's raised concern that there are inadequate numbers of extenders and this cases physicians to spend undue time with paperwork and routine clinical work. mr. mcclain, what does the private sector use as a benchmark for the physicians to physician to extender ratio? >> it varies depending on what type of clinic. our involvement are with the community based outpatient clinics. we operate 34 of those under contract with the va. and so we have a -- we utilize va's, for the most part, panel size of 1,200 per physician. and then the support -- the medical and also administrative support for a single doctor would be somewhere in fo

again the cms investigating this fatal crash and the driver they say could face dwi charge. >>> juste 7:00 last night chp received reports of a reckless driver in a red car on i-80 just before berkeley. shortly after there was a crash involving four vehicles. police say the deliver of the car, 50-year-old robert blackwell, tried to run but was stopped by an off-duty officer. blackwell is now facing felony hit and run. >>> after the driver hit the power pole the wires and transformers came down around the car. paramedics could not get to him until the the four was shout off. the driver was 62 years old but they have not released his name. >>> the san mateo county sheriff's deputy who killed soriano garcia says he feared for his life whether he fired two weeks ago. the young woman's family is first baptist orlandoing change. >> reporter: tony soriano finds comfort in family and friends, where 18-year-old soriano's funeral was held. the teen, who suffered from depression, was shot to death by a sheriff's deputy on june 3rd in half moon bay. her family called police saying she hadn't tak

cms uses medicare billing records. all of the hospitals submit the bills and then they analyze them. fairly archaic method. one of the problems with tracking all of these is anyone in the hospital knows how google or netflix is better organized technologically than the hospital. so we do not have very good access to patient charts. not a lot of standardization. it is hard to get accurate information. cms uses the best thing for them. host: new york. republican line. caller: hello? ok. ofive on the south shore long island. i see the urgent care centers popping up all over the place. open from saturdays and sundays, most days of the week" 9:00 at night. they open early in the morning. i believe they are relieving the emergency room. it is because of the affordable care act? do you have any information on that? i do not think most of that change has to do with the affordable care act. i do not think most of that change has to do with the affordable care act. emergency rooms are extremely expensive. weights can be hideous.

there is some merit to some of your points, but in the moment cm policy and politics, you have got todeal with the here and now and going forward. the issue to me for the united states and for the region is, what does one do at a time like when a legitimate government, a member state of the united nations, that has been a friend of the united days for the past decade, what do you do when it faces a threat of its , that threatens to undermine or is undermining the very distant of the iraqis they? we do not have an interest in and feeding and in chaos reigning in the country of iraq, nor do we have an interest in eating a group -- seeing a group, a terrorist group that straddles the border. history there that will have to be sorted out. meanwhile, there is a very specific and dire situation confronted by the government of the people of iraq by this very moment and how should the united states respond? does it have to be the united states to take the lead? guest: not exclusively. we are ready talked about the regional players. i think some kind of regional even to consult, would be a goo

this has been transformative in working with these new people, the people at cms, the sub agency of theter for medicare and medicaid services. they have been impressed with this and have learned things. to be honest, the people coming in from outside have learned things to about how to do very big projects in deal with the bureaucracy as you build a project. host: another tweet here -- host: well, you know, you mentioned testing. that is interesting. one of the big problems with the original site was that like a lot of government i.t. projects, the way that they tested things was that people wrote code and then they sent it out to people to test it. it would be a few days of feedback before you would get anything about whether what you did was working well or not. going to field was crash. in silicon valley, they test right away. there are things built into the system where a coder and get as they write the code and do the programming and whether it works or not. in terms of testing it as people use it, there is a system that everyone uses called aep testing where you make a change and

used to pay for a pay-for for the affordable care act and it's the success of the market share of the cms. the. the united states government is taxing health insurance providers based on their market share of health insurance and adding that cost, where? to the premium that's paid by the consumer. it's been estimated that the premium cost is going to go up about $512 a year for the average consumer just in order for the moderate -- the small and medium-size group provider to pay the fine or pay their share of the tax of $8 billion. that $8 billion in 2014, in 2019 goes to $14.3 billion and will go up add infinitum, which means costs will continue to climb. access has been restricted because a lot of people aren't playing in the system. a lot of specialty hospitals have chosen not to join the plans. specialty care to children and adults is not available. available. the other problem we've had is with navigators, it fundamentally underscores my belief in the private sector. for years i ran a business, it was a business where we employed some employees but mostly had independent contractors.