morrison, cms -- well, let me see. yeah. i'll say this. cms has enhanced oversight plans. these plans have been critiqued as ineffective and burdensome. has your co-op been placed under an enhanced oversight plan from cms? >> yes, as far as we know most of the co-ops have been. >> what kind of requirements have they put upon you based on that? >> there are only two. one is enrollment getting to 30,000. we're we're at 26,500 today. we clearly will hit that by the end of december, the says a big month. second the a resolve transition from our tpa which we've done so we expect to come off of the corrective action plan. >> great. do you believe these oversight plans can be effective? >> i think the oversight plans >> mr. morse srison. ? >> i would say it's been a challenge for co-ops to face not only state regulation but several levels of cms regulation and congressional oversight investigation which began before the co-ops opened their door so there's no question administrative resources have been distracted and diverted to comply with multiple levels of regulations that far

cms plays a dual role. cms to give co-ops to succeed and looking for flexibilities. at the request of co-ops, surplus notice and infusion of outside capital consistent with framework of the co-of op program. cms plays oversight role, serve as primary regulator of insurance in the state, work the ensure that the co-ops are well round and financially sound. evaluating applications, monitoring financial performance and conducting oversight, all co-ops are subject to standardized activities including calls to monitor goals and challenges, periodic on-site visits, performance and financial auditing and a host of additional measures employed as needed such as the evaluation of co-op sustainability. if a co-op experience issues, it's required to describe steps to resolve those. as part of our oversight efforts, cms has put co-ops on enhanced schedules or plans, despite the support and oversight, some new entrance markets have struggled to succeed. our first responsibility is to make sure current policy holders are able to retain coverage till the end of the year. cms's prio

will cms gives much ability to families? , with only one statewide exchange available in west virginia, one statewide exchange -- senator this will now result in families paying 120% higher premiums than they were the last year. is that fair? this issue is not just about another failed obamacare program costing taxpayers in excess of billions of dollars. it is an opportunity for us in this room and in congress to express our compassion and empathy for the hard-working families that have lost their sense of security. i look forward to the presentation today. i yield back the balance of my time. >> dr. burgess will take the rest of the time. dr. burgess: thank you for the recognition. i think it is important we have this hearing today. there is a lot of policy in the affordable care act. a lot of it was bad. and the co-op program was no exception. it has wasted millions of dollars, suffer from a lack of oversight, and created and stability for millions -- instability for millions. it was unsound from the start, another example

cms plays an oversight role. cms along with state departments of insurance, which serve as a primary regulate of of insurance in the state work to ensure the co-ops are well run and financially sound. cms has implemented the co-op program as required by statute and with the funds available, evaluating applications, monitoring financial performance and conducting oversight. all co-ops are subject to standardized ongoing oversight activities including calls to monitor goals and challenge, periodic on sight visit, performance and financial auditing, reporting only negotiations and a host of additional measures employed as needed on a case-specific basis such as the evaluation of co-op sustainability. cms increased the reporting requirements for co-ops required for them to provide quarterly statements saying they're in compliance with state licensure requirements. if the co-op experienced requirement issues, the co-op was required to describe the steps being taken to resolve those. financial data collection has helpe

when did cms know these co-ops would fail? >> we have been doing oversight since the co-op inception. each circumstance is very unique. periods ofdifferent time we had information where when you folks were going down the wrong path potentially. they put enhanced oversight and action plans and we took action. we are in the very early stages of this program. i think from the discussion today, you can see we have taken our oversight responsibility very seriously. trying to like we're be the best stewards of taxpayer dollars possible. is their political pressure to keep these co-ops alive? >> i would say we are trying to do our best job possible to make sure consumers can know that if they go to the marketplace now, they are strong and stable. we had done a tough job here. i think if there was another way we could have arrived here, we could have but we have been doing some tough for. >> that didn't answer the question but i understand. r's?o we need the three if i if i was going to start a business, i would not rely on 's to make

when did cms know these co-ops would fail? >> we have been doing oversight since the co-op inception. each circumstance is very unique. there were different periods of time we had information where when you folks were going down the wrong path potentially. they put enhanced oversight and action plans and we took action. we are in the very early stages of this program. i think from the discussion today, you can see we have taken our oversight responsibility very seriously. we do feel like we're trying to be the best stewards of taxpayer dollars possible. >> is their political pressure to keep these co-ops alive? >> i would say we are trying to do our best job possible to make sure consumers can know that if they go to the marketplace now, they are strong and stable. we had done a tough job here. i think if there was another way we could have arrived here, we could have but we have been doing some tough for. >> that didn't answer the question but i understand. why do we need the three r's? if i was going to start a business out

cms also plays an oversight role. cms worked to ensure the co-ops are well run and financially bound. cms and lamented a program as required by statute, evaluating applications, monitoring financial performance. all co-ops are subject to standardized, ongoing oversight activities including calls to monitor goals, periodic on-site visits, auditing, reporting obligations, and additional measures like the evaluation of co-op sustainability. cms increased the reporting requirements to provide quarterly statements saying they're in compliance. financial data collection has helped cms develop financial issues and give us an opportunity to work with insurance regulators to correct issues. cms has put some co-ops on enhanced oversight schedules. despite the support and oversight, some new entrants have struggled. when states determine a co-op should wind down, our responsibility is to make sure policyholders are able to retain coverage. it's necessary to make sure customers have access to quality, affordable coverage. we're w

however, as you know, cms has no additional funds to assist. the solution to this issue is to allow individual co-ops to raise capital. in fact, as you may remember, the ability to obtain private capital in section 1322 was one of the measures by which the original applications were judged. cms should amend the loan commitments to allow taxability of raising capital because the restrictions on obtaining additional capital are not required under the aca section 1322. second, risk adjustment creates additional issues and formal is -- formulas applied by cms are skewed due the benefit of pre-existing insurers with administrative ability and years of claims data. the solution? cms provides the risk adjustment formula for providing a level playing field for all carriers. third and finally, the risk corridor payments. the solution is a swift revolution -- resolution to the current funding deficit for the program will go a long way to improving the balance sheets and long-term outlook. finally, we at evergreen health hope that both sides of the island

i'm disappointed the ways cms has managed this problem. but equally to blame is congress we have not worked as a partner to support the emerging market to bring more competition dominated by one or two insurers i do wish we would have saved the co-op but i knowed better. and space sharing with the title affordable care act or obamacare somehow will not be productive you not spend the next several hours we could do meaningful oversight rather than trying to abolish the affordable care actther than trying to abolish the affordable care act but for them and to root for the law specifically congress has squandered the last five years from every bump in in the road rather than focusing on how to make it better. but they may get harder for those constituents i am not suggesting be affordable care act has been perfect but i think the bumps in the road is to move the ball forward of play can do that we can improve health care coverage for millions of americans. to say in the op-ed last weekend it's not about spreadsheets is about people to skyrock

will cms gives much ability to families?h only one statewide exchange available in west virginia, one statewide exchange -- senator this will now result in families paying 120% higher premiums than they were the last year. is that fair? this issue is not just about another failed obamacare program costing taxpayers in excess of billions of dollars. it is an opportunity for us in this room and in congress to express our compassion and empathy for the hard-working families that have lost their sense of security. i look forward to the presentation today. i yield back the balance of my time. >> dr. burgess will take the rest of the time. dr. burgess: thank you for the recognition. i think it is important we have this hearing today. there is a lot of policy in the affordable care act. a lot of it was bad. and the co-op program was no exception. it has wasted millions of dollars, suffer from a lack of oversight, and created and stability for millions -- instability for millions. it was unsound from the start, another example of th

>> cms has been doing oversight of the co-ops from the beginning of the program, as i i mentioned. we are just in t t second year of the program n n. scott: t t co-ops still left standing, including montana. the hearing was a chance to stress the suppose it successes. >> based on the 3.7 million americans, consumers in those states have already saved more than the total cost of the co-op program. scott: morrison told us he thinks the remaining co-ops will survive. after two separate hearings this week, congress promises they will be under plenty of scrutiny. sharyl: last week, we talked about excessive compensation of certain ceos. we shot we would -- thought we would show a hiaphic this week courtesy of "daily caller." look at this. these are above $400,000.. that is how much the president of the united states makes. scott: what is interesting is the two in red, colorado and south carolina. those are failed co-ops. gre green are ones that are stililactive, but going to be watched closely.y. sharyl: thanks so much, scott. the republican campaign field may be narrowing soon. governo

cms is like dog years, so it feels like about 35.story, one of our communications folks said, patrick, you need a new picture. i said, why? you look a lot older than when we started. i asked my wife, do i really need a new picture? she said, yes, you really need a new picture. i'll move through the slides relatively quickly, if i can. maybe i'll say "next slide" and you can move them. perfect. i'll adhere to the time limit. if you think about the affordable care act, three major changes. one, insurance coverage. we're at the lowest insurance rate in recorded history for the united states. i had another set of data come out yesterday. i won't talk much about that today. i will talk about health system transformation, delivery system reform, really focusing on the cost and quality of care. if we go to the next slide. this shows a cbo estimate from 2010, and then looking again at 2015, predicted over $20 billion in cost savings from reduced medical trend. as you all know, both our own actuary and independent analyses now are saying a po

he talked about the three domains and cms and hhs broadly want to gain insight. one is the area of value and value-based payment. the second he reference sudden transparency. now you mentioned we have anecdotes now about what's going on with some generic drug price increases and so-called branded generics. you mentioned some aren't really generics that get caught in this mix. but what would you suggest needs to happen yourself now from the standpoint of more transparency, more information about the drugs, the costs? we know there's a patchwork which under even generics are priced around the country. drug prices for generics can differ greatly depending on what program is buying them, et cetera. what do we do, and where do we go from that round? >> to me, i think one of the most important things that we have to factor in, in a collective desire to ensure affordability across the entire spectrum -- and to sort of answer that question, i want to pick up something that kristi said in her opening comment which is this is off is not a -- this is such an amazing time. w

i've got to calm down, get on cm. for three years, so right now, i ain't seen my family in four years. when i go to sleep at 10:00, 11:00, that's when i think about my family. that's the only thing i've really got, because in the end, no friends are going to do anything for you, but your family's the ones that are going to be there. >> it will now be up to administrators to determine if roca moreno will have his visitation restored. in the meantime, officers knight and demerey will update their photos with roca moreno's tattoos and question him about his ties to the nietas. >> on the wall, on the wall. >> just going to take a few pictures. >> what do they call you, roca? >> alfredo. >> alfredo? >> we're not going to call you by your first name. >> come on now. what do the other guys call you around here? >> alfredo. >> no, no, what's your ak, your nickname? it's going to be one of them? >> one of what? >> i ask questions, you don't answer? >> no, all depends on what kind of questions you ask me. >> where all this came

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has cms terminated any loan agreements? ms. jarmon: i am not aware. dr. cohen: we have terminated the loan agreements for the 12 co-ops that are shutting down. rep. collins: did we get any money back? vermont, we did get the vast majority of the money. there was some funding that was used in start up funds that was not recovered. basis, we ared making sure that consumers have coverage through the end of the year. the identities will be operating through the end of the year. at that time, we will do a run out of claims and understand the financial health of the organization and use all of our ability with the terms of the loan agreement to recover funds. rep. collins: that is not the case in new york. which lostn new york $250 million and is shutting down in two weeks time -- that does not line up with your testimony. dr. cohen: that is why we are doing so much of the hard work right now before the open enrollment period to make sure we understood the financial health of any one of these co-ops and because we want consumers to be confident that there would

we're working collaboratively with cms to bring innovative systems at the health plans have been doing in the private space into government programs. and it's critical. >> what's a good example of one of those? >> you could see what they're doing on hips and knees bundle payments. >> the conference of -- >> exactly. something health plans have been doing in the private sector. just like with the risk sharing arrangement with prescription drugs. it's getting the incentives right. we do it with providers by collaborating with them on the quality metrics on the price side, through global budgets and the like, so the incentives are to get the outcomes, not volume. that's the key. i think the challenge is, there's no silver bullet when it comes to prescription drugs, these types of risk sharing arrangements work when you have competitors in category or class. then the pharmaceutical manufacturer has an incentive to differentiate themselves. when you're a single source drug with no competitors, what's the incentive? you have a monopoly. health plans are price takers, we had no leverage to ne

not on this slide, our own quality measures for cms. over 59% of the measures improved significantly over the last three year so significant improvements in quality across the u.s. next slide. thank you. this just -- we'll test to see if i have to look it's -- our frame for delivery system reform. we talk about incentives, both privateer and consumers, value based purchasing, alternative pavement models and care delivery, true population health management and also engagement of patients in their care through shared decisionmaking and other means, and then we talk about information, which is transparency about quality and costs of care, but also the right information at the point of care. i'm still a practiceing precision, take caring of children with multiple chronic conditions and that information at the point of care is critically important. next slide. this is a payment framework. you do not need to memorize but was published 18 months ago now. four categories of payment alines with a lot of the private sector folks you'll have for i

>> well, there are a couple of things that cms can do.he first big one i think is that they could reduce or at least dial down the special enrollment periods with very big hardship exemptions that's allowing some of this instability to persist in the marketplace, and i think that would cut some of the losses that players like humana in particular and now united are facing. the second is that there were supposed to be these backstops called the three rs in risk corridors that were expected to give some cushion to the insurers in the early years when the exchange marketplaces were not stable. however, the end of september cms has now said they will not be paying out the entire risk corridor payments to the insurers, and as a consequence the pricing by the insurers on exchange has not been adequate for the losses they're facing. that's another change that could be made as well. >> a very thorny set of problems. anna gupte, thank you very much. anna is with lierinkpartners. >>> a big move late today by another dow component. nike will split i

cm g estimate is 27.8 million dollars. we tried our budget with 18.86, we tried to bring down the cost as best as we could. the ceiling core /tkpwaeugz has been changed from 6 inches to 3 inches. and we reduced angry /hraeugz throughout the process to make sure we're reducing the cost as much as we can but we could not bring it down to what we had budgeted. this is a breakdown of the cost. we're commending the award for 22.$6 million. we issued a total amount for 4.1 million dollars to maintain the construction schedule and have them build part of the ceilings that needs to be done as part of the embeds. so we'll be asking you to approve 24.2 million dollars. and that's all i have for this trade package. >> questions? >> just to clarify, just to kind of apples to apples, when we approved the pre-construction services of the design bill that was based on an expectation of 15.9 million construction and the actual direct, the equivalent is 19 something? >> yea. >> are those the comparisons. >> director harper, 19 + the part o

cm g estimate is 27.8 million dollars.we tried our budget with 18.86, we tried to bring down the cost as best as we could. the ceiling core /tkpwaeugz has been changed from 6 inches to 3 inches. and we reduced angry /hraeugz throughout the process to make sure we're reducing the cost as much as we can but we could not bring it down to what we had budgeted. this is a breakdown of the cost. we're commending the award for 22.$6 million. we issued a total amount for 4.1 million dollars to maintain the construction schedule and have them build part of the ceilings that needs to be done as part of the embeds. so we'll be asking you to approve 24.2 million dollars. and that's all i have for this trade package. >> questions? >> just to clarify, just to kind of apples to apples, when we approved the pre-construction services of the design bill that was based on an expectation of 15.9 million construction and the actual direct, the equivalent is 19 something? >> yea. >> are those the comparisons. >> director harper, 19 + the part of

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cohen if we could get a commitment out of cms to provide the analysis that resulted in the cms awarding additional funds to new york's co-op ends of that at the end of 2014 spin i will work on that. >> annie duke commit that cms will provide us any co-op corrective action plans that may exist as you've done this analysis. could you forward those to the committee speak with i will have to look and see. some of those are market sensitive but we will do our best to get will begin to the committee. >> thank you for that. also i would like to entry into the record a "wall street journal" article that does have a quote from the cms the risk of corridors were intended to be much -- budget neutral ask unanimous consent to enter this into the record. so moved. as we conclude our hearing, can i want to first of all have also say that we ask unanimous consent that members written open status be introduced into the record and without objection those documents will be entered into the record. and i'd like to thank our two witnesses for your comments as we all want to work together to a can be good s

reportera: la cirugÍa durÓ casi ocho horas, redujeron 8 cm de intestino, lo que lo mantiene en condiciÓn quÉ pudo en ilia: itan es un niÑo siete aÑos que has asumido la responsabilidad de cantar el himno de australia, pero cuando comenzÓ cantar, le dio un ataque de hipo. enrique: a pesar del ataque decidiÓ seguir cantando, ante la ovaciÓn del pÚblico, vamos a escucharlo. no te burles, ilia! ilia: pobrecito! enrique: te va a pasar un dÍa, despidiÉndote el noticiero. ilia: me despedirÉ como él, con responsabilidad. 6>> entiendo que haya cuestionamientos y discrepancias, pero tenemos solamente una porterÍa y debemos elegir. >> rubÉn sambueza, gool! >> lo vamos a extraÑar, nos dio muchas alegrÍas. >> estÁ en riesgo su carrera y Él lo sabe también. ♪

reportera: la cirugÍa durÓ casi ocho horas, redujeron 8 cm de intestino, lo que lo mantiene en condiciÓnrique: quÉ pudo crest presenta mi hermana siempre me dice que no todas las pastas y enjuagues son iguales. no le creía, hasta que un día mi dentista me dijo lo mismo. ahí me hice pro... ...con crest pro-health advanced. avanza desde el primer día hacia una boca más saludable, más fuerte, más limpia. esta pasta y enguaje hacen que mi boca se sienta increible... y mis dientes más fuertes. crest pro-health advanced es superior en estas cinco áreas esenciales. me va a ir muy bien. avanza desde el primer día hacia una boca más saludable, más fuerte, más limpia. mi hermana tenía razón ¡me fue increíble! en ilia: itan es un niÑo siete aÑos que has asumido la responsabilidad de cantar el himno de australia, pero cuando comenzÓ cantar, le dio un ataque de hipo. enrique: a pesar del ataque decidiÓ seguir cantando, ante la ovaciÓn del pÚblico, vamos a escucharlo. no te burles, ilia! ilia: pobrecito! enrique: te va a pasar ♪ ♪ >>buenos dÍas, hoy es martes 24 de noviembre, esto es al despertar y yo

. >> el sospechoso traÍa un cuchillo de caza de ocho a 10 cm de largo. >> escuchaba mucha sirena de policÍasaba pasando pero recibimos la alerta por correo electrÓnico de que habÍa gente herida. beatriz; no se ha dado aun la identidad del sospechoso. leÓn: expertos en salud mental recalca la importancia de identificar el comportamiento de personas con tendencias violentas, los iguales con consideran que una actitud hostil se puede considerar como ansiedad y que hay ciertas seÑales de alerta que pueden indicar que la persona tiene problemas. >> cuando escriben cosas, o dibujos tristes, o acuchillando otra persona, cuando se encierran mucho en su cuarto cuando escuchan diferentes tipos de mÚsica. leÓn: informarse de los problemas mentales es el primer paso. marÍa: se advierte que los cangrejos del pacÍfico estÁn contaminados con una toxina que puede ser mortal, debido a las altas temperaturas del ocÉano la madre naturaleza se ha encargado de producir un alto nivel de algas que afectan a los crustÁceos. >> yo he oÍdo a 1 bar que los que estÁn sacando cangrejos en diferentes Áreas. >> la tempora

cms is like dog years, so it feels like about 35.ue story, one of our communications folks said, patrick, you need a new picture. i said, why? you look a lot older than when we started. i asked my wife, do i really need a new picture? she said, yes, you really need a new picture. i'll move through the slides relatively quickly, if i can. maybe i'll say "next slide" and you can move them. perfect. i'll adhere to the time limit. if you think about the affordable care act, three major changes. one, insurance coverage. we're at the lowest insurance rate in recorded history for the united states. i had another set of data come out yesterday. i won't talk much about that today. i will talk about health system transformation, delivery system reform, really focusing on the cost and quality of care. if we go to the next slide. this shows a cbo estimate from 2010, and then looking again at 2015, predicted over $20 billion in cost savings from reduced medical trend. as you all know, both our own actuary and independent analyses now are saying a

we're working collaboratively with cms to bring these from the private space into government programs. and it's critical. >> what's a good example of one of those? >> you can see what they're doing on hips and knees now. bundle payments. something health plans have been doing in the private sector. just like with these risk-sharing arrangements with prescription drugs. we do it with providers by collaborating with them on the quality metrics and then on the price side the risk-sharing arrangements through bundle payments, through global budgets and the like, the incentives are to get the outcomes, quality outcomes, and not volume. i think that's key. there's no silver bullet here. when it comes to prescription drugs these types of risk-sharing arrangements work when you have competitors in category or class because then the pharmaceutical manufacturer has an incentive to differentiate themselves from their competitors. but when you're a single source drug with no competitors, what's the incentive? you have a monopoly. health plans were price takers. we had no leverage to negotiate. th

enfermeras que trabajo en el caso dijo que sacaron una larva que habÍa crecido hasta formar un quiste de 1 cma y al borde de la muerte. enfermera: nunca habÍa visto un caso asÍ en toda mi carrera de enfermera. reportera luis no sabe cÓmo entrÓ este gusano a su cuerpo. puede venir de la carne de cerdo que no estÉ cocinada totalmente o de vegetales que no estÉn correctamente lavados la odisea de luis actualmente no termina, sigue con terapias cognitivas para recuperarse. luis: ahora no puedo recordar varias cosas recientes pero cada dÍa que pasa estoy progresando. reportera: el personal mÉdico del hospital asegura que la operaciÓn de luis fue un Éxito ya que hubo la posibilidad de que luis perdiera la memoria y el habla. maria: los dueÑos de los negocios de la calle san josÉ, >> cuando hablamos de las personas que han sido afectadas no solamente hablamos de los negocios, hablamos de negocios y familias, pero tambiÉn de los empleados de los negocios. marÍa:la propuesta fue aprobada hace dos semanas. >> en la ciudad de alameda que durÓ varios meses en alta mar, evitaron que decenas de toneladas d

lourdes: tiene 1 cm pero los estragos que estÁ causando son gigantescos, tanto que se ha decretado el donde se establece esta mosca causa daÑos entre 25 a 50%. en la florida esto representa una industria de mÁs de 123.000 millones de dÓlares. lourdes: es lo que estÁ en riesgo, las autoridades han logrado cercar a la mosca estableciendo cuarentena de 97 millas cuadradas al sur de miami. estÁ prohibido cualquier movimiento de la fruta fuera de allÍ. >> cuando la mosca pone sus huevos dentro de la fruta eso causa que no se pueda mercadear esa fruta. lourdes: tampoco se puede exportar, una imagen que se repite por toda esta zona. arboles llenos de frutos que no se pueden recoger por ahora, y otros en el suelo, que tampoco se pueden tocar. >> entonces tienes el gasto de recogerlas, ponerlas en bolsas negras y botarlasen lugares apropiados. periodisat: impacta a las empresas y empacadoras. >> no pueden aguantar el golpe de la inversiÓn y al no poder cultivar y sacar sus productos y poder venderlos, a recuperar su dinero. >> me han quitado toda la fruta, hago todas mis cuentas, me los han qu

. >> we have got to be c cm, but not stupid. >> as president, i would give the mission to the pentagon and ask them what they need to accomplish the mission. >> they could be isis, they could be anybody. wh is our president doing? is he insane? >> folks wt to pop off and have opinions about whatat they think they would do, present a specific plan. >> mr. president, you want to insult me, you can do it overseas, you can do it in turkey, in foreign countries. mr. president, come back and insult me to my face. >> we cannot act as though we arshutting the doors to people in need without undermining who we are as americans and the values we have stood up for. sharyl: it is "follow the money." if the antics on the campaign trail are not alien enough for you, how about this? our government is using our tax dollars to pay for foreign kids to attend u.s. space camp. senator paul: we spenen$2,000 last year inviting 24 kids from pakistan to go to space camp in alabama. we borrow money from china to send it to pakistan. it is crazy, it is ridiculous, and it should stop. sharyl: senator rand paul w

the details are still yet to be worked out so they haven't been affirmed between the state and cms. cms granted a extension of the waver through december 31 and the new waver elements began jan 1 of 2016. caph, california association of public hospitals is working closely with the state to develop the detailoffs sth waver rks the special terms and conditions agreed upon by the kait and cms and [inaudible] myself represent the department at the boretd and will mead this week to talk more in detail about how the allocations will occur and what the details the study we would like to propose would be. >> that will be occurring in the next month and a half before 2016? >> that is correct, all of that is done before 2016. >> we can get a more detailed report at the begin thofg year? >> absolutely. >> thank you. any other questions, commissioners? if not was there public cominstant >> no public comment re quested. item 4 is general public comment and notd received public comment requests. we should move on to item 5 is the finance and planning committee report. >> mr. chung >> good afterno