mr. larsen? >> thank you, mr. chair, i'll pass. >> mr. larsen, thank you for being here. oh, i'm sorry -- >> can i request -- ask a quick question about the flexibility to the states? can states -- ten states were told they have insufficient rate review authority. you mentioned that as well, and that they might be taking them over, hhs is taking them over in september if they don't get it fixed. you also mentioned the fact that several of these states lack that authority to fix it, and unfortunately, as my understanding, many of these states don't have legislators that are currently in session. in alaska, we passed a law this year to address this, the rate review structure. it goes into effect january -- >> right. >> of 2012, but what is going to happen is my understanding is that hhs is still going to step in for this period between september and the date that it goes into enactment, and i really have to question how this promotes state's flexibility. you got a state that lack the authority. we passed a law to gain it. it doesn't quite mesh with the requirements under th

mr. larsen. appreciate the work you are doing and trying to do there at c.m.s. c.m.s. published its national health expenditures report for 2010 and found that the health insurance premiums will increase by 9.4% in 2014 as a result of the president's health law. your testimony, you discussed two tools as i view it, that the administration is using to decrease the rate of premium increases. however, the central promise of the law was that it would reduce premiums, not reduce the rate of growth in premiums. now, in light of the new report issued by your agency, how can the law keep its central promise of reducing premiums by $2,500? >> well, my understanding of the report was that it showed the rate of health care spending for last year was at the lowest it had been for many, many years. the rate was moderating. and that's a significant plan. i apologize and i'm not able to speak to the estimates by the c.m.s. person. it's the difference between what rates would have been with or without the a.c.a.

mr. larsen.l have 5 minutes to present your testimony. thank you. >> good morning, chairwoman ellmers, ranking member majors and members of the subcommittee. thank you for the opportunity to discuss how the affordable care act is improving the affordibility, accessibility and the quality of health insurance available to small businesses and their employees. providing and maintaining health insurance coverage for employees has been a challenge for small businesses for many years. states have struggled for decades, really, to improve their small group health insurance market, and i know this from my many years of experiences, insurance commissioner in the state of maryland. small businesses pay significantly more than large firms for the same health insurance policy. some estimates put that at about 18% more. there are a number of reasons for this. small businesses lack the purchasing power that large employers have. administrative costs for insurers in handling small businesses are much higher tha

mr. larsen for being here again. we will call our next panel. our next palle will be -- our next panel will be -- that's right, this one here? we have three witnesses, mr. john dickinson, director for health care issues at the u.s. government accountability office where he directs gao evaluations of private insurance, long-term insurance, and progress -- and prescription drug issues. we have daniel withrow, the president of css distribution group headquartered in kentucky and his testimony covers the u.s. chamber of commerce. i will yield to senator murphy for purposes of introduction. >> it is my pleasure to introduce to resell miller from the insurance division administrator and i commend her for her work in the consumer business services insurance division. she joined the division in 2008 and brought a background in policy issues having previously worked as director of the governor. as insurance administrator, she has a staff of 100 and a budget of $10 billion. they protect insurers and making sure they are financially sound and investigating

mr. larsen, for your continuing work on this complex and important issue. i know a little bit about it from the standpoint of a state official, having served as attorney general and participated in a number of hearings on rate review issues. hearings that were not required under connecticut law. one of the weaknesses is that hearings are not required, rates can go into effect without prior approval. despite your citing an example in connecticut, i agree the example of one insurance proposal being cut as a result of public notice and attention being focused on that proposed increase of 20%. there are more examples of rates going up than rate proposals being cut. i venture to say that is true across the country. let me begin with a question -- question, would you agree that approval or disapproval is a very important feature of the effective rate for you? -- rate review? >> we defined that would -- as a review process. if the question is in the spectrum of activities, at one and you have -- one end you have a review process and then at the other end of the sp

. >>> now on book tv come author erik larsen talks about his book in the garden of the beasts of america's first ambassador to hitler's germany william mrrson spoke at the chicago public library for 50 minutes. >> it is terrific to be back in chicago. it always is, especially on an actual nice day. i was here last week was 45 degrees. i have to tell you this makes me tremendously must all shook for the days when moodie came to my talks to read and i always like to tell this story about my very first book event, which took place when i was living in baltimore. it was just after it published a book called the naked consumer. [laughter] exactly. it's a book that nobody got. nobody read. well, one read it and reviewed the book and he did it because he was a target of the book. the book was about, by the way, about how corporations spy on individual consumers, very apt today perhaps, so why did get a call when i was living in baltimore to what to lamb tester pennsylvania to the talk, not to talk to a signing. i since learned that sunday afternoon talks are deaf and especially when you do a talk in lancaster pennsylvania on the first warm day