given it's a ppo model, you watch it. however, one of the things that is noted is that because of the low membership, you have a lot of variability in the rates from year to year. and that's why you see some variability between reporting periods. one of the things again drawing out . heche just to add to the discussion had no admits in the last 3/4. >> on slide it should be 65.2. >> yes. i'm sorry. there was an error. >> these are admissions into the er. if we move on to page 7. 9 days per thousand. this again is reflected of the small enrollment, but if you compare it to your other two health plans, you will notice that blue shield is at 169 and kaiser 185. so what does that mean? if you would set uhs is the baseline, you would find if they would make blue shield the baseline, you would expect them to be about 300 admits and kaiser about 280. they exceeded even if they are one. they are above and beyond what you would predict for utilization. now as far as the average, as you remember, uhs is a length of time of average

that they pay. >> well, the -- the hmo in california in general, it's decreasing gradually and the ppo is increasing, but there's still a large number of hmo members. in most cases, as far as anthem goes, the hospital pricing is a contract between anthem and the hospital. so, the professional component is where the -- with the exception of about 15% of our network, which is a full risk of a global setting with a contract with the hospitals, so the answer in short is that the hmo is currently not part of this initiative. and the prices paid at those institutions are the prices that t the. >> and this is a -- thinks it's related. it might not be. why can't reference pricing be part of the carrier network contracting negotiations, discounting up to the reference price. with was that a reasonable question in this context? >> i'm a physician at heart. in the negotiation rather than the negotiated price agreed upon by both parties. >> i guess that's right. as you establish a network that's willing to meet that price, can you leverage that from those outside that range and negotiate that as p

as you saw in some of the slides that were shown earlier, there was this comparison group of anthem ppo members in the same geography as was the, as were the calpers pens. members. we have a number of other clients that have as a result of the successful experience we had with calpers and with kroger have also joined the reference-based benefit movement, and so i've listed some of these. it's not as important as much as the fact that there is now, i would say, a shift, and a number of large employers are embracing this program as a way to disrupt the continued increase in health care costs very largely driven, in fact, by institutional pricing. so this has been a very encouraging development. in addition, we also have expanded it to include what kroger has included and what others have used in the past to include for outpatient procedures which are for cataracts, arthroscopy and endoscopy. so this is definitely something which has really blown the lid off, i think, the veil of secrecy over pricing together with a number of other events that have happened in the past and some recent publ

what i will notice is that the city plan is a ppo model, a preferred provider organization which is a health maintenance organization. but even given that difference you will notice there is an almost that the cost on a member per month basis is twice blue shield and even more on the part of kaiser. and you will also notice that if you compare the two groups that you will find that the city plans on an annual basis it's not an end point basis. blue shield is 37 and kaiser is 35. what that does if you are looking at a demographic factor rating whereas 20 is a 1, 40 is a 2, you will see that the city plan because of their age, their demographic factor applied to the rate is 2.29 versus kaiser which is 1.56 because of the cost in the age. this is a very significant issue. what you also noticed even with that, in spite of the decreasing membership that cost continue to grow year over year 13 percent last year which is above the national trend. moving on to page 5, here what we are looking at is the total cost per member per month, what we are looking at you will see the city active per me

the least expensive, blue cross, ppo, $550 a month. more for kaiser and blue shield. but they can offer other options. then there are silver plans. >> silver plans are going to pay about 70% of your medical costs. >> reporter: but higher premiums. so on, up to platinum. >> it's always a balancing act. we're trying to balance coverage needs with your budget needs. >> reporter: you can also buy individual issuance outside covered california. remember, ask if your doctor accepts the specific plan you choose before you sign up. for millions it could be a good deal. >> about 16 to 18% of californians are going to benefit significantly from the affordable care act. >> reporter: 77% of californians have job based, or government healthcare and will see little change. but some employers may stop offering health coverage. >> by 2019, we expect about 3% fewer californians will be in job based coverage. >> reporter: about 1 million californians like the rodriguezs will have to pay significantly more for healthcare. and those subsidies, they're the same nationwide. don't factor in

the least expensive, blue cross, ppo, $550 a month. more for kaiser and blue shield. but they can offer other options. then there are silver plans. >> silver plans are going to pay about 70% of your medical costs. >> reporter: but higher premiums. so on, up to platinum. >> it's always a balancing act. we're trying to balance coverage needs with your budget needs. >> reporter: you can also buy individual issuance outside covered california. remember, ask if your doctor accepts the specific plan you choose before you sign up. for millions it could be a good deal. >> about 16 to 18% of californians are going to benefit significantly from the affordable care act. >> reporter: 77% of californians have job based, or government healthcare and will see little change. but some employers may stop offering health coverage. >> by 2019, we expect about 3% fewer californians will be in job based coverage. >> reporter: about 1 million californians like the rodriguezs will have to pay significantly more for healthcare. and those subsidies, they're the same nationwide. don't factor in

. -- ppo. i was an independent freelance writer. i could always afford very good coverage, even when i struggled. the last 15 years i have been on my own small business plan, and costs me $1020 a month. i still have the doctors i want. i still have the facilities i want. i think it is working in massachusetts. i have 2 quick questions i have to ask. comparing massachusetts and what we can learn from our experience and the nation. my perception, and i was not paying close attention over the decades in massachusetts -- i never had to give up my doctor and i never had to give up my facilities. i was paying my way and i kept paying, but i paid more. what is the difference? why are we having this problem nationally? 10 years ago i called my senator and i said what is with this? my individual policy, which is a $1000 deductible and a 20% co- pay, was going to be a cadillac tax. it would be taxed at 40%. i was very concerned. the gentleman said it was passed by the legislators who were trying to stop the goldman sachses of the world from g

blue cross, keystone, hmo for about $2,000 a month with no deductible and an independence blue cross ppored me all the information i had provided would be inputted into the online application and merged with my online endeavors via my social security number just as soon as the bugs were out of the website, whereupon, i would be able to go online, review all nine plans that were available to me. that was great news except for the fact that a few days later when i finally could access the website, none of the data that i had provided over the phone was on my application. i had to start all over again. when i finally inputted all of my information, i was now asked to prove my identity by uploading my driver's license. it seems that my multiple efforts to get a quote convinced the computer model that i was a fraud. hey, if a crook invests this much time trying to impersonate me, i say he deserves my insurance. my fingers are crossed for this weekend. i'm convinced the conversation will change in this country just as soon as people can competitively shop. apparently, i'm going to have nine ch

i currently have a blue cross blue shield ppo 80/20 plan. it has been affordable to me and i want to reiterate that. i want to say that one more time. it's been affordable. i have been happy with it. and now i'm being told it's substandard. >> substandard means that with the new requirements the government has to cover pre-existing conditions, to cover more folks, they have to be brought up to speed and that doesn't come cheap. to keep up with that you're going to have to charge more and in your case how much more were they talking? >> my premium is going from 363 to 713. my deductible is going from 1750 to 3250. i want to talk about essential health care benefits. when i contacted blue cross blue shield, they told me that the reason that i no longer had the right to choose to stay with my plan as i was told i did is because i wasn't being grandfathered in with a date of march 23, 2010, when the affordable care act was signed into law. they told me that they were migrating quote/unquote into the health care marketplace. i view this as a loss

they can let their employees decide which hmo or ppo or insurance company to select. anecdotally, small businesses i have been talked to have been very, very pleased with the product offerings, the range of offerings and the prices. >> thank you. >> thank you very much. senator johnson, thank you for joining us. >> thank you, madam chair. in solving any problem in negotiation, first thing you want to do is figure out what can you agree on. there are a couple things i can agree on with you right off the bat. we need to fix this bill. and there's a lot to fix. secondly, it sounds certainly in your opening statement that you're giving states a lot of credit and we're having real problems on a federal level. i agree. the federal level i don't think has any capability of doing this. the states are far better, far better place to start solving this problem. i want to start my first question with mr. knoll. did kentucky need a 1600 page bill and 20,000 plus pages of regulation to do this small business exchange? quickly. you could have done it on your own, couldn't you? >> w

. >> i currently have a blue cross blue shield ppo, 80/20 plan. okay? and it has been affordable to me, and i want to reiterate that. i want to say it one more time. it has been affordable. i have been happy with it. and now i'm being told it's substandard. my coverage currently would be stopped as of december 31st. my premium is going from $363 to $713. my deductible, my deductible is going from $1750 to $3250. >> not tough to find these stories. >> that's the problem for the white house. this has moved from a theoretical debate over the past three years to real numbers where people are doing real math. i mean, people are getting these letters. these are not made-up things. people who have household budgets are trying to find a way to make this work. and the problem for the administration is, they can spin it and jay carney can refuse to give out the enrollment numbers and they can play games with the timing, but it doesn't matter. ultimately, the numbers are what they are. people are getting these notices. one of the other arguments that defenders of

i took out this plan that's a catastrophic ppo plan with united health care called pacific care because it's a california market. since 2005 it has been fantastic, giving me total freedom to choose. i have been with this plan to sloan keterring in new york, md anderson in houston. i have a rare and aggressive gallbladder cancer. it's very late stage. it's come back just in the last two years it came back viciously p in my liver and lung again. so i have had to fight. that's how cancer is. you can fight, fight and think you're winning but it's sneaky. >> and the ongoing relationship with your doctors is so critical. i know united pulled out of the market for various reasons, but the c ereo was explicit that ob care tipped the scales. the white house rejected that. i have to run. i will give you a quick last word on the tweet challenging your account. >> you know, i just didn't understand why they felt that was necessary. because let's fix this. it's so complex. it's unbelievably complex and confusing. >> and don't blame the victim. >> right. >> i have to run because i'm up against a hard

the huge choices that are available to small businesses. 267 different products, everything, hmos, ppos, no deductible, high deductible, everything from all of the major insurance companies. and our value proposition is we want to make it as easy as possible to small businesses to be able to offer coverage and offer small businesses the kind of clout they never had in the past. and that as well as the business community in the district stepping up to the plate, putting politics aside and helping us make hard decisions and helping us to build this, d.c. health link to provide service that's small businesses need and want and are desperate for in terms of affordability and predictability and an opportunity to offer great options to their workers. it took a village and the small business community was a part of it. >> thank you. >> madam chairman, back to the enzy proposal again, i heard your explanation. you voted against it because it eliminated lifetime caps that was required under obama care and eliminated the 26-year-old coverage which was required under obama care. but that this is e

the huge choices that are available to small businesses. 267 different products, everything, hmos, ppos, no deductible, high deductible, everything from all of the major insurance companies. and our value proposition is we want to make it as easy as possible to small businesses to be able to offer coverage and offer small businesses the kind of clout they never had in the past. and that as well as the business community in the district stepping up to the plate, putting politics aside and helping us make hard decisions and helping us to build this, d.c. health link to provide service that's small businesses need and want and are desperate for in terms of affordability and predictability and an opportunity to offer great options to their workers. it took a village and the small business community was a part of it. >> thank you. >> madam chairman, back to the enzy proposal again, i heard your explanation. you voted against it because it eliminated lifetime caps that was required under obama care and eliminated the 26-year-old coverage which was required under obama care. but that this is e

they could choose from post to your the hmos and ppos and point of service. plansn get no deductible or a high deductible plan. full employer choice. if they want to offer different levels of coverage, that employer can choose that as well. full choice. i wanted to include a slide on prices for the that has been in the news quite a lot. our premiums are very good and competitive. slide.you cannot see the hopefully, the one in your packet you can see. if you are 27 year old in the district of the individual side, you get a bronze level policy for a $124 a month. you can get a aonze a level policy for $295 month. very competitive. the same is true on the small group side. -- when we posted a doctors and legislation that required full transparency and pricing, we saw a real price competition. we made the rates public. what insurance company came to the lowered their rate twice. one company came back lowered their rate wants. andird insurer came back added additional products. we in the district saw real price competition work through price transparency. competit

i am also wondering if the insurance may be continuing to models -- ppo models. guest: that is a good point. one of the things we're seeing a lot of and the exchanges is that the plans are keeping their costs down by narrowing down networks. they are saying that you can sign up for a plan, but you can only go to these specific hospitals. that is the hmo model that you talked about. it is something that, if people are cost conscious, they might value. if they value choice more than paying a higher premium, they may be very frustrated. their local hospital may not be in the network. suddenly they are driving a good distance away to get the care they normally would have gotten around the corner. this will be a story of the upcoming year. we will see this take effect and people will start to either appreciate them because of the cost value or become frustrated because they cannot go to their local facility. host: take us back if you could. following the president's action on thursday, the house vote on the bill on friday -- remind us of what is in the senate. who has

they can just decide how much to contribute and let their employees decide which hmo or ppo or insurance company to select. anecdotally, small businesses i talked to have been very pleased with the product offerings, the range of offerings and the prices. very much.u senator johnson, thank you for joining us. >> in solving any problem in negotiation, the first thing you have to do is figure out what you can agree on. there are a couple things i can agree on right away, madam chair. we need to fix this bill. there's a lot to fix. in your opening statement it sounds like you're giving the states a lot of credit. we are having the problems on a federal level. the federal level as no capability of doing this. the states are far better places to start solving these problems. d, did kentucky need this massive bill to do small could youxchange e ? >> did you need a 1600 page bill to do this in new mexico? we didn't need a federal solution, did we? i think small business exchange is a good idea. >> and we had a very supportive republican governor and a democratic legislature and they compromised

i am also wondering if the insurance may be continuing to models -- ppo models. guest: that is a good point. one of the things we're seeing a lot of and the exchanges is that the plans are keeping their costs down by narrowing down networks. they are saying that you can sign up for a plan, but you can only go to these specific hospitals. that is the hmo model that you talked about. it is something that, if people are cost conscious, they might value. if they value choice more than paying a higher premium, they may be very frustrated. their local hospital may not be in the network. suddenly they are driving a good distance away to get the care they normally would have gotten around the corner. this will be a story of the upcoming year. we will see this take effect and people will start to either appreciate them because of the cost value or become frustrated because they cannot go to their local facility. host: take us back if you could. following the president's action on thursday, the house vote on the bill on friday -- remind us of what is in the senate. who has

we rejected the hmos in favor of ppos in the '90s. this conversation. we have breaking news from walmart. thank you for being with us. >>> coming up, we're going to talk to jim cramer about the big management changes. the ceo is out and we are going to talk about his successor, doug mcmillan next. today, that's easy. ge is revolutionizing power. supercharging turbines with advanced hardware and innovative software. using data predictively to help power entire cities. so the turbines of today... will power us all... into the future. ♪ (announcer) scottrade knows our and invest their own way. with scottrade's smart text, i can quickly understand my charts, and spend more time trading. their quick trade bar lets my account follow me online so i can react in real-time. plus, my local scottrade office is there to help. because they know i don't trade like everybody. i trade like me. i'm with scottrade. (announcer) ranked highest in investor satisfaction with self-directed services by j.d. power and associates. it's lots of things. all waki