Care act. Followed by the Supreme Court oral argument examining prayers before government meetings. Later, Consumer Financial Protection Bureau director richard cordray. Is now called the Mercedesbenz Superdome in new orleans where the new Orleans Saints play. Built entirely at public expense after hurricane katrina. When it hosted Football Games again, that was a national feel good story and rightly so. But the public paid for all the repairs and the leak put in a token amount per the public it is invested at about 1 billion. Owns the new Orleans Saints keep so most all of the revenue generated there. One reason people dont rebel against this is that they dont understand it is taking place. The second reason is that there they feel there is nothing they can do about it area it is largely based on inside heels and the most recent time there was a vote was in miami last year on whether to use public money to renovate the place where the Miami Dolphins play in the citizens of miami voted strongly against doing that because they got to vote on it. Author Gregg Easterbrook tonight at 8 00. House and Human Services secretary Kathleen Sebelius testified before the Senate Finance committee. She talked about fixing the andthcare. Gov website enrolling people through exchanges across the country. According to reports, next week, her agency is set to release in roman figures for the first month the health there a Just Healthcare kid was open. This hearing is 2. 5 hours. [no audio] [no audio] [no audio] [no audio] we will come to order. In february, 1958, against a backdrop of a divided nation, the junior senator from massachusetts spoke at Loyola College in baltimore. The young senator named john kennedy said, let us not seekir but act. Let us not the republican answer or the democratic answer but the right answers. Let us not seek to fix the blame for the past but except their own responsibility for the future. Later, the5 years jfk advice still rings true and its important for us to remember now as we implement the Affordable Care act. Five weeks ago, the administration launched the federalov, insurance website was to be the main vehicle for millions of americans to sign up for coverage under the Affordable Care act. Needless to say, it has been a rocky rollout. Problems have plagued the website and limited the ability of americans to buy the Health Insurance they need and deserve. Let me say right off the bat that this is unacceptable. Tohas been disappointing hear members of the administration say they did not see the problems coming. Sibelius, last time you came before this committee, i used two words to voice my concern about the implementation of the law. Since then, my words have been twisted and maligned. Make no mistake i believe in this law. I spent two years of my life working on the Affordable Care act act and theres nothing i want more for it then for it to succeed. Months ago, i warned that if a nipple mentation did not improve, the marketplace might struggle. I warned that if implementation did not improve, the marketplace might struggle. On updates were unsatisfactory. We heard multiple times that everything was on track and we now know that was not the case. Thats in the past. Now its time to move forward and figure out how to fix it. Madame secretary, you deserve credit for coming before congress and the American People and accepted responsibility for the website problems. Your focus is where it should be them on the future. Its very clear to me that you are working as hard as you can to fix healthcare. Gov. Keep that. Keep at it. We made a promise to the to fix a broken system. We made a promise to ensure that all americans have access to quality Affordable Healthcare. We made a promise to ensure that no one ever went rogue just because they got sick. You, madame secretary, must make good on that promise. Some people have called for your resignation. We cannot fix the past. Helpeed to stay at hhs and get the marketplace is working. You said recently you expect the website to be running smoothly for a majority of users by late november. There is no room for error. You must meet and i prefer you beat, that deadline. Because these market lysis open the door to quality care for millions of americans who lack Health Insurance. Congressional Budget Office said millions of americans would get health care. 10 years, that number will grow to 24 million. That cant question happen unless the market is run at full speed. I believe you will fix the problems because you know how critical the market laces are. For the First Time Ever, they guarantee consumers will have access to highquality comprehensive insurance. Consumers will never he forced into bargainbasement plans or refusal of Services Like child birth or cancer treatments. They will never be denied coverage because of preexisting conditions buried they will never be cut off because they get an annual or lifetime limit. We already have examples of how the marketplace is our helping real people. Consider these three stories from letters i have received since october 1. Gary from billings, montana said the monthly premium he pays for his family of four is just over 2000. Nextys monthly premium for year will be 1100 6065 thanks to the Affordable Care act. Allison from wolf point, montana wrote to say that thanks to the act, she will have access to insurance for the first time in almost 20 years. She suffered an injury in college and because of that preexisting condition, the cost of insurance was prohibitive. Instead, she rations business to the doctor, cut back on other activities. Skiing, no hiking, no or spec writing but now, she will have access to high quality coverage she can afford. She looks forward to being active again. ,ony, Small Business owner wrote in to express his excitement at getting insurance on the market lacewell save his business 10,000 per year. As a smallbusiness business owner, i can and pathetically state that the Affordable Care act is not only good for my business, it is the only place i can of ward to provide Health Insurance for my family of employees. 10,000he can reinvest he saved into staffing, training, and the heart grow to his Business Needs to stay competitive. He added this is good for my company, myself, my employees, my family, my tenant, and our country. Thats a pretty impressive list. I have no doubt that stories like these will keep coming in over the weeks and months ahead especially once the market laces are running at full speed. Marketplaces are running at full speed. I was glad to hear you want healthcare. Gov to be running at full speed. The purpose of this here is not to affix blame but to shed some light on where things stand. More importantly, to learn what the administration is doing to correct these problems and if there is a role for congress to help, we want to be there. Thats what matters right now. As president kennedy said, let us not despair but act. Let us not seek the republican answer or the democratic answer but the right answer. Lets get this done. Thank you, mr. Chairman. Thanks for scheduling todays hearing. Thank you, secretary stability is for being here today. It has nearly six months since you last appeared before the committee. Given all that has gone on during that time, especially with the implementation of obama care, i would like to say that todays impairments is long past due. When you are here back in april, you assured us the implementation was on track. And the exchanges would be ready october 1 and it appears your statements were at best misinformed. From where i said, things do not seem to be going smoothly at all. In fact, i think we would agree the best part of the implementation of the Affordable Care act has been an absolute debacle. You admitted as much last week when you testified before the house energy and commerce hold mee when you said accountable for the debacle. Madamesponsible for it secretary, while im glad you are accepting responsibility for this disasters rollout, i would have preferred that you and the rest of the administration were honest with us to begin with. Perhaps in april, you mightve thought things were on track but you had to have several indications before october 1 that there were problems with the website and the exchanges. It is simply inexcusable that the members of this committee were not told earlier that these problems were occurring. Was not for want of asking. I personally send you a number of letters asking for details and implementation of the health care law. Many of them were ignored entirely. Toward alier attitude Senate Committee over your agency is, to put it simply, appalling and is to be rectified. Has been anyonth indication, there are likely to be numerous additional problems ahead. It is only proper you provide this committee with more regular updates on the issues with which you are dealing. I would ask that you come here once a month for the next six months to provide this committee with status updates on implementation of obama care and i hope you will agree to do so. Problems youat have encountered thus far were not unforeseen. To separate reports, one from the Government Accountability office in june and another from the department of health and Human Services office of the Inspector General in august identified significant implementation challenges months ahead of the october 1 deadline. There is no indication that the warnings from these two independent nonpartisan were heatedatchdogs by the administration or that any thought was given to delaying the start of date as a result. When you were here april 1, i raised concerns about whether adequate testing was occurring to ensure that privacy controls were in place for the exchanges. Fact, i specifically asked you about having an independent review of the entire system before it went live to ensure that all appropriate privacy and security controls were in place. You assured me that all testing protocols were being followed and that privacy issues were a high priority. However, we know that no ends of the testing occurred. In fact he officials knew on september 27 that there was a high Security Risk to the system if it went on as planned. My colleagues and i sent several letters since the spring asking for more information. What privacy controls are being implemented as part of the Exchange Infrastructure . We asked for details about whether or not testing was being done to address the privacy and security concerns we had raised. To date we have not received any answers to those questions. So, not only can millions of americans not log into the website successfully, but those who have actually succeeded could now find themselves at the mercy of identity thieves across the globe. I would call this a less than ideal situation for our constituents. Bringing us to another set of issues that i hope you will be able to shed some light on later today. Let me start with a simple premise. Words matter. We have all heard the golden saying that honesty is the best policy. Unfortunately this wisdom does not seem to apply to the obamacare pledges. More and more promises made at this time or made at the time that this law was passed are currently proving to not be reality on a daily basis. That Health Care Reform would reduce costs by 2500 for the average family. The truth is with all the new mandates going into effect, the cost of Health Insurance in this country is projected to rise at remarkable rate. Some studies, including one from the Manhattan Institute, estimated that individual premiums will increase by 99 for females 99 for males and 62 for women nationwide. And then obama saying that if you could if you like your health care and like your doctor, you could keep it, this has proven to be simply untrue. This is why the Washington Post , gave him for pinocchios. This represents the highest level of untruthfulness. You really have to try hard to get for pinocchios. You do not simply get it for making a misstatement. It was not until the last few weeks that people in the administration and the white house started trying to be right with the president said. Lets be candid. It was not a new honest streak that change their tone, it was the fact that americans started receiving cancellation notices from their insurers. According to the associated press, 3. 5 Million People have received these notices so far. Put simply, there is a long track record of broken promises to this committee and the American People with respect to how this law should or would work and the impact it would have. I hope that that will stop today. No more caveats, no more excuses , just give us the truth. Answers like we dont know and we were wrong are perfectly acceptable as long as that is the truth. I want to thank you again, mr. Chairman, for holding this hearing. As you can see, we have a lot to discuss. I want to thank you, madam secretary, for being here. I know it is not the most pleasant thing you can do, but the fact of the matter is that these are the jinnah questions that have to be answered by you and others in charge of these programs. I have not even gone into i expect he will be able to get this the i. T. Problems solved , the Information Technology problems solved. That does not even begin to answer the questions about why Small Businesses are now will not employ more than 49 people because they trigger a huge, huge expense under this i think very poorly thought out plan to begin with. Thank you, senator. Secretary sibelius, thank you madam secretary for appearing today. I appreciate your taking time to explain what is going on here. Obviously your statement will be included in the record. You know the drill. Take as long as you want to summarize, this is a very important matter. Tell us what you want to say. Thank you, chairman, ranking members of the committee, i appreciate the opportunity to update the committee on the final Implementation Phase of the Affordable Care act. The law that passed both houses of congress was signed by the president and upheld by the Supreme Court and gives millions of americans an opportunity to obtain Affordable Health coverage. This is the first opportunity for Many Americans to get coverage, including People Living in pain with chronic illnesses, young adults whose employers do not offer insurance , and parents struggling to keep up with mounting bills. In the last five weeks, access to healthcare. Gov has been a miserably frustrating experience for far too many of these americans. It is unacceptable and i am focused on fixing it and am accountable. I recognize that there is an even higher level of accountability. Accountability to the sick, the vulnerable, the struggling americans who deserve Better Health care. The impact on the lives of everyday people is getting lost. I know this because i hear their stories cause a stories, as i am sure many of you do. We have a team of experts working on an aggressive schedule so that the Consumer Experience on the web gets better every day. As the chairman has said, by the end of november they are committed to having the site working smoothly for the vast majority of users. For we do not have is a fully functioning system yet that consumers need and deserve. We do have a plan in place to identify, prioritize, and manage the remaining axes across the system. We have reinforced our team with dozens of key personnel from the government and private sector, including respected engineers, technology managers, and software developers, designers and analysts from company like oracle and red hat. They are helping to diagnose problems and making quick decisions to analyze, troubleshoot, prioritize and resolve issues in real time. As this work continues we know that americans are shopping for plans, signing up and enrolling online on paper, on the phone, and in person. In fact, more than 2 Million People have already called the call center with an average wait time of less than 30 seconds. I want to share with the committee a few indications of progress, what we have improved and what we intend to fix of the problems that remain. The two major areas of for of focus our performance dealing with speed and reliability, and functionality, fixing the bugs and other problems in the system. In the first few weeks after the launch of healthcare. Gov, users had to wait an average of eight seconds for pages to load, today takes typically less than a second. One month ago viewing the health land took minutes, today takes seconds. Many consumers use to see a blank screen at the end of the application process. Today they see if they are eligible for financial assistance, the next step in the process. Users are receiving far fewer error messages and timeouts and are now able to process nearly 7000 registrants per hour with almost no errors. We have made more than a dozen additional fixes this weekend, allowing applications to be processed by additional insurers and allowing consumers to complete payments, approving the save and continue function, upgrading hardware so that the system can handle more users with greater stability. Last night we installed more upgrades focusing on direct enrollment in improving the Consumer Experience. Those upgrades will continue on an aggressive schedule between now and the end of november. We are making progress, but there is still a lot of work to do. Some have asked why not just to delay implementation of the new law until all the problems are fixed . There is a pretty straightforward answer. Delaying the Affordable Care act would not delay peoples cancer, diabetes, or parkinsons. It did not delay the need for dental Health Services or cholesterol screenings or Prenatal Health care. Delaying the Affordable Care act does not allay the foreclosure notices for families forced into bankruptcy by unpayable medical bills. It does not delay the higher cost that all of us pay when uninsured americans are left with no choice but to rely on Emergency Rooms for care. For millions of americans, delays are not an option. Peoples lives depend on this. Too many hardworking people have been waiting for to long for the ability to obtain affordable Health Insurance. We want to save families from going bankrupt, we want to save the lives for more of our friends and neighbors by allowing them to detect medical issues early. Delay is not an option. We are still at the beginning of a sixmonth open enrollment that ends at the end of march. There is plenty of time to sign up for the new plan. I want to put this into perspective, mr. Chairman. The average private insurance enrollment is about two weeks in a worksite. Many public lands allow for four weeks of open enrollment. Medicare, the yearly open enrollment that is underway right now is six weeks long. The new marketplace was specifically designed for a long open enrollment, 26 weeks. Those who enroll by the 15th will be able to access their benefits on day one. I am accountable to this committee and to the American Public for getting the fix is in place. We are committing committed to getting healthcare. Gov fixed so that millions of americans can get the financial and Health Security they have been waiting for. Thank you, mr. Chairman. Thank you, you have addressed the principal question i was going to ask, namely that many people think the site should be shut down until it is totally fixed. I am going to ask that question. Why keep limping along . Why not just shut it down until it is put together the way it should be put together . Many have pointed out that your fixes tend to have unintended consequences down the road. Some other part of the system going into and after all the other fixes have been made. People ask why that has not happened. We also know that every day there is a story that someone did not get on, blank page, security problems, that is a bad media campaign. It is negative, does not hurt you, it it does not help you, it hurts you. Why not have it shut down and just have one bad story and then for as long as it takes, a couple of weeks, go back and get that gateway up and running . You indicate that it delays health care for a lot of people and i appreciate that, but one more time, why not just get it done right . I have this series of rules in my office, i will not go through the rules, but one of them is do it now, the second one is do it right the first time. Why not shut down and do it right . Mr. Chairman, i am relying on the advice not only of the inside team and contractors, but a lot of the outside experts who have come in to take a look at this system and they did a number of things along the way. They did a series of diagnostics, looked at the entire system and determined at the outset that healthcare. Gov is fixable, that it is not fatally flawed, which was the initial report from many people. Secondly, we have asked that question a number of times. Would it be helpful to take down the whole system and make fixes along the way . We have been advised that that actually does not help, that it is better to do routine operations, some of which are hot patches that can be done while the system is fully running and others are better to be done in the maintenance between 1 a. M. And 5 a. M. , when the User Experience is low and we take the system down for periods of time. But given the fact that the various fixes, various functionality fixes, the code, have to be written in batches, it has been advised that you do not gain much from taking the whole system down for a week or a couple of weeks, that it is better to do this on an ongoing basis. Jeff science, who i think is somewhat in charge of fixing some of this as far as i can tell, says he has a punch list. And he is going to punch them out one by one. How many items are on that punch list . Which of them have been punched out . When do you expect to do the end to end testing . Jeff has come into help manage the operations between the contractors and the cms team and the aggressive fix schedules. He will be with us, hopefully, through this process. He has been enormously helpful in being a management lieutenant with maryland, the cms administrator. I would say that there are a couple of hundred functional fixes that have been identified. They are in priority grouping. The first series of them has been underway. It depends on the night. It is hard to give you a moment by moment snapshot. There was a number that were done last night, hardware, additional installations were done over the weekend. At 5 00 or 6 00 each day it is really identified whether or not the testing for the individual coding fix can be actually apply that night. The list changes, but mr. Chairman we will get you an update and i would say that we are into the list and not where we need to be, but that it is a fairly aggressive schedule to get to the entire list. Are you going to do an end to end . Wax because the site is running, it is an to end daily. People are coming through every day and it helps to identify some of what we are seeing. What we are doing with live time and to end testing, we could go back and inform the tech team what needs to happen. Speaking of, i want this to work. This is a twoway street, you have to tell us what is going on candidly, fully, so that we do not wake up in november and lo and behold are still not there yet. Secretary, as you know, for months i have expressed concerns about the privacy and security controls that have been implemented in this federally facilitated marketplace. Now we know that key officials in the administration knew that there were privacy and Security Risks as well as serious operational issues that might occur if the exchanges went live on october 1. Yet a decision was still made not to delay the launch until those decisions issues were fully addressed. Many people, including myself, called for an independent entity, like the Government Accountability office, to conduct an end to end review of the marketplace to ensure that the privacy and security patrols controls were in place. I have a number of questions each about knowing about proceeding even though you knew that these issues would occur. When did you find out about the potential Security Risk to users of the website, number one . Sir, i would say the preliminary report so, in august. Minor, g i o had identified that there risks that there were risks gao had identified that there were risks that we took seriously. Who briefed you on the potential Security Risks if the launch moved forward as planned . Did anyone a brief you on the Security Risks . We discussed security on a regular basis with the operations team, but no one suggested that the risks outweighed the importance of moving forward, including our independent evaluator, who made recommendations to cms as required. I have been suggesting that since april. You said you felt strongly that the launch needed to proceed on the first for the americans that did not have Health Insurance so that they could get coverage is soonest possible. How did you balance that need with the risk that those americans might then fall victim to Identity Theft or have their personal information compromised why security controls . By security controls . How did you balance that . I share your concerns about individual privacy. I would say that the site was developed with the highest standards in mind. It is certified by the federal standard and we took very seriously the information in the hub that was specifically designed so that the federal government was not storing privacy information and actually access other secure government websites, but we tried to store the minimum possible information. We do not collect personal Health Information. But you do collect numbers Social Security numbers. Sir, we dont collect them. The hub is a router function that actually identifies Social Security numbers and verifies them with the administration, but that information is not kept and stored. Do they not have to give their Family Income . Like that is verified by the irs and Homeland Security. It is also on the hub. Pinging the Homeland Security database, pinging the irs via best database, it is not storing unique information. What were the tradeoffs with launching the exchange on the first rather than waiting until a later date . Other pieces of the marketplace have been delayed through insufficient privacy and security controls. Senator, again i would say that the standards that were set out for security controls were met. You mentioned end to end testing. There were features of the system that were loaded very close to the launch date. That is why, i think, the administrator chose to authorize a temporary authorization to operate and not a permanent, because you cannot permanently authorize an authorization until you have the entire system. We knew we had features in the system that we had chosen not to apply from the outset. The shopping feature, the spanish website, again those need to be tested before the system can be only authorized. Can you tell the committee how many people signed up for health care under the Current System . Senator, we will have enrollment on enrollment numbers out next week. We are still working on particularly the 834s, the piece with insurers, we want to make sure that begin valid, accurate numbers. My time is up, mr. Chairman. Thank you, senator. Madame secretary, a Community Meeting at home, oregonians tell me to do everything i can to stop what they see as ridiculous, petty bickering in washington and help to get results by working cooperatively. In that spirit, as i told you, i am going to pass this morning on the blame game and for a few minutes, for this moment, even, lets just say the democrats and republicans are going to try to find some real Common Ground on this. The Affordable Care act that we discussed today focuses on expanding coverage and financial help to those who cannot afford insurance and more private sector choices for patients. Before the Affordable Care act, the last Health Care Reform was the expansion of medicare to provide Prescription Drugs to american senior citizens. It was enacted during the Bush Administration and is known as Medicare Part d. Like the Affordable Care act, is zeroed in on the same concerns, expanding coverage, expanding assistance to the needy with increased marketplace choices. Medicare part d has been a huge success. Anyone who doubts it ought to think about the terrific hearing the chairman had at the aging committee a few weeks ago where democrats and republicans all made the same point. The Medicare Prescription Drug program has been a godsend to millions of seniors by offering lifesaving medicine. It has cost 30 less than the congressional Budget Office predicted. But the Medicare Prescription Drug program, as you know, did not start out so hot. The reality of the first few months of that program was pretty much bedlam. I went back and looked at the newspapers from that time. I will just describe a few of the headlines. Glitches in drug plan upset seniors. Medicare drug program is a wasteful disaster. Medicare blunders become a monster. These headlines about the Medicare Prescription Drug program that democrats and republicans now together say is a success, the headlines of the Medicare Prescription Drug program are exactly the types of headlines that have been written about the Affordable Care act in recent weeks. Fortunately the Prescription Drug program got fixed and they got the chance to get off the ground. If this had been repealed, millions of Seniors Today would not have access to lifesaving drugs. Not a Single Member of this committee wants that. So, my question to you is what, in your view, madam secretary, could democratic and republican senators here on the finance committee do to make the latest Health Reforms the success, the way the Medicare Prescription Drug program has been . Senator, i think it is always welcome to have elected officials in their home state give information to constituents about what the law says, what their options are, what choices they have and access the process. That would be enormously helpful. Particularly to constituents who may not be web savvy. Who may not know about the law, linna be following this, but definitely need the benefits. I do feel that there is no excuse for what has been a miserable five weeks. I am committed to the fix of the website, on the other hand i know the people are using it every day and that the experience is Getting Better every day, so i am again encouraging the folks to use the website, use the call center, enroll in person and in the health center, find a navigator in the webs in the neighborhood, it is inordinately helpful. We would love to work with the committee on the issues that look down the road. Not just that the marketplace that we were talking about, but really the impact of having the opportunity to look at Delivery System changes. system changes. I noted the Committee Just came up with a bipartisan proposal around a huge issue for medicare seniors, looking at those kinds of frameworks that actually encourage higher value lower cost care as we move forward with more americans insured. I think that is one effort that should have a lot of bipartisan support. I would be encouraged, as you know, the Affordable Care act has a lot of features to deliver that the deal with sets of values for the medical dollars we are spending and how access to Preventative Care could actually change Health Profiles for millions of americans. Those kinds of opportunities that are here thank you very much, [captioning performed by national captioning institute] there is no question that this website has to get fixed and no way to express the frustration. I want to address the affordable insurance that is out there and the response that the public has had wanting to get on the website, get information because they need heat need health care and Health Insurance. Because of the time i want to move quickly, ask you a few questions, if you can do yes or no, that would be great. Let me share with you a story from michigan that was highlighted in an article in the l. A. Times that talked about a woman named judith, 48 years old, work in a department store, had an Insurance Plan that costs are 65 per month that was a was affordable, she thought she had insurance, but then she was diagnosed with cancer and found out that her plan had a 2000 annual limit for treatment, so she delayed her care and it got worse, she was in a difficult situation. Madame secretary, after january 1, will judith or any other woman face a cap on their coverage for Breast Cancer treatment . No. Will judith or any other woman be charged more or be denied insurance just for being a woman . No. After january 1 will judith or any other woman have to fear being denied coverage by her Insurance Company because of Breast Cancer . No, she will not. These are all good things. Some people in michigan certainly think so. I received a letter from greg miller, who said that his wife and he had a policy that covered their son and they received a notice this week that their son policy was being canceled because it was not compliant with the aca. It had a high deductible and paid only one doctors visit per year and had no Preventative Care with limited Prescription Drug coverage. In fairness, the insurer advised us to go to the Health Care Exchange to obtain a policy. We had no problem accessing the exchange or navigating to the various policy alternatives with much greater coverage than the old policy. We certainly want to hear more of that. Thank you for passing obamacare. After january 1, will his sons insurance policy he guaranteed to cover Prescription Drugs . Yes. After january first, with his insurance cover important preventative screenings without outofpocket costs for the family . Like yes. Yesterday i heard from crystal, a Small Business owner in pontiac, michigan, who has not been able to afford insurance for three years. She admitted that before the Affordable Care act she was one of the people who was using the emergency room and adding to the cost of everyone else and their insurance. Last month she went to healthcare. Gov and was able to ensure herself quickly without interruption. She got a plan for 163 per month. She said to me that it is a payment she can live with and she could not tell me how happy she was to finally have Health Insurance, especially at her age. Madam secretary, we have heard concerns about Small Businesses for years that have struggled for insurance. I certainly at every meeting for years and years at every performance meeting have wanted to talk about this. Can you discuss how pulling together Small Business owners like crystal in the market ways will help them continue to afford insurance . Small business owners, under the law, employers with less than fulltime employment have no obligation to provide coverage, but many of them want to, it is how they keep, recruit, and retain the best employees. They are often in a market where they pay higher rates and have exorbitant costs if one of their employees gets sick or has a diagnosis. So, having an option, and Small Business owners can shop inside or outside the marketplace, but there will be new options within the marketplace with plans specifically for them and for the employers with fewer than 25 employees and low income workers, they may actually qualify for a new tax credit to provide that coverage up to 50 of the cost of insurance so that they are there are not only more choices and features but a larger pool, but for some a significant tax incentive for employer coverage. Thank you, senator. Senator grassley . Thank you for joining us, madam secretary. You know of my interest in the claims act that brought 30 to 40 billion back, it is one of the best tools against fraud. I start by referring to a letter that you sent to congress on october 30. The letter states that the department does not consider qualified Health Benefits or other programs related to the oral facility marketplaces and other programs under obamacare to be federal health care programs. If that interpretation stands, it would have serious consequences. Your letter calls into question whether vital enforcement and oversight tools and rebates, kick ax and bribes would be available to your agency. It weakens the ability to use the claims act. I do not understand why you are giving insurers within the exchanges a blanket exemption from years of civil and criminal laws and regulations, including antikickback law violations, just to name a few. This is not about my position on the underlying law, madam secretary. You and i disagree on that, however we can both agree, i hope, that you are moving forward with implementation no matter how badly it goes and how many promises are broken along the way. Right now it is not going well. Trying to exempt obamacare from a host of criminal and civil laws designed to protect taxpayer dollars from fraud just adds insult to injury. These laws were put in place to stop aggressive practices that ripped off taxpayers. You should not just be able to exempt obamacare from these protections with a stroke of the pen. A few questions was this exemption requested by any providers . If so . Who provided it . No, sir, not to my knowledge, this was a legal discussion in the department. Because these are private plans, they are not government plans. The legal interpretation was that the Insurance Plans being offered in the marketplace and offering plans off the marketplace should be treated the same. These are not Government Insurance programs, these are private plans. If you have any discussion with any providers or offer than these plans prior to their decision to join . No, sir. Finally, would you make the lawyers who reviewed this decision available to my staff so that we can ask followup questions to better understand why the decision was made to greatly weaken the available statutes to protect taxpayer dollars . Wax i would be glad to do that. Again, we have not given up any authority over fraud. Our department continues to have careful monitoring. We can decertify grounds for being in the marketplace, we can work with the attorney general. The state insurance departments from around the country are the regulators of these private Insurance Plans and private companies, who have very aggressive antifraud efforts. It was just a legal determination, since these are private companies and not dollars coming out of the Medicare Trust fund, that they should not be declared to be Government Health plans. The Medicare Advantage plan is the same and is governed. Actually, it is not quite the same, senator. It is a private Insurance Plan where federal dollars are paid directly out of the trust fund to the Medicare Trust fund. This is different, these are individuals playing premiums paying premiums to the private marketplace. May i reserve my time for a second round . You may, absolutely. Thank you, mr. Chairman. Secretary sibelius, i have read the testimony and listen to it carefully and appreciated your commitment to making the website work. I am concerned, though, that a lot of the testimony and discussion we are having seems to imply that the problem we are dealing with has to deal with outlets on the website. Experts are being hired to get the website fixed and then everything will be great. The chairman asked you if it would not be better to hold off until we can get the website fixed. I want to expand the little beyond that. I am concerned, frankly, not that you will fix the website, but if the law will be fixed. I see that we are now finding that the concerns that many of us raise before about the law being properly laid out in real, our concerns about that are coming true. The president said if you like your plan, you can keep it. And not because the website is not working, but because of the way the law was put together we see that for millions of americans today, they are getting canceled. 100,000 in idaho, way more in terms of percentages than what the president is talking about. The president promised that if you like your doctor, you can keep your doctor. Millions of americans are finding out they cannot keep their doctor. The president promised that we could cut the average family premium by 2500 per year. Although i read your testimony where you talked about premiums, i do not know what data sets you are using. The data i am aware of shows premiums in the individual market skyrocketing. They are going up faster than they did before the law. A quarter of a million dollars, you will not see your taxes increase the single dime. Not one single dime. Yet, as we discussed then, somewhere between 800 billion in a trillion dollars of new taxes that were delayed in the implementation that are now starting to hit and squarely hit the middle class. My question to you is, isnt it time for a timeout . The law is not working as it was promised. Website is not working. Lets fix it. The law is not working. Isnt it time for a timeout so we can go when they start premiums go up and not down. Seeing the failure of the law to occur. Respectfully disagree about theassessment law working. There are millions of americans who have actually received benefits under the law. Adults who million have insurance now because they are covered on the parents plan. There are seniors who are experiencing not only additional benefits in their medicare plan, but despite all of the accusations that somehow Medicare Advantage would cease to exist, we have a stronger and less expensive program today than we did. Seniors80 discount for in their Prescription Drugs if they fell into the doughnut hole. Millions of americans who have private employer coverage now have no copays and no fromurance, everything cancer screenings to immunizations. We have the lowest healthcare Cost Increases in decades. In the private insurance market. In medicare, and medicaid. Noare at an alltime one you can go through those points, and those datasets youre talking about. Some of those have occurred. On the flip side we are seeing millions of americans lose their health care. Millions more seeing their premiums going up, and the price for some of these fixes that youre talking about is phenomenally higher. It time to go away and take a look at the areas of the law that simply are failing . Marketplace,n the the rates have come in about 60 ther than what congressional Budget Office projected those rates to be. The projection after not lower than actual fact. Those were the projections of the rates, much like we heard senator wyden talk about the projections around medicare and make our Medicare Part d. The rates are going down . I did not say they were going down. I said they are lower than was predicted. Millions of people in the market, they will actually for the First Time Ever have some financial help paying for their Health Insurance. We are going to have to move on here. One of the toughest Public Service jobs i ever had was the elected Insurance Commission of florida. One of the most doubling Insurance Markets was the individual insurance policies. Peopleuld happen is would be enticed to come in to cheap Health Insurance and then over time, as the group got sicker, there was no control on the rates. It would go up, and they found limited Health Insurance. That is what the Affordable Care act is trying to address. We are talking about the individual insurance policies. Not the group policies. Case, we nowcular have no lifetime limits. We do not have preexisting conditions. Looking in your states and find many examples where the socalled cancellation fact, theyd, but in are going into a policy that is going to give them protections because of the 10 things that are required. In the Affordable Care act individual Health Insurance policies. Colleagues ask my they look at this, please consider for example, a lady in that wasad a policy 54 a month. That sounds great. That is being canceled. When you got into the internals, as reported by cbs, lo and behold, she didnt have much coverage at all, and had she gotten a disease like cancer, she would have virtually had no coverage. Shes going to have that coverage under the policies and the individual markets that are covered under the aca. Thing abouty one what is going on in the states. Take a state like kentucky. They did their work. In the first month, they sign up 30,000 people. Look at my state. States basically because of politics they decided not to do anything about it. Up, notept money to set going to expand medicaid, and look at the difficulty that now the federal government has had in 27 up this exchange states. Why couldnt we have been like kentucky why couldnt we be like kentucky and be way ahead of the game . Excuse forere is no the website not working. Madam secretary, i am one of the ones that said, as i heard mr. Chairman say, that people have listed your words when you criticized the fact the website was not working, and i said it was inexcusable. What Legal Authority do you all have to guarantee the contractors responsible for this not working will be held into account . We have significant contracts with a number of key outside industries. See ti and to ssi are two of them. We have paid out a portion of the money that has been encumbered for the website built. On a not up and running sufficient level at this point and we have new management with one of our Key Contractors driving part of the fix. Sure the funding delivers on the product promise. It is not there yet and that is the promised commitment. We are working to make sure as bills come in, they are clearly reviewed and that we have the opportunity to make sure the havect we need and committed to is delivered. Mr. Chairman, i will make a final statement. As someone who has fought and bled for this and sincerely thinks it will work in the long run, i want to hold them account and burn their fingers and make for not being responsible in producing a product all of us could be proud. Thank you, mr. Chairman. Madam secretary, i want to mock to remind everyone again how we got here today. Committeeers of this details we only received assurances things would go smoothly. We started hearing from people directly involved in implementation of the exchanges were deeply worried about the websites launch. In june, the Government Accountability Office Issued a report it should have served as a warning to you as a hlighted information is implementation it was never addressed. By july, it was clear to me your department was being less than transparent about whether the exchanges would be ready by october 1. I introduced the exchange sunset at the 2013. My bill would have sunset the exchanges and the individual mandate for people unable to enroll starting october 1 as promised. August, we determined tasks remain to be completed in a short time. Your main website contractor one behind onere falling their highest priority items. Thatne included and services were intermittently not available. Several days later, the white hub isnnounced the data ready for operation. In midseptember, ems ordered a contractor to make a significant change to the system to require people to submit personal information before revealing any plans or associated costs. Days before the launch, testing showed a few hundred visitors crashed the site. The next day, a decision was made to move forward to watch it knowing there would be a high Security Risk during testing. I believe you were given advice, counsel, and warning, from experts inside your agency and out, that the Health Care Exchanges were not going to be ready. I believe to protect the you put us in, jeopardy. Millions of americans are scared and they do not know whether they will have coverage in a matter of weeks and do not know whether coverage will include. Letters now getting from Insurance Companies they do not understand. More people are losing their insurance than are signing up on the web that. They are being directed to a website that does not work. About lifeften talk and death in the context it deserves. At this time, it is real and it may means the difference between life and death for Many Americans at a loss for what to do. We know fixing the website will never fix the uncertainty and ramifications that result from this law. I have to wonder, if you have failed tos that you heed the warnings and ignored the calls for members of congress and proceeded to open the exchanges october 1, immediately followed by a promotional tool to tell everyone, it is a great problem to have. Kansans do not think these are great problem to have. Hometown, stephen wrote, i am completely disgusted. I have spent the last two days trying to get my application through. This could not be a critical issue except the Insurance Coverage i currently have is going away because of the new federal requirements. You yourself know this law has serious problems. You delayed half the deadlines notemployers and unions are for millions of other americans. Osing their health care their worry and fear are palpable. Your main goal should have been to protect americans to assure their safety. In your zeal to implement this law, not warnings, not advice, not counsel would deter you from implementing the exchanges there you said america should hold you accountable. That is why today, i repeat my request for you to resign. Thank you, senator. Madame secretary, thank you for joining us this morning. The problems we are facing with the marketplace website are unacceptable, they need to be fixed immediately. I would like to put things in a historical perspective. The ageold plan is facing hurdles. Problems the set show soul security. Medicare is facing trouble. New problems in medicare bug trend it drug benefit. Those are headlines from the early part of this decade. Major programs that have come below in terms of the social safety net in this country and health care security. While this is an excusable, it is a challenge that has been faced time and time when any program has been unveiled. I find it amazing that those that seek to ascribe blame have spent every waking hour of the last four years working to dismantle, destroy, obstruct, and impede the success of the Affordable Care act. They are concerned not about its failure, but about its success. What i hope we will focus on is how to succeed. I want to get a sense when those of us on the committee worked to put this together, we were under the assumption that state controlled by republican legislatures or governors would put a higher premium on the love of state rights than their dislike of the president or some ideological political opposition. Which is why we are seeing far Better Success in states that have established their own marketplace. What is the consequence of having so many of the states not pursue their own marketplace and delegating it to the federal government . Did you envision not having that many states . What has been the consequences of the burden of that . We really didnt know. We knew that 27 states had sued around the constitutionality of the bill. There was uncertainty what would happen when the court declared it unconstitutional how those states would react. Some have chosen a partnership where we still run the bulk of the exchange. It has added to the uncertainty of how large the operation would be. We did have deadlines in january of 13 for states to officially declare if they would run their own marketplace or not. And by february, a partnership plan. The state using the hub is significantly higher than they might have predicted initially at the outset of the plan. We have robust product offerings, very competitive. One fourth of the insurers are brandnew. They have choices, they have competition. The state marketplaces seem to be having greater success than those being run federally . The web features are running more smoothly if you think about one set of products and one set of prices in one state. It is a less complicated but all of the states, as well as the federal markets are using the hub. They are coming into the federal market to certify security and income let me ask you one last question because we are hearing from a number of providers, including Health Centers. My state did not set up its own exchange. Insurance companies have yet to provide them with networking contracts. In order to ensure network adequacy. If we are going to say state insurance regulators are responsible, many of these are actively hostile. How are people supposed to shop for a plan when the network is not yet in place . There is no plan that has a network that is readily available and made the scrutiny of the state insurance department. Every plan in the market has a network. Consumers can access that information as we shop for Insurance Coverage. We know president obamas promise that if you like the health plan you have, you will be able to keep your health plan. Millions of americans are finding out that just isnt the case. Henry ford said that customers could have his model t in any color they want so long as it was black. If you like your current plan, you can keep it as long as it is the model he chooses. I offered a proposal to give people the honest choice to keep their plans but everyone in the Majority Party voted against it. It still has the promise on their that if you like your health plan, you can keep it. 2600 wyomingites got word that they could not keep the insurance that theyve got even if they like it. I am working with the bill under ron johnson that would allow americans to keep their health care if they like it. These notices are a up to the American Public. It is hurting the economy and making Health Insurance less affordable. The onesizefitsall approach is hurting our country and we need more people in congress that understand this. My hope is that even my democrat colleagues are seeing the light. My question to you is this. What is the administration doing to help the people as a result of the broken promise . They cant qualify for subsidy and are facing thousands of dollars in insurance costs. Wyomings costs are higher than any other state in the nation and we only have two providers. There has not been an increase in the number of providers. Your answer . I believe the president s promise was in the law from the day that it was written. A grandfather clause that we wrote as a prophecy policy. The plans in effect that did not change to the detriment of the consumer, even though the Insurance Company could raise premiums, they could not eliminate benefits or take away items that the consumer alike. Those are in effect consumer liked. Those are in effect and will be enjoyed into the future. They dont have to come into compliance with anything in the law. But if the plans turnover and this is you heard senator nelson and we served together as Insurance Commissioners. Talking about the planned turnover. If plans changed over and over again since 2010, insurers have been on notice since 2010 that they needed to come into compliance. The Employer Market and every other part of Health Insurance. I am not worried about the insurers, i am worried about the people. They are worried losing the doctor that they like to go to. There are changes that have been made that are causing some problems. You also mentioned a number of people are signing up. I noticed in washington state, 35,000 people signed up for obama care. 87 will receive their coverage through medicaid. Tony 6000 people enrolled in kentucky and 80 of those will be in medicaid. 96 are going into medicaid. It has costs to the federal government, particularly with some of the increases that were put into this law. Are we going to be able to afford this increase . And the other customers paying the tab to provide the revenue to do this . When the Affordable Care act was passed, it was anticipated 100 of the states would expand medicaid. It was altered by the Supreme Court decision that made Medicaid Expansion a voluntary expansion for states. We have 30 governors republican and democratic who have declared their interest in moving ahead with Medicaid Expansion. That expansion of 100 of the states was paid for in the Affordable Care act. It is heart of the law that was passed in 2010. Unlike Medicare Part d that was not paid for when Congress Passed it. Thank you, mr. Chairman. I am convinced that the fundamentals are sound. We have seen the implementation in a very orderly way, protecting millions of americans. The practices that existed before the Affordable Care act are being dealt with. As my colleagues talk about the actions of private Insurance Companies today, go back and see how many people lost coverage. Insurance Companies Pulling out of markets, reducing benefits and increasing premiums. I also point out in regard to the exchanges, the number of carriers offering plans and the pricing of those plans came in much stronger than we anticipated. It is sound. Our disappointment as to how the website shopping and enrollment was not done more effectively starting october 1. I guess my question, madam secretary. As a result of the delay in individuals being able to shop and enroll, there are people that will be disadvantaged. People who have not gotten as far as they want. Consumer fatigue. People will have a more challenging time. We also have a large number of people that have lost coverage, which was understandable because these are policies that were changed since 2010. These are individuals that changed their insurance policies frequently. They want to enroll by mid december so that they can get coverage effective january 1. What steps are you taking to deal with to make it easier and more convenient for people to be able to shop and enroll . What steps have you taken for those suffering the delay to get the website working. Step one through six is getting be site fixed as rapidly as possible. We are deploying additional assets to the call center. Operations have additional individuals now. We have 12,000 trained Call Center Representatives that not only have in english and spanish version of scripts, but translators that can answer questions and up to 150 languages. They can take them from start to finish or help create an application. We are trying to train throughout the ground and they are actively working in their neighborhoods. The state has a contract through Community Groups and wellknown medical advocacy groups. Walking people through a paper application or on the phone or in person. I would urge you to make that available to those of us more comfortable using applications. We had alternate strategies to enhance those alternate strategies. The state exchanges operated by the states are having different results. Some are doing well and some are not. I would urge you to monitor the progress made on the state exchanges because we want to make sure those that have been disadvantaged because of the inadequacy of the performance of Online Shopping and enrollment that it might go beyond federal exchanges and those are also protected as you look at ways to compensate for the slower rollout. We have regular updates with the state directors. It won is occurring at 4 00 this afternoon. We are not only trying to Pay Attention to the federal marketplace, but keeping him very close touch with lessons learned. The applying them in other areas to figure out what is working and what is not. Using the full six months to really reach out and enroll people that are eager for Affordable Health care. Madame secretary, in september of 2009, the polls said that 88 of americans were satisfied with their current Health Insurance plan. Which is why the president made a promise that he made. As you can see, yesterday afternoon, the white house website says if you like your plan, you can keep it. You dont have to change a thing due to the health care law. We know that lying to congress is a crime. Lying to the American People is not. I would like to ask you a simple true or false question. Is that statement true . Or is it false . I think the statement the vast majority of americans that are insured are in the Employer Market or public plans are veterans plans. Those plans have stayed in place and have continued to offer benefits. The 11 Million People in the individual market will keep plans that now will have stronger coverage. Others will have to choose if they have a brandnew plan. Let the record note that you have refused to answer my question if it is true or false. In june of 2010, is it true that the department that you headed estimated between 40 and 67 of those buying insurance would lose grandfather status . Is it true that on the same day that your department estimated that 66 of the people in small employer plans and 45 would lose their grandfather status by 2013 . Senator, that is an inaccurate use of those statistics. Could i answer the question . I can tell you what the statistics mean. I would like to tell you what the statistics mean. She did answer, she said it was inaccurate. That is not what the statistics say. It was a look back at how much turn there was in the marketplace, not a projection of what was going to happen. Isnt it true, according to the congressional Budget Office that 156 million americans get their Health Insurance from their Employer Sponsored Health care plan in 2013 . The office estimated that because of the failure to keep the promise on the white house website, 78 million americans will not be able to keep their lands as promised. I dont have any idea what that statistic is. There are about 170 million that have employerbased coverage but i dont know the statistic. I would commend the estimate to you which is what congress depends upon. 78 Million People will not be able to keep their employer provided coverage. This is a false statement that this administration has consistently doubled down on and repeated time and time again. The only thing i can conclude is that it is impossible to do something in this administration that gets you fired. You can lie to the American People, consistently misrepresent the facts. It is impossible to get fired. So i will ask you about the navigators. The president is in dallas texas today touting the navigator program, which, as you know, are people who are hired to help people navigate the Affordable Care act. I would like to ask you this question, if you answer it. Isnt it true there is no navigators tor undergo a criminal background check, even though they will sensitive personal information from the individuals they help sign up for the formal care at . That is true. Part of the federal requirement. A a convicted felon could be navigator and acquirable acquire Sensitive Information on the notes to them . That is possible. They have taken the responsibility to screen individual navigators and make sure they are sufficiently trained for the job. It is possible. Thank you very much. Nice to see you. Letterto start with a from a Small Business owner in hudson, one of the most conservative suburbs in our state. He said, i am a smaller father and Small Business owner and began my business in 2009. Would sell me Health Insurance. I did not i could not get insurance at any price due to preexisting conditions. Now, my family is incurable. I get letters like this all the time. We all do. Of people in all kinds of walks in life. Senator menendez spoke of the difficulty of implementing a huge sold security program. Back to your junior whennior in high school your father, member of congress, that fateful year, voted for medicare. I suppose he shared stories with you about the opposition. In those days, the leading republican politicians like congressman dole and rumsfeld and gerald ford voted against it. Companies and the ama imposed medicare. The rolling out of it was so controversial, especially because medicare resulted in integrating southern hospitals and if you think this is controversial, what is happening now, imagine the difficulty a year after civil rights around the time of Voting Rights passing, that medicare forced hospitals to integrate. The whole view this is so controversial and so unprecedented when you roll out a new program, the important thing, i think, five years later people look back on medicare and thought, what was the big dear big deal and why were people so opposed . Five years from now, or 48 years after medicare, what are people going to say about the Affordable Care act in five or 48 years . I am hopeful this will be another significant step forward in ensuring all americans have access to Affordable Health coverage, which is not what we can claim today. The only western country which does not have health care as a basic right. This is a significant feature for not only uninsured americans, and they will have access, for the first time, either to Medicaid Expansion or to affordable plans in the marketplace. Also, those individuals who have been referred to a number of market, the individual the last marketplace where they do not enjoy the Consumer Protections every other person who has health care in their workplace and joys no pre existing condition limitations. No medical underwriting. Virtually 100 of people are medically underwritten. Few are healthy, that is great. If not, you are in terrible trouble. These folks want Health Insurance. They want Health Insurance. I think this is a significant step forward, and when we will look back on, hopefully, and applaud the day we finally made significant step. Republican and democratic president s have been attempting to accomplish this. Clearly, the opposition is still quite ferocious and i am hoping people understand what their options and benefits could be and what their opportunities are. Thank you for that. The sender and i were just talking earlier. Medicarepposed the drug expansion. I cannot speak for the reason he did. I did because it was too much of a giveaway and did not provide the level i thought it should for Prescription Drug benefit. It could have been done in a better way. I did we did something i know a number of people on our side of the aisle did. We helped we held town Hall Meetings and sent my staff out to help people, how can i sign up for Prescription Drug benefit. We helped constituents navigate a labyrinth and arduous path of how you get Prescription Drug benefits. My republican friends. It is the law. After this, i hope this disastrous rollout, i hope after ins my colleagues will work their states to help us work for the American People. I was hand handed a note from my staff. Republican house members in ohio have gone so far as to tell constituents who have questions to call browns office, because he voted for it and we did not. Publicas a nation and officials, we do our jobs. We took an oath. I just hope we pull together and make the law worked as well as it can. Thank you. The law, but a lobby administration has chosen to delay portions of. I think that has been done very discriminately. I think we all agree the rollout has been a failure of epic proportions. There were a couple of front page stories in politico today in which there was a tech expert quoted as saying, this might just be an error, but you cannot pass an undergraduate Computer Science class by making these mistakes. We have all talked a lot about it and we hope to get that right. I think eventually, that part will be gotten right. I believe this is fundamentally flawed legislation. Seeing is higher rates and fewer jobs. When you pass something that has rating,axes, community all kinds of mandated coverages, i think it is inevitable you will see rates go up. The point is this was built upon a Faulty Foundation predicated upon a bunch of promises made to the American People, which are being broken. I want to come back too, because i think it is so fundamental to you debate, on june 14 2010 the role you said would make it on the president posses promise that americans can keep their health plan and dr. They like under the new law. Did you read the regulation when you released it. Yes, i did. If you read it, how could you possibly say this regulation will keep the president posses federalwent on register, your agency estimates up to 69 of employer provided plans and individual market plants, will lose their grandfathered status by 2014 . I tried to explain to the sender that those estimates were made by the Health Economists who look back. That was a snapshot that had occurred in the individual market year in and year out. Few people stay for more than a year. We were doing that as a backward look. On notice to Insurance Companies, you can basically any coming into compliance with the law by keeping the plans in place. That is basically what the grandfather clause said. Fromt enormous pushback medical disease groups, advocacy , doesntth care it knowingly violate . The president and your promise that if you like your health care plan, you can keep it . There was not any caveat on that at the time. It was not like there were footnotes. It did not say, if you like your health care plan, you can keep canceled, or gets unless it gets changed, or unless we do not like it. It said, if you like your health care plan, you can keep it. The president said it over and over again. How can you go out knowing what you know and allow the president to continue to say that, and you and other Administration Members to say that . That is what the grandfather clause was all about in the first place. Have i say, it was very controversial. We felt it was important. Also, in the grandfather clause, with the samein caveat. I can tell you for the vast majority of people who get employerbased health care, are in a public plan or the v in the a plan, or medicare, and part of the insurance market, their plans are very much in place. In thes change coming individual marketplace, with Consumer Protections many people never enjoyed or experienced. Not have the plan they had in 2013. Youth and people americans in the market should be able to keep plant they like even if the government does not approve of them . If the plan was in place from the time the law was passed, that is what the grandfather clause said. I think most americans believe in grace. Most americans are pretty forgiving people and so, they will tolerate and accept honest mistakes. To me, this is a dishonest mistake. Thehave been misleading American People and the president has, over and over. I would much rather you just come up and say, we were wrong and we did not tell the truth. The pinocchio thing. You have four a yields on the statement. It strikes me people would be expected of it. Take it off the white house website. It is not a true statement and never was. It is one of those things that when people were sold this, it was based upon. It is a tragedy the American People bought into this and that you all knew full well it would not be the case. Thank you very much. Thank you. Thank you for being here today. We appreciate your testimony. You testified in your Opening Statement that q ssi had been hired to do the coronation of the web and the hub . They have taken on a new role in the last couple of weeks of organizing the fixes going in. Are you aware in june of this year, the Inspector General issued a report, finding q ssi violating cms requirements on security that exposed 6 Million Medicare beneficiaries to private information . I cant i am aware. Theyderstanding is basically inherited a contract from another contractor and did initially, various provisions in place. In themediately fix it transition and did self report that to us. They have a cost contract to do it theyre doing echo is there a contract for them to correct that . It was corrected immediately. There is a provision to make sure they comply with all of the requirements. The whole subject of navigators, it will be the vein of my question. On the 20th of june asking, if for the requirements you are putting in to protect secure information, have not received an answer yet, understand you have been very busy, and i respect that. I will use my time to answer a couple of death assay couple of questions. What are you doing to ensure they protect private information they are supposed to of american mustens . The navigators go through a minimum of 20 hours training. A significant portion focuses on privacy and security issues. Know, there is no personal Health Information never collected or needed. They do not have access to that, unlike and gas unlike an urance agent today excuse me for interrupting. I want to be sure i get to under the irs code, there are a number of provisions for personal information being used. To estimate the subsidy someone will get, you would have to know their income. Will the navigators be able to use the information to make the estimate . If the consumer chooses to share the information, they could give the Consumer Information about what they qualify for. I want to get to this point. The law prohibits Insurance Agents from being navigators unless they quit their job. It also has a medical loss ratio that basically allows Insurance Agents not to sell commission. Be forors were meant to the American People and the obamacare law. In the state of georgia, my state has been so concerned about the risk they have made it a requirement every navigator have a pet a criminal background check in reference to the question asked by somebody previously, do you think there should be a similar requirement nationwide by your require department to make sure no navigator gets private information without a background check . There are probably 45,000 agents and brokers who have been trained on the Affordable Care act and are very much part of the process of reaching out to individuals. We did write the requirements for the navigators that very much nearer what many states have in place for licensed Insurance Agents, and then added a provision that states could indeed add additional requirements. A would you reject to requirement they have background checks . I think that if that is the will of congress, we would take a look at it. Over to one shift other thing. My state is known for the capital city of atlanta and the vacation city of savannah. We are a very rural state. State, in a recent article in the new york times, the rates in rural georgia, particularly southeast georgia, are going up astronomically. Is world america getting hit disproportionately hard because of the effects of the Affordable Care act on its premium rates . I was the governor of a rural state. I can tell you world america has always paid a higher price for health care than urban america. Is less often a monopoly market. I do not think that has changed enough yet with the Affordable Care act. I think new competition in most markets in the country will begin to change that, particularly in this Exchange Market where people often have no choice and no competition. Thank you for your testimony. Thank you for being here today to answer some of these critical questions. Chairman, i noticed in your opening remarks, you expressed frustration about the Fact Administration officials are saying you said they did not see the problems coming. I share that frustration. There were plenty of warnings. One was a letter i sent you back in august. I sent this to you and the director. I sent it because i was hearing a lot from ohio about problems with enrollment and particularly problems from ohio because they did not believe they were getting the answers they need from you. I asked a bunch of questions. The concern ohio could not think there was even a minimal amount of coordination. Who in your agency is in charge. I also expressed my concern about what i knew about the i. T. Concerns. Comments that were pretty obvious, wondering whether those could be solved by october 1. I asked whether you had tested the technology, specifically whether systems were going to work and what the results were of the testing. I said i was concerned there would be a lot of confusion. Unfortunately, there have been. The august letter still remains unanswered. I want to ask you today, who is in charge of the federal can inn ohio who ohio . Is inistrator tavener he oversees the agency. Known for ohio . Do we have n individual . Accountable to the state of ohio . Not for state, no. You talked about how you think you should not take down this site, a suggestion by the chairman and others. You said better to do routine updates while it is happening. Are you testing the site . The agrades you are using . On regular basis. Will you provide the results . Regular i do not know what youre asking for. To the American People. Dayesting is going on every we did with every piece of part oft that became the site. It was tested not only by the company and the contractor as it was presented, but there was a cms test performed. Let me continue because i have a short time. A lot of stories from constituents. Onuy says he tried to get for two leaks and found that his coverage was doubled. A woman called in having tough time making ends meet. Telephoneof call and says she still has not heard back. The stories are out there. 12 Million People nationally will lose the coverage they have. We talked about a lot of promises that were made. How many ohioans had their Insurance Plans canceled . Do we know . I do not know. State that provide information, will we know how many . Quek again, the federal government, these are private plans. Ohio companies could give you that information. Haveis not information we at the department of health and Human Services. These are private Insurance Companies. We will not know how many people . Class you could ask the ohio Insurance Companies. That would be a great way to get the answer. Insurance companies are canceling plans because the legislation you are implementing does not permit the plant because it does not meet your mandate. It would be helpful for you to know how many of the plans are being canceled. The customer is in a grandfather plan after they have not received a notice. I really do not you do not care about the data . I do, but you asked if i could give you the answer. I cannot tell you for ohio. Let me ask a final question about covering the uninsured. We have talked about the promises. You keep the coverage, the cost being less rather than more. We have not talked about coverage. All of thisfter , over 1d bureaucracy trillion of consumer spending, and so on, there are still 30 million american 10 years from now after full implementation of this, that will not have Health Insurance . Is that accurate . I hope it is not the case. Do you believe it is accurate . I understand. I do not know what their premise is. Behink that is not likely to true, if the program can be fully realized. Do you have a number on that . I do not. Thank you. Thank you. Thank you, mr. Chairman. About theed as i am huge problems with the website, i am more concerned with some of the underlying fundamental with thisblems legislation that are starting to manifest themselves. I want to share with you a few short emails from the hundreds and probably thousands of e mails i have received from ofnsylvanians conveying some the concern, and, in particular, how the false promises are affecting real people, in this case, my constituents. I got an email october 11 from a dad in pennsylvania and i will quote this. Received notice last week my health care will more than tripled. I am currently paying 265 thousand dollars per month for me and my two young sons. On january 1 2014, the monthly premium will be 836 per month. The president promised you could keep your plan and families will save 2500 per year. I can teach my plan and i just cannot afford it. I qualify for subsidies. 80 a month. While there was a promise families would save money with this, it is clearly not the case for this family. There is another problem alluded to several times. We know famously the president and others have said, if you like your health Health Insurance, you can keep it. A woman from Lancaster County sent me an email. It is short. I will quote it. She said she is a twotime Breast Cancer survivor. President obama said if we like our insurance, we would be able to keep it. That was obviously untrue. Thats untrue. I got an email on october 7. Said ive been selfemployed for 1 years and have never been without health iven assurance. Three years ago i was diagnosed with multiple scle loss sis. Having a preexisting condition was not a problem for me as i had never let my insurance lafments my medication cost would be 4,000 per month without insurance. I received notice they were going to cancel my plan and i had to sign up for new coverage through the Health Insurance exchange. If my coverage is not in place before january 1 i will have to go without my medications. This will cause permanent disabilities, blindness and problems walking. Any plan i find that would cover me channels me back to signing up through the exchange. Im a Small Business owner and a productive member of society. I own my own house. Now 50eu78 in trouble. We call this woman and we discuss this. It turned out there were two options available to her through the exchange. One option would allow her to continue to see the doctors that have been treating her. The other option would cover the medication, negotiate option would cover both. Well its clear to me theyve been repeated many times, i think millions of times across the country. And its a hugte problem. So i guess my question for you is i understand this administration is never going to want to repeal this bill. I get that. I understand youve delayed whole sections of it but dont want to delay the individual mandate for instance. My question is there r there any changes you want to recommend we could make to this bill so that the promises that were made by the president , by yourself, by others for these people, promises which clearly are not being kept could actually in fact be kept . Are there any that you would recommend to us . Senator, id be happy to work with members of congress who want to achieve the goals of the bill which are to provide for the first time Affordable Health coverage for millions of people who dont have it and an additional goal of the bill i would say is to in the marketplace, the last remaining market where people have been denied coverage because about a quarter of the people who seek insurance cant get it at all, medically underwritten, denied because of preexisting condition where they have an opportunity to move forward. If there is some framework that is you have in mind, what i really want to do is get the program up and running and get information to people about how they can take advantage of the program as its designed, the bill as its designed does not honor these promises. Let me ask the grandfathering clause we all know has so many exceptions that many plans are simply not grandfathered. Are you willing to reexamine the exceptions to the grandfathering clause so that many plans could be actually grandfathered . I dont think grandfathering perspectively can work very well and since companies are now in a the and you will market with an array of new are you plans. In plans. Many have added consumer him many have added Consumer Protections in the last three and a half years. And in as you said, the regulation came out shortly after the bill was written. It provided a framework. Weve been working with insurers as they look to what plans they would put in the new marketplace, what plans they would keep in place. And in and the grandfather clause has been part of that ongoing discussion. Were going to have to move on. Thank you very much. Thank you mr. Chairman. I know youve probably seen lots of headlines. I dont know if youve seen this one, thousands face delay in healthcare enrollment. Over 100,000 workers will be able to sign up as of october 1. The reason why im asking you about that particular headline is because its from the boston globe august 3, 2006. And in that case, we do know the rest of the story. The rest of the story is that the governor of massachusetts estimated that only 123 consumers signed up in the first month but eventually tens of thousands did and now today the state has nearly universal coverage. They went from one in four people having insurance to uninsured being one in four to 2340u being one in ten. We know the results so to me its a reminder of what our goal was which is to address double digit increases in insurance rates were preventing people from getting Insurance Coverage. So to me the issues of the website and Software Since its part of a background ive had before, to me its about writing code and getting things tested and its very frustrating for andnd struggling for months months and months to get a scientific way to clean up that resource. That case its about just getting the code right and making it work and making it function. In that case, governor romney for and got a three month did he clay. Im not asking you to comment on that. I know the chairman asked to you comment on that. But i think there is no shame in pushing out a date based on technology. Thats my opinion. And i want to note that states own experience has been more positive. One of the issues that was local press was his issue of not having people have to sign up to enter the ite to get data as they call the amazon model and id like to get your comments about that. And then i want to get your comments about this issue of market and ual cancellations. That in the aid individual market only 17 of on an keep their plans annual basis. So obviously there is a huge churn that goes on in that individual market. Maybe we dont have a number or today, but it would be great to get that data and if we ave to get it from insurers we should have a number about what that annual rate has been my sense is we are probably following that pretty today. Ame people are saying what is normal churn in the individual and trying to site it as the end all, be all problem and anyway to shed light on those issues. Of the the discussion individual market, the data again that continues to be itedes our projection of what would happen with the Affordable Care account is a look back at market. Somewhere between 40 and 60 of turn over on a regular basis. Individual market contracts are year so its not unusual to policy or e same practice a year later. Theyre an continuous work benefit. Individuals who are in the market want to get insurance. Dont have a workplace insurance and theyre not medicare eligible and not a veteran. They want insurance, and often truggle with not only price increases at about 16 a year average but everyone is edically underwritten so any illness or disease could block you in the market in the first lace or put you in a pool that could sky rocket and lockout. The protections that the ha that e care act added to the individual market re the very ones that every worker in a Small Group Plan enjoy or in a work site enjoy. Locked out because of a preexisting condition. You must be offered the policy. Are in a risk pool so your own disease profile doesnt determine your rates. Thats really what is happening with that market. Of the peep 50 are not in their policies for a year. A third are there for only six months. It is a very volatile and unprotected very marketplace for way too many folks. Senator. You, mr. Rockefeller. I have e secretary, watched you today and watched eviscerated over in the house. Not for your resignation, your head but your resignation emanated from this panel. It all makes me want to just say some things. Number one, i attach some to the fact that this bill which was crafted a lot of committee, a ance lot of it open and in public, when it came to the floor, there was not one single voted for the plan. This was two years ago. More. A little bit and i try to ask myself how could that be possible. Son was asking as i would georgia ask about rural West Virginia at a st saturday i was Rural Health Center in a very virginia art of west occurred tocasually me there was 10 billion in a a thousand new Health Centers all across america. Does anyone know that . I dont think in West Virginia or generally. Prospect unned by the of lets say 100 Million People or underinsured, hat the president makes a couple of statements that perhaps he shouldnt have made, the whole at becomes argument. All the letters, i was promised that, and im trying to think of all the benefits that this. Rom i work very closely with the chairman and others on this bill finance committee to produce it. A magnificent work. Virginia dontst necessarily share that view right now because i think they have the problem that so many they simply that dont know whats in the bill of the absolutely aniacal and really admirable attack machine including all the television, this has to be the that ever happened to america and then i look at the bill and i said, as you country re the only that doesnt do Something Like weve done it very well. I think people will get and the under insured insurance and 80 of consumers change their plans every two years. Might be more t than that. Republicans are talking about provider shock saying wont be able to keep argument whichan is almost comical and being so you consider en the Affordable Care account are designed to help people who do Health Insurance and therefore by definition did not primary care ar physician. Single ing every possible dark attack but taking wo statements, taking the website, which is frustrating to all of us, but if theres worked out t can be it would be the website. Its a Technology Matter and that will happen. Im not for delaying unless they in time, in which case maybe a penalty should be lifted. Im incredibly proud of the incredibly proud of ou and marilyn tavern going before committees and getting viscerated but standing your ground and knowing exactly what ouve done far more than most of us. And certainly far more than most viciously o are making a political attack. Writtrisen in the last five years. You can really sour people on ads. Ple television its not that hard to do and give people a chance to i your resignation and hand it in today. Those things are so unrelated of underinsured or uninsured americans which this bill sets out to successfully period of years actually solve their problems. Talk about tax people saying that theyre desperate about it and that ct of the matter is they get 35 of their tax credit of the premium paid by tax credit and after that is 50 on basis. Nent you never hear that. You never hear that. So, this is not so much a but a statement of sadness about the ability of the upper body, the socalled body with the cup and the saucer that sort of routine. Hat we can be so maniacally political that we just seek to destroy and forget the agony through, e are going which this bill will cure. Senator, very much. Chair. Nk you mr. I thank you for joining us. Have shared headlines theyve notice theytly or in the past and relate to implementing to healthcare changes. To that. Add we dug up some headlines and one early f as in failure and one is not ready for primetime. A third was confusion reigns. And a fourth headline was pharmacists say some will die. And as you might guess, those headlines from this month or last month, this was rom 6 or 7 years ago when we were implementing Medicare Part for. Hich i voted i was one of 11 who voted for it. Had a huge donut hole. Fell into f people it. They didnt get any help from medicare. Stopped taking their medicines and got sick and sicker and went to the hospital money. St a lot of with the Affordable Care act we and fixed a problem and paid for by the industry and created by the original george w. Bush proposal which i supported. Were getting a lot of lament bout folks understandably oh throw are a Million People who apparently are not going to be ble to continue with their insurance policy. Maybe this is a substandard problem. Try to work and help those folks lets keep in mind, a lot of people, hundreds of thousands people, they call my office offices and have problems that arent worth the paper theyre written on and we to be concerned about those 2, 3, 4 erned about the million young people who today not having Health Insurance because theyre aged out. 22, 23, 24, 25 and today they have coverage. In mind as well. I have us keep in mind the the ons of people over years who actually lost coverage. They had coverage but lost it condition preexisting and lost it at the time when they needed it most of all. As we work to try to address the by a couple Million People sadly who are not going policies to keep the they want interfacing large increases, thats a problem. E need to try to help them and try to fix that. But at the same time lets try perspective. The other thing is, over in spend half as much on healthcare as we document they 18 . T eight and we spend they get better results and cover everybody. Last night when people went to to bed ty million went without healthcare coverage and were trying to do something about it. We had in committee, republicans us. Ent able to work with they were sad. E had three republicans that lasted forever trying to get to yes. Legislation was signed by the president and has a couple of good ideas that were republican ideas. So some good stuff from the republicans found their way into of law in the end and one those is the idea of large purchasing pools, we call them thats not a and democratic idea. Idea k it was republican and the alternative and tried to it and makeorporate it work. Its a good idea. The idea of the individual thats as i recall, thats i think a heritage that governor , part of the ed and massachusetts. Weve had i think roughly ten hearings just before the of the law and since on october 1st. I think when we were doing this i think we had two hearings and maybe the first 1 was four months after the was implemented and we then not to harang and harass people. The progressstion, with repairing the federal improvements have seen the americans change and what can we see in the next several weeks . Well, senator, i think im admit that the excruciatingly awful for way too many people. Get in people couldnt the site in the first place. Nd then when they were able to access the site, screens would go down all the time. Hey couldnt get from place to place. I would say that those are the areas of focus and we are in a continuous era where on a very with a very rigorous schedule of mprovements we are adding hardware and software to fix the peoplenality and getting from place to place, increase the speed and make sure we are the volume of people who clearly want to use regularss the site on a basis. O, there have been significant improvements. We are not satisfied at all where we are now. To an end of ed november experience that is better on volume and speed and reliance and making sure we get to people and we have a very specific plan to reinvite people back to the sites who started at one point along the way and may have been so frustrated that they gave up. We dont want to do that until their experience will be significantly better than it was the first time. That a lot of young folks have little patience with that doesnt work and thats what were doing. Thank you, senator. Ill turn to the most patient member of the committee. Thank you, mr. Chairman and secretary thank you for being here. Yesterday the administer testified on the security healthcare. Gov which was tested for the hub and the system. Ace she testified that there was no end to end testing. Fact, she approved a eptember 27th memo to move forward with issuing the operate. Y to the memo specifically noted this, quote from a security aspects of the system that were not tested due to the on Going Development uncertainty el of that can be deemed as high risk or the federal facilitate marketplace system. Yes or no were you aware of that memo . I was made aware of it resoepbltsr oh oeu recently. Did you talk mes about the security aspects and specifically this decision to authority d with the to operate . We did not discuss the authority to operate. Did you at any point notify security house of the concern thats exited about the exchange . Would say that there were senator, about risk did the white house know not aware of this and i did not have these discussions with the white house because i them aware of white house know there had been no end to end testing of aspects of the exchange . I think the white houses was ware of the operational issues involving end to end testing and i dont know the specifics. Again, i did not have the discussions about this Authority Issue with the white house. You testified last week in law ouse that it was the that made you stand up the exchange on october 1st. Fact, the statute as i read start ires enrollment to and not the exchange to stand up. Legal u given different advice within hhs . What the law says is that started on january 1st. The aw also said that secretary shall designate by date of open enrollment and that that to be ion needed promulgated i think it was by 2013 . Of correct. But that did not require to you stand up the website. It required to you open enrollment yes and a significant portion enrollment not the administer had done the authority to operate, if he had not signed it, the have stood up t on october 1st, would it . Thats correct. Short term temporary uthority to operate was done specifically because she had i. T. And m her Senior Operations team as well as the contract it wasnt the statute that made the website stand up on october 1st, was it . Enrollment began and a significant part of it was the website. Testified er yesterday that the estimated target enrollment number for the end of november was 800,000. Tely and i know that your plans are week that update through last month. When you release that do we have assurance youll break it own so youll show whether individuals chose medicare or silver plans, bronze, and platinum levels and a state by state breakdown . I can tell you, senator, well be able to did he lean ate between my understanding because tryingwhat theyre still to determine is how many metrics give. N well have the state breakdown and differentiation between medicaid verage and coverage. We intend to give you as much information that we can validate. I dont know if that we can nate the plan. What is the enrollment . There are all different kinds of target enrollments. Think there was a memo internally that called for about enrolled people to be through december, but i really were updating those targets. Early ell you our enrollment numbers will be very low. Set the effort to has d straight, secretary highlighted that premiums are lower than cbo projected. When they made their projections they made care tions because health cost is directly linked to and the owth assumptions they made was that e would have g. D. P. Growth in 2011 of 3. 5 and 2012 and 2013 of 4. 7. The reality is that gdp growth 2011 and 2. 2 in 2012 2 in looks to be under 2013. Actually hugely isappointing that in fact premium premiums have gone up o far because weve had relatively anemic growth in the united states. But there is incredible that were made for dp growth by the cbo that went into their estimates of Insurance Premium cost. You. E secretary, i thank i would just comment that in overall, the Underlying Health cost growth market, te insurance the public Insurance Plans, the two after the president signed the Affordable Care account this there was a of assumption the very slow ate of cost increase was due principally to the recession. Economists have now concluded that there are restrainers ost that were parted of the Affordable Care act that are our g a positive impact on healthcare spending on medicare spending which is grown at the rate in 50 years, medicaid spending nationally overall and t year private Health Insurance rates, again, since the Affordable Care act were passed have been at the slowest cost increase that has decades. N in so there is now a conclusion provisions the written into the bill about Delivery System changes, payment changes, different ways to measure quality out did the es, some im sure all of these were ncluded in the Manhattan Instituted when they completed found s of 49 states and on average premiums in the individual market increased by obamacare and in my tate of north carolina, the Manhattan Institute estimates 136 higher under the act. Dable care thank you. Madam secretary, i think a like a f senators would couple more questions. Senator hatch. Keep i very nt to long madame secretary. That misconstrue you said you felt there would be not a lot of people sign up between beginning of the next year. Is no. I said that the enrollment that well release next week which will be the first enrollment will be quite low given the struggles people have had getting access getting te and information. Well, do you expect the umbers to be very high during the month of november and december is my question . That with the site improvement well see more but until the sited is fully improved and we eally kind of open the doors wide to a lot of people, were strugglehave i think a getting significant numbers to sign up. Im not trying to put you on the spot, but what i come back to my original concern. Is it so difficult to put this off until we have it up and running right with the right kind of security so and private onal information is not subject to athat come into the system naturally. Prepared. Re not again, senator, i would say that the site has met the standards of security for federal government sites. Have taken great care again personally identifiable information in the hub. Met the testing is 24 7 as each piece of software is added we need to continue to test the site and have a art of why we temporary authority to operate and not a permanent one because the pieces of the system are fully installed and hen you can do end to end testing at the very end but that wont be for a while, so the strategies are in place and its on going and take privacy and security of the American Public ery, very seriously dont they have to give personal information, social earnings andber and set set cetera and isnt that put in the system . Thats they hit the hub referred back to data bases and Social Security and homeland i. R. S. And in the place will market retain application information in case there need to be subsequent have to get that information now . For the application, yes worried what im about. Wewe dont watch this and if dont have a fail safe system and you pretty much admit you testingve a third party unit in there trying to make sure we do have a third party testing. Who is that miter is the contract who the third party testing. It tested prior to going live in october. Off on going live in october. Test. Are continuing to we have a Security Team who is weeklying and performing testing of border deviceed and daily scans of the will ring tools and they conduct a full security test in when the nvironment entire site is loaded. But we dont have the spanish website up. Additional piece that will be coming. The shop website is coming. Do the end to end testing until the entire system is stood up. Testing is going on every day that makes my case we shouldnt be getting into this set up. s all it would be better and safer and peoples cted of rights and their personal information. Im saying is, i think you need an independent that isnt a hired contractor to do this. Raise these to issues. I know this is very difficult appreciated you testifying here today. Our e you will answer letters when we send them to you letters out to you i never got any answers on. Look, were not in it to just rough time. Were in it to get it right. I would love to work with you get it right. Thank you. Thank you. Main point ts the of this whole hearing is to get it right. And you just heard senator hatch say he wants to work with you to right. I mentioned in my Opening Statement that i am speaking for least majority of the committee to get it right. Its a 2way street. You have to tell us whats working and whats not working. American people strongly believe in transparency. We do in this committee. The more you dont tell us, the greater the problem is going to be. The more you do tell us, the good, the bad, the more likely gonna get this right at an earlier date. Until the end of to ber that were not going be up and running for the first of december. Work with us. This is the law. We want to do this right and points in the law that have not been brought out. Believe strongly to educe the healthcare costs in this country. We move more toward reform and that, in rts of efforts by private entities to control costs were making head way. One senator mentioned that japanese healthcare costs are eight . Administrative costs are 7, 8, 18. U. S. Ing we have to work to get the 18 now and other problems for fee service in this country. We want to keep working with you. Why . Our job. Hats we represent americans. We represent people all across country ask they want this to work. The politic. Ke they want the dog gone thing to work. Lets Work Together to make it work. I would welcome that. Thank you. Just one comment. Theres another party that has to be have the attitude, mr. That do you and that s the Republican Party in the senate and the house. The Republican National committee and all of those people that are doing everything they can to destroy you, the and lots of speculation as to what for that might be. Cooperate. O in other words, what the we rman is saying, is that will do everything we can. Ave he was unable quite farreaching extraordinary bill. Add that they have responsibility to help criticized the statements made. Senator. You, look, i think this is a terrible bill. Im a not because republican or a democrat. Ive worked as much on here inre issues around the last 37 years as any number of people. Frankly, better than most. Things desire to have work. Senator e tell you, reid said it well. Hey said is this basically he basically said that its just single n the way to a payer system, on a one size fits government run system. Thats what worries republicans i think it worries democrats too. And im very concerned about a socialized o medicine situation where we cant control the cost and cant control the system and we denigrate the of helping it. Naturally, im concerned about t and an i think a lot of republicans that are concerned about it and democrats that are concerned about it. This is an simple bunch of political hacks working at it. This is a very serious set of problems. I dont have envy you to be in your position and have to answer questions and have to be the front person in trying to thing work