That seems wrong. I know my friend is looking at it and we will make sure it changes. Thank you, mr. Speaker. With a chance for take this opportunity to correct the bizarre claim made yesterday by donald trump about parts of london being no go for the metropolitan police . Will be point out to mr. Trump the artifact excellent relationships between the Muslim Community in london and the police . I think the honorable gentleman speaks everyone in this house. The metropolitan police to a brilliant job and, of course, the fantastic relations with british muslims, and british muslims have made a massive contribution to our country. Donald trumps conflict comments light in the face of the principles of the United States and it is one of the reasons why those of you principles approved such an inspiration to so many people over the last couple hundred years. I think the best way to defeat nonsense like this is to engage in robust democratic debate and make it very clear that his views are not welcomed. Here, here. Thank you, mr. Speaker. [inaudible] well appreciated and respected by my constituents, but the issue they have they cannot run daily receive 11 of funding from nhs funding. Will the chancellor please work with me and my other colleagues to see what more money we can put into our hospices and commandeer . I know my honorable friend is a strong champion of his community and for the hospice that he talks about. We have taken steps to the hospice movement, not least removing the vat they paid in the last part of the. I think we want to get the right balance. I think its a good thing hospice is funded in part by local charities and support is so strong by the local community. They need the backing of the nhs and, of course, we are now putting money into the nhs because with a Strong Economy so they can help the hospice movement. Very grateful, mr. Speaker. Mr. Speaker, business is a my own authority will lose 9. 4 Million Pounds per year on top of already severe revenue support which is proposed. The seven northeast will lose 186 Million Pounds a year and the combined northeast, 223 Million Pounds a year. Meanwhile, the city of london will get 220 million westminster 440 million. This is his vision of a Northern Powerhouse . The system is going to apply as we reflect the discrepancies he identifies but i wouldve thought the labour party would support the devolution of business rates. Its a massive opportunity for local areas to grow into the benefits of that growth. And when it comes to the Northern House we have a fantastic announcement today of the new train franchises between over a billion pounds going into new trains, faster journeys and better journey which breaches the people in the north of england. He should get behind it. Peter bone. Today there was an important report that said that the tv debates in the general election with Great Success in teaching people who were not normally interested in politics, and particularly young people. Would the acting Prime Minister, and i know he may have an interest in this matter, for encouraging tv debates at the next general election . The tv debates benefit society by discussion between the Political Parties and the broadcasters. I think my right honorable friend the Prime Minister did exceptionally well in them last sunday. Thank you, mr. Speaker. Its my understanding that the secretary is banned teachers from entering the uk but will the government lead by example in considering making mr. Donald trump an example . Look, i think the best way to confront the views of someone like donald trump is to engage in a robust democratic argument with him about why he is profoundly wrong about the contribution of american muslims and, indeed, british muslims. And that is the best way to deal with donald trump and his views rather than try to ban president ial candidates. Order. Here on cspan2 we will be the british house of commons as members move onto other business. You have been watching Prime Ministers questions time and life wednesdays when parliament is in session. A quick reminder you can see this again sunday nights at nine eastern and pacific on cspan. For more information go to cspan. Org and click on series to get every program weve aired from the british house of commons since october of 1989. We invite your comments about Prime Ministers questions using hashtag pmq. Adam mcgill filner was the first firstly to work outside the home teaching in a private school. She successfully lobbied congress for funds for the First White House library. Mamie eisenhowers hairstyle and love of pink great passing sensations. Turn 11 was sold as a color. Jaclyn canoe was responsible for creation of the White House Historical association and nancy reagan as a young actress saw her name is taken on the black list of suspected communists sympathizers in the late 1940s. She peeled to the Screen Actors Guild and Ronald Reagan for help and later became his wife. These stories and more are featured in cspans book first ladys. President ial stories from the lives of 45 iconic american women. To the mix a great gift for the holidays. Gingrich all look into the personal lives at every first lady in american history, stories of fasting and women and how the legacies resonate today. The book is based o on a racial images from cspan first ladys series and has received numerous reviews including this one from michael beschloss, president ial historian and author. Share the stories of americas first ladies for the holidays. Cspan booktv first ladies is available as a hardcover or an ebook from your favorite bookstore or online bookseller. Be sure to order your copy tod today. Now a hearing on state Health Insurance exchanges under the Affordable Care act. House energy and commerce subcommittee on oversight and investigations heard from the acting administrator of the centers for medicare and medicaid services. A hearing is just under two hours. Good morning your this subcommittee will now convene. The oversight investigations subcommittee of energy and commerce and this hearing today is to continue the examination of the state Health Insurance marketplaces established under the aca. On september 29 the Committee Heard from a panel representing six state exchanges. Attempted to paint a rosy picture it is clear that our serious shortterm and longterm problems with state exchanges. One of our main concerns we will address itself centers for medicare and medicaid services, or cms, is conducting oversight over the billions of taxpayer dollars invested in establishing the state exchanges. Today we expect acting administrator andy slavitt, and welcome back. Today cms has handed out 5. 51 billion to the states to help them establish insurance exchanges. Despite this investment of taxpayer dollars, four states exchange is have been turned into a over to the federal exchange while countless others are struggling to become selfsustaining. As the federal dollars run dry and enrollment numbers appear far below what administration projections, all state exchanges face significant budget shortfalls. By law state exchanges were supposed results listing by january 1 of 2015. At which point the establishment grant money could not be used to operate the exchanges. Not be used. Ya cms has been issuing no cost extensions to state exchanges allowing them to use the remainder of the federal grants to 2015 and in some cases 2016 against intent and letter of the law. Federal funds still cannot be used for operational costs, but because of lax oversight and we could guidance we dont know whether the state exchanges have actually spent is federal money appropriate. Went in to get clear answers today. In the over five years since the aca was enacted, cms has issued only to guidance documents to inform state exchanges are the permissible ways to spend federal establishment fund. The first guidance issued in march 2014 was less than a page. The second came only after the hhs office of Inspector General issued an alert to acting administrator andy slavitt highlighted with urgency the state exchanges, that state exchanges may be using grant funds for operational expenses which is not allowed. In fact, the oig discovered based on budget documents that Washington Health benefit exchange mightve used 10 million in establishment grant funds to support operations such as printing, postage and bank fees, i can not allowed. Hhs, oig urged acting administers live up to Development Issue could guidance to the state exchanges on the proper use of establishment grant funds. What followed was a big twopage guidance document raft of concrete examples. Based on these quote guidances unquote one wonders if cms is encouraging the state exchanges to spend federal dollars in anyway possible against the stated purpose of law to keep the state exchanges limping along. To the committees investigation we learned of businesses were states exchange is may have used establishment grant dollars to cover operational costs are even transition costs when these Data Exchange shuts down and move to the federal platform. It has not always been easy to discern because the suns have been commingled and expenses and costs have been redefined. For example, rent which is an operational cost of any definition suddenly becomes Business Development costs are the system seems to be convoluted by design. Inspite of or perhaps because of cms handsoff approach of the state exchanges are struggling to become selfsustaining. They continue to face it problems, lowerthanexpected enrollment numbers and growing maintenance cost. As the hhs oig point out state changes are facing uncertainties in revenue. For state exchanges, hawaii, nevada, in mexico and oregon have already shut down their state exchanges in these states alone receives 733 million in federal establishment grant. The taxpayers return on investment appears minimal at best. Further there is little indication seanez attempt to recruit any money. It is our hope acting. Translator mr. Mellis out a blueprint for recouping is lost federal dollars so that the American People are not putting the tab. To better understand the challenges of the state exchanges face, ensure more tax dollars are not wasted this committee has a number of questions, why are they struggling to become selfsustaining . Isnis it the lack of a candidae oversight . If cms encouraging fiscal restraint . And where and exchanges decide to shut that has cms sought to refute any of the federal grant dollars, lastly are the exchange is doomed to fail . In my estimations in this oversight has been woefully sloppy at best, willfully ignorant at worst but with obvious spending abuses costing taxpayers millions. We hope cms will be forthright and entry the committees many outstanding questions on its failure in overseeing the acas state exchanges as will provide members the blueprint of how the administration can recoup lost taxpayer dollars. Right at the situation is a mess and taxpayers are on the losing side and that is unacceptable. This hearing comes at a time when premiums are on the rise, major insurers are publicly questioning their decisions to join. Coops are failing at 11 rate in are failing at dawn raid in state the changes are expressing doubts about their amplitude this longterm. Bounty evidence suggests the aca faces mounting problems in 2016. I thank acting administrator slavitt for testifying today and look forward to doing answers to our questions. I know recognize Ranking Member degette for five minutes. Thank you very much, mr. Chairman. Today were having get another hearing on the Affordable Care act. As usual, tried to im disappointed that you are having another hearing focused on undermining the law rather than focusing our efforts on trying to make the law work better. And i know with respect to the topic of this hearing today, cms is trying to implement efforts to make the law work better, and they think we should be using our time today to see how we can partner to make that happen. Since the aca was passed over five years ago this committee has held dozens of first oversight hearings. Not one has been focus on ways to make the law work better. That one of them has presented a balanced view of the laws benefits, but despite that weve gotten a lot of good news out of these hearings about the number of americans that the law is helping and with the agencies are trying to do to improve coverage despite some of the bumps in the road. You know, even more disturbingly to me though, its been really an uphill climb to track and put this legislation because some of our colleagues both here and in congress and around the country have intentionally place roadblocks to implementation to actually make it harder for the own constituents to access care. Some of the governors when the law was passed refused to implement Medicaid Expansion which would give Health Care Coverage to millions of low income americans. One republican president ial candidate who also happens to be a u. S. Senator recently bragged that he killed obamacare by limiting risk corridor payments. Ive got two things to say in response to the. First, i think its really disappointing that members of congress would brag about taking Health Care Away from vulnerable americans. Secondly, i think people are wrong on the facts. The transport is not going anywhere despite countless attempts to repeal, undermine, define and defend the law. The cory booker actress making comprehensive health care a reality for american families. Its saving lives. Since passage of the law more than five years ago an estimated 17. 6 million americans have gained Health Coverage to the acas of various provisions. According to the recent cdc data, the uninsured rate has dropped to a historical low of 9 , down from 16 in 2010. I just went into my colorado folks yesterday at the airport coming out here and they told me despite the failure of the colorado coop system of or two ago theyre expecting because of the revisions and innovation to making in colorado, they may be up to 95 coverage in colorado. Thats extraordinary for the health care of our constituents and thats what we should be working to achieve. Ive got an article from the New York Times entitled rise and Cervical Cancer detection is a link to Affordable Health care, mr. Chairman. According to research from the american cancer society, more women are receiving an early diagnosis of Cervical Cancer due to an increase in Health Insurance coverage under the aca. And id like to ask unanimous consent to put that in the record. Without objection. Early diagnosis improves womens prospects for survival of the disease and it also bolsters their hope to preserve fertility treatment. Women with Health Insurance are far more likely to get a screening that can identify Cervical Cancer early. You know, i know that its hard to make his specific about constituents. Its hard sometimes to my colleagues on the other side of the up to acknowledge the actual people are being held by this law, but millions of americans are benefiting from it, and a lot of people like me think we could be making it even better. The reason i am talking about this this morning is because on the house floor we will be likely voting this week on a reconciliation bill cheroot repealed key part of the Affordable Care act. This will be by our calculation the 62nd attempt to eliminate or repeal key provisions of the aca. If enacted, virtually all of the historic gains in Health Coverage we have made in the last five years would be lost. This would be a tragedy for the American People and a gross failure of leadership. Weve done so much good this year and is subcommittee. We did bipartisan work on pandemic flu. We did bipartisan work on the volkswagen investigation. And many other things. I think this could be the committee where we had these hearings and then we sat down to think about how to improve rather than to undermine the Affordable Care act. I hope thats what well do in the next year but, frankly, i dont out a lot of hope. I yield back. Before it is the next speaker we have several members hear from the National Democratic institute in support of the house democracy a partnership. This is a peer to Peer Exchange cochaired by peter roskam and we have a guess from kenya and peru. Welcome. Just let you know, this is a lovefest among us. We all like each other. So take that you can sometimes win the argument in the end we are still into for the same cause spirit is the chairman will yield. We may disagree but we disagree in a civil way. Watch this. [laughter] thats going too far. [laughter] thank you. I know recognize mr. Upton for five minutes. I think i thank the chairman. And a we continue our oversight in the obamacare. They still continue to struggle as we know. Exchanges are struggling to sign up new customers come struggling to cover operational costs, struggled to fix ongoing i. T. Systems, problems and struggling to become selfsustaining. We welcome the cms acting administrator, mr. Slavitt today and we appreciate your sentiment on this very important issue. As a state exchange struggle to survive these understand the cms role in overseeing been. The government robust investment of federal funds in the state exchange is should be accompanied by equally robust accountability by the stewards of taxpayer dollars. Yet the committees oversight is revealed that cms took a handsoff approach to the state exchange is. For example, cms rubberstamped no cost extension requests issued permissive and vague guidelines and welcome failed state exchange is to the federal platform with no questions asked. This is not acceptable. We want to hear directly the cms plans to improve its oversight over the stated changes to ensure that they are spending some grant dollars legally, actually ill grant dollars legally, and wisely. We also must understand a longterm sustainability of the state exchange is. Especially against the backdrop of rising premiums, failing coops, and Insurance Companies touting their petition patient and the exchanges next year. The writing is on the wall that we very well can see yet another big taxpayer investment spiral down the drain. So its critical we all understand the short and longterm challenges that state exchange is are facing as well as what cms is doing to help the exchanges confront other challenges. Regardless of ones views of the President Health law, the law and its implications event oversight as we continue to see today, billions of dollars are certainly at stake and i yield the balance of my time to vice chair blackburn. Thank you, mr. Chairman. Mr. Slavitt unwelcome but we appreciate you were here. Shopping on the federal exchange was supposed to be a simple shopping for insurance on kayak and that absolutely has not happen. What we continue to hear from our constituents is that this insurance, the obamacare insurance product is too expensive to use. Once they do get it because of the copays and deductibles and premiums that are there. Its a very expensive product. We want to look at the gao report from september. Today we want to go through this with you as both chairman upton, chairman murphy have said. It is very difficult for our constituents. And basically what it appears is that this has been a false promise that was given to people, that they would have Health Care Access because theyre going to insurance. And that has not come about. So we are very concerned about the dollars that have been spent on the state exchange is. We are concerned about the quality o of the product them ad they give the balance of my time to dr. Burgess. Thank you for yield and. Yielding. The administration has invested billions of dollars in an experiment. The experiment that did not include the necessary safeguards and, in fact, ignored successful models in the private market. The Health Benefit exchange is our one such experiment. Millions, billions of taxpayer dollars have been pumped into reinventing the wheel and millions of americans, myself included, have been forced to rely on exchanges to purchase Health Care Coverage. My experience as against one healthcare. Gov has been extremely frustrating. And my expense as a member of congress, a member of this committee and is subcommittee has been just as frustrating. I know there are those who want to accuse us of trying to undermine the law. And, in fact, that is not the case. The law should work and we as members of the subcommittee, we as members of the full committee, we as members of congress have a constitutional obligation for oversight has are those federal dollars are spent. It is the extreme difficult getting questions answered. It has been extremely difficult getting information. That needs to change come at a hope in this last year of the administration we perhaps can at least now admit to each other for our series problems with the law as it stands, and our series actions that we can take to fix those. Thank you, mr. Chairman. Ive we give back the time. Of recognize the Ranking Member of the full committee, mr. Pallone. Thank you, mr. Chairman. We are here today for yet another hearing to attack the Affordable Care act since the august recess the majority of the subcommittee since having dedicated to undermining the law. The majority is called in the state exchange is an cms to criticize of them come and get burdened them with massive document requests in the middle of the open enrollment. I do not mean to suggest that we should not be doing oversight of the invitation of the aca, but what we are seeing from my republican colleagues is not that was oversight designed to improve the law. Instead the majoritys efforts are simply designed to hamper implementation and undermined the Affordable Care act regardless of the facts but, frankly, its incredibly frustrating to hear time and time again listening to my republican colleagues late into the administrations witnesses, criticize the efforts of the Department Without any sense of perspective on historic gains and coverage of that energy. I wouldve hoped by this point nearly seizures after the passage of the law we could add a balanced perspective on where application of the law faces challenges but just as important where it is helping americans lead to better lives and become more productive citizens. We should be talking about ideas to advance the mission of the law, to provide quality, Affordable Care to all of our constituents, or even make the fixes were appropriate. We should be Holding Hearings about ways to target the remaining uninsured. At cms will testify today the aca is could make a huge difference in the lives of millions of americans. Is making families stronger, states stronger, america stronger. The law has faced challenges but we have had many more successes that gw but for my colleagues on the other side of the aisle so im just going to take a moment to ensure that we hea here somef the successes in todays hearing. Because of the Affordable Care act, 17. 6 million uninsured people have gained coverage for the laws very is covered proficiently since the start of this years enrollment period, 2 million americans have selected plans to the federallyfacilitated exchange. More and more states are making the right decision on Medicaid Expansion which is benefiting their most vulnerable citizens as well as saving billions of dollars. Preexisting conditions candelabra preclude individuals from gaining Health Insurance. Consumers do not have to worry about losing coverage if their employment changes. Reductions in the uninsured rate means that doctors and hospitals provide less uncompensated care which ensure costs are being passed along to consumers and employers who pay premiums for Health Coverage. Instead of acknowledging any of these successes, my republican colleaguecolleague s insist on holding more hearings and debate and more bills to undermine the law. Whats worse they are actively try to take Health Insurance way for those who now have to. This week the house may be voted on reconciliation bill to repeal key parts of the Affordable Care act. This is the House Republican 62nd attempt to repeal or undermine key provisions of the law. The republican bill eliminates subsidies for individuals purchasing coverage through the exchanges and eliminates the Medicaid Expansion. According to the Congressional Budget Office the gop bill would increase the number of uninsured americans by at least 20 million by 2018. The republican bill would undo many of historic gains in Health Coverage we made in the past five years. While offering nothing to help those lose coverage or make health care more affordable and available for all americans. Asked for a viable republican alternative to the Affordable Care act, which republicans have said they would offer force over years now, let me just say this. I will believe it because i will believe it when i see because i have not seen it. I yield back. I ask unanimous consent members was written Opening Statements interest them in the record without objection. You are whether committee is holding a hearing in when doing so has a practice