Transcripts For CSPAN2 Key Capitol Hill Hearings 20131122

Policy, can you keep it. There were a lot of people that wanted to buy policies that cost less and that didnt have lifetime caps lifted. There are a lot of people that wanted to buy that didnt cover their 26yearold. You didnt let us do that. And that is the problem. We are smart people. We can make our own decisions. We dont need the government telling us what we have to have. And that is the biggest complaint i get from idahoans, from americans saying why are you politicians and washington, d. C. Constantly telling us what we should do for ourselves . And thats the basic problem of all of this. Whenever you try to socialize in the industry, nationalize an industry like its been done here, its never worked. Its been in tried in all sorts of countries and it never works. Its not going to work here. Well, let me go over a couple other points. First of all, i want to ask mr. Knoll, im told that there are have been 150,000 small group plans that have been canceled in your state. Is that true . Sir, im not familiar with the number there. The department of insurance is the agency that handles the mechanisms for that. Ill be glad to provide that information to you. I got it. They said there is 150,000 small group plans that have been canceled. On the other side of the ledger, through november 8th, 309 have signed up again. Thats a big problem it seems to me. We have 150,000 canceled and 309 signed up. Certainly with the small group, its to note that the open Enrollment Period that affects individuals is not the same with small groups. There is a continuous open Enrollment Period available to small groups. They can sign up any time during the year. Its really encouraging to hear you were one of five that made the rollout work on october 1st. In the morning of october 1st, Bloomberg News was reported we were one of four jurisdictions. Four . That went live without a glitch. That is really good to hear that they were able to sign up. They were able to get on and do what they wanted to do. That is a really good thing. What is the population of the district . We are a small population jurisdiction. About 640,000. Im told that in the first month with you up and running, no glitches, everything is working good and that kind of population you had five enro enrollees in the first month. Is that true . No, thats not true. What is the number . I can provide your office with the exact numbers. We did issue most recent numbers as of november 13th. We had close to 700 employer accounts created. In terms of individual whos completed their applications, both for premium reductions and full premiums, we were at about 1,350 for full price applications. And close to 2,000 for reduced price. Each application could be a familiar live ten. We only count applications. In terms of account holders who collected a plan, over 1100 account holders selected a health plan. And 565 account holders said they wanted to be invoiced to pay. Now theyre not required to pay until december 15th. So i just want to make sure that people who are residents of the district are reminded of that. Were not asking for people to pay early. Were just if they want coverage to be effective january 1st, they do have to make their payment by december 15th. So my calculations then is youre a little under 1 signed up of the population of the district. Would that be fair . I can provide you better numbers. Right now folks who are shopping and making decisions, theres a lot of activity through dchealthlink. Com. Im encouraging Small Businesses to take their time selecting Health Insurance. It is not an easy decision. And if youre not not working with a broker who can help you through it, you really do have to take your time. I can tell you as a former insurance regulator myself, insurance is very complicated. Consumers who get 150page document which is their insurance contract which has the exclusions and what is included is very complicated. So although weve made it much easier through our web page to shop and compare apples to apples, we provide fourpage coverage summaries that make it much easier than before. It is still not a quick decision. We encourage everyone to take their time. Thank you. Senator booker, let me welcome you to this committee. Let me welcome you to the United States senate. I look forward to your leadership. Youve already been a champion of Small Business. Youre a perfect person to join us in our effort to help them. Thank you very much. Thank you. This is such an important issue for the state of new jersey that im very grateful to have the opportunity. I want to thank all the panelists. I wish we had more time. I look forward to reading more of your testimony submitted into the record. Mr. Greenblatt, first of all, i appreciate your jersey connection, a guy who vacations in jersey and you have some jersey boy aura to you. I want to say to you first and foremost as the geologists say, you rock. And you rock not because of your jersey connections, i feel the kinship of you and any the last month have come to washington. You goat go home, i think. Im going to stick it out here and battle it out. You deal with prague in a tichl that i have to deal w i cut 25 of my employees as a mayor. The reason i had to cut so much is because health costs were going up, my taxpayers couldnt afford it. I have to balance a budget every year. So do you. The challenge that you have which ive seen working with local manufacturers in my city that i want to expand is that you said you export products to china, right . Youre competing globally, right . I like you a lot. And when you compete globally, youre competing against countries in europe and asia and across the globe, right . And many of those countries have Different Health care systems and most of those countries, most of our competitor nations have much Lower Health Care costs, right . Its parts of the system. Their taxes are 15 . Our taxes are 40 . It makes it challenging to compete with canada. I want to compete with canada in every way except in toronto. Their mayor has challenges there. So my point to you is that your pragmatism i love. Because this is not about politics. Its not about the pugilism that is row found in washingtonment its about solving problems, lowering costs, giving access and Small Business people like you want to keet with the big boys, right . Absolutely. And what i see in my city is many folks have a hard time keeping employees who could hes gloi to other companies and have better insurance plans. You probably know of people that will go to companies and get less salary for Better Health insurance. I think that is one of our positive attribute thats we have such a good plan. So the key here, the goal here is to make sure that we take this variable which has made Small Businesses get so crushed in the past and helps them be more competitive not only in keeping employees locally but also competing against other countries that have Lower Health Care costs. They have Lower Health Care costs. And youre competing against them because you internalize the costs and manufacture the companies dont. Right . Right. So thats the flag ma ticpra. I dont care about the next election, i care about solving the problems. They may not like politicians, but most people are saying fix this thing. So mr. Hickey, who has no new jersey connection, im sorry you do, sir. In my last 90 seconds, sir, would you please youre well down the field. You have a functioning exchange. You heard the good jersey boy mr. Greenblatt and mr. Allens problems. You could please tell us what the future could look like for them and how to solve the very real problems they brought up . Number one, put together an Exchange Board that is from both sides of the aisle. But as you say, they care about the people of new jersey. Our board has people i dont know sorry to interrupt you, i dont know if you heard about my governor, he is quiet he and soft spoken, but did he not participate in the exchanges. We have one of the best local insurance based knowledge there is and we didnt engage in that, new jersey. We left it to the federal government. So were way behind new kentucky. Not a place we want to be in new jersey. But continue. And that board being made up of people even though they were vitriolic against the aca, once they got on that board, they said we have an obligation, a duty to the people of new mexico and we are going to make this work. Right and left coming together. Right. And we all came together. We have a great chairman. He is also a doctor. We all came together and we met and we met and we met and we resolved the issues. And we hired an excellent ceo and we hired a company of previous private exchange ven r vendor, a shop in the box is what we call it. And it already works. And we knew it would work. And so that was and my time expired. People are hurting now. We have to fix this before the next election. I appreciate you showing us a way forward. Thank you, mr. Chairman dr. Hickey. Senator enzy . I didnt anticipate getting into my Congressional Review Act, but since its been brought up several times. I will. One of the reasons that it included some things that you would prefer not to have in it is when the federal register is published and says that theres going to be this huge kst and people losing their insurance even though the president promised that if they like their insurance they can keep it, your choice isnt to pick from the things in there. You have to reverse the whole regulation, the whole regulation would have made it possible for people to keep their insurance if they liked it. So you had also have a very limited time to be able to bring up a Congressional Review Act and have that kind of a forced eighthour debate and up or down vote on regulation. They could have made it so that people could keep their insurance if they liked it provided it didnt have the two things. Thats not how it works. There hasnt been any effort in the meantime to do that. Now that its been exposed. There is a tremendous effort and interest and senator johnson has a bill that would comply with what i think the chairman said would be acceptable to go ahead and fix it so that people who like their insurance could keep it. Although, it should have been done three years ago. So the Insurance Companies would have had the opportunity to adjust to the time. To have their stuff together for this particular time. I think it would have helped out businesses. There are three change thats id like to make in obama care and if we made those three changes, it would make more of a difference in jobs in the economy than the stimulus package did. One of those is to change the hours for part time from 30 to 40. And that is the standard by the Small Business administration. And this is the Small Business committee. So i would hope that we would do that. I had a ten step plan for fixing Health Insurance before the president ever became a senator. And one of the things is Small Business health plans. We had an opportunity to do that. That would allow Small Businesses to group together through their association, any association across state lines, nationwide so theyd have a big enough group they could infectively negotiate with any Insurance Company. There is another proposal that would have allowed them to selfinsure on those big groups. Those would have provided a lot of advantages for Small Business. Those are not available. Small Business Owners of wyoming are asking me what can be done . Wyoming didnt do an exchange. Its less populated than the district of colombia alom colum. We only have two Insurance Companies that are interested in serving there. We only had two provides providing prescriptions until we bid prescription part d. One of the things that surprised us, 48 companies wanted the business in wyoming. Even though it is a small populated state. And what was the effect . Before the law even went into effect it dropped prices by 25 and gave people choices. We could have had that same thing here. But we dont. I want to thank you all for the testimony you had. I had some pretty specific questions that i would ask. Just quickly, mr. Allen, you mentioned that drugs cost 52 more because of the name brand requirement . Could you give expand on that a little more . Yes. The difference in premiums to go to the new policy that includes brand name drugs, the difference in the premium is 52. 3 . And none of your employees are using brand new drugs . Yes, i did a poll among my employees and not one Single Person is presently taking or plans to nay any pharmaceuticals that are available only as a brad name product. Thank you. I think there are a number of great examples there. I appreciated mr. Greenblatt. Sometimes can you use a little stability in what the prices are going to be. Hes not getting that under the exchange. I thank the chair. And i thank the senator from wyoming. Senator shaheen just to put for the record and the senator knows, there are 576,000 people in wyoming, less than in the District Of Columbia. One chose the exchange, one chose not. Senator . Thank you very much thank you for holding the hearing. Thank you all for being here. Im sorry i missed your spoken testimony this morning. But i do think its very important for all of us to hear from Small Businesses and in New Hampshire, 96 of our employers are Small Businesses. It is a foundation of our economy. And the frustrations that you have shared are ones that i think everybody on this panel appreciates and shares in terms of how to make this law work and what we can do better. You know, one of the biggest concerns that i have heard from New Hampshire Small Businesses is about the costs of health care and mr. Greenblatt, you and senator booker engaged in a back and forth on that this morning. But Small Businesses currently in New Hampshire pay 18 more than Large Businesses because of administrative costs. So finding a way to address the challenges that you face is going to be critical. And, you know, looking at what we can do to fix this legislation, i think, is very important. And in that vain, i offered a bill that would delay open enrollment in the individual market because that is the immediate problem that were facing in New Hampshire. And i did that because we want to make sure that people have time to enroll. Now fortunately with the shop exchanges, thats an on going opportunity. But New Hampshire, like wyoming, like a number of other states, also has not chosen to do a state exchange. And so we are very much struggling with whats happening at the federal level. I wonder for mr. Knoll and miss kaufman as you have participated in state exchanges that are working, if you could talk about the reaction of those businesses that have enrolled in the shop exchanges and the District Of Columbia and in kentucky. And how theyre feeling at this point about the product that theyre getting. Mr. Knoll, maybe you would go first. Sure. As youre aware, the enrollment process in the small group exchange, the shop exchange, is really a twostep process. The first step is the employer themselves will come to the exchange and shop and try to determine which plans they want to offer to their employees. Once they go through that process and pick the plans that they want to offer, then the employees are given a 30day open Enrollment Opportunity to go online and pick the one they want. So the it takes a little longer in the shop to really get to the point where you actually are enrolling. So that process has to be completed. That is the open Enrollment Period for the employees has to be completed. We had a participation requirement in kentucky that says that 75 of the employees have to participate. If they dont, then the employer so that takes time. Weve gotten to the point where now employers have selected plans and the open Enrollment Period is on going. Employees can come in and choose. And then, you know, so what im trying to say is its difficult to say how thats all going to happen. Its predicting the future. So we are very, very encouraged about the numbers. I mean weve had over 93 employers that have gotten to the point where their employees are now picking plans. Great. Thank you. Thank you. [ no audio ] so this is the first time they can offer coverage to their workers and themselves because if the workers arent covered, its likely the owner isnt covered either. So one Small Business was very excited about that. Another small busy spoke to on october 1st said the owner said based on his quick review of all the products, hell save 12 , at least 12 . At that point in time he has not made a decision of the products he wanted to offer. Another small busy spoke to said they were very happy not to be paternalist paternalistic. They can let their employees decide which hmo or ppo or Insurance Company to select. Anecdotally, Small Businesses i have been talked to have been very, very pleased with the product offerings, the range of offerings and the prices. Thank you. Thank you very much. Senator johnson, thank you for joining us. Thank you, madam chair. In solving any problem in negotiation, first thing you want to do is figure out what can you agree on. There are a couple things i can agree on with you right off the bat. We need to fix this bill. And theres a lot to fix. Secondly, it sounds certainly in your Opening Statement that youre giving states a lot of credit and were having real problems on a federal level. I agree. The federal level i dont think has any capability of doing this. The states are far better, far better place to start solving this problem. I want to start my first question with mr. Knoll. Did kentucky need a 1600 page bill and 20,000 plus pages of regulation to do this Small Business exchange . Quickly. You could have done it on your own, couldnt you . We tried to do it back in 1990, early 90s. You didnt need a federal bill, did you . Did you really need a 1600 page bill and 30,000 pages, 20,000 pages to do this in new mexico . [ no audio ] we had a 60 page bill creating the xhapexchange. Again, ill stipulate. Another thung we agree on. I think Small Business exchange is a good idea. It is sharing the risk pool. Right. We had a supportive republican governor doing it and a Democratic Legislature and they compromised on this bill. And we moved right out of the gate. I think states are a great place to start. You know, to paraphrase senator booker this is about solutions. It is really about recognizing reality. Its about telling the truth. In fact, the fact of the maer is the American People have not been told the truth. Let us atalk about costs. We were guaranteed if you pass this law, the costs for an average family plan would be reduce by 2500 per year. Miss salt der a great job. I want to ask you because you have the exact experience. If you have Health Care Plan and you add patient services, is that going to increase the cost or decrease it . If i have one now . Yeah . It will increase. Yeah. Dr. Hickey, if you add Emergency Hospital services to that, is that going to increase the cost or decrease it . Theyre automatically covered. Again, if you in other words, if you add coverages to Health Insurance plan, is that going to increase the cost or decrease the cost . That generally will increase the costs but the state, again, coming back to the state, the state had the authority under the federal bill to decide what essential benefits were going to be covered. But again, im just talking about the truth of what promises were made here. We were promised that the Health Care Law would actually decrease costs. But all of the added costs, all the added coverages, all the added mandates have increased costs, correct . Sir, if i could point out to you that 25 of the premium that you pay today goes to cover the uninsured. And the services they get from wherever they get it from. So that, i think, is where the opportunity once those people get covered the Insurance Companies will have a major opportunity to lower the costs. Please let him answer. Thats not what the Business People are experiencing. Please let him answer. I have limited time, i have to move quickliment i do want to talk about the other totally broken promise, the fraud. There is a massive fraud. If you like your Health Care Plan you can keep it. And i do have that law. I appreciate senator enzy pointed that out if you like your health plan, can you keep it. The appreciate madam chairs attempt but her bill only covers those individuals participating in individual market where we are going to see, i believe, because of the increases in costs, 49 , 52 increase in Insurance Premiums, were going to see a massive loss of employer sponsored coverage coming next year. And so i guess i would certainly encourage the madam chair to take a look at my bill which actually is all inclusive. And it is not quite so onerous on or forcing Insurance Companies to do what they may not be able to do because of state regulators. Id really like you to take a look at your law versus my law. Id my law. I would love to work with you folks to actually start giving america the freedom and allow them to keep their ability to choose the type of Health Care Plans they can afford that they want. Thank you, madam chair. Your bill guts the Affordable Care, mine fixes it. Well talk about that later. Thank you, madam chairman, first of all i want to give a quick update at one of our last hearings about obama care and Small Business. We had a very compelling witness, the owner of dots diner. I followed up with him in response to his testimony. Unfortunately its gone from bad to worse due to, he was forced to cancel policies he provided before, in particular, so that many of his employees could still be eligible for a subsidy on the exchange. Now, he followed the law by giving 90day notice. And he also asked and hired a consultant to come in and help his employees with the obama Care Exchange application. However, all the website problems have pretty much shut down their ability to purchase insurance on the federal exchange for now. The consultant is next coming in december 1st, which gives them two weeks to enroll. If his employees go to the individual market, theyll see an average premium increase of 54 . And if they cant get plans there on the exchange, theyll be 30 individuals who are previously happy with their employer based coverage who wont have any coverage. So thats very real world but unfortunate update. In terms of questions, miss kaufman i wanted to ask you a few particularly based on congress and Congressional Staff going to the d. C. Shop exchange under this special carveout rule for congress. Are there more than 50 members of congress or employees that will procure insurance on this d. C. Shop exchange . Im sorry, on all of the enrollment for employers is protected information and im not able to share with you any specific details about the congressional enrollment. Based on the size of congress, 535 members, and the size of their employee base, would you expect that number to be more than 50 . More than 50 people enrolling . Yes, i didnt understand your question. Thats correct. The provision under the Affordable Care act that speaks of professional enrollment essentially overrides the Small Business size and thats how youre able to avail yourself of the same choices that Small Businesses have in the district. Is there any other Large Employer, over 50, who gets the same treatment and gets to go to that exchange . At this time the congressional provision only applies to congress but in 2016 forget about the congressional provision. Right now for 13, going into 14, there any other Large Employer who has that opportunity to go to the d. C. Shop exchange or whose employees can . In the city we made a decision to limit the size of the Small Business market to up to 50 workers. So congress is the only Large Employer who gets that special premium . Its a function of an one of the provisions in Affordable Care act. And is there any Large Employer who gets this huge subsidy well above the normal income base subsidies of obama care in that exchange . Small businesses in the district are they also, many contribute 100 to the premium just as youve heard from other witnesses. Small businesses, especially nonprofits in the district provide Platinum Plus level of coverage to their workers and contribute 100 to the many many contribute 100 to the premiums so they do better than congress. Depenthey have a clear distin between over 50 and under 50. Are is there any other Large Employers, which means over 50, who go to an exchange and go to the d. C. Shop exchange at all or go there and contribute this subsidy . So, in the district, we do not allow larger employers to come in. In 2016, larger employers up to 100 can come in, starting in 2016. And then it will be a policy decision for the district whether or not to expand the d. C. Health link to larger size employers. What in your opinion justifies this completely different and better treatment for congress . Congress gets the same treatment as all Small Businesses in the district. You have the same congress isnt a Small Business. Its not under 50 employees. So by going through d. C. Health link, you get access to everything that Small Businesses in the district get. The broad choice my question. Your time is up. Justifies a completely different senator viter, your time is up. Let me answer that question. The federal government is not a Small Business. The federal government is a Large Business and the federal government and congress employees, postal workers as you know very well because youve studied this issue very well, under the same as Large Businesses in america. And that Insurance Premium is shared between the worker and the government. Their employer. Now, thats not the subject of this hearing. We can talk about it. Weve debated it. Youve had ample time to debate it on the floor. Lets take it to the floor. Madam chair, can i briefly respond. No, you may not. Can i briefly respond . Ill give you 20 seconds to respond because you have a lot of time on the floor on this issue and miss kofman has not. You can respond, miss kofman does no have the time. Congress is not a Small Business, its a Large Employer and treated completely differently than any other Large Employer. And far better by being able to go to this exchange only Large Employer thats allowed to do that. By being able to get a huge subsidy, only Large Employer thats able to do that for this time period or any time soon. If your bill passes, the only large employ welcome back. Thank you all so much and lets begin. If youll just briefly introduce yourself in light of the time wed like to extend this for another 30 minutes. Its very important. Most of the members have left except senator vitter and myself. If you would proceed, please im sorry, senator booker is also here. If you would introduce yourself briefly and begin. Thank you, madam chair. Good morning i guess its afternoon by now, to you, chair landrieu. Can you speak into your mike . Its uncomfortable but youve got to lean forward. Okay. So thank you very much for inviting me here this morning. Im fiphyllis borzi and here to discuss the department of labors activities related to communicating with Small Business about the opportunities and requirements that exist under the Affordable Care act. The departments Employee Benefits Security Administration is committed to helping Small Business and employees benefit from the law. The Health Insurance marketplace premium tax credit and notices to Coverage Options through marketplace are all designed to expand access to Affordable Health coverage. For Small Businesses, the Small Business Health Options program, the shop exchange, offers one shop stopping one stop shopping, sorry, to enable Small Businesses to find and compare private Insurance Options. It is administered by hhs and the states. The marketplaces will help individuals evaluate private Insurance Options for coverage ee effective january 1st, 2015. The new fair labor standards act, gives employees information for Coverage Options available through the marketplace. And if applicable, information about their employer offered coverage. Employers covered by the flsa are required to provide this key notice of Coverage Options to each employee, no later than october 1st, 2013. For all new employees hired after that date, employers have to provide the notice within 14 days of the employers state date. Although theres a statutory duty on employers to provide this notice, there is no fine or penalty under the statute for failing to do so. On may second the department issued technical release 20132 providing guidance on the Coverage Options notice and as well as model notices. We are increasingly using model notices in an effort to be helpful to Small Businesses because a model notice makes the notice requirement far less burdensome. Employers need to figure out for themselves how to comply with statutory requirements or hire somebody to help them. They worked with hhs and other sister agencies to develop the model notices and the model notice serves as compliance assistance tool for employers, but employers are not compelled to use the notices. There is one model notice and second one for employers who dont offer a health plan. These notices are posted on our website in multiple for mats for use by employers and also available in spanish. The two model notices make the process shopping for Health Care Coverage easier for both employers and employees. For example, the model notice for employers who offer Health Care Coverage, deliberately contains more information that the minimum statutory requirements for this notice. Why . Because then employees will have more information about their Coverage Options inside and outside of the marketplace. This also creates efficiencies for employers because the extra information in the model notices matches exactly the marketplace employer coverage tool designed by hhs which is part of the single streamlined application for the coverage in the marketplace. This means that an employer who uses our model notice wont face additional requests for information from the marketplace about coverage with respect to the employee because the model notice satisfies both the flsa and hhs requirements. Outreaching compliance assistance are very High Priorities for epsa, we partner with hhs, treasury, Small Business administration, using a multifacetted approach please try to wrap up. Certainly, coordinated online information linked to other afgss and web nar trainings and compliance and participant assistance. We have benefit advisers available to small employers with compliance through the website and through our toll free hot line. I think ill stop there. Thank you very much. Mr. Cohen, please introduce yourself briefly and get into your testimony. Thank you, chair landrieu and members of the committee. Im gary cohen, serving as director of the center for Consumer Information and insurance oversight within the centers for medicare and medicaid services. Thank you for your opportunity to discuss the many benefits the Affordable Care act provides. I was very pleased to hear from state partners from kentucky and new mexico and District Of Columbia about the successes in building a Small Business marketplace at the state level. From the very beginning, we encouraged every state to set up their own marketplaces because we believe that the states were in the best position to create marketplaces in the way that vet the residents of their states. We have worked very closely every day with our state partners to help them stand up those exchanges and we take great pride in the success theyve had. But i think its also important to remember that the reforms of the afford anl care act are not just about the changes. They go beyond the exchanges to the entire Small Business market. As you noted, in your Opening Statement, madam chair, many Small Businesses that would like to offer Health Benefits to employees have faced significant challenges in the market as it exists today. Premiums have been going up, double digit, 20 plus every year. Small businesses have been charged 18 more for the same type of coverage that Large Employers pay. Most importantly they were subject to wide variations and high volatility in premiums based on the type of work that the business did the Health Status and demographic characteristics of their employees. A Small Construction Company would pay more than an Accounting Firm of the same size for coverage. Small employers face significantly higher rates if they have Older Workers or more women in the workforce than others. Because of the small risk pool, if even one employee became sick, rates for the entire company would skyrocket. The Affordable Care act is changing all of that and transforming this market. So most importantly, were expanding the risk pool to all of the Small Business enroll ees in an entire state. Were spreading the risk among all of those employers. Were saying that you cant charge more just because some people get sick or women. There are limits to how much more you can charge to people because of their age. Because so the whole point of this, for the Small Business market to function more like a Large Group Market has functioned. As you noted, where premiums have been significantly lower. In addition, what weve said, insurance should be real insurance, it shouldnt run out as soon as you have an illness that requires a hospital visit. It should provide the essential benefits that were determined by states and were pegged in most cases to what was prevalent in the Small Group Market today. So these are not a whole bunch of new benefits that nobody had ever throughout about or wanted to have. This is what Small Businesses have today. Thats the type of coverage thats real coverage so that people dont find if they become sick and have to go to the doctor or hospital, you dont have that coverage. You dont have hospital coverage or Prescription Drug coverage. Its real coverage. Now, in addition, the Affordable Care act created the Small Business Health Care Tax credit to help smaller employers of 25 or fewer employees who insure who earn an average of less than 50,000 a year and if the employer pays at least 50 of the premium cost of their employees, they qualify for a tax credit. That has been in effect and hundreds and thousands of Small Businesses have already benefited from it. Beginning in 2014. The tax credit increases to up 50 of the employers contribution to their Employers Health care cost. Just want to touch very briefly on some things weve done to make sure that Small Businesses are aware of these benefits and options. In particular, we want to say, we have worked very closely with the agent Broker Community and understand most Small Businesses do obtain coverage from a agent, using an agent or broker. Weve done a series of many web nars and trainings for literally tens of thousands of agents and brokers who participated in those so they can understand how to participate in the shop exchange. And in addition, our regional offices have conducted many, many workshops and programs out across the country to inform Small Business about the benefit to the Affordable Care act. Thank you very much. Thank you very much. Mrs. Markowitz. Chair landrieu and members of the committee, thank you for having me to discuss sbas efforts, i serve as agencys principle representative for illinois, indiana, michigan, minnesota, ohio and wisconsin. In this role i oversee sba Affordable Care outreach through seven district offices in the midwest. Americas 28 million Small Businesses are back bone of our economy, creating two out of every three new jobs and employeeing half of americas workforce. Were committed to providing entrepreneurs with the tools and resources they need to start and grow businesses. This includes an aggressive effort to ensure Small Business owners have the facts they need to make sound Business Decisions for businesses and employees. With the nationwide network of 68 district offices, sba is uniquely providing information on the Affordable Care act. We have participated in more than 1200 afford care act out reach events reaching over 68,000 Small Business owners and stake holders across the country. I have personally presented over Health Care Forums and my team in region five participated in an additional 100 plus events throughout the midwest. These events are often hosted in partnership with local chambers and other Community Organizations and enable sba so connect with a wide range of entrepreneurs. In conjunction with our federal partners at health and human services, the department of labor and other agencies, sba provides Small Business owners with the most updated information on the Affordable Care act. We continue to educate enprenewenpr enprenaurs and tax credits available for Small Businesses and enrollment details relative to the marketplace. I cant emphasize enough theres a great deal of misinformation about the Health Care Law. In my travels i frequently meet with Small Business owners anxious and apprehensive about how the Affordable Care act may impact their business. When i speak at outreach events, many entrepreneurs often mistakingly believe they will be affected by the employer shared responsibility rules. Im able to reassure them this is not the case. In fact, 96 of all businesses and most of the businesses that i encounter in these sessions are too small to be impacted. Of the remaining 4 , the vast majority already provide health care that meets the standards required by the law. When entrepreneurs have access to accurate information, they are able to have questions answered and letter better equipped to make decisions best for their unique business. Sba promotes the benefits available to Small Businesses through the marketplace, whether its a staterun exchange or federal program, they are designed to give Small Businesses with generally up to 50 fulltime employees, the same purchasing power and options enjoyed by larger companies. While theres no requirement for employers to participate, the marketplace provides a tremendous opportunity for many Small Business owners who want to purchase quality affordable insurance for their employees. In addition to these efforts, they develop online and tool kit that compliments our in person counseling activities and provides Business Owners with on demand access with the latest information about the Affordable Care act. We have created extensive online content at both sba. Gov and businessusa. Gov. They receive 2 million visitors per month. Launched a direct e news letter which reaches more than 1 million subscribers. In participation with the Small Business majority, we have helped 35 Affordable Care one on one webnars for Small Businesses across the country. These Popular Online sessions reached 16,000 entrepreneurs and very well received. Sba leverages are extensive Resource Partner Network to help educate Small Businesses on Affordable Care act. Earlier this year, we held a series of comprehensive web nar training for aur Small Business Development Centers and Womens Business Centers and support counselors. Working with 1 million entrepreneurs annually, they are able to expand the Affordable Care act and in their communities. Sba is committed to collaborating with federal partners and ensuring Small Business owners have the facts and resources this need to understand and benefit from the law. Thank you for the opportunity to testify today. I look forward to your questions. Thank you, our hearing has gone 15 minutes over time. But this is so important i want to continue the questioning. I think weve gotten a lot of valuable testimony on the record as we continue to try to fix and approve the Affordable Care act. Let me ask all three briefly in my first question, we have the department of labor represented here, miss borzi, center for medicaid and medicare. The three of you are primarily responsible for helping implement the Affordable Care act at the federal level. Theres undoubtedly justified criticism of what has happened so far at the federal level and in those states where governors, mostly republican, but some democrats have refused to set up their own exchange and ask you to come in and do it. Theres been some difficulties. So my question, what are you going to promise to do better . What are you working on specifically . I want 30 seconds each of you starting with you, mrs. Mar markowitz and what can you learn to do a better job, starting with you . Speak into the mike. Sorry. You have to press your button. Sorry. What the sba is focused on is outreach. We continue more than ever to get the word out to Small Businesses. One of the biggest problems that we run into is a misinformation in the Small Business community which is purposely, i think in large measure. It is very prevalent. Most of the rooms i walk into are filled with Small Businesses that are nowhere near the size that would be impacted by the employer shared responsibility provision. And yet they are positive that they will be impacted by this. We cleared that up. Just for the record, could you clear that up now, when you walk into a room, its mostly filled with businesses that are of what size . Well under 50 employees. Are they affected at all . Not at all. No business in america that is under 50 employees are affected at all by the employer shared responsibility . No, in fact, that represents 96 of overall businesses. Instead of in addition to not being impacted by the employer shared responsibility, those 96 of businesses have access to new benefits and protections that they never had before. Often i walk into a room and there could be a negative perception of this act and they havent begun to explore the benefits available too them because they are so confused by the misinformation. What were doing, i wont surprise you, were working hard to improve the online experience. Im pleased to say we have made significant improvements and i keep hearing every day more and more get through the application in a reasonable period of time and get enrolled in coverage. Theres a story on nbc news today, is the stortry about the healthcare. Gov rollout outdated and i think it is. We moved on from where we were before. I was really impressed by all of the three states talking about the involvement of their stake holder communities and i think weve done that. But its different at the federal level than it is state level. But i think we need to work really hard to make sure were working with the agent Broker Community, Consumer Community and Small Business community and so forth to make sure that everybody gets the benefits of this law. Miss borzi. I had the same experience my colleagues had. I do a lot of Small Business roundtables. There was a lot of misinformation, not only do they not understand that the employer responsibility penalty doesnt apply to them, what i found is remarkable that they dont understand that the Small Business tax credit is already available, has been available since the law was signed. These are Small Businesses who are trying to do the right thing by their employees, i know youre very interested in the notice requirement that we administer. We are trying very hashed to make sure that people understand that this can be an opportunity for Small Businesses to understand a little bit better about their responsibilities and i certainly will promise you that we will work closely with your staff and the other staff of the other members of the committee to try to be try to make the experience of having to fill out these forms, clearer and easier. I appreciate that. My last few minutes, i want to submit the forms that the department of labor put out that i found very, very confusing. Next Health Care Insurance marketplace coverage, first of all, it should have said that if you receive this as an employer and under 50 people, you disregard it, its not its not appropriate for you. Over 50, this is what im going to submit something that weve come up with that might be a more clear form. I hope you all will work on that once the website gets up. People can have a better walk through experience because the Consumer Experience with this is extremely important. Thank you all very much and im going to get senator johnson and senator booker. Thank you, madam chair. Mr. Cohen, in general, what is happening to the Insurance Premiums now, not after taxpayer subsidy, what has happened to the Insurance Premiums of Young Healthy individuals under the Affordable Care act . I think they vary a lot from state to state and even within a state, region to region. I dont think its possible to make a broad general statement about that. Well, i would like to enter in the record i guess republican Staff Committee put together a summary sheet of whats happened. For the state of illinois, somebody 27 years old, male experience 104 increase and female 42 . Is that with subsidies or without . Gross premium. Without subsidies. But the big has subsidies in it. We wont be confused. The point being, the only way anybody is going to not the only way, one of the prevalent ways people see their share of Health Premiums reduced is because taxpayers going to subsidize their care. In wisconsin, let me finish, madam chair, the cost of the male 27 years old, increase 125 , female about 77 . A lot of that has to do with the fact that were community rating, were limiting the Insurance Premium rate on older sicker individuals and were increasing the premiums making younger healthier people pick up the burden. I think what were hoping to do is increase the number of younger people who are covered because the rate of they pay a lot more than they were currently paying in the individual market, correct . What were doing is expanding the risk pool to spread the risk across the whole population. Thats the idea behind the law. Mr. Cohen, let me ask you as an expert in cms, when did you realize that what the president was saying, if you like your Health Care Plan, you can keep your Health Care Plan. If you like your doctor, you can keep your doctor. Did you believe that ever . We the law provides that issuers could continue plans as grandfather plans as long as they wanted to into the future. The law was designed to enable that what the president said to be true. It was really up to the Insurance Industry to make decisions as they have in the past. Let me explore that. My bill, if you like the health plan, you keep it act, uses the president s exact same language in the bill. The problem with the president s the grandfather clause in Affordable Care act, you can keep your plan, as long as you totally change it. What we did is took out the as long as you totally change it. Didnt force those initial Health Benefits on those plans. The fact of the matter is, you couldnt keep your plan unless you changed. They are not essential to the health care requirement. There are other things they are subject to, maximum no they are not subject to its quite the opposite. You cant add more people on a grandfathered plan under the law. Im not asking to add more people. Guaranteed issues, thats what youre talking about. Lifetime maximums. Well get you the list of the exchanges required in the grandfather clause because we extract then my bill. But any way, getting back to my question, did you believe that if people like the Health Care Plan they would be able to keep it across the board, that nobody would lose their Health Care Plan if they wanted it . I believe the law provided an opportunity for Insurance Companies to have grandfathered plans which would make the president s promise to be true and it was also true that the large majority of americans who have employer sponsored coverage through Large Employers were also able to keep their plans. Every american . I mean, for example, did you realize that state high risk pools like in wisconsin that covers 22,000 wisconsinits, did you believe those would be available . Before the afortdable care act, every american wasnt able to keep his or her health plan, you could lose it if you got sick. Were talking about the promise made, if you like your Health Care Plan, you keep it. Ive got a couple in wisconsin, both cancer victims, that have been dropped, will be dropped from the high risk pool because it becomes obsolete, january 1st. You knew that as a Health Care Expert . The law did not require states to drop their high risk pools. The law allowed states to continue their high risk pool. That was a decision that was made by the state of wisconsin. You knew those things would be gone . No. You really believed that every american would be able to keep their Health Care Plan and doctor, you believe that to be a true statement . Theres nothing in the law that requires anybody lose their doctor. I ask whether you believe that. I believe the law contained provisions that were nabld not to be true. It is not government mandated health care, its up to Insurance Companies to offer what they offer in the marketplace. They were given the option, ability to maintain the existing plans as grandfather plans, if they do that, people are able to keep those plans. Its a choice the gentlemans time millions of americans are losing their Health Care Plan, are you surprised by that . Well are you surprised, yes or no . Im not surprised or unsurprised. I didnt have an opinion as to what the market would do. I knew what the law provided. Senator johnson thank you for sharing such clarifying comments. Senator booker. I want to thank the chair. You held this hearing in a difficult time with a lot of political noise and nonsense and rancor, reminds me of great president who once said its not the critic who counts, the man who points the strong man stumbles or doer of deeds could have done better. Its the person in the arena. Thank you for holding this hearing and bringing right and left together to discuss practically whats going to help americans. And so i have a very simple question which is fueled by my frustration. I want to form a new caucus already, only been here 20 days. Whats going to grow american businesses . Whats going to help Small Businesses, which as you pointed out, are the job creators, driving our economy right now . What was before i dont want to go back. Im not putting this country in reverse to go back to a time when Small Businesses were getting crushed because they were losing good employees and didnt have Health Insurance. Small business were getting crushed because those that tried to step up to the plate and provide insurance in a globally competitive market were competing in its countries who fixed this problem with Lower Health Care costs. They internalized this or put their workers in the corner. Weve got to figure out a way to fix this in a way thats going to grow and strengthen Small Businesses. The idea itself is very good. That we could find a way to create a competitive Business Environment for Small Businesses so they dont have to worry about this fear. I agree with the ranking member. This is about freedom from fear. I know tons of businesses that lived in that fear. So i just the one thing that is already been discussed that you forget rhetoric, practically youre seeking what im seenging, when you go around the state of new jersey, there is so much confusion, fueled by politicians and media folks about the facts. 96 of businesses are not affected here. And yet, i have Small Businesses in new jersey who think somehow its going to shake arent even aware there are federal subsidies to help them. And so in this state of mass confusion, fueled by media and politicians, please tell me from your experience what is the best way to cut through all of this mi mitch goss and how can we get the truth to Small Businesses who need to be freed, liberated from fear and now how this actually could help them . Anybody. With a name like o brian markowitz, you are about bringing things together, building bridges. Its true. It is about education and bringing the focus onto the benefits available for the 96 of Small Businesses that are not only not affected by the employer shared Responsibility Division but have these benefits they cant focus on because of misinformation. That is what we as an agency are entirely focused on. We work with hhs, a great partner in this outreach as has some of our state partners. Once the business gets rid of that fear that you allude to which is very real, they can focus on the fact there are these tax credits. They are very excited about exploring those for their business. They understand more about the broader reform and they cant be discriminated for having a workforce for employeeing women or sicker or older employees. Once the business finds out about the 1820 rule and understand all of these benefits are available because of this important reform, they are very excited about it. Thats what were out there doing, creating more outreach and education. As you witness the relief, even the excitement from Real Companies who you dont ask if they are republican or democrat, how can we help the company . You see it and ive seen it. The relief many businesses feel. Can i ask you very pragmatically, when youre explaining things, is there any one change or anything practically that we could do here in washington besides listen to ourselves speak to help this bill get a little better than it is now . Practically is there anything you suggest to help the committee . Honestly, what youre doing today is very helpful. Bringing the focus onto the truth and i think as the exchanges move forward, i know hhs is working around the clock. In night outreach before the launch, the focus on businesses is on broader reform. Once we get through the misinformation, after the launch, they werent so focused on the website issues but this broader reform and how it impacts their businesses. The elephant in the room was the pricing and the launches happen for the shop exchanges, even though they may not be fully functional, there is pricing information. With this information, its more information that businesses can go away and do analysis and think about how shop can be a resource for their business. Its all about information, education, outreach and getting the truth out and cutting through the misinformation. So if i might just very quickly, i would just add one of the reasons why the state exchanges have been so as you s successful, they had Research Available and weve been able to give them grants and weve been limited in terms of what were able to do. Why were you limited . Because of the appropriations, we dont have funding under the appropriation process to do as much we do outreach but do as much as we would like to do. Thats one area to Work Together in a bipartisan way to get the facts out, that would be wonderful. Last word. One quick thing, the thing that troubles all business, regardless of size, is uncertainty. Theres lots of misinformation but theres also lots of uncertainty because they keep hearing that its going toe repealed and changed. Its very important as all of us go out to be able to say to Small Businesses, this is whats going to happen when. Because they are not just. Its not just 96 of them arent affected. Its that this act can actually give you positive benefits like more choice, the ability to get coverage, which you werent able to get for your employees before. Thank you very much. This has been an excellent hearing. Let me particularly thank senator booker. This has been an extraordinary first full hearing for you to you always remember your first. Yes, and you will remember this one. And it has been an extraordinary privilege to be here with you and senator johnson, thank you for participating all the way to the end. I started this morning by saying and i knew this hearing would be full of a lot of strong opinions, but i started this morning by saying as mark twain said that a can go halfway around the world before truth gets out of bed and puts the boots on in the morning. This hearing was held to get the truth out about the benefits of the Affordable Care act to Small Business and the challenges that are presented to us. As americans, i think if we Work Together, [inaudible conversations] a couple of live events to tell you about today. The National Journal hosted a discussion on fiscal policy and the financial system. Thats at 8 30 a. M. Eastern. At 12 15 p. M. Eastern a look at the health care and insurance marketplaces. Lady bird johnson was the first wife of a president to become a millionaire by investing in and running radio and tv stations in texas. Watch our Program Saturday at 7 p. M. Eastern on cspan and live monday night our series continues. During the present historic trip to china, mrs. Nixon accompanied him. Mrs. Nixon was looking at the cigarettes of pandas on them and choosing i also understand you admired the pandas at the zoo. No, part of a darling . We will make sure that you of pandas to go home with. It was important for her to support her husband. Just her being there was so much goodwill. The news reports would come out, though talk about the president , but they would always get what a wonderful job pat nixon did. First Lady Pat Nixon monday night live on cspan. President obama awarded the president ial medal of freedom, the nations highest civilian honor the 16 wednesday. Recipients included former president bill clinton and the late astronaut sally ride. This is a little as than an ho hour. Ladies and gentlemen, the Vice President of the United States and jo jill biden. [applause] ladies and gentlemen, the recipients of the president ial medal of freedom. [cheers and applause] mr. Ernie banks. [cheers and applause] mr. Ben bradlee. The honorable bill clinton. [applause] ms. Irene in a way accepting on behalf of her husband, Daniel Inouye. Dr. Daniel kahneman. [applause] the honorable Richard Lugar. [applause] ms. Loretta lynn. [applause] doctor mario molina. [applause] mr. Walter nay, excepting only half of his partner, Bayard Rustin. [applause] mr. Arturo sandoval. Ms. Smith accepting on behalf of her husband, dean smith. Ms. Gloria steinem. [applause] reverend c. T. Vivian. The honorable Patricia Wald. [applause] ms. Oprah winfrey. [applause] ladies and gentlemen, the president of the United States, and mrs. Michelle obama [applause] good evening, everybody. Please have a seat. Well, on behalf of michelle and myself, welcome to the white house. This is one of my favorite events every year. Especially, its special this year as i look at this Extraordinary Group of individuals, and our opportunity to honor them with our nations highest civilian honor, the president ial medal of freedom. And this year its just a little more special because this marks the 50th anniversary of president kennedy establishing this award. We are honored, by the way, today to have with us one of my favorite people, at full kennedy fo kennedy, a pretty good basketball letter, president kennedys grandson, jag. [applause] this metal has been bestow it on more than 500 deserving people. Tonight im looking forward to joining some of these honorees as was members of the Kennedy Family as we pay tribute to these 50 years of excellence. And this morning we are honored to at 16 new names to this distinguished list. Today, we salute theres competitors who became true champions in the sweltering heat of a chicago summer, ernie banks walked into the cubs locker room and didnt like what he saw. Everybody was sitting around, heads down, depressed, he recalled. Ernie piked up and said, what a great day, lets play two. [laughter] thats mr. Cub, a man who came up through the negro leagues making 7 a day and became the first black player to suit up for the cubs and one of the greatest hitters of all time. In the process, bernie became known as much for his 512 home runs as for his cheer and his optimism and his eternal faith that someday, the cubs would go all the way. [laughter] and thats serious believe. Thats something even a white sox fan like me can respect. But he is just a wonderful man and a great icon of my hometown. Speaking of sports, dean smith is one of the winningest coaches in College Basketball history. But his successes go far beyond exes and those. Even as he won 70 of his games, he graduated 96 of his players. The first coach to use multiple defenses in the game. He was a pioneer of poplars the idea of pointing to the pastor. After basket the Commission Point to the person who passed them the ball. With his First National title on the line he did have the good sense to get the ball for 19 your kid named michael jordan. Although they used to joke that the only person who ever held michael under 20 was dean smith. [laughter] while coach smith couldnt join us today due to an illness that is facing with extraordinary courage, we also honor his courage in helping to change our country. He recruited the first black Scholarship Athlete to North Carolina. And help integrate our restaurant and a neighborhood in chapel hill. Thats the kind of character that he represented on and off the court. We salute indicators who pushed the limits of science, changing how we see the world and ourselves. And growing up, sally ride read about the Space Program and the newspaper almost everyday and she thought, this was the coolest thing around. When she was a ph. D candidate at stanford she saw an ad for astronauts in the student newspaper, and she seized the opportunity. The First American woman in space. Sally didnt just break the stratospheric glass ceiling. She blasted through it. And when she came back to earth she devoted her life to helping girls excel in fields like math, science, and in jenin. Young girls need to see role models, she said. You cant be what you cant see. Today, our daughters, including mobile and sasha, have set their sights a little bit tire because sally ride showed him the way. All of us have moments when we look back and wonder, what the heck was i thinking . I have that [laughter] quite a bit. [laughter] psychologist Daniel Kahneman has made that simple question his lifes work. In a historic career in israel and america, he basically invented the study of human decisionmaking. He has helped us to understand everything from behavioral economics to, those living in california make people happy . An interesting question but hes also been called an expert on irrational behavior, so im sure that he could shed some light on washington. But what truly sets daniel apart is his curiosity. Guided by his belief that people are endlessly complicated and interesting. At 79, he still discover new insights into how we think and learn, not just a we understand each other but so that we can work and live together more effectively. Dr. Mario molina, love of science, started as a young boy in mexico city in a homemade laboratory in a bathroom at home. That passion for discovery led mario to become one of the most respected chemists of these air. He was awarded the nobel prize not only for his pathbreaking research, but also for his insistence that when we ignore dangers of Carbon Emissions we risk destroying the ozone layer and endangering our planet. Thanks to marios work, the world came together to address a common threat. And today, inspired by his example, we are working to leave our planet safer and cleaner for future generations. We also have to salute musicians to bring such joy to our lives. Loretta lynn was 19 and the first time she won big at the local fair. Arcand vegetables brought home 17 blue ribbons. [laughter] and made her cantor of the year. [laughter] thats impressive. For a girl from butcher hollow, kentucky, that was fain. Fortunately, for all of us she decided to try her hand at things other than canning. Her first guitar cost 17. And with it, this coal miners daughter a voice to a generation singing what no one wanted to talk about, saying what no one wanted to think about. And now over 50 years after she cut her first record, and canned her first vegetables, loretta lynn still reigns as the rule breaking recordsetting queen of Country Music. As a young man in cuba, Arturo Sandoval love just so much of landed him in jail. It was the cold war, and the only Radio Station where he could hear jazz was the voice of america, which was dangerous to listen to. But he listened anyway. Later, he defected to the United States knowing he might never see his parents or beloved homeland again. Without freedom, he said, there is to life. Today, arturo is an american citizen and one of the most celebrated of the players in the world. There is many place on earth where the people dont know about jazz, he says. Thats true in part because musicians like them have sacrificed so much to play it. We salute pioneers who pushed our nation towards greater justice and equality. Apap just minister, c. T. Vivian, was one of dr. Martin luther kings closest adviser. Martin taugh potus is an actione find out who we really are. Time and again, reverend vivian was among the first to be in the action. In 1947, joining a sit in to integrate an element restaurant. One of the first freedom riders, in selma to register blacks to vote for which he was beaten, bloodied, and jails. Rosa parks said of him, even after things had supposedly been taken care of and we had our right, he was still out there inspiring the next generation, including me, helping kids go to college with a program that would become upward bound. And at 89 years old, reverend vivian is still out there, still in the action pushing us closer to our founding ideals. Early in the morning, the day of the march on washington, the National Mall was far from full. Some in the press were beginning to wonder if event be a failure. The marchs chief organizer, Bayard Rustin, didnt panic. As the story goes, he looked down at a piece of paper, looked back up and reassured reporters that everything was right on schedule. The only thing those reporters didnt know was that the paper he was holding was blank. He did know how it was going to work out, but byard had an unshakable optimism, nerves of steel. Most importantly a faith that if the cause was just and people organized nothing can stand in the way. For decades this great leader, often at dr. Kings side was denied his rightful place in history because he was openly gay. No metal can change that, but today we honored Bayard Rustins memory by taking our place for his march for true equality no matter who we are or who we love. [applause] speaking of game changers, disruptors, theres a young girl named Laura Steinem who arrived in new york to make her mark as a journalist, and magazines only one her to write articles like how to cook without really cooking for men. [laughter] gloria noticed things like that. She has been called a champion notice or. Shes alert to all the ways, large and small, that women had been and in some cases continue to be treated unfairly just because they are women. Because a writer, speaker, and activist, she awakened a fast and often skeptic public to domestic violence, lack of affordable childcare, unfair hiring practices. Because of her work across america and around the world, more women are afforded the respect and opportunities that they deserve. But she also changed how women thought about themselves. And the glory continue to pour her heart into teaching and mentoring. Her one piece of advice to young girls is, i love this, do not listen to my advice. Listen to the voice inside you and follow that. When Patricia Wald asked issued comeback after having her first child, she said she would like some time off to focus on the family. She devoted almost 10 years to raising five children. But patricia never lost the interest to practice law. While her husband watched kids at home, she would hit the library on weekends. At the age of 40, she went back to the courtroom to show the young kids a thing or two. As the first theme of judge on the d. C. Circuit, patricia was a top candidate for attorney general after leaving the bench or idea of retirement was to go to the hague to preside over the trials of war criminals. Patricia said she hopes enough women will become judges that its not worth sobering anymore, but today we celebrate her, and along with glory, she shows there were all kinds of paths listening to your own voice. We salute communicators who shined the light on stories no one else was telling. A veteran of world war ii and more than a dozen ascetic battles, ben bradlee brought the same intensity, dedication to journalism. Since joining the Washington Post 65 years ago, he transformed that newspaper into one of the finest in the world. With ben in charge, the post published the pentagon papers rethink the true history of americas involvement in fayette not, expose watergate, unleashed a new era of investigative journalist, Holding Americas leaders accountable and reminding us that our freedom as a nation rests on our freedom of the press. When ben retired, senator Daniel Patrick moynihan put the admiration of many into a home poem. His brain has ceased by this nation stands with his strength increased. And i also indicated to ben, he can pull off those shirts and i cant. [laughter] he always looks so cool in them. [laughter] early in Oprah Winfreys career, our bosses told her she should change her name to suzy. [laughter] i have to posture to say, i got the same advice. [laughter] they didnt say i should be named suzy, but they suggested i should change my name. People can relate to suzy. Thats what they said. It turned out, surprisingly, that people can relate to oprah just fine. In more than 4500 episodes of her show, our message was always, you can. You can do and you can be, you can grow, and it can be better. She is living proof, rising from childhood poverty and abuse to the pentacle of the entertainment universe. But even with 40 enemies, the distinction of being the first black female billionaire, oprahs greatest strength has always been her ability to help us discover the best in ourselves. Michelle and i count ourselves among her many devoted fans and friends. As one of the sands wrote, i did know i had a light in me until oprah told me it was there. What a great gift. And, finally, we salute the Public Service strengthen our nation. Daniel inouye was a humble man who didnt wear his medal of honor very often. Instead you like to wear a pin representing the Good Conduct Medal he earned as a teenage private. To behave yourself takes a special effort, he said. I did not want to dishonor my family. Danny always honored his family in this country, even when his country didnt always honor him. After being classified as an enemy alien, danny joined a japaneseamerican unit became one of the most decorated in world war ii. And is the second longest serving senator in american history, he showed a generation of young people, including one kid with a funny name growing up in hawaii who notice there was somebody during some of those hearings in washington that didnt look like everybody else, which meant maybe i had a chance to do something important, too. He taught all of us that no matter what you look like or where you come from, this country has a place for everybody who is willing to serve and work hard. A proud hoosier, dick lugar has served america for more than half a century, from a young Navy Lieutenant respected leader in the United States senate. I will always be thankful to dick for taking me, a new junior senator, under his wing, including traveled together to review some of his visionary work, the destruction of cold war arsenals in the former soviet union, something that doesnt get a lot of Public Notice that was absolutely critical to making us safer in the wake of the cold war. I should say traveling with the deck, you get close to unexploded landmines, mortar shells, test tubes filled with anthrax and the plague. [laughter] his legacy though is the thousands of missiles and bombers, submarines and warheads that no longer threaten us because of his extraordinary work. And our nation and our world are safer because of this statesman. And anytime of unrelenting partisanship, dick lugars decency, his commitment to bipartisan problemsolving stands as a model of what Public Service ought to be. Last, but never least, we honor a leader who we still remember with such extraordinary fondness. He still remembers as a child waving goodbye to his mom, tears in her eyes as she went off to Nursing School so she could provide for her family. And i think lifting up families like his own became the story of bill clintons life. He remembered what his mom had to do on behalf of him. And he wanted to make sure that he made life better and easier for so many people all across the country that were struggling in the same ways and had the same hopes and dreams. So as a governor he transferred education so more kids could pursue those dreams. As president , he proved that with the right choices you could grow the economy, lift people out of poverty, you could shrink our deficits and still invest in our families, our health, our schools, science, technology. In other words, we can go farther women look out for each other. And as weve all seen as president and he was just getting started. He doesnt stop. T cell to lead relief efforts after the asian tsunami, hurricane katrina, the haiti earthquake. Is foundation and Global Initiative has helped to save or improve the lives of literally hundreds of millions of people. And, of course, i am most grateful for his patients during the endless travels as my secretary of state. [laughter] so i am grateful, bill, as well for the vice and counsel that youve offered me on and off the golf course. And most importantly, for your lifesaving work around the world which represents the very best in america. So thank you so much, president clinton. [applause] so these are the recipients of the 2013 president ial medal of freedom. These are the men and women who, in their extranet lives, remind us all of the beauty of human spirit, the values that define us as americans, the potential that lives inside of all of us. I could not be more happy and more honored to participate in this ceremony here today. With that, what i would like to do is invite our honorees to just sit there and let all of us stand and give you a big round of applause. [applause] [cheers and applause] all right. Hey, hey. All right. I guess we should actually give them the metal. [laughter] so where are to redo. Spent president ial medal of freedom recipients, ernie banks. [applause] spin with an unmatched enthusiasm for americas pastime, ernie banks slot, sprinted and smiled his way into the record books. No defense as mr. Cub, he played an extraordinary 19 seasons with the chicago cubs, during which he was named to 11 allstar teams, hit over 500 in rome 500 home runs, and one most viable players honored. He was elected to the Baseball Hall of fame in 1977, and he will forever be known as one of the finest power hitters and most dynamic players of all time. [applause] ben bradlee. [applause] a titan of journalism, ben bradlee is one of the most respected newsman of his generation. After serving our nation in world war ii, ben bradlee went on to defend liberty here at home. Testing the limits of a free press during his tenure as executive editor of the Washington Post, he oversaw coverage of the watergate scandal, and successfully challenged the federal government over the right to publish the pentagon papers. His passion for agassi and unyielding pursuit of truth continues to set the standard for journalism. [applause] [applause] the honorable william j. Clinton. [applause] among the finest Public Servants of our time, president william j. Clinton argued cases for the people of arkansas, served his state and the governors mansion, and guided our nation into a new century. As the 42nd president of the United States, bill clinton oversaw an air of challenge and change, prosperity and progress. His work, after leaving public office, continue to reflect his passionate than any commitment to improving the lives and livelihoods of people around the world. In responding to needs both at home and abroad, and that sound of the clinton foundation. Ea showed that through creative Cooperation Among women and men of goodwill, we can solve even the most intractable problems. [applause] [cheers and applause] irene inouye, excepting only have of her husband, the honorable daniel k. Inouye. [applause] dedicated public servant, daniel k. Inouye understood the power of leaders when united in common purpose to protect and promote the tenets we cherish as americans. As a member of the revered 442nd regimental combat team, Daniel Inouye helped free europe from the grasp of tyranny during world war ii for which he received the medal of honor. Representing the people of hawaii, from the moment the islands joined the union, he never lost sight of the ideals that bind us across the 50 states. Cinder in the ways reason and resolve helped make our country what it is today, and for that we honor him. [applause] dr. Daniel kahneman. [applause] daniel comments groundbreaking work earned him a nobel prize in Economic Sciences for his research developing processes. After escaping from nazi occupied france as a young boy and later joining the Israel Defense forces, dr. Kahneman grew interested in understanding the origins of peoples beliefs, combining psychology and economic analysis, and working alongside others, use simple expense to demonstrate how people make decisions under uncertainty circumstances and he forever change the way we view human judgment. [applause] the honorable Richard Lugar. [cheers and applause] representing the state of indiana for over three decades, in the United States senate, Richard Lugar put country above party and self to forge bipartisan consensus. Throughout his time in the senate, he offered Effective Solutions to our national and international problems, advocating for the control of nuclear arms and other weapons of mass destruction. Working with the sender sam nunn, Richard Lugar established the nunnlugar cooperative Threat Reduction program one of our countrys most successful National Security initiatives, helping to sustain American Leadership and engaging nations in collaboration after decades of confrontation. He remains a strong voice on Foreign Policy issues, and hes informed perspective will have broad influence for years to come. [applause] loretta lynn. [applause] born of coal miners daughter, loretta lynn has followed a bold path to become a legend in Country Music. A singer, songwriter and author. She has written dozens of chart topping songs, released scores of albums, and won numerous accolades. Breaking barriers in Country Music and entertainment she opened doors for women not only by winning tremendous achievements, but also by raising issues few dared to discuss. Fearlessly telling her own stories with candor and humor. Loretta lynn has brought a Strong Female voice to mainstream music, capture the emotions of women and men alike, and revealed the common truths about life as it is lived. [applause] dr. Mario molina. [applause] the curiosity and creativity that inspired mario molina to convert his familys bathroom into a laboratory as a child has driven him through decades of scientific research. Born in mexico, his passion for chemistry brought him to the United States where his investigations of fluorocarbons lead to breakthroughs in understanding of how they deplete the ozone layer. The impact of his discoveries extends far beyond his field, affecting environmental policy and fostering international awareness, as well as earning him the 1995 nobel prize in chemistry. Today, dr. Molina remains a global leader, continuing to study air quality, Climate Change and the environment that connects us all. [applause] accepting on behalf of her life partner, dr. Sally ride. 30 years ago, dr. Sally ride soared into space as the youngest american and first woman to wear the stars and stripes above earths atmosphere. As an astronaut, she sought to keep america at the forefront of Space Exploration but as a role model, she fought tirelessly to inspire young people, especially girls, to become scientifically literate and to pursue careers in science, technology, engineering and math. At the end of her life she became an inspiration for those battling and critic cancer, and for the lesbian, gay, bisexual and transgender community. Detail of a quiet hero, sally ride story demonstrates that the sky is no limit are those who dream of reaching for the stars. [applause] walter naegle, excepting only have of his partner, Bayard Rustin accepting. [applause] spinning Bayard Rustin was a giant in the American Civil Rights movement, openly gay and a time when many had to hide who they love. His unwavering belief that we are all equal members of a single human family took him from his first freedom ride to the lesbian, gay, bisexual and transgender rights movement. Thanks to his unparalleled scale as an organizer, progress that once seemed impossible appears in retrospect to have been inevitable. 50 years after the march on washington, he organized, america honors Bayard Rustin as one of its greatest architects for social change, and a fearless advocate for its most formidable citizens. Vulnerable citizens. [applause] Arturo Sandoval. [applause] yoArturo Sandoval is one of e worlds finest jazz musicians, born into poverty in cuba and held back by his government, he risked everything to share his gift with the world, eventually defecting. In the decades since this astonishing trumpeter, pianist and composer has inspired audiences in every corner of the world, and awakened a new generation of great performers. He remains one of the best ever to play. [applause] accepting our behalf of her husband, dean smith. Dean smith spent 36 seasons taking College Basketball to new heights. As head coach at the university of North Carolina at chapel hill, he led his team to 11 final fours, two national titles, and 879 victories, retiring as the winningest mens basketball coach in history. Dean smith brought the same commitment to supporting his players off the court. He helped more than 96 of his letterman graduate, and in an air of deep division, he topless to overcome bigotry with courage and compassion. He will forever stand as one of the greatest coaches in College Basketball history. [applause] Gloria Steinem. [applause] a trailblazing writer and feminist organizer, Gloria Steinem has been at the forefront of the fight for equality and social justice for more than four decades. Instrumental to a broad range of initiatives and issues from establishing ms. Magazine and take our daughters to work day, to pushing her womens self empowerment and an end to sex trafficking. She has promoted lasting political and social change in america and abroad. Through her reporting in speaking, she has shaped a base on the intersection of sex and race, brought critical problems to national attention, and forged new opportunities for women in media. Gloria steinem continues to move us all to take up the cause of reaching for a more just tomorrow. [applause] reverend c. T. Vivian. [applause] equipped only with courage and an overwhelming commitment to social justice, the reverend c. T. Vivian was a stalwart activists on the march toward racial equality. Whether at a lunch counter on a freedom ride or behind the bars of a prison cell, he was unafraid to take bold action in the face of fierce resistance. I pushing change through nonviolent demonstration and at this agency, c. T. Vivian establish and lead numerous organizations to support underserved individuals and communities. Is legacy of combating injustice will shine as an example for generations to come. [applause] Patricia Wald. [applause] Patricia Wald made history as the first woman appointed to the United States court of appeals for the District Of Columbia circuit, rising to chief judge of the court. She always strove to better understand the law and fairly apply it. After leaving federal service, judge wald help institute of standards for justice and the rule of law at the International Criminal tribunal for the former yugoslavia in the hague. Hailed as a model judge, she laid a foundation for countless women within the legal profession, and helped unveil the humanity within the law. [applause] oprah g. Winfrey. [applause] oprah g. Winfrey is a global media icon. When she launched the Oprah Winfrey show in 1986, there were few women, and even fewer women of color, with a National Platform to discuss the issues and events shaping our times. But over the 25 years that followed, Oprah Winfreys and a gift for tapping into our most fervent hopes and deepest fears drew millions of viewers across every background, making her show the highest rated talk show in television history. Offscreen, Oprah Winfrey has used her influence to support underserved communities, and to lift up the lives of young people, especially young women, around the world. In her story, we are reminded that no dream can be deferred when we refused to let lifes obstacles keep us down. [applause] [cheers and applause] spent the medal of freedom honorees, please. [applause] all right. Well, that concludes the formal parts of todays ceremony. I want to thank all of you for being here. Obviously, we are deeply indebted to those who we honor here today. And were going to have an opportunity to take some pictures with the honorees and their family members. The rest of you, i understand the food here is pretty good. [laughter] so i hope you enjoy the reception, and i hope we carry a way from this a reminder of what jfk understood to be the essence of the american spirit, that its represented here and that some of us may be less talented, but we all have the opportunity to serve an open peoples hearts and minds in our smaller orbits. So i hope everybody has been inspired as i have been participating in being with these people here today. Thank you very much, everybody. [applause]