When you were working to establish the exchange that there was the template your website had issues and im assuming all thats been resolved and the people that went into medicaid temporarily cms approved are now out of that . All of those temporary medicaid members have been redetermined into either requalified health plans or medicaid. Great. And ms. Otoole, do you still have a backlog of about 180,000 public insurance renewals in the system . Thank you for the question, congressman. We do not. That has been resolved. Okay. And it says despite additional funds, im sure you do continue to struggle some, obviously. And again, i applaud all of you for what youre doing. The goal of our committee is to find out where we can make improvements, right . But minnesota announced that theyre going to revert to the old system for minnesota care because of mshares problems, is that true . Congressman, that is true just for a short period of time, and that is we have prioritized that functionality for the very beginning of 2016. Okay, great. And in hawaii, i guess youve totally turned yours over to the federal exchange now. Because the information i have you extended it till october of 2016. Originally announced Health Connector would shut down due to insufficient funds. But recently they have extended it through october 2016, is that true or not true . The outreach will extend through open enrollment and then the Corporate Affairs of our independent nonprofit will wrap up and it will take till october to do the accounting and the like. Okay, great. Mr. Chairman, i yield back. Thank you. Mr. Tonka, youre recognized for five minutes. Thank you, mr. Chair. Let me thank all of our witnesses for joining us today and presenting good information. I know that some statebased marketplaces have faced challenges in building and managing their i. T. Platforms. These challenges are well publicized. What is less well known perhaps is the efforts that statebased marketplaces have in implementing and tailoring the acas of their own citizens. So id like to ask our witnesses, what is your statebased marketplace doing to ensure that consumers in your state are receiving culturally and linguistically appropriate outreach as well as health care . Mr. Allen, we might start with you and well go across the table. Thank you for the question, congressman. In taking over responsibility for the marketplace, that was exactly the number one question that landed with us was given the success weve had in oregon in driving down the rate of uninsured, the remaining population is relatively small, but relatively hard to reach. And so we have made the decision to move from a wide Media Broadcast advertising kind of an outreach approach to something thats much more tailored that works through community partners, organizations that work in communities with color and other areas, much more targeted kinds of technology, outreach to try to work hard to get to those geographic and demographic populations that are amongst the hardest to get insured. Thank you. Ms. Otoole, please . Thank you, congressman. Happy to answer that. And weve learned in minnesota that with the remaining uninsured, like mr. Allen said, they are harder to reach. We have 26 statewide grantees who work in every Community Around minnesota to help reach out to these populations and enroll them. Were really proud of that. And we paired them also with Enrollment Centers around the state that are sponsored by brokers. And so were trying to come at it there afrom all angles. You know, weve learned this is not an easy decision for people. So they need help and they need inperson assistance so weve focused resources there. Thank you. Three principal items. This year our media strategy is very focused on ethnic media dealing with the hispanic, portuguese and asian communities in pockets throughout the state that are underinsured. Secondly, our section of navigators and walkin centers for this fall is specifically targeted towards underinsured communities. And thirdly, theres an Innovative Program where because massachusetts has a state insurance mandate, our department of revenue knows who does not have insurance. Now, they would never share data with us. Thats out of bounds. But they are able, on our behalf, to notify uninsured residents of their opportunity to become insured through the statebased marketplace. Thank you very much. Mr. Kissel. We changed our outreach model from a mediadriven model to a personal model. We added marketplace sisters to speak, the 15 or 20 languages and dialects of the people of the nations of the pacific rim in addition to the cultures of america. We went from a call center to a personal outreach, although we still operated the call center. And we went into the areas where, for an average, there are people who lost their homes due to economic conditions. We find that more than half of those families have one or two working members. And we help them enroll in coverage. We also moved forward with the essentially what was im not a rocket science, but the Social Security model where you have multilayers of a, depending upon the needs of the individual. You can call and if youre sophisticated, you can logon to the computer. And if you need help, we, in fact, make house calls. My telephone number, personal Contact Information is on the website. Wonderful. Mr. Lee. Yes, from day one, weve done outreach, which is anchored in local communities in a wide range of langlanguages. Its not just about outreach. Its about making sure care that is delivered that is culturally appropriate. We have contract requirements in our negotiations with the plans to hold the plans to account. 3 of our 12 plans are among 9 nationally recognized plans for providing culturally appropriate care. Its something were going to hold our plans to account to. Thank you so much. And finally, mr. Wadle, please. Thank you for the question. We, too, have been focusing all of our outreach into our communities where we know that in connecticut, that our uninsured reside in basically ten zip codes. And so we can go right into those communities and work with those residents. Thank you very much. Thank you, the gentleman yields back. I now recognize mr. Flores. Thank you, mr. Chairman. The exchange still shows im ineligible for coverage. Anyway, states continue to opt out of the theyre trying to state up their state exchange, theyre migrating to the federal exchanges, we all know we need to try to understand the impact on that in order to do that, we need to know how sustainable the state exchanges are. So ms. Otoole, would you tell me what taxpayers can expect from your state exchange over the next five to ten years, and will it be sustainable somewhere during that time period . Congressman, thank you for the question. Im happy to answer it. Like i said in my opening testimony, we are financially sustainable at this point. Our budget is balanced. Its based on real numbers and real experience. And the board of directors in march of this year has passed a threeyear Financial Plan that looks out. So we keep a close eye on this. Its something were concerned about. You know, our board and our team is committed to living within our means. So if we have to, you know, revenue has to match expenditures. And if we have to make hard decisions, we will. I also mentioned in my testimony that we have a task force, a Bipartisan Task force in minnesota thats looking into some of these issues that took it out of the legislative arena to have a more indepth conversation throughout this fall. And we look forward to that work continuing. Okay. Mr. Gutierrez. Our current expense profile, because its still a buildout year, is high, and well need to reduce it, making some hard choices along the way. But massachusetts is fortunate in that the Connector Authority was initially substantiated with a reserve fund. It also has dedicated Revenue Sources from our cigarette tax and from the state insurance mandate penalties as well as the carrier administrative fees. So we have a very diverse set of Funding Sources and bipartisan commitment to the effort. Mr. Lee. From day one coverage california has been putting money in the bank from our plan assessments while going through establishment funds. We have over 200 million in the bank. We have a wholly sustainable model over the long term. You talked about the assessments. What impact has that had on premiums in your state . Its actually compared to what health plans were spending to enroll people in the individual market previously, we think it reduces overall effect on the premium dollars. Its about 3. 5 of premium. But enrolling people in the individual market is very expensive. And prior to the exchange coming along, plans were spending as much as 12 on commissions and a whole range of acquisition. Id like to think were the cheapest state in town. Mr. Watley. We, too, have a fully balanced budget that also right now we have about 12 to 15 million in reserves within our budget as well. Okay. And whats the impact been on premiums in your state . The impact on our premiums related to the assessment has similar to california, we feel that it has allowed the marketplace to level off and compete evenly across the state. Mr. Kissel, whats been the impact excuse me, mr. Gutierrez whats been the impact on premiums in your state from the assessments . If i made a statement on that, i think i would be speaking without firsthand knowledge. So id like to respond to that more fully. Thats fine. Okay. Ms. Otoole. Thank you, congressman. Last year we saw rate increases on average of about 4 . Our department of commerce in minnesota reviews that, so we dont thats an independent review process aside from our organization. They have not released rates for this year. That happens later this week. Okay. Would you advise after that happens . Im happy to do so. Okay. Thank you. Given the short amount of time, i dont have time for another question so i yield back the balance of my time. Thank you. I recognize ms. Castor for five minutes. Thank you, mr. Chairman, for calling this hearing in the rate of underinsured americans under the aca. Thank you to all the witnesses here today and what youre doing for families across the country. When i think of the Affordable Care act, i often think i think its helpful to break it up into its pieces. First you have the Consumer Protections, the Affordable Care act brought. You have a piece on medicare. Weve strengthened medicare. And then you have the policies and strategies to reduce the rates of uninsured all across the country. So for Consumer Protections, the aca is working, we no longer have discrimination based upon a preexisting condition like a cancer diagnosis or diabetes. That has been a godsend to families. The Consumer Protections that allow young adults to stay on their parents policies. Ive heard directly from many friends back home what a benefit that has been. And then Insurance Companies can no longer cancel you if you get sick. So thats and there are others, but thats an important piece. Then under medicare, medicare is stronger. We invested savings into lengthening the life of the Medicare Trust fund. We are also we also are closing the doughnut hole, put money back into the pockets of our parents and grandparents through less costly prescription drugs. And then medicare is undergoing reforms so that care is provided in a smarter way. But then it comes to the rates of uninsured. And its pretty remarkable. And this is important as well when you think about it for people who already have insurance because what the Affordable Care act has done is helped people take personal responsibility for themselves and make insurance more affordable. That way you dont have this Cost Shifting to people that do have insurance. So the recent Census Bureau report said that since the passage of the Affordable Care act five years ago, 17. 6 million americans have gained coverage. And that from 2013 to 2014, weve had the largest reduction in the uninsured rate in america in 25 years. And its important to note that at the same time, the rate of employersponsored Health Insurance has remained constant because that was kind of a that was a question mark going in. So so far, so good. And id really like to thank you all for i heard today a little healthy Competition Among the states, how proud you are of some of the things youve been able to do. I certainly heard it from my colleague, mr. Yarmouth, from kentucky where theyve done a fantastic job. Mr. Lee, congratulations since opening of the exchanges, california has provided a life line to so many families in california through covered california, medical. What has happened to the uninsured rate in california . The uninsured rate, depending on census figures, its dropped to about 12 , huge reduction and one of the fifth largest reductions in the nation. Its also, if i may, congresswoman, your note that its also for people that have insurance are seeing the benefit of lower rates. A million californians in the individual market that dont buy through us benefit from our two Years Holding rates down. So i think your note on those benefits arent just for the uninsured, but its also for insured people that are in jobs that have insurance that now have rates being kept in check. Im glad she came in so she could hear that directly after she worked so hard on the Affordable Care act and passage. How are you working to ensure that coverage remains affordable from this point forward and meaningful for families . One of the things were doing at covered california, were working with our 12 health plans that say how do we actually affect care where its delivered . In the end affordability is about delivering the right care at the right time. The movement weve seen in congress, a Common Movement moving from volumes to value is something we are working with all of our health plans to change payment, to promote primary care, to make sure people with chronic illnesses get the right care at the right time. And that needs to be the focus all of us around this table have. As one of the other congresspeople noted, its not just about giving people an insurance card. Its making sure people get the right care and that right care is delivered at the right time. Thats going to be the key for all of us in reducing costs over the long term. Thank you, mr. Wadley. On behalf of access health, youre here on behalf of access health. Congratulations and thank you for what youve done in lowering the rate of uninsured. Tell us what has happened to the uninsured rate in connecticut and what this has meant for your citizens. Thank you, congresswoman. The uninsured rate in connecticut has been cut in half just in the last two years. We see that it will continue to go lower. So that has been very exciting. What i would also say is our next its really what our next step. So similar to what mr. Lee has said, it really comes down to how do we start working through Health Disparities, wellness, access to primary care physicians. Those are some of the goals that we are working on right now as working with the residents of connecticut. Thank you very much. And i yield back. The gentle lady yields back. Everything great with mr. Wall well be able to go next without objection. I thank the gentleman and my colleagues for that. I know theyve asked each of you if there were trouble with your exchanges and you all wisely answered yes because its never easy to roll one of these out. Ive just got to go to an oregonspecific issue, though. Im going to ask each of you to put a highlight on this. Did the governors in your state use their paid Campaign Political advisers to craft official communication and Management Strategies for the rollout or the termination of your exchange . Yes or no . Mr. Wadley . I dont know the answer if our governor did that or not. All right. Mr. Lee . I have no information about how my governor uses his staff. Mr. Kissel . Not to my knowledge, but the governor has very courageously taken on the burden of this exchange by embedding it in all of the departments. Mr. Gutierrez . Not under the current administration. Got it. Ms. Otoole . Thank you, congressman. I have no information about that. I think mr. Allen knows potentially the answer to this question in oregon. Well, congressman, i was not directly involved in the management or operation of the exchange at that point and have no direct experience with that kind of involvement. All right. Good answer on your part. However, i want to introduce into the record, mr. Chairman, a series of newspaper articles that were acquired that investigative reporting that was done that clearly indicate that our governor at the time used his outside Political Campaign staff to manage and coordinate the messaging on cover oregon and may be worse than that based on emails that have been made available from foya. I just think its important for the committee to know, as we investigate what happened to this money, what happened in the behind the scenes apparently in our state of oregon . And so mr. Chairman, without objection, id like to have those entered in. No objection. Do you know how close completion oregon was when they pulled the plug on it . Congressman, i dont have direct knowledge of how close it was to completion. I do know as there is on the record a Technology Assessment report provided to the cover oregon board at the time that the decision was made, whether to move forward with that infrastructure and move to the federal marketplace that indicated that were they to choose to maintain that the existing infrastructure, it was already failing to meet benchmarks necessary to be available for open enrollment in 2015. So my understanding is is about 90 done. I would have no information. You havent asked. Okay.