[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
STATUS OF THE AFFORDABLE CARE ACT IMPLEMENTATION
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON WAYS AND MEANS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
FIRST SESSION
__________
OCTOBER 29, 2013
__________
Serial No. 113-FC13
__________
Printed for the use of the Committee on Ways and Means
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COMMITTEE ON WAYS AND MEANS
DAVE CAMP, Michigan, Chairman
SAM JOHNSON, Texas SANDER M. LEVIN, Michigan
KEVIN BRADY, Texas CHARLES B. RANGEL, New York
PAUL RYAN, Wisconsin JIM MCDERMOTT, Washington
DEVIN NUNES, California JOHN LEWIS, Georgia
PATRICK J. TIBERI, Ohio RICHARD E. NEAL, Massachusetts
DAVID G. REICHERT, Washington XAVIER BECERRA, California
CHARLES W. BOUSTANY, JR., Louisiana LLOYD DOGGETT, Texas
PETER J. ROSKAM, Illinois MIKE THOMPSON, California
JIM GERLACH, Pennsylvania JOHN B. LARSON, Connecticut
TOM PRICE, Georgia EARL BLUMENAUER, Oregon
VERN BUCHANAN, Florida RON KIND, Wisconsin
ADRIAN SMITH, Nebraska BILL PASCRELL, JR., New Jersey
AARON SCHOCK, Illinois JOSEPH CROWLEY, New York
LYNN JENKINS, Kansas ALLYSON SCHWARTZ, Pennsylvania
ERIK PAULSEN, Minnesota DANNY DAVIS, Illinois
KENNY MARCHANT, Texas LINDA SANCHEZ, California
DIANE BLACK, Tennessee
TOM REED, New York
TODD YOUNG, Indiana
MIKE KELLY, Pennsylvania
TIM GRIFFIN, Arkansas
JIM RENACCI, Ohio
Jennifer M. Safavian, Staff Director and General Counsel
Janice Mays, Minority Chief Counsel
C O N T E N T S
__________
Page
Advisory of October 29, 2013 announcing the hearing.............. 2
WITNESS
Ms. Marilyn Tavenner, Administrator, Centers for Medicare &
Medicaid Services, U.S. Department of Health and Human
Services, Washington, DC....................................... 6
STATUS OF THE AFFORDABLE CARE ACT IMPLEMENTATION
----------
TUESDAY, OCTOBER 29, 2013
U.S. House of Representatives,
Committee on Ways and Means,
Washington, DC.
The committee met, pursuant to call, at 10:04 a.m., in Room
1100, Longworth House Office Building, the Honorable Dave Camp
[Chairman of the Committee] presiding.
[The advisory of the hearing follows:]
HEARING ADVISORY FROM THE COMMITTEE ON WAYS AND MEANS
Chairman Camp
Announces Hearing on the Status of the Affordable Care Act Implementation
1100 Longworth House Office Building at 10:00 AM
Washington, October 22, 2013
House Committee on Ways and Means Chairman Dave Camp (R-MI) today
announced that the Committee will hold a hearing on the problems
Americans are experiencing with the Obama Administration's launch of
the Affordable Care Act (ACA). The Committee will hear testimony from
Marilyn Tavenner, Administrator of the Centers for Medicare & Medicaid
Services (CMS) at the U.S. Department of Health and Human Services
(HHS). CMS is the Federal agency that oversees the operation of the
Exchanges through the Center for Consumer Information and Insurance
Oversight (CCIIO). The hearing will take place on Tuesday, October 29,
2013, in 1100 Longworth House Office Building, beginning at 10:00 A.M.
In view of the limited time available to hear from the witnesses,
oral testimony at this hearing will be from the invited witness only.
However, any individual or organization not scheduled for an appearance
may submit a written statement for consideration by the Committee and
for inclusion in the printed record of the hearing.
BACKGROUND:
President Obama has acknowledged that the October 1 launch of the
health care Exchanges was unacceptable. Americans have been unable to
create accounts, and individuals continue to receive repeated error
messages and inaccurate information from www.healthcare.gov. According
to Consumer Reports, only 1 in 35 individuals were able to create an
account on www.healthcare.gov. Recently, the Administration announced a
``tech surge'' of the ``best and the brightest'' to fix the problems,
but experts have warned the ``online system required such extensive
repairs that it might not operate smoothly until after the December 15
deadline for people to sign up for coverage starting in January.''
The Ways and Means Committee has conducted extensive oversight of
the implementation of the Affordable Care Act to ensure that the
Administration is implementing the law as promised. Despite significant
reports about the difficulties they were encountering in building the
Exchanges, Administration witnesses dismissed such reports. Instead,
they repeatedly assured the Committee that warnings from nonpartisan
independent auditors were wrong, including the Government
Accountability Office, which reported the Administration was behind
schedule and at risk of experiencing enrollment problems.
The significant and ongoing problems with the launch of the
Exchanges further exacerbates the challenges facing American families.
Individuals are unable to create accounts, navigate the website and
receive accurate information about cost and choices, while insurers are
receiving inaccurate enrollment data. Despite these ongoing
malfunctions, millions of Americans will be forced to deal with these
challenges as they attempt to either comply with the individual mandate
to buy coverage or pay a tax.
This hearing will examine the status of efforts by CMS, HHS and the
Obama Administration to identify the problems plaguing the launch of
the Exchanges and the specific plans to fix the design flaws. The
hearing will seek answers to why the Exchanges are not working, whether
the Exchanges will be ready to fulfill all of their required functions
and what steps are being taken to ensure that CMS and HHS will be able
to accurately verify subsidy eligibility--prior to the distribution of
premium tax credits and cost sharing subsidies.
In announcing the hearing, Chairman Camp stated, ``After spending
over $600 million, the American people want answers to some very basic
questions about the launch of ObamaCare. Why doesn't the website work?
Why were the American people told everything would be ready, when it
was clear that was not the case? How deep are the problems and how long
will it take to get those problems fixed? And most importantly, if
people can't navigate such a dysfunctional and overly complex system,
is it fair for the IRS to impose tax penalties?''
FOCUS OF THE HEARING:
The hearing will focus on the status of the Obama Administration's
implementation of the Affordable Care Act.
DETAILS FOR SUBMISSION OF WRITTEN COMMENTS:
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Note: All Committee advisories and news releases are available on
the World Wide Web at http://www.waysandmeans.house.gov/.
Chairman CAMP. This hearing will come to order.
Good morning. I would like to welcome Marilyn Tavenner, the
Administrator at the Centers for Medicare and Medicaid Services
at the U.S. Department of Health.
Welcome to the committee today. I look forward to your
testimony, and I look forward to the hearing to really get an
honest, straightforward assessment of the status of the health
care law.
Six months ago, Health and Human Services Secretary
Sebelius told this committee a dozen times that the
administration will be ready on October 1. We now know the
administration was not ready, and just last week Secretary
Sebelius suggested they could have used 5 years to get the
exchanges up and running.
Despite having more than 3 years to get the system up and
running, officials at the Centers for Medicare and Medicaid
Services who are charged with implementing the exchanges added,
and I quote, ``Due to a compressed time frame, the system
wasn't tested enough.'' And, frankly, 3 years should have been
enough. And had the administration provided more forthcoming
answers and shared in a transparent manner the reality of the
challenges it was encountering in the implementation process, I
suspect many of these glitches could have been avoided.
While the Web site can eventually be fixed, the widespread
problems with Obamacare cannot. Almost daily we hear reports of
Obamacare increasing costs, harming job creation, and forcing
Americans off their current plan. These problems can't be fixed
through a technical surge or tech surge, and they are not just
a glitch in someone's health care coverage or job.
Not a week goes by that I don't hear examples from the
people I represent in Michigan and job creators about the
increasing costs and how Obamacare is making it harder for
businesses to invest, grow, and hire people. Just last month,
Meridian Public Schools in my district announced that it would
be cutting the schedules of hourly workers to fewer than 30
hours per week as a result of Obamacare. And this month, the
Detroit Free Press reported that at least 146,000 Michiganders
have received cancellation notices for their current health
plan due to Obamacare. In fact, based on what little
information the administration has disclosed, it turns out that
more people have received cancellation notices for their health
care plans this month than have enrolled in the exchanges.
The widespread acknowledgement that the health care
exchanges were not tested months in advance as promised is
cause for concern, but the concerns don't stop there. The
Treasury Inspector General warned in August that it was not
confident about the IRS' ability to protect confidential
taxpayer information or to prevent fraud, and neither am I.
On top of that, the exchange does not give individuals the
information they need to make an informed health care decision.
When going through the options, how are Americans able to see
if they are even eligible to be in the exchange, if their
current doctor is in the plan, what the real costs of their
premiums will be, and how much their copay will be?
No amount of Web site fixes can make right the President's
broken promises that health care costs will be lowered by
$2,500 or that Americans will be able to keep the plan they
have and like. Those are worthy goals, reducing costs and
maintaining coverage, and they are ones that we should all work
together to accomplish.
I would be remiss if I didn't remind my colleagues that the
alternative put forward by Republicans at the time was the only
plan scored by the nonpartisan Congressional Budget Office as
actually reducing premiums. Democrats chose to go down another
path, and that is where it has led us. Instead of plowing
forward with this unworkable law, the administration should at
a minimum seriously consider delaying the law for families and
individuals, just as it has done for big business. If they fail
to do so, I fear we could see a fundamental breakdown of the
insurance market, where premiums will skyrocket, pricing
millions of Americans out of health care, yet still be forced
to pay the individual mandate tax.
Administrator Tavenner, we cannot solve a problem until we
realize the full extent of the problem. Your answers today and
in the future will be critical to this committee's oversight of
the health care law and, more importantly, to our work to make
sure Americans have access to affordable health care.
Before I recognize Ranking Member Levin for the purpose of
an opening statement, I ask unanimous consent that all members'
written statements be included in the record. And without
objection, so ordered.
Chairman CAMP. I now recognize Ranking Member Levin for his
opening statement.
Mr. LEVIN. Thank you, Mr. Chairman and colleagues.
And, Marilyn Tavenner, a warm welcome.
We start this hearing facing a basic reality: Democrats
want to make the Affordable Care Act work, congressional
Republicans don't. That reality has been reflected in 40-plus
efforts by Republicans to repeal, dismantle, or defund the
Affordable Care Act. That reality was reflected in their zeal
shutting down the government and jeopardizing the full faith
and credit of our Nation, damaging our Nation's global standing
and leading to enduring harm, costing our economy $24 billion,
tens of thousands of jobs, a dramatic drop in consumer
confidence.
Now, having still failed to derail the ACA, the Republican
focus of attack has shifted. The new front relates to
HealthCare.gov. There very clearly are challenges to
implementing new, pioneering access to health care. Consider
these headlines. You can see them there. For example,
``Problems Plague Rollout,'' NPR reported. ``Plagued by Delays
and Confusion Over Coverage,'' said the San Francisco
Chronicle.
These headlines are from 2005 as Medicare Part D was
launched. That year, in dramatic contrast to the Republican
conduct to date, Democrats who had opposed that law worked to
make it a success, working with Republicans on a bipartisan
basis, Republicans who had passed that law to address many
problems, and most importantly, we worked with our constituents
to ensure they could sign up.
The reality is that the Affordable Care Act, which
Republicans are failing to work on with Democrats, is working
quite effectively in States running the marketplaces. You can
see from that slide.
[Slide]
Mr. LEVIN. In Kentucky, more than 26,000 people have
enrolled for coverage. In New York, more than 37,000 have
signed up. And in Washington State, more than 35,000 people had
enrolled as of a week ago. And the irony is that Republicans
have erected hurdles to States throughout the Nation taking
responsibility for implementing the law.
The Web site for the Federal insurance marketplace must be
fixed, and it is being fixed. This gentleman from Salt Lake
City, Mr. Sherburne, is among those who have enrolled. A self-
employed father of three, he has been uninsured for years,
paying cash for doctor visits and the occasional trip to the
emergency room, he told his local newspaper. Once he got into
the marketplace Web site, he compared 38 plans and got coverage
for his family for $123 a month. And I quote, ``Once they get
the bugs worked out, it will work well and bring peace of mind
to a lot of people,'' end of quotes. And he added, ``I am
thrilled to have coverage, period.''
Prior to this year, what awaited Mr. Sherburne and tens of
millions of other Americans who don't get health insurance
through their employer, but rather had to sign up on their own,
was a maze of invasive personal medical history questions
within applications that seemed to never end. When individuals
did get through the process, too often a preexisting condition,
no matter how minor, was used to deny coverage, to charge
exorbitantly high premiums, or to exclude needed benefits.
Thankfully, these days are behind us. They are behind us.
This hearing provides a chance for every Member of this
committee to proceed in a constructive, not a destructive
manner, and for the Administrator to lay out how the Web site
is being fixed, as it must be, and for everyone on this
committee to join in this effort to make available, not to
prevent access to quality, affordable coverage for every
American. I yield back.
Chairman CAMP. Thank you.
Today we will hear from the Administrator for the Centers
for Medicare and Medicaid Services at the U.S. Department of
Health, Marilyn Tavenner.
Your written statement will be made part of the record and
members have received it, but you will be recognized for your
oral testimony for 5 minutes. Welcome.
STATEMENT OF MS. MARILYN TAVENNER, ADMINISTRATOR, CENTERS FOR
MEDICARE & MEDICAID SERVICES, U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Ms. TAVENNER. Thank you, Chairman Camp, Ranking Member
Levin, and Members of the Committee.
On October 1st, we launched one of the key provisions of
the Affordable Care Act, the new marketplace, where people
without health insurance, including those who could not afford
it and those who were not part of a group plan, could go to get
affordable coverage.
We know that consumers are having difficulty enrolling via
the marketplace Web site. It is important to note that the
Affordable Care Act, however, is more than just a Web site. It
creates a new market which allows people to access quality
affordable health care, it allows them to have insurance
options, it creates a pooling of consumers into Statewide group
plans that can spread the risk between sick people and healthy
people, between young and old, and then bargains on their
behalf to get them the best deal on health insurance. By
creating competition where there wasn't competition before,
insurers are now eager for new business and they have created
new health care plans with more choices. The premiums for
coverage were lower than expected and millions of Americans
will also qualify for tax credits to make the coverage even
more affordable.
We know that consumers are eager to purchase this coverage,
and to the millions of Americans who have attempted to use
HealthCare.gov to shop and enroll in health care coverage, I
want to apologize to you that the Web site has not worked as
well as it should. We know how desperately you need affordable
coverage. I want to assure you that HealthCare.gov can and will
be fixed, and we are working around the clock to deliver the
shopping experience that you deserve. We are seeing
improvements each week and, as we have said publicly, by the
end of the November the experience on the site will be smooth
for the vast majority of users.
Over the past month, millions have visited HealthCare.gov
to take a look at new health care coverage under the Affordable
Care Act, and in that time nearly 700,000 applications for
coverage have been submitted across the Nation. More than half
of those are in the Federal marketplace alone. This tremendous
interest confirms that American people are looking for quality
affordable health care coverage.
We know that the consumer experience has been frustrating
for many Americans. Some have had trouble creating accounts and
logging into the site, while others have received confusing
error messages or had to wait for slow response times. This
initial experience has not lived up to our expectations or the
expectations of the American people, and it is not acceptable.
We are committed to improving performance and have already
made progress. In the first few days when the site went live,
few customers could create an account. Now over 90 percent can.
We have updated the site several times, fixing bugs and
improving the HealthCare.gov experience, and we have added more
capacity in order to meet demand.
We are pleased with these quick improvements, and parts of
the system are already working well. For example, the data hub,
the routing tool that provides an efficient and secure way to
verify information submitted by consumers, is sending
determinations to the marketplace in less than 1.2 seconds.
Social Security has reported 4.2 million transactions with the
hub and the IRS has responded to more than 1.3 million
requests.
Even with this success, we know there is still significant
work to do, and we have called in a team of experts, led by
Jeff Zients, to analyze the site, identify and prioritize
fixes. We have spent the last week going over that. And while
these problems will require a lot of hard work, the bottom line
conclusion is this HealthCare.gov site is fixable.
To get the job done, we have identified a clear path
forward, a lot of fixes that will be undertaken one by one. To
ensure the work is done as quickly and as efficiently as
possible, we have enlisted the help of QSSI to serve as general
contractor for this project. They are familiar with the
complexity of the system and the work they have provided for
HealthCare.gov, the Federal data hub, is working well and
performing as it should. QSSI has the skills and expertise to
help us address these problems. They will work with leadership
and contractors to prioritize the needed fixes and make sure
they get done.
We are committed to improving the consumer experience with
HealthCare.gov. While we continue this work, I encourage people
to continue to apply by phone, by mail, or by finding local
help in their community.
The fact is the product of the Affordable Care Act, a
marketplace for quality affordable health insurance, will work.
The product is not going away and the people are not going to
continue to wait. We know the price is not changing. We know
Americans have time to apply and enroll in affordable coverage.
Thank you, Chairman Camp.
[The prepared statement of Ms. Tavenner follows:]
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___________
Chairman CAMP. Well, thank you.
Administrator Tavenner, how many people have enrolled in
the exchanges?
Ms. TAVENNER. Chairman Camp, that number will not be
available till mid-November. We have over 700,000 who have
completed applications.
Chairman CAMP. So you know the applicants, but do you know
the enrollees? Do you have an idea of how many of those
applicants became enrollees? Because that is really the number
that matters.
Ms. TAVENNER. We will not have that till mid-November. We
have people who are shopping now. We expect the initial number
to be small, and I think you have seen that in our projections,
and that was the Massachusetts experience as well.
Chairman CAMP. I have to tell you, the numbers I am hearing
from insurers in my home State of Michigan are not good, of
enrollees, it's a very small number. In fact, I think I could
have a meeting in my office, and have all of them fit in, of
the people who have successfully enrolled in the plans. I
understand that CMS' stated goal is 7 million enrollees by the
end of March. Is that correct?
Ms. TAVENNER. That is correct.
Chairman CAMP. And I think critically important, of that 7
million, 2.3 million of those need to be young and healthy. I
think those are your metrics. Is that correct?
Ms. TAVENNER. I don't have that metric with me, but I will
check on it.
Chairman CAMP. Okay. I believe those are numbers that CMS
has put out.
The Associated Press reported in early September that there
was a memo prepared by the Assistant Secretary for Planning and
Health. Are you aware of that press story and that memo? I
think it went through your office to Secretary Sebelius.
Ms. TAVENNER. That went through the enrollment numbers?
Chairman CAMP. Yes. And it said that there were month-to-
month predictions of enrollment numbers showing a path to the 7
million that I mentioned.
Ms. TAVENNER. Right.
Chairman CAMP. Could you make that memo available to the
committee?
Ms. TAVENNER. Certainly.
Chairman CAMP. According to the press report, the memo
estimated that 494,620 people would sign up for health
insurance under the program by October 31st. Now, we are
obviously very near that date. Have you met that estimate?
Ms. TAVENNER. I will not have those numbers available till
mid-November.
Chairman CAMP. So do you not know? Do you not have any idea
of how many people have enrolled or are you----
Ms. TAVENNER. Folks are still in the process of enrolling
both in the State-based exchanges and in the Federal exchange,
and we will have those numbers available in mid-November.
Chairman CAMP. Are you getting those numbers?
Ms. TAVENNER. Am I getting those numbers? Not yet. Not from
the States.
Chairman CAMP. You have no numbers on who is enrolled? So
you have no idea?
Ms. TAVENNER. We will have those numbers available in mid-
November.
Chairman CAMP. So no one is forwarding even weekly updates
on how the system is working?
Ms. TAVENNER. I think we have seen some of the press, and I
think that was on the graph earlier, about what States have
listed. We will get those numbers in mid-November.
Chairman CAMP. I understand you are not publicly releasing
those numbers, but I am asking do you have any idea of on a
weekly basis how many people enroll? I mean, how do you not
know how many people have enrolled?
Ms. TAVENNER. Chairman Camp, we will have those numbers
available in mid-November.
Chairman CAMP. But is your staff updating you on those? Are
you getting those on a periodic basis? I realize you are not
prepared to give this to the committee, even though this is a
government program and we are trying to do oversight here and
we are trying to understand what the problems are, but do you
have some idea of what those problems might be in terms of the
numbers?
Ms. TAVENNER. I am not quite sure what you are asking me.
Chairman CAMP. Well, you have said that 700,000 people have
completed the application process, so clearly you are getting
some information. Do you have any idea of how many of those can
move to the next step of enrolling, looking at plans, how many
are eligible, how many have decided to enroll?
Ms. TAVENNER. Once individuals complete the application,
then they go into the shopping experience, where they can look
at plans. We do get numbers on the number of applications, and
then we need to break those out. And that is why I have said,
this is part of the rollout that we will give in mid-November
for the October data.
Chairman CAMP. Okay. So you do have the applications, which
is the 700,000 number----
Ms. TAVENNER. Yes.
Chairman CAMP [continuing]. But you don't have how many
people successfully enrolled.
Ms. TAVENNER. I am saying people are still in the process
of enrolling.
Chairman CAMP. Of those 700,000, do you know how many of
those are eligible for Medicaid at this point?
Ms. TAVENNER. We have some information on who is eligible
for Medicaid, and then obviously States have their own
information about that, and it depends on whether a State has
expanded or not and what is going on inside. It is very State
specific.
Chairman CAMP. Can you share with the committee the
information you have about those that have enrolled that are
eligible for Medicaid?
Ms. TAVENNER. We will also have that information available
in mid-November as well.
Chairman CAMP. Because that would mean of those 700,000, a
significant portion would not be in the exchange if they are
qualifying for Medicaid. Isn't that correct?
Ms. TAVENNER. We will have that information available to
you in mid-November.
Chairman CAMP. Yeah, but the law is that if they are
eligible for Medicaid they are not enrolling in the exchange.
That is my question.
Ms. TAVENNER. Correct.
Chairman CAMP. So there could be a significant portion of
that 700,000 that would not be enrolling in an exchange. Is
that correct?
Ms. TAVENNER. There could be numbers in there that will be
eligible for Medicaid, that is correct.
Chairman CAMP. Do you know how many of the 700,000 have
qualified employer-sponsored insurance and therefore will not
be eligible for the exchange?
Ms. TAVENNER. Those individuals who have employer-sponsored
insurance, usually at the end of the application they are asked
that, and if that is the case, they usually don't proceed.
Chairman CAMP. Do you know how many of those 700,000 are
young adults, say, under the age of 26 who might choose to stay
on their parents' plan if it is cheaper?
Ms. TAVENNER. I do not.
Chairman CAMP. And do you know how many are undocumented
aliens and who may not be eligible to enroll in the exchange?
Ms. TAVENNER. So as you are aware, we actually have a
connection through the data hub to check for that, and if they
are not eligible, they do not complete the application and they
do not go on to shop.
Chairman CAMP. But of these 700,000, do you have any idea
how many are just looking and how many are trying to enroll?
Ms. TAVENNER. We actually look at the people who are
shopping, and obviously the majority of the people who are
completing applications are there to actually purchase
insurance, and so they continue to go through the shopping
experience.
Chairman CAMP. Well, there are media reports that say as
many as 80 percent of that 700,000 number are actually eligible
for Medicaid. Is that a number you would dispute?
Ms. TAVENNER. I don't know where that media report is or
how they would get that information.
Chairman CAMP. Well, if that is true, I mean, that is the
only information we are getting, frankly, today. I, frankly,
would have hoped for a little bit more from you. But if that is
true, then less than 140,000 of these applicants are
potentially enrollees in the exchange, and that is assuming
they don't have employer-provided coverage, that is assuming
they can't stay on their parents' plan or are otherwise
ineligible in some other way. But that means you are likely to
hit less than one-quarter of this October estimate of 494,620.
How many people did you estimate would enroll between November
15th and December 15th, which we are 2 weeks off from that
period?
Ms. TAVENNER. I don't have that in front of me. I will be
happy to get you that information.
Chairman CAMP. If you could get that to the committee, I
would certainly appreciate that.
But I think given that the back end systems aren't working
and insurers have resorted to manually enrolling people one by
one, I just think the system literally doesn't have the human
resource capacity to manually enroll the numbers that are being
projected here.
I assume that many people who are holding off are the young
and healthy, so the risk pools in these exchanges are not going
to align with the projections. So I think not only are we going
to miss the 7 million enrollee target, it appears that we are
going to miss the demographic makeup as well, and that is going
to be very important to have a functioning system. If the
demographics are wrong and there aren't as many young people
enrolling, what happens then, what happens to premiums?
Ms. TAVENNER. I think the premiums are locked down for
2014, so obviously the next 6 months of enrollment are
critical. And I will remind you that enrollment does occur till
March 31st of 2014. I will also remind you that the
Massachusetts experience was very slow initially and that it
started to ramp up over time. We expect the same type of
projections.
Chairman CAMP. But it doesn't look like you are even
meeting your own projections that you had prepared.
Ms. TAVENNER. I have not listed any information on
enrollment. I think there are some assumptions you are making.
Chairman CAMP. Well, I am just referring to this Associated
Press memo that I appreciate you are willing to give to the
committee that said that half a million people would sign up by
October 31st and that they would enroll. But if we don't meet
this demographic of 2.3 million young people, I mean, it is
very clear that premiums will go through the roof, whether in
the next few months or in the future. And if that is where we
are headed, and it appears that we are, how will you provide
relief to individual Americans who don't want or can't afford
this insurance, and how do we prevent the premium spike in 2015
as insurers will readjust their prices to reflect the actual
enrollee demographic?
Ms. TAVENNER. Currently, if you look at the premiums for
2014, we did not see premium spikes, we actually saw a very
competitive marketplace. In fact, we have over 200 issuers just
in the Federal exchange alone who have offered more than 3,000
plans at very competitive prices. So markets have as many as 54
plans in a market. We have also seen 25 percent new issuers in
markets. So far what we have seen is the absolute opposite of
what you are suggesting.
Chairman CAMP. Have you enrolled in the plan?
Ms. TAVENNER. I have employer-sponsored insurance. I would
not be eligible for the plan.
Chairman CAMP. From the Federal Government? Is that what
you mean?
Ms. TAVENNER. Yes.
Chairman CAMP. So you are not participating in Obamacare?
Ms. TAVENNER. I am participating in employer-sponsored
insurance, which 85 percent of the country does.
Chairman CAMP. So you have government insurance. Have you
gone on the site and tried to enroll or tried to shop for
plans?
Ms. TAVENNER. I haven't gone on to shop for the plans. I
went on, actually signed up for an account just to see what it
looked like and go through the application process, but did not
sign up for coverage. I am not eligible for coverage, nor did I
shop.
Chairman CAMP. I just want to mention to you a letter that
I received from my district. And this man wrote me and said,
``My wife has been recently informed by her insurance carrier
that her health care policy does not comply with the Affordable
Care Act. Now we must purchase a new policy to get the same
coverage at an 18 percent increase in our premium.'' So what
happened to the if you like your insurance you can keep it
question? What would you say to that individual?
Ms. TAVENNER. Well, I would take them back to pre-
Affordable Care Act days where in fact if you were in the
individual market, you were living at a 50 percent churn. Half
the people in the individual market prior to 2010 didn't stay
on their policies. They were either kicked off for a
preexisting condition, they saw their premiums go up at least
20 percent a year, and there were no protections for them. And
sometimes they were in plans that they thought were fine until
they actually needed hospitalization; then they found out it
didn't cover hospitalization or it didn't cover cancer.
So I would take them back to the fact that since 1986,
health care costs and coverage have been the number one issue
for small businesses for the last 20 or 30 years and we have
been talking about it for the last 20 or 30 years. That is
actually why I came into this job, is to try to deal with this
issue.
So now what I would say is this: Now if, in fact, the
issuer has decided to change the plan, didn't have to, plans
were grandfathered in, in 2010. If they didn't make significant
changes in cost sharing and this sort of thing, they could keep
the plan that they had. But some insurance companies have
decided, and I think that is what you were referring to in your
opening statement, that they want to offer new plans. And if
they offer new plans, they have to come into the requirements
of the Affordable Care Act, which are you have to offer the 10
essential coverage benefits, you cannot judge people on
preexisting, you cannot discriminate based on sex. There are
lots of things that are required under the Affordable Care Act
that actually protect consumers.
But these premium increases were going on a long time prior
to the Affordable Care Act, and, in fact, we have seen the most
premium moderation in the last 3 years than we have seen
probably in 15 or 20 years. That is what I would say to them. I
would try to explain to them the real issues.
Chairman CAMP. Well, the carrier told them that the plan
didn't comply. But nothing you said had anything to do with how
they can get their costs down. And I think that is the real
problem that we are seeing here, is that the costs are----
Ms. TAVENNER. Right. So what I would tell that individual
is if their carrier is telling them they are changing the plan
and they are offering an increase, that they would need to go
take a look at what is available in their State and in their
market, which is certainly something that is available to them
through the exchange.
Chairman CAMP. Yeah, at an 18 percent increase.
All right. With that, I will recognize Mr. Levin.
Mr. LEVIN. Well, thank you.
A warm welcome.
The chairman talked about the Web site, and you said it is
going to be fixed. And I might say, if everybody would pitch in
to make it work, the goals that have been set would be more
readily met. That is what happened with the prescription drug
program. We all pitched in to make it work. And it had major
problems at the beginning, and instead of standing in the way
we said, we didn't vote for it, let's make it work, and it
began to work. If we all had the same spirit about ACA, it
would be more than helpful.
But then the chairman asked you about the notices that are
coming from the insurance companies, and I would like to ask
you about that. A gentleman from Michigan who had an $800 Blue
Cross plan got this notice from Michigan Blue Cross, went into
the Web site with the help of navigators, and ended up with a
Blue Cross Silver HMO plan with tax credits in that case. And
instead of $800 a month, it is $77 a month.
And let me refer you to the interview on ``Meet the Press''
with the Blue Cross Florida Chief Executive Officer. He was
asked by David Gregory, in Florida the oldest and largest
health care plan provider, Florida Blue Cross, confirmed it is
cutting 300,000 policies. And this is what the chairman of Blue
Cross of Florida said: ``We are not cutting people,'' and I
quote. ``We are actually transitioning people. What we have
been doing is informing folks that their plan doesn't meet the
test of the essential health benefits; therefore, they have a
choice of many options that we make available through the
exchange, and, in fact, with subsidy, many people will be
getting better plans at a lesser cost.''
So this has become a matter of legitimate discussion, and I
think all of us would appreciate your addressing it.
Ms. TAVENNER. Yes, sir. Again, going back to prior to the
Affordable Care Act days, these individuals in a small group or
individual market had no protections, they had no guarantees of
coverage, and they were still being charged somewhere between
20 percent or more of premium increases year over year. So they
could be kicked out at any time for a preexisting condition.
Sometimes they thought they had coverage when they did not, and
when they went in and had a cancer diagnosis or a cardiac
diagnosis, they found out maybe they had a $5,000 hospital
limit or they had certain disclaimers. Then, of course, there
was always, if you were diagnosed with asthma or high blood
pressure or some other chronic disease, you might not be able
to get coverage at all. So that is what is different. So that
is the first part.
The second part is in 2010 we told issuers to try to give
some transition time, if they wanted to keep policies as they
were currently defined, whether they were in a group market or
an individual market, they could. And so some of them elected
to do that. Now some of them are moving to the new standards,
and the standards under the Affordable Care Act are pretty
simple. You have to have the 80 percent MLR. So you can't be
taking money more than the 20 percent to marketing,
advertising, profit. You had to meet the 10 essential health
benefits. You had to define copay, deductible, and diseases in
clear and understandable terms so people would know what they
were buying. You had to have choices among plans. And then
there are folks in the individual market who when they go on
the site may qualify for tax credits. Some in some States may
actually qualify for Medicaid expansion.
But this problem existed long before the Affordable Care
Act. Now folks are transitioning to the new standards of the
Affordable Care Act, which guarantee you can't be denied, you
won't be kicked off of a policy because you develop a problem,
you may be eligible for tax credits depending on your income.
So these are important protections that are now available
through the Affordable Care Act, and I think that is important.
Mr. LEVIN. Thank you.
I yield back.
Chairman CAMP. All right. Mr. Johnson is recognized.
Mr. JOHNSON. Thank you, Mr. Chairman.
Ms. Tavenner, thank you for being here.
You know, I have been hearing from folks back home who,
rightfully so, are very serious about their concerns and fears
about their health care. Steven from Plano tried to purchase
insurance through the exchange, but ended up more confused and
frustrated. Operators on the 1-800 line didn't have answers to
his specific questions. They simply reiterated that anyone
could sign up for the exchange, but he should wait until later
that evening or the next day to apply since the systems were
having technical difficulty.
Worse, a single father and police officer in Plano went to
renew his 11-year-old daughter's plan. She has no medical
problems, yet her premiums doubled--doubled. Those are the real
stories of fathers, mothers, sons and daughters who have to
live with a law that up to now has completely failed them.
Ms. Tavenner, the administration delayed the employer
mandate for 1 year. The Treasury witness before the committee
testified the reason the administration granted big business a
1-year delay is, quote, ``Employers and their representatives
have requested transition relief for 2014 because of concerns
about the difficulty or costs of complying with the employer
mandate.''
Secretary Sebelius appeared before this committee and
repeatedly said Obamacare was ready. It clearly wasn't.
Doesn't the failed launch indicate many individuals are
going to have to at least have as much difficulty complying
with the individual mandate as big business had with the
employer mandate? Yet from the announcement last night, you
have only given individuals a 6-week delay. CMS announced
700,000 people had submitted applications for exchange coverage
nationwide, but with all the challenges you have been facing,
there are some serious questions about what these applicants
know.
CBS news reported, quote, ``The shop and browse feature is
not giving consumers a real picture. In some cases, people
could end up paying double what they see on the Web site.'' So
how many applicants applied based on the wrong premium
information? Do you know?
Ms. TAVENNER. The completed applications were done, the
700,000. These were individuals who completed applications and
figured out if they were eligible for a tax credit. I do not
know where CBS news is getting their information about
erroneous tax credits, so I can't address that.
I will say that in the individual mandate issue, that folks
can apply through March 31st. We have said publicly that we
will have the Web site in good working order by the end of
November. We have always predicted that folks would increase
their interest in enrollment in December and probably again in
March, and so we believe that we are in good shape to handle
that.
Mr. JOHNSON. Well, if you have identified the problem and
are taking steps to identify who received faulty price
information, apologize--and provide the right information--are
you doing that now?
Ms. TAVENNER. Yes, sir. If we have given people the wrong
information, we will certainly correct it, but I am not sure
what CBS news is referring to.
Mr. JOHNSON. I would like to bring to your attention a
story which ran last week in Mother Jones with the headline,
quote, ``How HealthCare.gov Could Be Hacked.'' Let me just
quote from the article. ``Security experts say the Federal
health insurance Web site is vulnerable to a common technique
that hackers use to steal personal information.''
As you may know, I am chairman of the Social Security
Subcommittee, and one of my longest outstanding priorities has
been to protect Americans' Social Security numbers. So for the
record, is the Obamacare Web site 100 percent safe from hackers
who could steal Americans' personal information, including
their Social Security numbers, yes or no?
Ms. TAVENNER. We follow all the standards to protect
information, including Social Security numbers.
Mr. JOHNSON. Are you trying to say yes?
Ms. TAVENNER. Am I trying to say yes that we follow the
standards to protect information? Yes, sir.
Mr. JOHNSON. You know, folks are confused and scared. They
have heard the horror stories and are now experiencing them
firsthand. How can they trust the Federal Government to not
only fix the Web site, but more importantly, give them the
assurance that their personal information will be safe and
their health care will be affordable, that if they want to keep
their current plan, they can do so?
The problems don't stop at the technical failures of a Web
site. The real problem stems from the colossal failure to
deliver what this law promised the American people.
Thank you, Mr. Chairman.
Chairman CAMP. All right. Thank you.
Mr. Rangel is recognized.
Mr. RANGEL. Thank you so much, Mr. Chairman.
And welcome to our distinguished committee. You may wonder
why the administration appears to be under such severe attack
by some Members of this committee, especially as it relates to
our goal to provide health care for 30 million Americans that
can't afford or don't have access to it, but it should give you
some small comfort to know that historically the Republican
Party always fought vigorously against these types of programs.
I don't think that one Republican voted for the Social Security
Act, even though those old enough to enjoy the benefits.
Chairman CAMP. That is not accurate.
Mr. RANGEL. Well, we will see maybe one or two. I don't
know.
Chairman CAMP. No.
Mr. RANGEL. But they opposed Medicare. I spoke with
President Johnson, and he shared with me at the ranch people
that had signed off on Medicare. And anyway, it is big
government. Even if it saved lives, who cares. You are against
big government. So why should Obama be spared the attack
because he wants Americans to be healthy and strong and
productive? We have to be consistent, and you guys and ladies
have been.
What I don't understand is that people aren't born as
Republicans and Democrats, and there has to be somebody,
regardless of party label, that has suffered the embarrassment
and the pain of being denied an insurance policy because they
have been sick before. The people who actually need health care
the most are too high a risk for some of the insurance
companies, and this body, Republicans and Democrats, allowed
things like this to happen.
When I was a kid, if my mother took three of us, three
children to see a doctor and we weren't sick, they would think
she was crazy, because you couldn't afford a doctor. Now health
care will provide you getting the type of treatment to avoid
you being sick and having to lose your dignity in impersonal
emergency rooms that provide the most expensive health care
that we have. But Republicans, who have always been admired for
being fiscal conservatives, have certainly seen the price of
health care, the lack of quality that we may have today, soar
to become such a part of our national budget that, in my
opinion, it is a threat to our national security, because as
prone as some of you are to enter into conflict with other
countries, you need healthy young people to fight these wars.
And health care is important from birth throughout one's life.
So I don't know how you are going to explain when this
program, which is destined to succeed, how politically you are
going to explain your positions today. And since your entire
political program is locked into hatred for the President and
this program, it seems to me that we have to find other ways
for us to politically combat each other, because I hate to see
the day that there is no Republican Party and I have to rely
just on my party for justice and fair play. And so we have to
come together some kind of way to see what is best for America.
Now, you may not like this program, and it certainly has
been disappointing as a start, but what I want to see more from
this committee is how can we improve and get quality health
care for all Americans. This has to be a part of the goal that
all of you have. And you also have to recognize that when we
are lucky enough to have public servants to work for the
administration, whether Democrat or Republican, that they are
servants the same way we are and they deserve some dignity as
well.
And so for America, I hope and have every reason to
believe, like Social Security, like Medicare, that the goodness
of the program will prevail. And if there is anything that we
can do to help you, and there may be some Republicans that will
join with me, to make certain that we get rid of what is not
working and make certain everyone has access to health care, I
wish I could see the politics involved in this, because I am a
partisan, but a stronger America means a stronger party, and
that is what we are here for. And I just want to thank you for
your dedication and for you to recognize that it is all
political and we have to do our job and get on with it. Thank
you for your service.
Chairman CAMP. All right. Thank you.
Mr. Brady is recognized.
Mr. BRADY. Just a quick fact check on the blast from the
past. Republicans did support Social Security and Medicare, and
more recently Republicans were the ones that reformed Medicare
to add that important prescription drug benefit so we could
have seniors lead healthier lives, stay out of hospitals, and
enjoy their grandchildren more.
What has become abundantly clear, the flaw is not the Web
site, the flaw is the law itself. This is what happens when you
inject 159 new Federal agencies, bureaucracies, and commissions
between you and your health care. And this was supposed to be
the easy part. Just wait until you see the government making
decisions about patient care, about reimbursements and
treatments that you receive from your local doctor and
hospital.
Ms. Tavenner, I have a great deal of respect for you, and I
suspect many Republicans do, yet the White House, Secretary
Sebelius, you, and your staff made repeated claims to the
American public and to Congress that everything would be ready
on time, everything was a go. None of that proved to be true.
Now we are told everything will be okay very soon. So why
should the American people believe you now?
Ms. TAVENNER. Congressman Brady, I would go back to what
has worked in the last 3\1/2\ years since the Affordable Care
Act was implemented. We have been able to make a difference in
the lives of coverage of young people, we have been able----
Mr. BRADY. But specifically on the Web site and the
exchanges, why should the American people believe you now? You
have had nearly 4 years to get it ready. Now you are saying in
4 weeks more it will be great. So what is different? Why should
anyone believe these claims?
Ms. TAVENNER. Because I think we have identified two major
problems. One had to do with the initial volume. And despite
our best volume projections, we underestimated the volume, the
interest in the site.
Mr. BRADY. But you know that the volume isn't the same as
the applicants in the enrollment, that you, yourself, visited
the site. Clearly you weren't shopping for it. Others did as
well.
Ms. TAVENNER. Right.
Mr. BRADY. So to Chairman Camp's point, the number of
applicants, the number of enrollees, apparently still not
known, is pretty modest. Wouldn't you agree?
Ms. TAVENNER. Well, but I would tell you that the number of
visitors to the site and the number of people interested in
completing applications was larger than even our initial
projections. And we worked our projections off of the 7 million
number that Chairman Camp mentioned. We also worked it off our
history with Medicare Part D. So we have added capacity to the
system and we have improved system performance. So that is the
first thing.
The second thing is we have found some what I will call
functional or glitches, as we call them in the public term, in
the actual application itself which we are repairing, and that
is the gradual improvements that you will see over the next 4
weeks and that is why I am confident about the end of November.
Mr. BRADY. Well, can I tell you, my constituents are
frightened. Like millions of Americans, they are now being
forced out of the health care plan that they like. The clock is
ticking on a Web site that is broken. Their health care isn't a
glitch. It is what they depend upon.
So, you know, you have been described as the quarterback of
the Obamacare rollout. I am sure that is not the term you chose
for yourself. But can you guarantee no American will experience
a gap in their health care?
Ms. TAVENNER. So what I can guarantee is that we have a
system that is working. We are going to improve the speed of
that system----
Mr. BRADY. Excuse me.
Ms. TAVENNER. Yes?
Mr. BRADY. You are saying the system right now is working?
Ms. TAVENNER. I am saying it is working, it is just not
working at the speed that we want and at the success rate that
we want, and those are the things we are working on. We also
have alternative methods for folks. They can use the call
center, they can use paper applications, and then we have in-
person assistants available in each State. So I can guarantee
you that we can reach out to each individual and help them
select a plan and enroll. So, yes, sir.
Mr. BRADY. But to my point, this is not supposed to be
fixed until November 1st. People have just 2 weeks to apply,
enroll, be confirmed. So what happens on January 1st, when they
have an illness, they need patient care then, they have not
heard back from the government? What do they do then?
Ms. TAVENNER. They have until March 31st to enroll.
Mr. BRADY. No, but their plan has been cancelled, as
millions of Americans have found out.
Ms. TAVENNER. You are talking about people who----
Mr. BRADY. What my constituents want to know, what happens?
Ms. TAVENNER. The individuals who have received notices
from their issuers is a different situation. They can certainly
obviously sign up, transfer, as we talked about earlier with
Blue Cross of Florida, or they can go on the exchange or call
the call center----
Mr. BRADY. But my point is, it has been cancelled, they
don't have health care, they have tried to get on the Web site
unsuccessfully, they don't know if they are enrolled, it is
January 1st, they are facing a gap in coverage. What do you
tell them?
Ms. TAVENNER. I am telling you they can call the call
center today and we will help them. They can go online, and if
they are not successful, we can help them through the call
center. We also have people in their individual markets that
can help them in person. So there are more methods than just
the Web site, and I think that is important.
Mr. BRADY. I think what has become clear as well is
Obamacare is not ready. The question is, why don't we make it
voluntary? Why don't we give Americans a choice so they are not
forced into this health care that they don't want?
Mr. Chairman, yield back.
Chairman CAMP. Mr. McDermott is recognized.
Mr. MCDERMOTT. Thank you, Mr. Chairman.
Mr. Rangel has asked me to correct something. The vote
coming out of this committee was on a party line vote. There
were no Republicans who voted for it when it left this
committee. When Social Security----
Chairman CAMP. Will the gentleman yield?
Mr. MCDERMOTT [continuing]. There were 81 who finally voted
for it, mostly progressives, but there are none less in the
Congress.
Chairman CAMP. Yes, 84 percent of Republicans voted for the
Social Security act 77 years ago. I am glad we are debating
current events here, Mr. McDermott.
Mr. MCDERMOTT. Reclaiming my time, Mr. Chairman. With the
way my Republicans colleagues have been fretting over the
success of the Affordable Care Act exchanges, you would never
know they spent $24 billion shutting down the country to get
rid of it. Suddenly they seem desperate to see a bill that they
didn't want actually work. It is like the ``Annie Hall'' joke:
The exchanges are terrible and not enough people can enroll.
Now, this is one of the biggest reforms our country has
ever made and we are only 4 weeks into it. Medicare wasn't
built in a day. Part D didn't roll out without snags along the
way. As others have mentioned, many of the Republicans who are
now calling for blood over this rollout were begging for
patience on Part D. The kinks of that rollout were easily
brushed off by many GOP alarmists who sit on this dais. We
waited 6 months to hold an oversight hearing on Part D. We are
barely 4 weeks into this one, and we are already declaring it
dead. It is premature death.
We would have all loved to see this launch be seamless and
smooth, but we can't get caught up in the glitches and the
technical difficulties and lose our perspective. Help lines are
up and running. I want to put the first chart up, because I
think that you need to know that it is working in some States
in this country. We have had a health plan finder in the State
of Washington that has been out on the street before October 1.
In Washington State we were ready to go and we have got 92,000
people who have now enrolled.
Now, there is a difference between enrolling and being
approved, having your plan approved, because you have to make
your first payment. So when you talk about enrollment, you may
be talking about something different. You are not comparing
apples and oranges.
But there are States in which it is working. People can
sign up by mail, in person. We had actually a mobile signup van
that is going around the State stopping in small towns and
giving people a chance to talk to somebody. And 49,000 people
are already in the program, not just finished the application.
Now, there have been some glitches, even in our State, but
we got around them. Our country does have a serious problem,
however, with access to quality health insurance, and it is not
being caused by Web sites. All of the computer programmers in
the world aren't going to be able to help the 180,000 Hoosiers
that fall into the affordable coverage gap because Indiana
isn't expanding its Medicaid. Of course, that is nothing
compared to Georgia's 400,000 people who aren't going to get
anything, or Florida's 760,000.
And then, of course, there is Texas. Texas is always the
best and they are not going to be outdone. Texas boasts
1,460,430 people who will simply get nothing, no Medicaid, and
I guess they can come to the government exchange, which people
here want to kill. That is over a million Texans, working poor
with minimum wage jobs, multiple of them, and they are just
trying to get by.
Now, they could be covered at no cost to themselves or the
State of Texas, but instead the GOP wants to see this President
fail because they would rather let their constituents go
uninsured than compromise. Those Texans and Floridians and
Hoosiers are simply out of luck.
Meanwhile, in other red States, like Kentucky, they have
enrolled already 26,000 people through the State exchange or
expanded Medicaid. Arkansas, now, they don't want it, either,
and they don't want to accept the Medicaid money. They
constructed their own way, in cooperation with the Federal
Government, and they have got 56,000 people enrolled in
Arkansas. Now, here is a red State that worked very hard to
partner with the Federal Government and arrive at a solution
that is working for its residents.
It is time really to start working together. Forty-four
attempts to repeal this law. It is now law, folks. It is now up
and running. It is going to run. And it is time to stop this
kind of sniping and get together and figure out how to make it
work. No one on our side thinks the law is perfect.
Chairman CAMP. All right. Thank you. Time has expired.
Mr. Ryan is recognized.
Mr. RYAN. Thank you. And thanks for being here.
I think what we are seeing here are all these rude
awakenings that the American people are waking up to find; you
know, promises made and promises broken. We had a hearing here
in this room on August the 1st with the IRS, and the IRS
confirmed that the delay in the employer reporting requirements
would mean that the IRS would not have the data on the so-
called back end from employers until 2016 to verify if an
individual had been given an offer of affordable employer-
sponsored health insurance in 2014. Now, the reason this
matters is that determines whether a person is eligible for a
taxpayer-funded subsidy or not.
To mitigate this, Dan Werfel, the IRS Commissioner, told us
that, quote, ``We are going to help the individual at the front
end when they are navigating through the exchange to understand
whether they have an employer plan.''
Let me ask you this: Of the 700,000 applicants you have
received, how many of them did you verify whether or not they
have been offered employer-sponsored insurance?
Ms. TAVENNER. The verification of employer-sponsored
insurance is part of the application process. So if, in fact,
that was available to them, they would not go on and complete
the application.
Mr. RYAN. So it is just a self-attestation. Is that what
you are saying? You had no way of corroborating this?
Ms. TAVENNER. We actually ask some additional questions. If
you have gone online and go through the application, it
actually requests some additional information. And we have ways
of verifying whether or not employer-sponsored coverage was
offered. So it is not just as simple as yes or no. If they
don't have it, it is a no, and so we accept that. If it is a
yes, then we try to work with them to see if they are eligible
for anything or not.
Mr. RYAN. Okay. So I look at yesterday, you released a
report that purported to talk about premiums for young adults.
The report admits, quote, ``These estimates do not take into
account the tax credit eligibility requirements relating to
other minimum essential coverage or tax filing requirements.''
Young adults on their parents' plans.
Let me ask you this. Are you proactively finding out if
individuals under the age of 26 who are eligible to stay on
their parents' plan are doing that or not? Because they are not
eligible for a subsidy then as well.
Ms. TAVENNER. Right. So what we have seen is since the
Affordable Care Act we have over 3 million young adults who are
getting coverage through their parents' plans, which is pretty
much the pool that we anticipated. So they are going through
their parents' plan.
Mr. RYAN. No, but when they go on the Web site, are you
verifying whether or not their parents have a plan that they
are eligible for before determining whether they, themselves,
get a subsidy?
Ms. TAVENNER. It is part of the application process. I can
get you more information on that.
Mr. RYAN. Well, here is the point. Look, 2 weeks ago in the
CR we passed a law that President Obama signed, quote, ``Prior
to making such credits and deductions available, the Secretary
shall certify to Congress that the exchanges verify such
eligibility consistent with the requirements of the act.''
Here is the question. Are we really verifying at the front
end whether a person is actually eligible for these subsidies
or not? Here is why this matters. If they are not eligible for
the subsidy, and then once we reconcile these records, they get
taxed the money back off of their refund.
And so this is what I mean when I say rude awakenings.
People are signing up for insurance, they are getting tax
credit subsidies funded by taxpayers. The IRS is already
telling us they are confused about how to do this. You are not
telling us whether or not you are proactively determining
whether, say, an under-26-year-old is actually eligible for the
subsidies you are trying to sell them. And the problem is once
we learn whether or not they were eligible, and if they
weren't, people in good faith will be signing up for subsidies
that they are actually not eligible for.
Ms. TAVENNER. I think you are asking a different question,
which is, are we doing 100 percent income verification on
everyone?
Mr. RYAN. And subsidy eligibility verification.
Ms. TAVENNER. Yes. So part of the question in the
application process is, are you dependent on your parents? Are
you dependent on your parents' tax plan? So that is part of the
questioning that goes on. And if so, we move them in that
direction. But more importantly, part of what you are asking is
the income verification, which is done in 100 percent of the
cases.
Mr. RYAN. I am not asking about income verification.
Ms. TAVENNER. Okay.
Mr. RYAN. I am asking about, if a person signs up, were
they offered credible employer insurance? Because the employer
mandate has been delayed you don't have that verification tool,
so you had to come up with a new verification tool to determine
their eligibility for subsidies. Because if a person is offered
insurance at their job----
Ms. TAVENNER. Right.
Mr. RYAN [continuing]. That meets your definition of
credible insurance, then they can't get Obamacare subsidies.
Ms. TAVENNER. That is correct.
Mr. RYAN. If a person is 25 years old and they go on the
Web site and they say their income is X, and that is eligible
for subsidy, they can get that subsidy. But if they were
eligible to be on their parents' plan they are not allowed to
get that subsidy.
Ms. TAVENNER. That is right.
Mr. RYAN. The question is, are you filtering that?
Ms. TAVENNER. Yes.
Mr. RYAN. Because here is the problem. If you get this
wrong, the way the law works is you have to take that money
back in their tax refund. Tax refunds matter. People plan their
lives around their tax refunds.
Ms. TAVENNER. I understand that.
Mr. RYAN. They plan their spring breaks for their kids.
They plan their car payments, their bills. And what people in
this country don't yet know is that if you get this wrong,
which you have already acknowledged you are not doing it right,
they are going to get their tax refund taken away from them
because they will have signed up for a subsidy that they
weren't eligible for which they didn't even know.
Ms. TAVENNER. And if you have been on the site, this is
part of the clear instructions to folks, including the under
age 26, including the fact that you are basically completing
this application under penalty of perjury. It is very clear.
There is also help instructions on each site to explain each
process, what is credible employer coverage, what happens if
you are under 26. It is all available on the Web site.
Mr. RYAN. Okay. So if they get it wrong, they are the one
who is going to get taxed.
Chairman CAMP. Okay. Time has expired.
Mr. Lewis.
Mr. LEWIS. Thank you very much, Mr. Chairman.
Thank you, Madam Administrator, for being here. Thank you
for all your hard work and for your years of service.
I happen to believe that health care is a right and not a
privilege, that it is not just for the fortunate few, but all
citizens of America.
Now, the Affordable Care Act is the law of the land. It was
passed by the Congress, signed into law by the President of the
United States, and upheld by the United States Supreme Court.
There have been more than 40 attempts to repeal the act, and it
did not succeed. And by attempting to repeal it, Members of
this body, Members on the other side of the aisle closed down
this government and threatened the economy of the United
States, costing us more than $24 billion.
This reminds me of another period in our history not so
long ago. During the 1950s, many Southern Senators signed the
Southern Manifesto after the Supreme Court decisions of 1954.
And those Senators, along with many Southern governors,
subscribed to the doctrine of interposition and nullification,
and some even massive resistance. That is what we saw on the
part of the Republican Members of the House and some of the
Republicans in the Senate.
The Affordable Care Act is working. It is helping to make
health care affordable and accessible to hundreds, thousands,
and millions of our citizens who never had it before. When I
was growing up in rural Alabama, we couldn't afford to see a
doctor. None of the poor people in Alabama, in Georgia, in
Kentucky, in Arkansas, and all across the Deep South can see a
doctor. We must do what is right, what is fair, and what is
just.
Now, Madam Administrator, I have a chart here this morning,
and I want you to walk us through this chart. And I want to use
my remaining time for you to explain to the Members of the
Committee the success and the benefits of the ACA. There have
been a deliberate and systematic attempt on the part of the
majority in the House and the minority in the Senate to make it
impossible for all Americans to receive quality health care.
And some of us will not stand for it. We will stand up and
fight for what is right, for what is fair, and what is just.
Health care is a right and not a privilege. Walk us through the
chart.
Ms. TAVENNER. Let me start with the 78 million consumers
saving $3.4 billion on their premiums. This is due to some of
the work that was done around the medical loss ratio. These
were benefits that actually went in forms of checks to
individuals. I actually got thank you notes from people that I
have never heard of, that I have never met thanking me for
getting a rebate back. It could go to the individual or it
could go back into their premium for the following year.
Seventeen million children with preexisting conditions used
to be able to be denied coverage, this goes back to the flaws
in the individual market that existed prior to the Affordable
Care Act; 6.6 million young adults able to stay on their
parents' health insurance plan, that is critical, particularly
at the time with what we were going through with our economy;
7.1 million seniors in the donut hole. And let me remind you
that in addition to that, you saw our release yesterday about
the Part B premium being flat for next year. That is some of
the work of the Affordable Care Act in controlling costs.
And let me just say, going back to your point, Congressman,
is that if we had the highest outcomes, if we had the lowest
infant mortality, if we had the longest lifespan, maybe what we
were paying would be worth it. But it is not the case. As you
know, our country does not look good in terms of overall health
statistics, and certainly the South is suffering from that more
than the rest of the country.
Mr. LEWIS. Thank you very much.
With that, I yield back my time.
Chairman CAMP. All right. Thank you.
Mr. Nunes.
Mr. NUNES. Thank you, Mr. Chairman.
Madam Administrator, just in response to Mr. Ryan's
question, we went through the Web site, and we don't see
anywhere where it shows that if you are under 26 that there is
a verification.
Ms. TAVENNER. So let me also say one thing that I had
wrong. As a young adult you can stay on your parents' policy
and you can get your coverage that way.
Mr. NUNES. But the question was there was no check on the
subsidy.
Ms. TAVENNER. Or you may go as an individual and you would
be eligible for a subsidy. There is no penalty.
Mr. NUNES. Well, if you are 26, if you are under the age of
26----
Ms. TAVENNER. You can go either way.
Mr. NUNES [continuing]. To Mr. Ryan's point, you can get a
free subsidy and get that back on your tax return. That was the
point Mr. Ryan was making. And there is nowhere----
Ms. TAVENNER. You are eligible for a subsidy, yes.
Mr. NUNES. You are eligible. So you can be on your parents'
health care. And you are still eligible for a subsidy.
Ms. TAVENNER. But I will remind you part of what you
complete on the application is do you have coverage. You are
also under penalty of perjury. So you have to tell the truth on
your application. That is kind of a requirement.
Mr. NUNES. Okay. In your submitted testimony you attributed
the problems to HealthCare.gov Web site to a subset of
contractors. Is that correct?
Ms. TAVENNER. I don't think I said that it was due to a
subset of contractors. I said we had two issues that we were
dealing with. The first was capacity, in that our first few
days the volume was more than we anticipated, so we had to add
capacity. We had a problem with account creation, with the
email account creation, which was subsequently fixed.
Mr. NUNES. So on your August 1 testimony to the House
Energy and Commerce Committee, to Congressman Pitts' question,
do you remember this question?
Ms. TAVENNER. You will have to ask the question.
Mr. NUNES. He asked, and I quote, ``Do the contractors who
HHS is paying to build these exchanges have certain targets or
milestones that they have to meet?'' You replied,
``Absolutely.'' Congressman Pitts then asked you, ``Can you
tell us today that every contractor has met these targets and
is on time?'' You replied, ``Yes, sir, I can.''
So it seems there are two possibilities here. First, the
exchanges were progressing fine for years, just as you
repeatedly told Congress, and the breakdown resulted solely
from problems with a few contractors that suddenly occurred 60
days before Obamacare was open to the public. Or the second
possibility is, is that there were problems much earlier that
were being reported in the press, but you did not tell Congress
about these. Which is closest to the truth?
Ms. TAVENNER. If I remember the questions correctly, what
Congressman Pitts was asking me related to the hub, and the hub
was progressing on time and on schedule. It still is. The hub
has actually operated pretty much flawlessly. And most of the
questions were around the hub.
Mr. NUNES. So it has been also reported that neither
criminal background checks nor high school diplomas will be
required for so-called navigators to be hired to help Americans
access the exchanges. Is this true?
Ms. TAVENNER. Could you repeat that? I am sorry.
Mr. NUNES. Neither high school diplomas nor criminal
background checks will be done on the folks that you hire to
help Americans navigate the Obamacare Web site.
Ms. TAVENNER. I don't think that that is true. Are you
talking about through the navigator program? There are
standards, and I can get you those standards.
Mr. NUNES. Okay. Well, it has been a press report.
Has anyone in the White House or anyone else asked you to
delay divulging enrollment numbers as it regards to Mr. Camp's
question at the beginning?
Ms. TAVENNER. No. I think if you remember, we had said all
along that we were going to release our first numbers the
middle of November.
Mr. NUNES. So no one at the White House, no one in the
entire Obama administration has asked you not to release those
numbers.
Ms. TAVENNER. We have made a group--we made the decision
that we were not releasing the numbers till mid-November.
Mr. NUNES. And you don't know, you have no idea what those
numbers are at this point?
Ms. TAVENNER. I told you we would release the numbers in
mid-November.
Mr. NUNES. Okay. I will take that as you don't want to
answer the question.
Did you ever argue to Secretary Sebelius, or to anyone at
the White House, or to anyone else that the exchanges would not
be ready October 1 and that a delay in launching them would be
warranted?
Ms. TAVENNER. I did not ever argue that we should delay the
exchanges. What I did present to the Secretary in September is
that there were certain functions that we should delay beyond
October 1, and I think those have been very much in the press.
That had to do with the automation of SHOP. It had to do with
the Spanish-language Web site. It had to do with Medicaid
account transfers. So that was presented in September as things
we would not bring live October 1.
Mr. NUNES. Before my time expires, I want to yield quickly
just 5 seconds to Mr. Ryan.
Mr. RYAN. Look, I find it puzzling we have to explain to
administration officials how the law works. The law is if you
are under the age of 26 and you are eligible to stay on your
parents' plans you cannot receive subsidies.
Ms. TAVENNER. You are right.
Mr. RYAN. And there is nothing, nothing on your Web site
that tells an under-26-year-old those facts. So you are
encouraging people to sign up for insurance and a subsidy that
they may not be eligible for and they don't even know this.
Ms. TAVENNER. Congressman Ryan, I am happy to go back and
check on that and get you information.
Mr. NUNES. Yield back.
Chairman CAMP. All right. Thank you. Time has expired.
Mr. Neal.
Mr. NEAL. Thank you, Mr. Chairman.
I think one of the differences here in the legislative
modeling is the way that we attempted to repair the drug
prescription benefit, known as Part D, in terms of addressing
the donut hole. We didn't suggest that we wanted to repeal the
law. We simply said to repair it. And I remind everyone that
part of it was gimmickry as it related to the donut hole as
well. But our position was let's improve it. And in the
Affordable Care Act, I think that you could safely say that
that has happened.
Now, I want to go to a broader argument here, and that is
that 97 percent of the people in Massachusetts are covered, and
virtually every child in Massachusetts is covered. We are in
the midst of marketing the open enrollment plan. And I got to
tell you the marketing is terrific.
But I want to come to another point, and that is the
following. There is a great picture at Faneuil Hall, where much
of the American Revolution was designed and hatched, of
Governor Romney--or as we know him on this committee, Paul
Ryan's running mate, the other guy on the ticket--Ted Kennedy,
the Heritage Foundation, and the governor sets his hand to this
legislation, which has become a model for applicability,
efficiency, and success. Hardly perfection. But what a grand
possibility. Why, in your estimation, has the Massachusetts
plan worked?
Ms. TAVENNER. I think the Massachusetts plan over time has
allowed individuals to not have to worry about preexisting. It
is required that they have insurance. It is required that they
participate in group coverage, a group market. It is the same
principles we have applied through the Affordable Care Act. And
it has been a huge success. They started out very slowly. It
took them years to get to where they are today. But they do
have good coverage. And if you look at their outcome, they have
got excellent outcomes in health care as well.
Mr. NEAL. The business community worked with the governor,
worked with a Democratic legislature that has three Republicans
in the State Senate, and they came to the conclusion that using
the discipline of the marketplace could be part of the
solution. And getting everybody in was the ideal. And then we
would argue about many of the other matters. But getting
everybody signed up was a key component, and we would use the
private sector to discipline price. Correct?
Ms. TAVENNER. That is correct.
Mr. NEAL. So I guess the argument we have here is, why
wouldn't we be trying to sand the edges of the ACA to make it
work as opposed to this determination to make sure that it
doesn't work?
Yield back my time.
Chairman CAMP. Thank you.
Mr. Tiberi is recognized.
Mr. TIBERI. Thank you, Mr. Chairman.
Thank you, Ms. Tavenner, for coming today. You have got a
great reputation. Thank you for your service. You have got a
very difficult job to do. Best of luck in doing it.
I want to just make a note to you and to the members of the
audience here. On September 30, the Republican House passed a
continuing resolution that funded government and delayed for 1
year the individual mandate and the implementation of this
bill. That was on September 30. That died in the Senate,
delaying this for 1 year.
The reasons why we believe that was the right policy, and I
think history will show that it is, is what we have seen in the
28 days since, and that is the disastrous unveiling of this
bill. You don't have to be a Member of Congress and talk to
constituents to understand the difficulty that the
implementation has caused in people's daily lives. And as Mr.
Brady said, the nervousness and the fear.
You have been telling us that there are other options, in
addition to the Web site. The President actually has gone out
and sold that pretty well. So if a constituent of mine goes and
makes the phone call to try to find out some information, can
she find out by calling the phone number if the doctor in her
current network is covered?
Ms. TAVENNER. She cannot find out through the phone call if
the doctor--and that is I think true--that was true in the
market prior to the Web site.
Mr. TIBERI. Can she find out if the plan costs more than
her current plan?
Ms. TAVENNER. Yes, I think she can find that out.
Mr. TIBERI. By calling the phone number?
Ms. TAVENNER. Yes. What happens is they work them through
the application. The call center would help them.
Mr. TIBERI. She has to actually apply before she can shop.
Ms. TAVENNER. Well, yes, that is important because it is
important to understand if she is eligible for a tax credit,
because that affects the prices that she would pay.
Mr. TIBERI. So can she find out the cost of a plan without
signing up or comparison shop without signing up?
Ms. TAVENNER. So if you are not interested in the tax
credit and you just want to know what rates are available, we
actually have on the Web site the ability to do that. So, yes.
Mr. TIBERI. But the Web site is not working.
Ms. TAVENNER. No, this is actually on the front end. What
is not working sometimes are some of the pieces inside the
application. But if she is just interested in rates in her
market, that is available through the Web site. There is also
the ability, and we have a link with that on the Web site, to
use Kaiser's site that also allows them, if they believe they
are eligible for tax credits, to actually go in and simulate
what that would be like for them.
But if they want to know, if they are not interested in tax
credits, they just want to know what is available to them,
which I have had several friends who have said to me, I know I
am not eligible for a tax credit, I just want to see what rates
are available in the individual market.
Mr. TIBERI. But they have to sign up to do that.
Ms. TAVENNER. No, they do not.
Mr. TIBERI. You are positive on that.
Ms. TAVENNER. I am positive on that.
Mr. TIBERI. Isn't the person who is on the phone with my
constituent who is trying to find out if their doctor is in
network or----
Ms. TAVENNER. No, you asked a different question. Doctor in
the network I said is not available through the Web site.
Mr. TIBERI. Right. So the person who is making the phone
call, my constituent is talking to somebody on the other line,
aren't they accessing the same information on the Web site that
our constituents are encouraged not to do because the Web site
is not working?
Ms. TAVENNER. So two different issues. If they are
completing an application then they would complete the
application and we would give them information. But if you are
just interested in knowing what the insurance rates are in your
area, that is actually available without completing an
application. You can just go on the Web site and get that
information.
Mr. TIBERI. But if they are accessing the phone network
because they can't access the Web site----
Ms. TAVENNER. They can give them that information.
Mr. TIBERI. Isn't that person they are talking to accessing
the same Web site?
Ms. TAVENNER. Yes. But it is not inside the application.
Mr. TIBERI. So we are asking people to call and talk to a
person who is accessing the same Web site that we are
encouraging our constituents not to use because it is not
working right.
Ms. TAVENNER. Let me try this again. The problem that we
have in the Web site sometimes is in the application process
itself. Inside the application people were getting stuck in the
application process. What you asked me is can you get plan
information without completing the application process,
therefore not getting into the problems. And the answer to that
is yes.
Mr. TIBERI. Okay. Let me just tell you the concern that I
have----
Ms. TAVENNER. Okay.
Mr. TIBERI [continuing]. That you are going to have to deal
with, and the members of the other side of the aisle won't
acknowledge. We understand the Affordable Care Act is the law
of the land. We do. But we also understand from our
constituents that there is a disaster of a rollout that is
occurring, not a hiccup, but a disaster of a rollout that is
occurring. I have constituents who have said to me their doctor
is not going to be covered in the new plan. Their plan is going
to be more expensive. And finally, a constituent who said, let
me get this straight, Congressman, you guys passed a bill that
tells me that I am transitioning, you are telling me to
transition to another plan, and you are telling what that plan
is going to be. It is not going to have the same benefits that
I have now. I am going to pay more. But you are going to give
me a tax credit back so I can pay less, even though it is going
to cost more.
That is just crazy. And for us not to acknowledge that is
crazy is just so disappointing and discouraging.
I yield back.
Chairman CAMP. The time has expired.
Mr. Doggett.
Mr. DOGGETT. Thank you, Mr. Chairman.
While I am troubled by the determination of our Republican
colleagues to destroy the rights of Americans to access
affordable health care, I recognize that the promise of
affordable health care can also be denied through a management
failure. I share some of the concerns that have been raised
here this morning. And if there were even one Republican Member
of this committee who wanted to fix the shortcomings in the act
and to learn lessons from the rollout about how to improve
access, we could have a constructive hearing that focused on
those limitations and how to address them. At the top of the
list for any Texan would surely be the million people that,
when we thought we were providing protection when we enacted
this law, who are getting absolutely nothing out of it.
The limitations with the Web site are a part of the concern
that I have. Let me ask you specifically, will the SHOP Web
site for small businesses that was delayed be fully functional
during November?
Ms. TAVENNER. Yes. We will institute the SHOP component at
the end of November.
Mr. DOGGETT. Will the twice-delayed Spanish-language
version of HealthCare.gov be fully operational in November?
Ms. TAVENNER. By the end of November, yes, sir.
Mr. DOGGETT. There are estimates that three out of four
eligible individuals for the Web site need some in-person
assistance--eligible for tax credits--will need some assistance
in person to access that. That is why the navigators, for one,
are so very important. In large measure because of the statute,
people in Maryland get 15 times as much money per individual
uninsured eligible for the exchange for the tax credits as do
people in Texas. People in California get about four times as
much. It makes it all the more important that the navigator
system work as well as the Web system works.
I have had some concerns about the way that navigator
system works and have been asking whether it is possible to get
prompt reports about whether the navigators are doing their job
and whether they are accessing people, whether by paper, phone,
or Web. I have been told that there are no progress reports
that will be available on those navigators and what they are
doing until after the beginning of the year. Surely, there are
some reports that you can make available that will tell us
whether these navigators are doing any more than the little I
have seen them do in my part of Texas.
Ms. TAVENNER. Yes, sir. You should not have to wait till
the first of the year.
Mr. DOGGETT. You can get us progress reports?
Ms. TAVENNER. Yes, sir.
Mr. DOGGETT. When you announced the navigator grants for
Texas, there was an indication in the original notice that
there would be a second round of navigator grants. Instead, it
appears that contracts were reached with two national firms to
provide enrollment assistance, and those firms are at least
required to provide in some cases weekly reports on their
progress. In what way are those enrollment assistance two
companies--I believe the one for Texas is called Cognosante,
they got a total of about $30 million, much more than any
individual entity as a navigator in Texas--in what way are they
being integrated with the local navigators and assistance
counselors to reach out to the uninsured?
Ms. TAVENNER. And I can get you that information. But I
will tell you that there are navigators inside each of the
Federal exchange States that we awarded contracts to. But in
addition to that, there are volunteers through the Texas
Hospital Association and others. And I can get you a full
report of that.
Mr. DOGGETT. Okay. Well, I am interested, and today is not
the first time I have asked for a full report as to how these
enrollment assistance folks came into being and how they are
involved with local folks. We have had to set up, in San
Antonio and in Austin, our own network to try to make up for
what we did not get in the way of Federal assistance at the
local level. And these new enrollment assistance people, I am
interested in getting prompt progress reports on them also to
see what they have actually done, if they have actually signed
anyone up, and what kind of people they are signing up, and
whether this is, the navigator system, the enrollment
assistance system, the certified counselors are any better
organized and coordinated than the Web site and the 55
contractors have been.
Another area of concern----
Chairman CAMP. Time has expired, Mr. Doggett.
Mr. Reichert is recognized.
Mr. REICHERT. Thank you, Mr. Chairman.
This law started out on a troubling note right from the
beginning. Republicans were not a part of the process, weren't
asked to be a part of the process in building this law. And
Nancy Pelosi herself said we must pass the law to find out what
is in the law.
And as one of my colleagues mentioned this morning, let's
just sand around the edges. We have done some sanding around
the edges. And that is basically due to the fact that the
Republicans have been calling attention to some of the issues
that now we are becoming aware of because people are now
beginning to read the law and finding out what is in it. So
three programs have been completely halted since the law has
passed. Seven others have been repealed and have had funding
rescinded, and they have been signed into law. Now, that takes
Republicans and Democrats and the President of the United
States to agree to all those things for those things to happen.
I think that most people feel right now it is not time for
any sanding to take place, but the chainsaw needs to come out.
So we are going to keep on, and we are going to be persistent.
Were you working for CMS on January 29, 2010?
Ms. TAVENNER. January 29?
Mr. REICHERT. Were you part of the process in working to
help implement Obamacare?
Ms. TAVENNER. I actually was not working for CMS January
29, 2010.
Mr. REICHERT. Okay. When did you start working to implement
the health care law?
Ms. TAVENNER. I actually came to CMS late February of 2010.
Mr. REICHERT. Late February. Do you know if you can keep
your health care plan if you like it?
Ms. TAVENNER. Do I know that I can keep my health care
plan?
Mr. REICHERT. Do you know if it is true, as the President
has said and many Democrats have said, if you like your health
care plan you can keep it? Is that a true statement?
Ms. TAVENNER. There were health care plans that were
grandfathered----
Mr. REICHERT. Is that a true statement?
Ms. TAVENNER. It is a true statement that plans were
grandfathered in.
Mr. REICHERT. Okay. Thank you for that answer. So if you
like your doctor you can keep your doctor, too. Is that a true
statement?
Ms. TAVENNER. I think doctors come and go inside networks.
Mr. REICHERT. So if a person has a doctor and they want to
go to that doctor and the doctor is in the network, they can
still go to that doctor? They can keep their doctor if they
like their doctor?
Ms. TAVENNER. If that person is in a plan where that doctor
is in the network, they can keep that doctor.
Mr. REICHERT. On January 29, 2010, and it has been reported
even today in some of our papers, the President knew years ago
you are not going to be able to keep your health care plan. You
are not going to be able to keep your doctor in this health
care plan. He talked to the Republican retreat on January 29,
2010, and he said, when he was asked the question about keeping
your doctor or your health care plan, he said, quote, ``For
example, you know, we said from the start that this was going
to be important for us to be consistent in saying to people if
you can have your--if you want to keep your health insurance
you have got it, you can keep it, that you are not going to
have anybody getting in between you and your doctor and your
decision-making.'' And then he says, ``And I think that some of
the provisions that got snuck in might have violated that
pledge.''
Are you aware of some of those provisions that got snuck in
that might have violated that pledge?
Ms. TAVENNER. I do not know what you are talking about.
Mr. REICHERT. I just gave you a quote from the President of
the United States, your boss.
Ms. TAVENNER. No, you are asking me the provisions that
were snuck in, and I don't know.
Mr. REICHERT. Yeah. Are you not familiar with the health
care law?
Ms. TAVENNER. I am very familiar with the health care law.
Mr. REICHERT. The President apparently is aware of some
provisions that were snuck into the law that says that, you
know what, you are not going to be able to keep your health
care plan, you are not going to be able to keep your doctor.
But yet you just said you can. So you must not be aware. You
didn't read the law, as Nancy Pelosi said you should, when the
thing was passed. Otherwise, you would know about those
provisions.
You know, in Washington State my constituents can't keep
their health care plan; 290,000 individuals in Washington have
received notices canceling their health care plan. Do you know
that that is happening? Have you heard those stories?
Ms. TAVENNER. I am aware that there are issuers in States
who are canceling their old plans, which were grandfathered in,
and moving to new plans which have to meet the requirements.
Mr. REICHERT. So what you just said about keeping your
health care plan isn't true.
Ms. TAVENNER. No, they could keep it. The issuers chose----
Mr. REICHERT. No, they can't keep it. They just got
cancellation notices. You can't keep it. The President says you
can't keep it. Why are you saying you can? I don't understand.
Chairman CAMP. All right. Time has expired.
Mr. Thompson is recognized for 5 minutes.
After that, in order to make sure everyone has an
opportunity to question, Mr. Levin and I have agreed to go to 3
minutes.
So you are recognized for 5 minutes.
Mr. THOMPSON. Can you start the clock again? They started
it when you recognized me.
Chairman CAMP. All right. We will give you those 10 seconds
back. There you go.
Mr. THOMPSON. Thank you very much. Thank you, Mr. Chairman.
Ma'am, thank you very much for being here.
I want to thank my colleague from California who earlier
pointed out that it wasn't you or CMS that set up this computer
system, that you used private sector outside vendors. And I
think that that speaks to an issue that at some point we need
to look at, and that is our Federal procurement process, which
is in part responsible for a lot of the problems that we have
seen.
And I also want to thank Mr. Neal for pointing out that in
fact when we work together we can avoid a lot of the problems
that we are seeing. And we should be working together to make
sure people have access to quality affordable health care
rather than trying to find fault and blame and trying to defund
or derail or sabotage a program that is designed to help people
have access to quality affordable health care.
And nowhere is that seen better than looking at what we are
doing in some of the States. And it is my understanding, and
some of my colleagues have pointed it out today, that we have
some States that are doing a pretty good job with their
delivery of the Affordable Care Act. My home State of
California has something called Covered California. And I
understand that we have had about 125,000 applications that
have been submitted, about 2 million unique visits to the Web
site, and about 150,000 calls daily to Covered California,
because people really do want to have coverage.
There has been many benefits in my home State. About
200,000 people are covered with preventive care. About 40,000
kids who have preexisting conditions now have coverage. About
100,000 seniors are getting preventive care under Medicare. I
have had a number of people who have contacted me, and I will
just mention two, Samuel Calicura from Martinez, who said that
he was paying $131 a week, and now he is paying $45 a month for
his coverage. Cynthia Adams from Santa Rosa was paying 600
bucks a month. Now she is paying $134 a month.
Now, in full disclosure, as I have mentioned to you
privately, I have had some terrible messages from people who
are experiencing some real problems with the system. Usually it
is insurance companies, as some of my colleagues on the other
side of the aisle have mentioned, are canceling their
grandfathered-in programs and policies and issuing new
policies. And I have even had a community college in my
district that is using the Affordable Care Act to reduce hours
of part-time employees. So just about everything that has
happened that has been bad in the last 3 years has been
associated with Obamacare.
And I think we need to be able to draw the distinction and
point people to these exchanges so they can do some comparison
shopping and get these policies that will provide them with
insurance. And I would like to see you guys do a more
aggressive job in regard to that.
I would like to know from you, ma'am, how are the State
exchanges working? And what effects are the problems of the
Federal Web site having on State-run exchanges? And how are the
new upgrades and the Web site fixes going to affect State-run
exchanges such as Covered California?
Ms. TAVENNER. Let me say that the State-based exchanges are
doing a very good job. And California, as you mentioned, has
been a really nice success story. But there are large and small
States. Obviously, California and New York are huge States that
are having great success.
Where we have been able to work closely with them, and we
talk with them daily, is obviously they use the hub for
verification of information, and the hub has worked pretty much
flawlessly. And I always knock on wood when I say that. So they
have been able to get information. The problems that we are
seeing inside the application process do not affect the State-
based exchanges. So the information they need from us they are
able to get.
You all may have been aware that there was an incident over
the weekend with Verizon that took the whole site down. And
when it did, it also took down the hub. So States were impacted
during the day on Sunday and into Monday with an issue with
Verizon. But other than that, they have been able to come and
go and access the hub without difficulty.
Mr. THOMPSON. Thank you, Mr. Chairman. I yield back my
time.
Chairman CAMP. Thank you.
Dr. Boustany is recognized for 3 minutes.
Mr. BOUSTANY. Thank you, Mr. Chairman.
Welcome. Good to see you.
I think in answering Chairman Camp earlier you established
the fact that of the Nation's 2.7 million uninsured from 18 to
35 years of age, you are not going to reveal numbers on who has
enrolled in that age group until sometime in mid-November. Is
that correct?
Ms. TAVENNER. Yes, sir, mid-November.
Mr. BOUSTANY. Okay. Same goes for applicants? You will have
no metrics on the number of applicants in that age group?
Ms. TAVENNER. We will release our metrics in mid-November.
Mr. BOUSTANY. Okay. How confident are you that those in
this age group will actually sign up for the exchanges given
that they don't actually get information on the plans unless
they actually go through the application process?
Ms. TAVENNER. You know, we have actually had feedback from
individuals who have worked through the application process,
who have signed up, and there has been good representation,
good stories in the young age group as well.
Mr. BOUSTANY. I mean this is a tech-savvy group. They are
already being confronted with a major barrier with the Web site
problems. And as you said earlier, ACA is much more than a Web
site. I mean, we all know that they are going to see higher
premiums, particularly in that age group. There has been a
number of reports and studies that demonstrate that is going to
be the case.
Clearly, the penalty is much lower than the cost of the
insurance. And knowing something about the behavior of this age
group, I have real concerns that we are going to see some
adverse selection.
Ms. TAVENNER. Well, Congressman, I would remind you in this
age group many of them will be eligible for tax credits. So
that will also help with their premium costs. And also for
those under the age of 30, there is an alternate catastrophic
plan.
Mr. BOUSTANY. I understand. But if the premiums go up, then
that means the subsidies go up. Is that correct?
Ms. TAVENNER. Well, the subsidies are based on your income.
Mr. BOUSTANY. Right. But if your income is what it is, and
your premiums are going up, and we know there is upward
pressure on premiums, then subsidies go up.
Ms. TAVENNER. But I will remind you what we saw in the
premiums, which are locked and loaded for 2014, has actually
been about 18 percent below what CBO estimates were for premium
increases. So we have a good story to tell there.
Mr. BOUSTANY. But we see other evidence going longer term
that we are going to see upward pressure on premiums as a
result of the construct of this law. I have spent 30 years in
medicine. I understand what this is going to do. And I have
very deep concerns about what we are going to see with premium
costs. But as premium costs go up, subsidies go up. That means
the burden on the taxpayer goes up. That means deficits go up.
Ms. TAVENNER. So I will remind you that premiums were going
up at double-digit increases prior to the Affordable Care Act.
And what we are actually seeing is a moderation in premium
increases for the last 3 years.
Mr. BOUSTANY. That is a false dichotomy, I mean, because
there are other solutions to getting premiums down and actually
lowering costs. So I don't accept that as a complete answer on
the cost of these premiums.
Let me ask you this. Transparency is clearly very, very
important. And will you or HHS or CMS, somebody in the
administration provide information on the taxpayer's cost with
regard to these subsidies for 2015 and beyond?
Ms. TAVENNER. I am sure that part of our information in
reports we produce will include that information to you, yes,
at the time.
Chairman CAMP. All right. Thank you.
Mr. Larson.
Mr. LARSON. Thank you very much, Mr. Chairman.
I would like to associate myself with the remarks of Mr.
Thompson and Mr. Neal, and focus on an area that I think this
committee could become eminently involved in.
First, I would like to point out what a success Connecticut
has been. I want to commend Governor Malloy and Lieutenant
Governor Wyman, who have headed that up with Kevin Counihan.
Tremendous success, including more than a third of the people
that have signed up for the program are under age 35. And so it
demonstrates that when you are working together and
cooperating, that indeed these things can work.
And as Mr. Neal pointed out, the thing that is astonishing
from a Democratic view, if Democrats were to have their way in
health care we would have had Medicare for all or a single-
payer system. Instead, we opted for coming together and ending
up with a program that was idea of the concept was the Heritage
Foundation, piloted by a Republican governor in a Democratic
State. And so we come up with a private sector initiative.
Here is the deal. The deal is this: that if this committee
were to approach this issue the same way we did tax reform and
say the following, we are going to take the very best of the
public health system, the very best that the public health
system can offer, including the National Institute of Science,
the National Institute of Health, the Center for Disease
Control, everything that our public health systems within our
State has brought together over these many years, and then do
that in combination with the private sector so that we can take
the entrepreneurial advantage that the private sector can bring
to this remedy, and then take science and technology, most
notably the genomic project that is currently going on that has
untold benefits.
What the American people want to see is to help them out,
to solve their problem, to help them get better health care.
They don't want to see this endless tastes great, less filling
debate from the committee. I challenge the chairman, let's do
what we did with tax reform. Let's break down into individual
groups and solve this problem together so that we are taking
the best of the public sector, the best of the private sector,
and all that innovation, technology can bring to bear on
changing the paradigm for the American citizen so it is their
health and well-being that becomes the focus, not the ideology
of either party, but the health and well-being of the American
citizen.
That is what this should be about. And we can do it. And by
taking both sides of what both parties and both ideas can bring
to this discussion, the best of the private sector, the best of
the public sector, and everything that science and technology
and innovation can provide.
There is more than $800 billion annually in waste and
inefficiency. This is the most inefficient economic system in
the world. Can't we come together to solve that? Use this
committee to lead the way and set the example for what regular
order can provide by challenging everybody to sit down, as we
have in tax reform, and come up with a solution for the
American public, not this ongoing debate.
Chairman CAMP. The time has expired.
Mr. Roskam.
Mr. ROSKAM. Thank you, Mr. Chairman.
Administrator, thanks for your time today.
So I have an independent recollection of driving around
Chicagoland, I represent the western suburbs, and it was June
of 2009. President Obama was in town giving the speech to the
AMA. I knew I was going to be called on to make some comments
afterwards. So I am listening to it on the radio. I am on
Michigan Avenue, downtown Chicago, I am listening, I am
listening, I am listening. And the President says this. It is a
paragraph that you are familiar with, but I want to revisit it
with you now in light of constituent contacts that I have had.
He said this: ``I know that there are millions of Americans who
are content with their health care coverage. They like their
plan and they value their relationship with their doctor. That
means that no matter how we reform health care, we will keep
this promise: If you like your doctor, you will be able to keep
your doctor, period.'' No parentheses, no exclamations, no
asterisks, period.
Continuing: ``If you like your health care plan, you will
be able to keep your health care plan, period. No one will take
it away no matter what. My view is that health care reform
should be guided by a simple principle: Fix what is broken and
build on what works.''
That was a declarative statement by the President of the
United States selling, in anticipation, the passage of the
Affordable Care Act. That deeply resonated with a lot of folks.
He repeated it, repeated it, repeated it. Made other claims,
like it is going to save $2,500 on average per family and so
forth.
So here is my point. Diane Isser from Hoffman Estates is a
57-year old breast cancer survivor. It was reasonable for her
to assume, based on the plain language of the President, not
subsequent parsing, but the plain language of the President,
that she would get to keep her coverage. And here is her new
reality. She gets the letter from Blue Cross Blue Shield that
says that they are unable to offer that coverage. Her rate goes
from 363 a month to 713 a month, almost doubling. Now, she had
a preexisting condition, so this is not a question of whether
her breast cancer was covered or not. She is being moved into a
Gold plan, which presupposes that she had decent coverage from
before.
Can you understand the level of frustration and concern
about what many Americans perceive to be a false claim from the
administration? Not that it was somehow changed or now that,
well, we have got this wonderful plan for your life that says
we know better than you, we are going to tell you what kind of
coverage you want. Diane knows exactly the type of coverage she
wants. So that is one concern.
The other concern is, you have alluded to it, is the Web
site. I have got another constituent, Denise Banages, from Lake
in the Hills, who is a professional in this arena and has spent
countless hours advising clients. And, you know, the advice is
take screen shots, protect yourself, and so forth.
My time has expired. But can you understand at least the
level of frustration based on the claim of the President of the
United States that people were going to be able to keep what
they had and it is not turning out to be true as they
understood that statement?
Ms. TAVENNER. I understand that for about 86 percent of
America that had employer-sponsored insurance and they were
satisfied with those plans and they still have those plans.
What we were dealing with in the Affordable Care Act is the
individual market where the constituent you talk about is
lucky, she was able to have insurance. Many people were blocked
out due to preexisting, due to other issues. And that is what
we were trying to fix. That is what I understand.
Chairman CAMP. All right.
Mr. Blumenauer is recognized.
Mr. BLUMENAUER. So if I ask a 3-minute question will the
Administrator have a chance to answer also?
Chairman CAMP. Give it a try and we will see.
Mr. BLUMENAUER. Thank you, Mr. Chairman.
I would like to just dive in a little bit to follow up on
what my friend Peter was talking about, and, frankly, the
sheriff who was acting like a district attorney with you a
little while ago. Have we ever had the ability to force a
doctor to stay in a particular plan? Is that sometimes beyond
the control of the patient and the doctor in terms of networks?
Ms. TAVENNER. That is correct. Doctors have always had to
individually negotiate.
Mr. BLUMENAUER. So we can have a framework, but you are not
going to be able to force doctors to stay or insurance
companies to keep them. They change all the time, don't they?
Ms. TAVENNER. That is correct.
Mr. BLUMENAUER. And this notion that somehow we would force
insurance companies to never change policies. Haven't we seen a
third to two-thirds of the individual market change in the
course of a year for the typical patient?
Ms. TAVENNER. Absolutely.
Mr. BLUMENAUER. So it is not anything that my friend from
the State of Washington, which has 7 million people, arguably
at least a million households are either uninsured or in the
individual market, that they would see several hundred thousand
people every year who would have those individual policies
change. Is that not true?
Ms. TAVENNER. That is true. Prior to the Affordable Care
Act, what they were assured of is they had to worry about were
they going to lose their coverage, what was going to happen
with premiums. And they were still going through a churn of at
least 50 percent a year. What we have done is we have
stabilized the premiums, we no longer allow denial for any
preexisting, and we are creating a more competitive market. And
Washington is a great example.
Mr. BLUMENAUER. And many of these people who are subject to
the churn, it is because they find out that they actually try
and use the insurance----
Ms. TAVENNER. That is right.
Mr. BLUMENAUER [continuing]. And they find out, wait a
minute, it is great insurance until you get sick, or until you
bump up against artificially low caps, or having moving targets
as insurance companies do deeper dives about eligibility. Isn't
that part of the churn?
Ms. TAVENNER. That is true.
Mr. BLUMENAUER. Is that going to be possible anymore, that
people will have limits and get thrown off, that people will be
able to go back into the history and throw them off?
Ms. TAVENNER. They will not. They will not be able.
Mr. BLUMENAUER. Mr. Chairman, part of what is I find a
little disconcerting is that people are in a never never world
where they think that in the past we have been able to force
insurance companies to continue to offer, that they have been
able to force doctors to be in the networks. And this is
entirely consistent with the intent of the Affordable Care Act,
is to give them superior insurance without those problems. And
I do think that we are not really talking about apples and
oranges.
Thank you, Mr. Chairman. I will yield back.
Chairman CAMP. Thank you.
Mr. Gerlach for 3 minutes.
Mr. GERLACH. Thank you, Mr. Chairman.
Thank you for testifying today, Ms. Tavenner.
First, I want to go back to a question raised by
Congressman Nunes, who was following up on a question by
Chairman Camp about the release of the numbers as the total
number of enrollees to date, and you said bottom line you are
not going to release those numbers until mid-November. Then in
response to Congressman Nunes' question, you specifically said
we made a group decision not to do that, not to release them
until mid-November. Who was part of that group to make that
decision? What were the individuals that were part of that
group's decision?
Ms. TAVENNER. I think it was in response to the question
was did the Secretary or the White House direct me. And the
answer to that was no, this was a group decision. We actually
sat down with the Secretary and talked about what would make
sense in terms of when we would release.
Mr. GERLACH. So who was the group. That is what I am
asking. Individually, who made up that group?
Ms. TAVENNER. These were different components within HHS,
different operating divisions. And then obviously we had
conversations with White House staff as well.
Mr. GERLACH. Okay. And who was the White House staff you
had conversations with?
Ms. TAVENNER. This would be members of the Domestic Policy
Council, it could have been members of the budget office.
Mr. GERLACH. Who are their names? Do you recall?
Ms. TAVENNER. No, I don't recall. These were different
series of meetings where we had a discussion about this.
Mr. GERLACH. Aware of any memos or email exchanges to that
regard between the different component group members?
Ms. TAVENNER. I am not sure, but I am happy to go back and
take a look at that.
Mr. GERLACH. Okay. If you can take a look at all of those
emails and memos, and if you have those please share those with
the committee if you would.
Secondly, in your testimony you indicate that the problems
that are being experienced with the Web site is based, quote,
``Unfortunately, on a subset of contracts for HealthCare.gov
that have not met expectations.'' Is it the contracts that have
not met the expectations or is it the contractors implementing
the contracts that have not met expectations?
Ms. TAVENNER. I am not sure which quote you are referring
to.
Mr. GERLACH. It is on the bottom of page two of your
testimony.
Ms. TAVENNER. Okay. All right.
Mr. GERLACH. Quote, ``Unfortunately, a subset of those
contracts for HealthCare.gov have not met expectations.'' So is
it the contracts that have not met expectations or was it the
specifications of those contracts were not properly developed
and properly executed or properly implemented? Or is it the
contractors themselves that took a good contract and have not
performed properly?
Ms. TAVENNER. So I think that in the case of the FFM site
is what I was referring to, and we have been working with the
contractor. We have had some issues with timing of delivery.
Mr. GERLACH. Who is that contractor?
Ms. TAVENNER. That contractor is CGI.
Mr. GERLACH. Okay. So it is the contractor in that instance
that is not meeting expectations?
Ms. TAVENNER. Yes. But we are working with them.
Mr. GERLACH. Okay. Are there provisions in the contract
with that company that if it fails to perform in any
substantive way that it is to repay or refund back to the
government for funds that you have allocated to it for the
purpose of performance?
Ms. TAVENNER. I can get you the details on that.
Mr. GERLACH. Okay. There is also a tech surge underway.
Chairman CAMP. I am afraid time has expired.
Mr. Pascrell is recognized.
Mr. PASCRELL. Thank you very much, Mr. Chairman.
Despite our Democrats' opposition to Part D 10 years ago,
we committed to making the best of the program. And because of
all the changes that have occurred on the Part D prescription
program, 90 percent of seniors right now are satisfied. And why
are they satisfied? Well, in my district, before that vote, I
made seniors know that I was going to vote no and oppose, and I
told them the two reasons. The gap, the donut hole when you are
paying for premiums and you are not getting any benefits. That
was horrendous. And number two, an outside source was not
sitting down and being the third party to negotiate the prices
of prescription drugs.
So it lost. We lost the policy fight. And what did we do?
We went back to our districts and we told our seniors, although
we voted no, we personally believe and will work with the Bush
administration to make it work. That is what we did. And how
many of you stood up to do that? None. Zero. Zero.
Let's talk. Let's not water the wine here. Let's say it
like it is. You refused to expand, many of these governors,
Medicaid, they refused to set up State marketplaces, and
leaving millions of dollars in outreach on the table and
education funding. And what happens?
Well, to those I say this, and to you I say this, who I
deeply respect, here and off the floor of the committee and off
the floor of the House: What are you going to do about the
approximately 17 million children with preexisting conditions
who can no longer be denied health insurance coverage? You want
to go back? You want to say you are no longer covered any
longer? You are going to tell the parents of those kids? Which
one of you is going to stand up and tell the parents of those
children the game is over, sorry, that was just a phase we were
going through?
Mr. GRIFFIN. Will the gentleman yield?
Mr. PASCRELL. Yes, I will.
Mr. GRIFFIN. I would just tell you that----
Mr. PASCRELL. Where are you?
Mr. GRIFFIN. Right here. You asked a question, I am going
to answer it. It is a false choice to say it is Obamacare or
nothing. There are numerous proposals, including the one that I
am a cosponsor of that deals with preexisting conditions.
Mr. PASCRELL. Let me take back the time, sir. Let me take
the time back. Are you serious, what you just said? Are you
really serious? After what we have gone through, after what we
have gone through in the last 3\1/2\ years? You can sit there
and say that you had a legitimate alternative after these
years? We have gone through 44 votes, 48 votes now of you
trying to dismantle this legislation. You call that
cooperation? I don't. I don't call that cooperation.
Mr. GRIFFIN. Will the gentleman yield? You are asking a
question.
Chairman CAMP. The gentleman's time has expired.
Dr. Price is recognized.
Mr. PRICE. Thank you, Mr. Chairman.
Welcome, Madam Administrator. I appreciate your testimony
today and the work that you are doing. I think the American
people are looking in at this hearing and just shaking their
heads. I spent over 20 years taking care of patients, and this
is about patients. And what we on this side of the aisle want
is the highest quality of care for all Americans, a system that
is affordable and accessible and provides the greatest number
of choices and continues innovation in our health care arena so
that folks can have the highest quality of care.
But our belief is firmly, and I think that it is playing
out now, is that the ACA violates every one of those
principles. That is why we oppose this policy.
There is not enough time, Mr. Chairman, to correct all of
the record that has been stated, but here is an article from
the New York Post I would like to insert into the record.
Elderly New Yorkers are in a panic after getting notices that
insurance companies are booting their doctors from the program
as a result of the shifting landscape under Obamacare. Quote,
``UnitedHealthcare told Dr. Leibowitz that because of
`significant changes and pressures in the health care
environment' he would be getting the ax on January 1.'' Not
that they were trying to force him into it, but that he would
be getting kicked off the program.
Forcing insurance companies to change their plan? You bet
they are. Here is from CareFirst Maryland. An individual sent
me this letter. Quote, ``The ACA requires you to pick a new
plan to maintain coverage because your current plan will cease
to exist at the time of your renewal through the ACA.''
Chairman CAMP. Without objection, the letters will be in
the record.
[The information follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
___________
Mr. PRICE. Thank you, Mr. Chairman.
I have some specific questions I would like to have you
answer. When did CMS become aware of the problems with the Web
site?
Ms. TAVENNER. I think CMS became aware of the problems
within the first week, when we had the volume surge.
Mr. PRICE. CMS didn't have a clue that there was going to
be a problem on October 1, when the Web site went live. Is that
correct?
Ms. TAVENNER. The problems that we saw in the first week we
attributed to volume. Once the volume started to back down----
Mr. PRICE. How about before October 1, was there any sense
at all that there were going to be problems with the Web site?
Ms. TAVENNER. No. There are always going to be issues with
a new Web site, what I would call the customary glitches that
you see, but no, not this.
Mr. PRICE. Did you have any meetings with the White House
prior to the rollout date on October 1 to inform them of any
problem that you anticipated?
Ms. TAVENNER. No, not of any problems I anticipated. I
talked earlier about programs that we decided to delay, the
SHOP, the Spanish.
Mr. PRICE. Have you been involved with any conversations
with Secretary Sebelius or the administration about delaying
the individual mandate?
Ms. TAVENNER. About delaying the individual mandate? No. We
have discussed the individual mandate at some degree, but not
about delaying it.
Mr. PRICE. There was a hearing last week in Energy and
Commerce. CGI, one of the contractors, said that there is
hidden source code on the site that says applicants have no
reasonable expectation of privacy and that this was due to a
decision that CMS made. Did you all make that decision?
Ms. TAVENNER. I will have to get back to you on that. I am
not sure what they were talking about in that comment.
Mr. PRICE. Thank you. My time has expired.
Chairman CAMP. Thank you.
Mr. Crowley.
Mr. CROWLEY. Thank you, Mr. Chairman.
Ms. Tavenner, I think you have noticed, and I have lost
count at 22, I think you were asked 22 times when the
information will be available. Just to clarify for the last
time, that information will be available sometime at the end of
November. Is that correct?
Ms. TAVENNER. That is what I said, mid-November, many
times.
Mr. CROWLEY. I want to make this clear to all my
colleagues. The information, so we can be clear, will be
available at the end of November. Is that correct?
Ms. TAVENNER. Mid-November.
Mr. CROWLEY. Mid-November. I am sorry. I was a little
early. Mid-November. I had to get it straight for myself as
well. I appreciate that.
Now, you understand that this is from the same party that
attempted to repeal the Affordable Care Act over 40 times? You
understand that, don't you?
Ms. TAVENNER. I do understand that.
Mr. CROWLEY. So you understand that repetition is a part of
the rote here, that the more you ask it, the more you try to
repeal things, maybe you feel better about it, but I wanted to
be cognizant of that.
Ms. Tavenner, you mentioned that over 700,000 people have
completed the application that then allows them to shop and
compare plans with their exact prices and available tax
credits. So does that show the system is working even with the
problems that you have already started addressing?
Ms. TAVENNER. Yes, sir. The system is working. We would
like it to work better, and that is what we have committed to
do by the end of November.
Mr. CROWLEY. So really the key measures right now are the
interest in the site is so impressive in terms of how many
people are beginning to take the first steps of the process to
for the first time afford insurance for themselves in this
country. Is that correct?
Ms. TAVENNER. That is correct.
Mr. CROWLEY. Ms. Tavenner, you are aware that every Member
on that side of the aisle, the Republican side of the aisle, to
a person is opposed to the Affordable Care Act?
Ms. TAVENNER. Yes, sir.
Mr. CROWLEY. You don't have to answer the question. I am
being a little rhetorical.
Do you understand that they don't want you to succeed? You
don't have to answer that question. They shut down the
government of the United States of America in an attempt to
repeal the Affordable Care Act. It doesn't pass the laugh test
that they somehow care about getting this right, or you in your
performance as Administrator, of getting this right and making
sure that this health care law is enacted properly.
We Democrats are looking for problems to fix. My Republican
colleagues, when it comes to this issue of the Affordable Care
Act, they are looking for problems to exploit.
We can fix a broken Web site. What we cannot fix are broken
ideas and a broken agenda, and that is what they have offered
to the American people. I am not asking you to comment. I am
just making a rhetorical statement and questions to you. But it
is very sad. They have nothing to offer, and therefore they
will attack and tear down. It is much easier to tear down the
building than to build a building up. And I appreciate the work
that you are doing to get this right, to make it work for the
American people.
And with that, I yield back the balance of my time.
Chairman CAMP. All right. Thank you.
Mr. Buchanan and then I will go to Mr. Smith. So Mr.
Buchanan is recognized.
Mr. BUCHANAN. Thank you, Mr. Chairman.
And welcome, Madam Administrator.
Last week in Florida--I represent a part of Florida, but
obviously looking at Florida as the only member of the Ways and
Means there--we had over 300,000 people have been notified,
some cancellations, some adjustments, they claim, to their
thing. That is one carrier, Blue Cross Blue Shield, so it is
probably hundreds of thousands more than that. And it seems it
is this one group in general, not just in Florida, but across
the country got reported yesterday, I think, which are
independent contractors. You might look at a group like
realtors, for example, that are self-employed, that they are
the most at risk in terms of their insurance or trying to find
insurance. They are getting the cancellations.
And then a part of that report, as you probably know or
read, is that they have known about it for 3 years, the
administration has known about it. Are they going to come
forward and just express the concern about this one category, I
think it is 16 million people, up to 80 percent are at risk
that might lose their insurance?
Ms. TAVENNER. I am not sure what question you are asking.
Mr. BUCHANAN. I am just talking about people that are
independent contractors, like realtors, one segment that are
getting notices from Blue Cross Blue Shield.
Ms. TAVENNER. Right.
Mr. BUCHANAN. One of the gentleman mentioned from
Washington, but in Florida last week we got 300,000 notices
from Blue Cross Blue Shield. It seems like it is concentrated
on the small business person, you know, someone that is a sole
proprietor or an independent contractor.
Ms. TAVENNER. I think the individuals who are getting these
notices tend to be small business or individually insured. But
I am not aware of realtors or any one group, but I can check
into that.
Mr. BUCHANAN. The other thing I wanted to mention, you said
that you thought in the last couple, 3 years that rates have
moderated. I can just tell you they have been going up 20, 25
percent in my district, in the last 3 years on average. They
have got them down somewhat, they have made some adjustments.
The other point I just wanted to mention, I think you said,
I am trying to quote what you said, you thought the system is
working? Did you say that, that you thought the system, the
ACA, is working?
Ms. TAVENNER. I think we have seen a lot of improvements in
the ACA, yes, sir.
Mr. BUCHANAN. Let me tell you, it is a public relations
nightmare. I hope that you honestly don't feel that you think
the system is working. This is just an incredibly bad rollout.
There is a lot that needs to be done. I can't imagine how you
could think that the system is working.
And my concern is, frankly, with such bad experience, so
many people going to the site, trying to get on and get
insurance, why would they want to get involved in a product, if
they have had such a bad experience up front, I have been in
business 30 years, why would you want to get involved in a
company or a product that in the next 2 or 3 years, or you have
a concern or an issue, that you might get the same treatment
where you can't get ahold of anybody?
Ms. TAVENNER. Well, I think if you talk to individuals who
have successfully enrolled, they will tell you they are quite
satisfied with what they were able to get in terms of pricing
and product.
Mr. BUCHANAN. My sense, 70, 80 percent of people have not
been able to get through. And I don't know how they can feel
good about moving forward with health care if they can't get
even get online to do business.
Chairman CAMP. All right. Mr. Smith is recognized.
Mr. SMITH. Thank you, Mr. Chairman.
And thank you to Administrator Tavenner for sharing your
insights here today. And I have heard from many citizens about
this transition, and they are seeing higher premiums, higher
deductibles, higher copays, and yet we hear that you are saying
the premiums are actually going down.
Could you assure some of these Americans that are seeing
higher premiums, virtually less coverage than they were
previously experiencing, could you assure them that their
premiums will be going down over time?
Ms. TAVENNER. So I can tell you that what I said is that
compared to CBO estimates the premiums had actually come in
about 18 percent less than CBO estimates. The other comment
that I made is, if you look at large group insurance, that what
we are seeing are some of the lowest trends in terms of premium
increases, somewhere between 4 and 5 percent. So I can tell you
based on trends, yes, it is coming down.
Mr. SMITH. Now, I have also heard from some citizens who
went to the Web site with employer-provided coverage for that
employee, but that employee had a family and he wanted to
investigate in terms of whether or not in qualifying the
exchange for the subsidy, and was virtually unable to do so.
Ms. TAVENNER. So what we have encouraged, there are some
complicated families who are always going to need assistance,
and that is why we have encouraged the use of the call center.
There are some folks that when they complete the application
they are going to have some difficult question and they are
going to need to work with an in-person assistant. And so that
is why the call center exists, and it is available 24/7, and a
lot of folks are using it.
Mr. SMITH. The tax credit that you mentioned, basically
suggesting that it is a remedy for some of the increased costs
through the ACA, is that accurate?
Ms. TAVENNER. I didn't say it was an increased remedy. I
said it is assistance to those individuals at lower income
levels. If you talk to people about why they don't have health
insurance, there are two reasons: they can't afford it and they
are embarrassed to admit that they don't have it. So we are
trying to help both. We are trying to get information out there
that it is available to everyone and we are trying to help them
with the cost.
Mr. SMITH. On the dates that you established, the mid-
November for the numbers of participants----
Ms. TAVENNER. Yes.
Mr. SMITH [continuing]. Reaching coverage through the Web
site, and then also November 30th for other problems being
rectified----
Ms. TAVENNER. Yes.
Mr. SMITH [continuing]. How did you arrive at those dates?
Ms. TAVENNER. So we have said all along that we would have
information available on enrollment and other metrics after the
end of the first month. So the first month closes obviously
this Thursday, so we will work with States to put together
metrics that will be available in mid-November. That is
something we have talked about for months internally. That was
an operations decision.
And then the second question, how we came about identifying
the problems in the system and deciding the end of November is
actually sitting down and looking at the problems, deciding how
long it would take us to correct them, how long it would take
for us to add the other issues, which are the issues of SHOP,
Spanish, et cetera, and that is how we came up with the end of
November. It wasn't just us. We also worked with the technical
experts. That is part of the tech surge that you have read
about.
Mr. SMITH. All right. Thank you.
Chairman CAMP. Ms. Schwartz is recognized.
Ms. SCHWARTZ. Thank you.
And thank you for this opportunity. And thank you for being
here. We didn't talk about it too much, but a bit this morning,
but really the purpose of this hearing is to really acknowledge
the difficulties and really a deeply troubling initial rollout
of the Web site that is supposed to enable all of our
constituents and Americans to access health care coverage in
these health care marketplaces. And the fact is, and you
acknowledged some of this, there have been inexcusable and
unacceptable rollout of the launch of this marketplace. And as
you know, millions of Americans, and they are in all of our
districts, are anxious to obtain the information on the options
for affordable coverage with the consumer protections that you
have pointed out.
We saw this interest when millions of Americans went online
on 1 day, October 1, 2013. And the fact is that the
administration really failed these Americans. They really had
an experience they should not have had. Americans failed to be
able to access the information on these options and to be able
to enroll the way they expected to and hoped for.
The administration has failed to properly test the Web
site, at least that is the way it has been reported, failed to
take action to recognize and fix these problems along the way.
And you did in the beginning acknowledge that this initial
experience was not a positive one and essentially apologized.
So I appreciate that, and I think so do they.
But you also have to acknowledge that that initial
experience has actually done some damage to Americans'
confidence in this Web site, in the marketplace, and even
potentially the options that they would have available to get
health coverage. So this is not only an opportunity for
millions of uninsured and underinsured Americans to get
affordable, meaningful health coverage, but it is also an
obligation under law to make sure that this Web site works,
because that is the way they are going to find out their
options and to be able to enroll.
So, you know, going forward, there can be just no more
excuses. We need to hear from you that there is actually a path
forward. And you can be as specific and explicit as you
possibly can be with us and with the public to help regain our
confidence and the public's confidence in the ability of the
administration and these subcontractors and contractors to get
this right.
We have heard reports of a lack of coordination in
implementing these different contracts. Can you speak to--and,
again, if you could be specific about this--because I want to
be able to go home and to be able to say this is going to work.
And it has to work, because that is the way Americans will
access this information and be able to sign up. And we all know
those people who are underinsured, uninsured, and they are
looking for these options.
So you need to give us some more explicit information about
how you are going to better implement and better coordinate
these contractors to get this right for the American people.
Ms. TAVENNER. And that is the information in my opening
statement. We obviously brought on QSSI to serve in the general
contractor role. We at CMS have been doing that, which is not
unique. CMS tends to oversee most programs. But because of what
I consider the failures in the initial rollout, we felt we
needed to bring on additional expertise, so we have brought
that on in terms of QSSI, which will be accountable to me.
Obviously I am accountable for this. So I think that is one of
the big things.
The second thing is we have identified two what I will call
category issues. One had to do with system performance and
speed. So these were actually people who could complete
applications and do the work, yet the system was just slow. And
we are an impatient society. So we have added capacity and
other things to deal with that. And persistent performance. And
I have some metrics there.
But on the other side are what I will call the defects,
like the sticking in the application, where we are actually
going through punch lists. And we are starting, and I hope you
have noticed this, to do daily tech blogs, daily tech updates
with the press to try to be more transparent about the problems
and how we are fixing them so that you see continuous
improvement.
Ms. SCHWARTZ. Which we appreciate.
Chairman CAMP. All right. And time has expired, so you will
have to supplement anything further.
Ms. SCHWARTZ. It will be helpful to have that. Thank you.
Chairman CAMP. Thank you.
Mr. Paulsen.
Mr. PAULSEN. Thank you, Mr. Chairman.
Ms. Tavenner, thanks for being. I know you have got a tough
job.
You know, before October I think much of the public was
looking at the whole debate about Obamacare or the Affordable
Care Act as some big political heated argument up on Capitol
Hill, and, you know, many independent analysts for a long time,
many years have been predicting that there are actually going
to be higher premiums, these cancellations were going to be
coming, you weren't going to be able to keep your doctor or
your health insurance even though that was the promise that was
laid out by the President in his State of the Union speech a
long time ago.
And now these are being confirmed from our constituents. I
mean, directly from our constituents we are hearing these
stories about these challenges and their own expenses. And I
look at Tricia from Bloomington, who contacted me, and she says
her rates are going up 30 percent in January, and she has been
looking at the exchange options and the available plans, but
they are even more expensive. I have also heard from Susan and
Roger who are in Chanhassen. They like the plan they are on,
they have been on it for a few years, the rates have been going
on previously, but now they are going to go up another 20
percent. And the insurance company notes that a lot of that is
due to the regulations associated with the Affordable Care Act.
And they have looked at plans on the exchange as well, and they
are more expensive, it is not the coverage they want. And they
also have concerns about keeping their information private. And
they don't qualify for the subsidies that are offered as well.
But let me ask this question, because I want to better
understand how the administration came up with the November 30
date or deadline, because that is the new date, the October 1
has been moved to November 30. Jeff Zients has been hired now
as kind of leading the effort. He said he has hired a new
general contractor, they have a punch list of things to get
done. So they have got milestones, testing dates, specific
projects that need to get done.
Can you tell us a little bit more about what the
administration did to lead to the conclusion that the exchanges
now would be ready to go on November 30 and can you provide a
list of the punch list items to the committee?
Ms. TAVENNER. So, yes, I can provide a punch list and some
of the work that we are doing, that is not a problem, and I can
give regular updates to the committee.
But how we came up with the November 30 date is we actually
pulled in a team of external experts to take a look at the
system, look at the problems, say, is it fixable and how long
does it take? So that is the process. So you will see
continuous improvement week over week, and we can give you some
of those milestones.
Mr. PAULSEN. Okay. So for 3 years we have been preparing
for October 1. Now we have got 2 months going into November 30.
How do you know the schedule is going to be kept on November
30, and what happens if you miss that date? What happens if you
miss November 30?
Ms. TAVENNER. The system is working. It is just not working
as smoothly or as consistently as we want. So the system is
built. The hub is working. We were able to correct the create
account issue, which was a big sticking point in the beginning,
and so now we are doing the rest of the fixes and improving
system performance.
Mr. PAULSEN. If you could provide a punch list to the
committee, I think that would be very helpful as we move
forward to the November 30 deadline.
I yield back, Mr. Chairman.
Chairman CAMP. Mr. Marchant.
Mr. MARCHANT. We have reached out to our constituents to
find out what they are experiencing trying to comply with the
law. These are people that recognize it is the law, they are
trying to comply, and they are frustrated.
The first group basically is getting on the Web site,
sometimes it is taking hours, sometimes it is taking several
days, but they are finally getting on there, and they are
finding that they can get care, but that their premiums are
raised significantly, sometimes double. That is the first group
that we are hearing from.
The second group is a group that is receiving a
cancellation from their insurance company. That prompts them to
begin to think about it. They begin to think about complying
with the law. These are not rebellious people. These are people
that really sincerely are trying to comply with the law. And
they are finding out that they can't keep their insurance
company, they can't keep their doctor, and they genuinely
believed the President when he said that they could. And these
are people that now are very, very frustrated. They are going
through this process. They are very angry, to begin with. Then
they are very frustrated. And then they get into a very fearful
state, because they are realizing that they have been told that
the Web site will be up and running by November the 30th, but
they are also confusing--maybe they are confusing the date that
they must be signed up by December the 15th to have their
policy go into effect on January the 1st. And most of them are
experiencing some fear that they are going to genuinely have a
gap in their service; regardless of the prices and the
conditions, that they are going to have a gap in their service.
And I think that is something you should really be concerned
about, that there is going to be a huge gap.
The last group that I am hearing from, in Texas, we have
worked for years to come up with a high risk pool, and we have
a group of people that are not on Medicare, they are not on
Medicaid, they are uninsurable, they have chronic illnesses,
and they are very vulnerable.
Is there some effort being made by your organization to
reach out specifically to those State high risk pools and give
them some additional assistance and pay some close attention to
that group? Because that group in many instances is the most
vulnerable of any group in America.
Ms. TAVENNER. Yes. And let me remind you, this is the group
that in previous years, before the Affordable Care Act, would
have had no options, and now they are insurable. And these are
folks that we are reaching out to. We are running the high risk
pools in many States, but we also coordinate that with States
who are running their own to help them transfer into----
Mr. MARCHANT. But in my----
Chairman CAMP. All right. Time has expired.
Mr. Davis.
Mr. DAVIS. Thank you. Thank you very much, Mr. Chairman.
Thank you very much for being here and answering our
questions.
In Illinois, quite frankly, the launch has gone extremely
well. As of October the 21st, almost 300,000 unique visitors
had gone to get covered at Illinois.gov, with 132,344 visitors
participating in the plan comparison screener on the Web site.
Over 8,000 people called the Get Covered call center since its
launch. The Medicaid expansion has been a huge success, as
evidenced by approximately 100,000 people signing up for
CountyCare prior to the October 1 launch date. This is a
special waiver through which residents of Cook County can
enroll early and start receiving health coverage in 2013
through Cook County facilities. In January, they will be rolled
over into the regular Medicaid program.
Another innovative program in Illinois was an express
enrollment process for SNAP recipients. In August, the State of
Illinois sent a notice to about 123,000 SNAP recipients, that
is, households with single adults, not disabled, offering them
an option for express enrollment in the newly eligible group by
signing and returning a form. As of October the 21st, the State
had received about 46,000 of those forms back and about 26,000
people have been enrolled, and they are in the process of
enrolling the rest.
Finally, the State has launched a new smart online
application system called ABE.Illinois.gov, Application for
Benefit Eligibility. The new site was launched October the 1st,
and the Web site has been functioning smoothly. The most recent
data shows that 47,766 accounts have been created on ABE, and
28,729 applications have been submitted for processing.
And we looked at how our newspapers have expressed their
analysis of what was taking place. The Northwest Herald
reported that through only 2 days, Get Covered Illinois had
more than 230,000 visitors and nearly 800,000 page views with
more than 5,000 applications. The Associated Press stated that
Chicago hair stylist and bartender Mike Leon called the Federal
call center after he tried the Federal Web site 5 days in a row
and couldn't get it to work. The call center staff helped him,
and he got through in 2 minutes. So our experiences have been
perhaps different.
I thank you very much and yield back.
Chairman CAMP. All right. Thank you.
Ms. Black is recognized.
Mrs. BLACK. Thank you, Mr. Chairman.
And thank you, Ms. Tavenner, for being here today.
I want to go back to what Dr. Price said. This is really is
about patients. And as a caregiver for over 40 years, I
certainly know and have heard from my patients over the years
about preexisting conditions. And I do think that we probably
could have fixed that without having a total government
takeover, as we are seeing here. It is not about politics, it
is about patients.
And I want to go to something from my State. Since the
October 1 launch date, I have received overwhelming number of
stories from my constituents with concerns about the health
care law. In fact, in my own hometown newspaper, The
Tennessean, they reported that more than 28,000 Tennesseans are
now losing access to the State-sponsored insurance program,
which covered those with preexisting conditions, seniors,
children, and small businesses. And one small business owner,
Greg, from my district in Fairfield Glade, shared this story
with me, and I want to share it with the committee: Diane, I
operate a small painting business, and was very happy with the
Cover Tennessee program for small businesses and their
employees. It had a small copay and covered up to $25,000 each
year. It covered 12 doctors visits and an annual physical at a
reasonable cost. And this program is being cancelled effective
January 2014 because it does not meet the minimum requirements
of Obamacare. This directly contradicts the promise made by
President Obama that we could keep our existing program.
They had affordable health care that they liked, but they
didn't get to keep that. And I ask, is this right or is this
just for this group of people? These 28,000 citizens of
Tennessee are now forced to find new coverage plans on the
health care Web site that doesn't work. So I think when we talk
about fairness and justice, we have got to remember, there are
people out there that this is not fair and this is not just
for.
But let me turn to another piece, and that is the
implementation. We understand that the contractors who made the
Web site did their own unit testing, but CMS was responsible
for the end-to-end testing, or the system's integrated testing,
making sure that each unit worked properly with the next unit.
Now, that testing failed. And every contractor has said that
CMS made that decision to move forward with the launching of
the Web site. And you claim that you didn't know that there
were surge problems with the Web site. But CMS is the project
manager on this and CMS called the shots. So either there was
incompetent management on your part or CMS' part, those that
you work with, or you ignored those fundamental concepts that
were taken into account when the Web site of this complexity
and size was built.
I want to know why if sufficient systems integrated testing
was not conducted and you made the decision to move forward
with the Web site. So was there a systems integration testing
that was actually done?
Ms. TAVENNER. So the testing was actually done. We started
testing almost immediately. It was kind of continuous testing.
I think what you are asking is did we do the testing across the
hub and all the agencies----
Mrs. BLACK. That is right.
Ms. TAVENNER [continuing]. And the answer to that is yes.
And so that was done. And then the question inside the FFM, did
we do end-to-end testing in the FFM, and the answer to that is
yes, that was done.
Mrs. BLACK. Okay. So those tests were done, stress tests,
load tests, how you accounted for and tested for peak hours?
Ms. TAVENNER. Yes. So stress testing and load testing were
done. In retrospect, the volume was we were projecting about
three times the volume that we ever saw on the Medicare Part D
experience, because we were dealing with a much smaller
population. So in the first few hours of the site it had
probably five times the volume that we ever projected. So in
retrospect, we could have done more about load testing.
Mrs. BLACK. Mr. Chairman, I want to know if we can get a
copy of those tests so that we can actually see what was done.
Chairman CAMP. If you can make those results available to
the committee, we would appreciate it.
Ms. TAVENNER. [Nonverbal response.]
Mrs. BLACK. Thank you.
Chairman CAMP. Thank you.
And Mr. Young is recognized.
Mr. YOUNG. Thank you, Mr. Chairman.
And thanks so much for being here, Ms. Tavenner.
Ms. Tavenner, as a former project manager and management
consultant, I am perplexed as to the genesis of some of these
problems with respect to the Web site and the broader rollout,
and so I would like to explore with you maybe what the problems
were.
Let me step back and talk about the issue of openness and
transparency. It was CBS News that last week reported that as
we went into the summer of 2012 there were certain key
regulations that contractors were waiting on, they had to be
issued in order for them to continue to do their work, put
forward requirements for their IT systems and put together
HealthCare.gov. Could we put up a slide, please, to illustrate
some of the regulatory issuance pattern?
[Slide]
Mr. YOUNG. We see that over the couple of years preceding
the summer of 2012, we had 109 proposed regulations put forward
by HHS. Then starting in the summer before the Presidential
election we had zero regulations, all the way through the
election. And since that time period we have seen 60
regulations put forward by HHS.
So my question to you, Ms. Tavenner, is that--and CBS News
did indicate that some of the rules were ready to go back in
June or July, according to one insider that they quoted in
their report--so why did HHS stop issuing regulations, as the
person on the inside, the so-called quarterback of this Web
site?
Ms. TAVENNER. So the regulation process, I don't know that
at any point we stopped issuing regulations. As you can see, it
has been a continuous process. The regulations, we were
basically----
Mr. YOUNG. But there was a gap you see right up there.
Ms. TAVENNER. I do see that gap.
Mr. YOUNG. How do account for that?
Ms. TAVENNER. That is like a 2-month gap. And I don't know
that that would be unusual. If we were to go back, and I am
happy to go back and map the last 4 years, we have probably had
2-month gaps at other intervals.
Mr. YOUNG. So you think CBS News missed that?
Ms. TAVENNER. No. I don't know what CBS News did. I am just
telling you. We have had a continuous regulatory process going
on. We have worked with the public. There is obviously a lot of
back and forth between us and OMB in the regulation process. It
is not unusual for a reg to take 2 months, 4 months, or longer.
Mr. YOUNG. So you can assure us that partisan politics
played absolutely no role in that?
Ms. TAVENNER. I think, again, the regulatory process was
continuous. At no point were we not either working on white
papers, proposed regs----
Mr. YOUNG. Right.
Ms. TAVENNER [continuing]. Just getting the work done.
Mr. YOUNG. As you know, as you have heard here today, there
are real consequences to our constituents for the failures and
shortcomings of this Web site. You have acknowledged that.
Ms. TAVENNER. Let me talk to you about the Web site.
Mr. YOUNG. Well, I have got limited time, so I am going to
move on.
Ms. TAVENNER. Well, I thought you wanted me to explain the
problems with the Web site.
Mr. YOUNG. One of my constituents----
Ms. TAVENNER. Do you want me to explain the problems with
the Web site?
Mr. YOUNG. Submit supplemental material.
Ms. TAVENNER. First of all, I would just say it is not a
Web site, it is an insurance program. Okay?
Mr. YOUNG. Okay.
Ms. TAVENNER. And sometimes I think we think it is like a
Web site.
Mr. YOUNG. Right.
Ms. TAVENNER. Web site just, like, looks at things.
Mr. YOUNG. Right.
Ms. TAVENNER. This is a complicated program tied to 34
States, including very individualized Medicaid programs. People
need to understand.
Mr. YOUNG. Thank you, Ms. Tavenner. I would like to go back
to HealthCare.gov, which is the Web site associated with
signing up for required government-sanctioned health care. And
Marvin, one of my constituents, writes on behalf of his wife,
who was told by her insurer that due to health care reform,
effective 1/1/14, the policy in the name of said citizen has
been or will be terminated as of January 1, 2014.
When can she sign up for her health care, Ms. Tavenner?
Ms. TAVENNER. And does it go on to talk about other
policies or just says she is cancelled and that is it?
Mr. YOUNG. It goes on to say she is cancelled.
Ms. TAVENNER. She is eligible and she can sign up for a new
plan----
Mr. YOUNG. She needs to sign up through the Web site.
Ms. TAVENNER. She can sign up through the Web site or she
can go to that individual issuer.
Chairman CAMP. All right. Time has expired.
Mr. Becerra.
Mr. BECERRA. Thank you, Mr. Chairman.
Ms. Tavenner, thank you very much. Appreciate you being
here. And I think it has become very clear, and I hope that in
all the hearings that take place further that we understand
that we have to work together, because it is unacceptable to
have an important part of the health insurance program, this
Web site, not work the way it should.
In fact, let me give you a quick example. There is a
gentleman from Los Angeles, 34-year-old male, Andrew Stryker,
and he had been reported in a number of press reports. He
waited 3 hours to try to get on the Web site and finally had a
chance to apply, and he says that that was tough. The good news
for Mr. Stryker is that he is saving $6,000 as a result of
being able to apply for the plan.
So it is unacceptable for anyone to have to wait even 3
hours. And even though he says that he would have waited all
day given the result he got, what we want is for everyone to
experience the $6,000 savings, maybe not that much, maybe more,
but we want them to experience savings and to finally have the
health security that you, every single Member on this committee
has when it comes to health care. We don't have to worry about
going bankrupt if we have to take our child to the doctor or to
the hospital. And that is what Andrew Stryker now will have.
And so let's fix this Web site. Let's not fixate on the Web
site, let's fix the Web site.
Now, if I can have, I will put on the screen the
application process.
[Slide]
Mr. BECERRA. Today if you apply for the Affordable Care Act
insurance, you have essentially three pages, and the third page
is really more a signature page than anything else, to apply to
get onto a health insurance policy, a health insurance plan.
If we can have the next slide.
[Slide]
Mr. BECERRA. This is what the process was before the
Affordable Care Act. You had some 12, 13 pages that you would
have to fill out, many of them asking all sorts of very
personal questions, very deep medical probing that was done,
from strep throat, allergies, if you have ever suffered that,
acne, all the way of course to whether you had cancer, heart
disease. You could even be asked if you had learning
disabilities.
Now, can you explain why it is that all of a sudden we can
go from a 13-or-so-page application that really probes into
your personal life to one that is only three pages long?
Ms. TAVENNER. I think as you are well aware, thanks to the
changes in the Affordable Care Act, there is no longer the
preexisting denial, everyone is entitled to insurance, which
was part of the goal.
The other thing that I will say is people may talk about
the Affordable Care Act, or Obamacare, but once you get through
that and you actually talk to folks about what is going on for
them, if they had a child with a preexisting condition, most of
them had issues with insurance, they had to go through this
complicated process, they like what they are getting now.
Mr. BECERRA. Yeah. So no longer will I get asked if I have
heart disease or acne. I can apply and I won't have to worry
about what my personal lifestyle is, I will be able to get
insurance. And this 13-page application is now history for all
those folks who go ahead and apply through the individual
insurance market. So what I hope they will do is, again, fix
the Web site so we can get to the process of giving folks like
Andrew Stryker a $6,000 saving.
Chairman CAMP. All right.
Mr. BECERRA. Thank you very much. I yield back.
Chairman CAMP. Mr. Griffin and then Mr. Schock.
Mr. GRIFFIN. Thank you, Mr. Chairman.
Thank you so much for being here. I have heard a lot of
good things about your work from Leader Cantor, Eric Cantor. So
thank you for being here, and I wish you well.
I first wanted to say that as I tried to indicate earlier,
it is really a false choice to say it is Obamacare or all the
things that were never fixed in the health care world have to
continue. There are many different options in between there. I
have signed on to legislation that would also deal with
preexisting conditions.
So I just want to make clear to the public, to imply that
you have to take all of what Obamacare delivers to get to
address preexisting conditions or you get none of that
addressed, that is just not true. And we can have that debate.
I have heard from a lot of Arkansans. I want to read a
message I got via Web site from a constituent. Her name is
Jennifer in Little Rock. She says, quote, ``I am an Arkansas
State employee, government worker. We received a newsletter
from the Employee Benefits Division during open enrollment. Our
insurance covers less now and costs more. It says, `These
changes were made to more closely align the plans with the
Affordable Care Act.' '' And in another sentence, quote,
``Because of this, the value of the plans were lowered to be
more in line with the law,'' end quote. ``I am quite disgusted.
Just because the Federal Government is starting a health
insurance marketplace doesn't mean that my coverage needs to
change, but it has, and it has changed for the worse. If you
need a copy of this newsletter, please let me know. Thank you
for working on this problem.'' I have a copy of the newsletter
here.
So there are a lot of people that tell that story, and I
have pages of it. Yes, there are people that are getting
covered because of preexisting conditions. My point is, you
don't have to do it this way. And that is why a lot of us
continue to have a problem with the law. Yes, we have voted 43
times or so, but what the talking points don't tell you is
seven of those votes became law because the President agreed to
those things. So the idea that we have had the same exact vote
44 times is talking point nonsense.
But I guess what I would ask you is, are these increased
premiums and increased copays, is that just the cost of
providing more access to health care? What do I say to people
who ask, why am I paying more? Do I just tell them, hey, that
is a tax? We didn't call it a tax, but that is a tax you got to
pay so that more folks have access. Is that fair? Is that what
it is really?
Ms. TAVENNER. What I would say to those folks is it is
going to depend on their individual, you know, situation,
because if they are in a group market where they already had
group employer-sponsored insurance, that is a different
situation. If they are in an individual market, what you can
say to them now is they now have access to health care and they
now have a competitive market.
Mr. GRIFFIN. So if you are paying----
Chairman CAMP. All right. Time has expired.
Mr. Schock.
Mr. GRIFFIN. I appreciate you. Thank you.
Mr. SCHOCK. Thank you. With all this discussion about Web
sites that don't work, let's talk about a Web site that does.
On WhiteHouse.gov right now, if you go to WhiteHouse.gov,
``Health Insurance Reform Reality Check.'' Headline: You can
keep your health insurance if you like it. Currently on the Web
site. Linda Douglass of the White House Office of Health Reform
debunks the myth that reform will force you out of your
insurance plan if you like it, force you to change doctors,
period. To the contrary, reform will expand your choices, not
eliminate them.
WhiteHouse.gov then cites three sources to substantiate
their claim. One of them is a blog post by Linda Douglass, one
of them is a video of a press conference that the President
gave in July, and one of them is a teletownhall hosted by AARP.
And if you click on them, interestingly, the first question
that the President was asked at the teletownhall came from a
woman named Margaret in Greeley, Colorado, and she says, ``Mr.
President, I have heard I could lose the health insurance that
I have currently.'' And the President says to that question,
and I am quoting: ``Here is a guarantee that I have made: If
you have insurance that you like, then you will be able to keep
that insurance, period.'' That is on WhiteHouse.gov Web site
today. ``Reality Check,'' is their headline, ``on Health
Insurance Reform.''
Let me tell you, Ms. Tavenner, the reality check that
millions of Americans in my district are getting. Michelle York
from Triple Digit Trucking in Jacksonville, Illinois, just sent
me this letter today, and it is from Blue Cross Blue Shield.
``All plans must be compliant with the new health care law.
Therefore, Blue Cross Blue Shield health insurance plan that
you currently have now will no longer be available after
December 31. Your premiums will go from $474 to $865, effective
January 1, a nearly 100 percent increase.''
She writes to me, Ms. Tavenner, ``I do not understand how
my current policy can legally be cancelled since I am already
doing what I am supposed to do.'' What am I supposed to say to
Ms. York in Jacksonville, Illinois?
Ms. TAVENNER. The first thing I would do is I would
encourage her to go talk to the Web site or go to the call
center and see what is available in the market.
Mr. SCHOCK. So wait a minute. She is told by the President,
the WhiteHouse.gov today says if you have health insurance that
you like, you will be able to keep it. She has health insurance
that she likes, she has been paying her premiums, she wants to
keep it, but she can't. Isn't that a lie?
Ms. TAVENNER. You know, there has always been the issue
where issuers had the ability to stop offering a policy or
change a policy.
Mr. SCHOCK. No, this is the not the issuers wanting to stop
to offer a policy. The issuer is saying we are being mandated
that we can't continue to offer this policy. It is a yes-or-no
question. The WhiteHouse.gov Web site says if you want to keep
the health insurance that you have got, you can keep it, and
now they are being told they can't. That is a lie.
Ms. TAVENNER. Those issuers were grandfathered in, in 2010,
and they are choosing to make a different decision now.
Chairman CAMP. All right.
Mr. Kind.
Mr. KIND. Thank you, Mr. Chairman.
Ms. Tavenner, thank you so much for your patience and your
indulgence here today. Let me ask you to end on a high note,
shall we speak. I think all the questions surrounding the ACA
Web site have been asked and answered and exhausted. I know
Secretary Sebelius will be here again tomorrow answering a lot
of the same questions you just had. But really the key to all
this, what we are trying to do is make sure that all Americans
have access to quality affordable health care coverage in their
life, period. There may be different ways of doing it and that,
but the real key is affordable. What can we do to help bend the
cost curve within the health care system so it is more
affordable for all Americans.
Cost containment. You have been given a lot of tools under
the Affordable Care Act for cost containment, trying to get
better value, good quality of care at a much better price. What
are you seeing out there right now in that regard and whether
or not it is sustainable in the future?
Ms. TAVENNER. That is a great question. What we have seen
in our early work with the Innovation Center, and obviously
chiefly targeted at the Medicare population, is the more we tie
quality and outcomes to payment, the better results we are
getting for the individual and the lower the cost trend. We
have had probably 3 years of the lowest cost trend in Medicare
that we have seen in the last 50 years. That doesn't mean that
we don't have to keep fighting it every day. We also work with
issuers on the private side so that they align their quality
programs and their indicators the same as we so that the trend
is just not a Medicare trend, it is across the entire
environment.
Early success encouraging; a lot of work to do.
Mr. KIND. Yeah. I see recent data just came out about per-
beneficiary costs for Medicare being revised downward yet
again, and really that is going to be the key to our long-term
unfunded liabilities that we are facing that are driving these
budget deficits, these rising health care costs. I think there
is a lot that is going.
And, Mr. Chairman, I would respectfully recommend that at
some future hearing we call Ms. Tavenner back, mainly focused
on cost containment within the health care system, so we can
delve into it in greater detail. I yield back.
Chairman CAMP. I am sure she will be anxious to come back.
We have two more, Mr. Reed and then Mr. Kelly.
Mr. Reed.
Mr. REED. Thank you, Mr. Chairman.
And thank you, Ms. Tavenner. And we have worked together
before, and I appreciate that relationship. And you have
demonstrated to me in that relationship in those prior dealings
a very high level of competence. And I have been listening to
your testimony today, and I really want to focus on my
oversight responsibilities on this committee.
You had indicated to Mr. Buchanan, Ms. Tavenner, that you
were not aware prior to October 1 of any problems with the Web
site. Did I misinterpret your response to Mr. Buchanan's
question?
Ms. TAVENNER. No. We had tested the Web site and we were
comfortable with its performance. Now, like I said, we knew all
along that there would be, as with any new Web site, some
individual glitches we would have to work out. But the volume
issue and the creation of account issues was not anticipated
and obviously took us by surprise and did not show up in
testing.
Mr. REED. So that didn't show up in testing. So when I read
the New York Times article that talked about confidential
progress reports from Health and Human Services Department
showing senior officials repeatedly expressed doubts that the
computer systems for the Federal exchange would be ready on
time, blaming delayed regulations, a lack of resources, and
other factors, is that New York Times report inaccurate?
Ms. TAVENNER. We were working in a compressed time frame
for sure, but how we chose to resolve some of that is some of
the things that we delayed, the programs that we delayed, which
I have been through, SHOP, Medicare account, transfer, Spanish,
there were three or four programs that we said, okay, we will
not be able to adequately test those. We went through testing
on the remainder of the Web site. We also had independent
validation. Obviously your initial testing, you find areas, you
correct them, you improve, but we went through the testing
process.
Mr. REED. And I appreciate that. So you made some
determinations to delay and suspend some of the programs.
Ms. TAVENNER. Yes.
Mr. REED. And then you had mentioned that you had done that
through a group decision-making process. And then there were
some question as to who was involved in that group decision-
making process, and you were very hesitant to give any names
involved in that group. Do you know the names of the people
that were involved in that group?
Ms. TAVENNER. So the program delay recommendations were
CMS. We made those recommendations to the Secretary in
September. And I think I indicated----
Mr. REED. And then did she unilaterally make that decision
to delay it or did she inform the White House of any
indication----
Ms. TAVENNER. So I informed White House staff, I informed
the Secretary of our decisions, and they supported it.
Mr. REED. Perfect. So who on the White House staff did you
inform?
Ms. TAVENNER. I would be glad to get you that information.
Mr. REED. Why can't you give me that information?
Ms. TAVENNER. I am just saying it was staff within the
White House. I am happy to get you that information. I just
want to give you accurate----
Mr. REED. You don't know the name of the staff member? As
you sit here today, you don't know the name of the staff member
you directed that to?
Ms. TAVENNER. So I was talking to several staff. I am happy
to get you that list.
Mr. REED. Why can't you tell me that name here?
Ms. TAVENNER. Because I would want to give you the entire
list, I would want to give the date, I would want to give you
correct information. I think that is appropriate, Mr. Chairman.
Chairman CAMP. All right.
Mr. Kelly.
Mr. KELLY. Thank you, Mr. Chairman.
Ms. Tavenner, thanks for being here. I know you have a
great deal of experience in the private sector. You have done
things. And I know we have had a lot of talk about how it is
not working, but this failure to launch is really troubling to
me, and it is all about the process. So my question, who is in
charge of this? Was it you?
Ms. TAVENNER. Yes. I am in charge of the program.
Mr. KELLY. All right. So there is a little saying out
there, you have got to inspect what you expect. Were there any
expectations at all? Because we keep hearing that we just
didn't expect this level, we didn't expect this level of
volume. It is incredible for me to sit back and understand that
that is possibly the case.
I think this was designed for failure from the beginning,
and I tell you why I think that. It was never achieved to
achieve success. It just wasn't. And if you are telling me the
process, the bid process, the people that got the final bid to
build this site, there is no bid process, right?
Ms. TAVENNER. There was a bid process, yes.
Mr. KELLY. All right. So they competed against other people
to get this bid?
Ms. TAVENNER. Yes.
Mr. KELLY. All right. Is there a performance bond included
in that?
Ms. TAVENNER. Yes, I am sure there is, but I need to check
on that.
Mr. KELLY. Okay. Well, I want to get an answer to that,
because to my knowledge there was absolutely no performance
bond.
Ms. TAVENNER. And I am not the contracting specialist.
Mr. KELLY. No, no, no, no, no. Well, but you are in charge
of it. You have got to have oversight. And I am deeply
disturbed that we are talking about a site that started off
with an expectation of cost. It has gone way off the charts,
and there is no concern about that. Right? This is not about
health care. This is about a Web site that from the very
beginning, after 3 years and all this investment, we still
can't get up and onto it. And if I asked you a question, who is
in charge, and you say you are, I am expecting to get answers
from you as to who actually was there, how did these people get
the bid, were they held accountable for their lack of
performance, and is there a performance bond in there that
allows the American people to recover some of their money,
because not one penny came from the government, it came out of
taxpayers' pockets.
Ms. TAVENNER. So I am happy to get you that information.
Mr. KELLY. Well, I got to tell you, and again, this has
nothing to do with you. These cost overruns are off the chart,
and the idea that somehow there is an answer in the future is
unacceptable. We have driven the gap between what the American
people expect, and what they expect do now expect is so little
from the government.
You know, my little town of Butler, Pennsylvania, they had
a bid for police cars. Do you know part of that bid was a 10
percent bid bond, performance bond that was included? I can't
understand how a little town that has a $7.8 or $7.9 million
budget can ask for those types of guarantees from bidders,
responsible bidders, and the United States Government cannot.
And the cost of this, if it is actually true, and I want to
get to the bottom of it, if it really started off and you
expected somewhere around $100 million to be spent, and it is
now up over $600 million and that doesn't include any of the
other rollout costs, can we actually sit here and talk to the
American people with any degree of confidence and saying, we
have got your best interests at heart here. We have also got
your wallets, and we are going to drain them.
This is an absolute incredible, incredible lack of
efficiency and responsibility on behalf of the administration,
and it doesn't surprise me. This is the way they operate with
every single thing. And I can't believe that everybody is
finding this out because of what they read in the newspaper. If
you read the model, if you had the model, if you had the tests
going, you couldn't possibly sit here today and say it is going
exactly the way we expected.
Chairman CAMP. All right. Thank you. Time has expired.
As a reminder, any member wishing to submit a question for
the record will have 14 days to do so. And if any members
submit questions at this hearing, I would ask that the
administrator respond in writing in a timely manner.
Chairman CAMP. Again, I want to thank Administrator
Tavenner for her testimony today, and appreciate your continued
assistance as we answer some of the questions that were raised
at this hearing. And I appreciate your offer of regular updates
as we move forward.
With that, this committee is adjourned.
[Whereupon, at 12:56 p.m., the committee was adjourned.]
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