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FAILURE TO VERIFY: CONCERNS REGARDING 

PPACA’S ELIGIBILITY SYSTEM 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

JULY 16, 2014 

Serial No. 113–161 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 

(II) 

COMMITTEE ON ENERGY AND COMMERCE 

FRED UPTON, Michigan 

Chairman 

RALPH M. HALL, Texas 

JOE BARTON, Texas 

Chairman Emeritus 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOSEPH R. PITTS, Pennsylvania 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE ROGERS, Michigan 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

Vice Chairman 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

ROBERT E. LATTA, Ohio 

CATHY MCMORRIS RODGERS, Washington 

GREGG HARPER, Mississippi 

LEONARD LANCE, New Jersey 

BILL CASSIDY, Louisiana 

BRETT GUTHRIE, Kentucky 

PETE OLSON, Texas 

DAVID B. MCKINLEY, West Virginia 

CORY GARDNER, Colorado 

MIKE POMPEO, Kansas 

ADAM KINZINGER, Illinois 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

BILL JOHNSON, Missouri 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

HENRY A. WAXMAN, California 

Ranking Member 

JOHN D. DINGELL, Michigan 

Chairman Emeritus 

FRANK PALLONE, JR., New Jersey 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

MICHAEL F. DOYLE, Pennsylvania 

JANICE D. SCHAKOWSKY, Illinois 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

JOHN BARROW, Georgia 

DORIS O. MATSUI, California 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

JERRY MCNERNEY, California 

BRUCE L. BRALEY, Iowa 

PETER WELCH, Vermont 

BEN RAY LUJAN, New Mexico 

PAUL TONKO, New York 

JOHN A. YARMUTH, Kentucky 

(III) 

SUBCOMMITTEE ON HEALTH

JOSEPH R. PITTS, Pennsylvania 

Chairman 

MICHAEL C. BURGESS, Texas 

Vice Chairman 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

MIKE ROGERS, Michigan 

TIM MURPHY, Pennsylvania 

MARSHA BLACKBURN, Tennessee 

PHIL GINGREY, Georgia 

CATHY MCMORRIS RODGERS, Washington 

LEONARD LANCE, New Jersey 

BILL CASSIDY, Louisiana 

BRETT GUTHRIE, Kentucky 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

RENEE L. ELLMERS, North Carolina 

JOE BARTON, Texas 

FRED UPTON, Michigan (ex officio) 

FRANK PALLONE, JR., New Jersey 

Ranking Member 

JOHN D. DINGELL, Michigan 

ELIOT L. ENGEL, New York 

LOIS CAPPS, California 

JANICE D. SCHAKOWSKY, Illinois 

JIM MATHESON, Utah 

GENE GREEN, Texas 

G.K. BUTTERFIELD, North Carolina 

JOHN BARROW, Georgia 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

HENRY A. WAXMAN, California (ex officio) 

(V) 

C O N T E N T S 

Page 

Hon. Joseph R. Pitts, a Representative in Congress from the Commonwealth 

of Pennsylvania, opening statement ................................................................... 1 

Prepared statement .......................................................................................... 2 

Hon. Frank Pallone, Jr., a Representative in Congress from the State of 

New Jersey, opening statement .......................................................................... 3 

Hon. Fred Upton, a Representative in Congress from the State of Michigan, 

prepared statement .............................................................................................. 5 

WITNESSES

Kay Daly, Assistant Inspector General, Office of Audit Services, Office of 

Inspector General, U.S. Department of Health and Human Services; and 

Joyce Greenleaf, Regional Inspector General, Office of Evaluation and Inspections, Office of Inspector General, U.S. Department of Health and 

Human Services ................................................................................................... 6 

Prepared statement .......................................................................................... 8 

Answers to submitted questions ...................................................................... 66 

SUBMITTED MATERIAL

Article entitled, ‘‘Obamacare Fails to Fail,’’ The New York Times, July 13, 

2014, submitted by Ms. Schakowsky .................................................................. 39 

Article entitled, ‘‘7 predicted Obamacare disasters that never happened,’’ Vox, 

July 15, 2014, submitted by Ms. Schakowsky ................................................... 42 

Article entitled, ‘‘Sebelius Stands Firm Despite Calls to Resign,’’ The New 

York Times, October 16, 2013, submitted by Mr. Pitts .................................... 53 

Letter of June 4, 2014, from Mr. Upton to Mr. Waxman, submitted by Mr. 

Pitts ....................................................................................................................... 56

Report entitled ‘‘Marketplace Inconsistencies,’’ by CMS, Center for Consumer 

Information and Insurance Oversight (CCIIO) ................................................. 59 

(1) 

FAILURE TO VERIFY: CONCERNS REGARDING 

PPACA’S ELIGIBILITY SYSTEM 

WEDNESDAY, JULY 16, 2014 

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON HEALTH, COMMITTEE ON ENERGY AND COMMERCE, Washington, DC. 

The subcommittee met, pursuant to call, at 10:15 a.m., in room 

2322, Rayburn House Office Building, Hon. Joseph R. Pitts (chairman of the subcommittee) presiding. 

Present: Representatives Pitts, Shimkus, Blackburn, Gingrey, 

McMorris Rodgers, Lance, Cassidy, Guthrie, Griffith, Bilirakis, 

Ellmers, Pallone, Schakowsky, Green, Barrow, Castor, and Waxman (ex officio). 

Staff Present: Clay Alspach, Chief Counsel, Health; Matt Bravo, 

Professional Staff Member; Leighton Brown, Press Assistant; Paul 

Edattel, Professional Staff Member, Health; Sydne Harwick, Legislative Clerk; Katie Novaria, Professional Staff Member, Health; 

Chris Pope, Fellow, Health; Chris Sarley, Policy Coordinator, Environment & Economy; Macey Sevcik, Press Assistant; Heidi Stirrup, 

Health Policy Coordinator; Ziky Ababiya, Minority Staff Assistant; 

Karen Lightfoot, Minority Communications Director and Senior 

Policy Advisor; and Matt Siegler, Minority Counsel. 

OPENING STATEMENT OF HON. JOSEPH R. PITTS, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH 

OF PENNSYLVANIA 

Mr. PITTS. The subcommittee will come to order. The chair will 

recognize himself for an opening statement. 

On July 1st, 2014, the Department of Health and Human Services Office of the Inspector General released two disturbing reports 

regarding eligibility verification for individuals purchasing coverage in the exchanges. According to the reports, between October 

1st and December 31st, 2013, OIG identified 2.9 million inconsistencies between applicants’ information and data received through 

the Data Hub or from other data sources. One-third of these is related to income. 

Resolving these inconsistencies is often critical in determining 

eligibility for the nearly $1 trillion in exchange subsidies that are 

being spent over the course of the next decade, and this is why 

Congress passed a law requiring the Secretary of HHS to certify 

that processes were in place to verify eligibility before subsidies 

were made available. Secretary Sebelius made such a certification 

to Congress on January 1st, 2014. Yet one OIG report states, ‘‘As 

2 

of the first quarter of 2014, the Federal marketplace was unable 

to resolve about 2.6 million of the 2.9 million inconsistencies because the CMS eligibility system was not fully operational. It was 

unable to resolve inconsistencies, even if applicants submitted appropriate documentation.’’ 

It is clear that the eligibility system is far from operational. CMS 

reports that it now has in place an interim manual process to resolve inconsistencies, and it hopes to have a fully automated process later this summer. 

It is absolutely stunning that this administration, nearly a year after the launch of the exchanges and with $1 trillion on the line, 

has yet to build a functioning eligibility system. Given the administration’s false promises when it comes to Affordable Care Act implementation, CMS’ hope to have a fully automated process up and 

running later this summer deserves to be treated with skepticism. 

From telling Americans falsely that they could keep their health 

plan and doctors, to Secretary Sebelius’ commitment that the exchanges would be ready to launch on October 1st, implementation 

of this law has been a series of broken promises. Additionally, this 

problem appears to be getting worse, not better. According to documents released by this committee, as of May 27, at least 4 million 

inconsistencies have been identified. 

These facts make it clear that the administration is taking a, 

‘‘shovel the money out the door first, verify later,’’ approach when 

it comes to exchange subsidies. It is simply unacceptable that CMS 

does not yet have the internal controls necessary to validate Social 

Security numbers, citizenship, national status, income, and employer-sponsored coverage. Americans sending taxes to Washington 

don’t deserve to have their money so blatantly disregarded by a 

Federal Government that is supposed to serve them. 

OIG has recommended that CMS, ‘‘should develop and make 

public a plan on how and by what date the Federal marketplace 

will resolve inconsistencies.’’ One has to wonder how long it will 

take to clear this backlog and whether proper internal controls will 

be in place to prevent this from happening again during the next 

open enrollment period this fall. 

One also has to wonder how the administration intends to claw 

back any improper subsidies that were given as a result of inaccurate information. Middle-class families could be left on the hook 

for thousands of dollars in payments back to the IRS as a result 

of this failure. 

My time has expired. I yield back. And now recognize the ranking member of the subcommittee, Mr. Pallone, 5 minutes for an 

opening statement. 

[The prepared statement of Mr. Pitts follows:] 

PREPARED STATEMENT OF HON. JOSEPH R. PITTS

The Subcommittee will come to order. 

The Chair will recognize himself for an opening statement. 

On July 1, 2014, the Department of Health and Human Services Office of the Inspector General released two disturbing reports regarding eligibility verification for 

individuals purchasing coverage in the Exchanges. 

According to the reports, between October 1 and December 31, 2013, OIG identified 2.9 million inconsistencies between applicants’ information and data received 

through the Data Hub or from other data sources. 

3 

One third of these related to income. 

Resolving these inconsistencies is often critical in determining eligibility for the 

nearly $1 trillion in exchange subsidies that are being spent over the course of the 

next decade. 

This is why Congress passed a law requiring the Secretary of HHS to certify that 

processes were in place to verify eligibility before subsides were made available. 

Secretary Sebelius made such a certification to Congress on January 1, 2014. 

Yet, one OIG report states, ‘‘As of the first quarter of 2014, the Federal marketplace was unable to resolve about 2.6 million of 2.9 million inconsistencies because 

the CMS eligibility system was not fully operational. It was unable to resolve inconsistencies even if applicants submitted appropriate documentation.’’ 

It is clear that the eligibility system is far from operational. CMS reports that it 

now has in place an interim manual process to resolve inconsistencies, and it hopes 

to have a fully automated process later this summer. 

It is absolutely stunning that this Administration, nearly a year after launch of 

the exchanges and with $1 trillion on the line, has yet to build a functioning eligibility system. 

Given the Administration’s false promises when it comes to Affordable Care Act 

implementation, CMS’ hope to have a fully automated process up and running later 

this summer deserves to be treated with skepticism. 

From telling Americans falsely that they could keep their health plan and doctors 

to Secretary Sebelius’ commitment that the exchanges would be ready to launch on 

October 1st, implementation of this law has been a series of broken promises. 

Additionally, this problem appears to be getting worse, not better. According to 

documents released by this Committee, as of May 27, at least four million inconsistencies had been identified. 

These facts make it clear that the Administration is taking a ‘‘shovel the money 

out the door first, verify later’’ approach when it comes to exchange subsidies. 

It is simply unacceptable that CMS does not yet have the internal controls necessary to validate Social Security numbers, citizenship, national status, income, and 

employer-sponsored coverage. Americans sending taxes to Washington don’t deserve 

to have their money so blatantly disregarded by a federal government that is supposed to serve them. 

OIG has recommended that CMS ‘‘should develop and make public a plan on how 

and by what date the Federal marketplace will resolve inconsistencies.’’ 

But one has to wonder how long it will take to clear this backlog, and whether 

proper internal controls will be in place to prevent this from happening again during the next open enrollment period this fall. 

One also has to wonder how the Administration intends to ‘‘claw back’’ any improper subsidies that were given as a result of inaccurate information. Middle class 

families could be left on the hook for thousands of dollars in payments back to the 

IRS as a result of this failure. 

I appreciate the Office of the Inspector General’s work and would like to thank 

you for being here today to discuss the findings of these reports in more detail, and 

I yield back. 

OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY 

Mr. PALLONE. Thank you, Mr. Chairman. 

Let me welcome the Office of the Inspector General’s representatives here today. The work you do is invaluable to our committee 

and Congress, and there is always a role for us to strive to do better so we can ensure that taxpayer dollars are well spent. 

But I think there are some important lessons I hope we can learn 

from today’s hearing. The first and most important is the fact that 

a data inconsistency on a consumer’s application does not equate 

to errors. In fact, nearly all of the cases of inconsistencies can be 

easily resolved. The second lesson is that we should use OIG to 

learn how we can strengthen our Federal programs, not as a political blunt object to mislead the American public. 

4 

We get it. Republicans don’t like Obamacare. In fact, they won’t 

recognize one single benefit from the law, and they predicted one 

disaster after another, and none of them have come true. I respect 

my chairman a lot, but, I mean, all I kept hearing in his comments 

about how we are so worried about this subsidy. Well, this subsidy 

goes to middle-class people, not to poor people, not to rich people. 

I think it is, what, something between $25,000, $30,000 and up to 

maybe $80,000 or $90,000 for a family of four in order to get the 

subsidy. That is the middle class. That is the middle class that we 

are trying to preserve. These are the average Americans. 

Why are they so worried about a subsidy for middle-class people 

instead of worrying about the big corporations or the oil companies? I could have 10 hearings on all the subsidies for the oil companies, and God knows what they are getting away with. These are 

not the fat cat contributors. This is the average person. 

And the ACA is working. The results are in. Three independent 

surveys support this claim. During the law’s first open enrollment 

period, 9.5 million previously uninsured Americans got health coverage, reducing the uninsured rate amongst working adults from 

20 percent to 15 percent in less than a year. According to a Commonwealth Fund survey, the overwhelming majority of the newly 

ensured, including 74 percent of Republicans, are satisfied with 

their coverage. 

Now, that doesn’t mean the law is perfect. No one on my side of 

the aisle is arguing that. But we have had some technical hiccups 

with enrollment. The reports that OIG will discuss today, I believe, 

are a reflection of those challenges. We have learned how to improve the process. And this fall, the hope is to strengthen the system even further and capture millions more Americans who need 

healthcare coverage. 

But if Republicans really want to talk about taxpayer dollars 

being spent wisely, let’s have that conversation. We can talk about 

Speaker Boehner’s frivolous lawsuit against the President or the 

wasteful $3 billion being spent on this repetitive, unnecessary 

Benghazi fishing expedition. And then there is the $2.3 million 

they spent defending discrimination in the courts during the Defense of Marriage, or DOMA case. 

The House GOP is interested in wasting taxpayer dollars to score 

political points. The ACA, on the other hand, is helping people get 

access to health care, and it is saving lives. So I would just ask my 

colleagues to stop the political stunts, stop trying to dismantle the 

ACA’s success, and come together with Democrats to strengthen 

and improve its historic benefits and protections. We are trying to 

help the middle class. That is what this is all about. And without 

that subsidy, they are not going to be able to get health insurance. 

So I would like to yield now 1 minute to Congressman Green 

from Texas. 

Mr. GREEN. Thank you, Chairman. 

I thank the ranking member for yielding. 

According to the recent report from the Commonwealth Fund, 9.5 

million additional adults ages 19 to 64 are now covered by insurance. Seventy-three percent of the people who bought health plans 

and 87 percent of those signed up for Medicaid said they were 

5 

pleased with the new insurance. Even 74 percent of the newly insured Republicans like their plans. 

Mr. Chairman, there are certainly shortcomings in the Affordable 

Care Act both in policy and implementation, but as I always say, 

if you want something perfect, don’t come to Congress or a legislative body. Yes, the 9.5 million newly insured and millions more are 

benefiting from reforms included in the law. 

It is long past time to move beyond political posturing and misinformation campaigns to get back to business, time we start working 

to improve the law in ways where there is broad agreement. The 

American people deserve better, and I hope to work with my colleagues to build on this success and make changes that best serve 

the public. 

And I yield back my time. 

Mr. PALLONE. I yield now to the gentlewoman from Florida, Ms. 

Castor, the remainder. 

Ms. CASTOR. Well, thank you, Mr. Pallone. 

And thank you, Mr. Chairman, for calling this hearing on how 

we improve the Affordable Care Act for America’s families. 

I appreciate the Inspector General’s Office, all of the work you 

have done to help us identify where we need to improve. 

Why is this important? Millions and millions of Americans are 

depending on us. And I look at my home State of Florida. We, surprisingly, had 1 million Floridians sign up through the Federal 

marketplace. It is remarkable. But now we are going to face a different open enrollment period starting November 15th to February 

15th. We have got to ensure that this is working for our families. 

So help us prioritize where we have to pay additional attention, 

help us make this better for America’s families. 

Thank you, and I yield back. 

Mr. PITTS. The chair thanks the gentlelady. 

All members’ written opening statements will be made a part of 

the record. 

[The information follows:] 

PREPARED STATEMENT OF HON. FRED UPTON

For months and even years, the alarms were sounding over the president’s health 

care law that it was not ready for prime time and that it would not work for the 

American people. For the past nine months, since the start of the first open enrollment period, we have seen this play out in a broken and still-incomplete Web site, 

cancelled plans, rising costs, and false promises from the administration. 

The Office of Inspector General is before the subcommittee today to discuss important work that underscores some of the major problems that continue to plague this 

broken law. Two recent reports from the administration’s own nonpartisan watchdog 

provide a preview of what the future of this law holds. These reports indicate that, 

despite assurances from the Secretary of Health and Human Services, the backend 

and verification systems for the health care exchanges is still not built. OIG has 

found that HHS failed to resolve nearly 2.6 million of 2.9 million data inconsistencies as of February of this past year. This committee has uncovered that this 

number grew to more than 4 million by the end of May. What’s worse, HHS still 

does not have a fully operational eligibility verification system in place although the 

systems should be the highest priority. 

The administration should never have gone live last fall in the first place without 

the Web site being structurally complete, and yet everyday Americans are left to 

endure the administration’s incompetence. And, according to media reports, it seems 

the administration has made it a higher priority to fight bad publicity, than to actually fix the problems. 

6 

Taxpayers could be on the hook for improper payments in a program that is esti- mated to spend $1 trillion over the next decade. Middle class families filing their 

taxes in 2015 could come to find out they owe the IRS thousands of dollars based 

on an inaccurate eligibility determination. 

Sadly, it is clear this administration has taken a ‘‘spend first, verify later’’ approach to this law, and it’s taxpayer dollars that are on the line. Once again, ordinary Americans stand to suffer because of the administration’s reckless rollout of 

this health care law and its disregard for taxpayer dollars. 

Mr. PITTS. On our panel today we have two witnesses, Ms. Kay 

Daly, Assistant Inspector General, Office of Audit Services, Office 

of Inspector General, U.S. Department of Health and Human Services, and Ms. Joyce Greenleaf, Regional Inspector General, Office of 

Evaluation and Inspections, Office of Inspector General, U.S. Department of Health and Human Services. 

Thank you for coming. 

While we have two witnesses on our panel, I understand their 

statements are one and the same, so I will ask Ms. Daly to present 

the joint statement, and then both witnesses will be available for 

questions from members. 

Ms. Daly, you will have 5 minutes to summarize your testimony. 

Your written testimony will be placed in the record. You are recognized for 5 minutes. 

STATEMENT OF KAY DALY, ASSISTANT INSPECTOR GENERAL, 

OFFICE OF AUDIT SERVICES, OFFICE OF INSPECTOR GENERAL, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES; AND MS. JOYCE GREENLEAF, REGIONAL INSPECTOR 

GENERAL, OFFICE OF EVALUATION AND INSPECTIONS, OFFICE OF INSPECTOR GENERAL, U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 

Ms. DALY. Thank you and good morning Chairman Pitts, Ranking Member Pallone, and other distinguished members of the committee. Thank you for the opportunity to testify today about two 

new reports from the Department of Health and Human Services 

Office of Inspector General. These reports provide a first look at a 

critical component of the health insurance marketplaces that were 

established under the Affordable Care Act: their verification of enrollee eligibility. 

Accompanying me today is Joyce Greenleaf, our Regional Inspector General For Evaluation and Inspections. First, I will highlight 

our report, which responded to a congressional mandate to examine 

the effectiveness of enrollment procedures and safeguards. Then I 

will talk about our companion report, which addressed a specific 

risk area: the inconsistency resolution process. 

Our mandated work examined and directly tested internal controls at the Federal, California, and Connecticut marketplaces. 

These controls related to verifying the identity of applicants and 

application information, determining eligibility of applicants for enrollment in qualified health plans, and maintaining and updating 

enrollment data. Our period of review for that report was October 

through December of 2013. 

We concluded that the Federal, Connecticut, and California marketplaces had certain procedures in place to verify an applicant’s 

information. However, not all internal controls were effective. The 

presence of an internal control deficiency does not necessarily mean 

7 

that applicants were improperly enrolled in health plans or in insurance affordability programs. Other mechanisms exist that may 

remedy the internal control deficiency. These deficiencies in internal controls may have limited the marketplace’s ability to prevent 

the use of inaccurate or fraudulent eligibility information. 

We recommended in this report that CMS and the Connecticut 

and California marketplaces take actions to improve internal control deficiencies. These include verifying the applicant’s identity, 

determining the applicant’s eligibility, and maintaining enrollment 

data. 

For the companion report, we analyzed from a national perspective how marketplaces resolved inconsistencies between applicant 

self-attested information and other data sources. We obtained data 

from the State marketplaces from October through December of 

2013, and for the Federal marketplace we analyzed data through 

February of 2014. 

During those time periods, many marketplaces were unable to 

resolve most inconsistencies. The most common were related to citizenship and income. The Federal marketplace wasn’t able to resolve 2.6 million of 2.9 million inconsistencies because the CMS eligibility system was not fully operational. 

The ability to resolve inconsistencies varied across the marketplaces. Seven state-based marketplaces reported that they were 

able to resolve those inconsistencies without delay. 

Now, inconsistencies do not necessarily indicate that an applicant provided inaccurate information, nor do inconsistencies equate 

to errors in enrollment in health plans or insurance affordability 

programs. However, marketplaces must resolve these inconsistencies to ensure eligibility is accurate. 

So, accordingly, we recommended that CMS develop a plan for 

resolving the inconsistencies in the Federal marketplace. We also 

recommended that CMS ensure that inconsistencies in State-based 

marketplaces were resolved according to the Federal requirements. 

These are the first two reports in a series related to operations 

of the marketplaces. We have a substantial body of work underway 

and planned to ensure that taxpayer dollars are spent for their intended purposes in a system that operates effectively and is secure. 

This work will examine additional critical issues related to eligibility systems, payment accuracy, contract oversight, data security, 

and consumer protection. 

I want to thank you all for your interest and support for the 

OIG’s mission and for the opportunity to discuss our work today. 

We are happy to answer any questions you may have. 

Mr. PITTS. The chair thanks the gentlelady for her testimony. 

[The prepared joint statement of Ms. Daly and Ms. Greenleaf follows:] 

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Mr. PITTS. We will now begin questions and answers, and I will 

recognize myself 5 minutes for that purpose. 

Ms. Daly, on January 1st, 2014, Secretary Sebelius certified to 

Congress that the exchanges are verifying eligibility. Federal law 

required this certification before exchange subsidies could be made 

available. OIG’s report states, ‘‘As of the first quarter of 2014, the 

Federal marketplace was unable to resolve about 2.6 million of 2.9 

million inconsistencies because the CMS eligibility system was not 

fully operational.’’ 

Based on these facts, isn’t it true that HHS made the certification to Congress before the eligibility system was fully operational? 

Ms. DALY. Chairman Pitts, we of course looked at the Secretary’s 

report purely for informational purposes and didn’t really analyze 

it to understand more about what was behind that, what the Secretary had available for making that certification, so I really can’t 

speak directly to your question. I am sorry. 

Mr. PITTS. Although your statement says ‘‘because the CMS eligibility system was not fully operational.’’ Do you stand by that 

statement? 

Ms. DALY. Oh, absolutely, sir. 

Mr. PITTS. All right. Has CMS provided the OIG a firm timetable 

when their eligibility verification system will be fully operational? 

Ms. DALY. No, sir, not to my knowledge. 

Mr. PITTS. Is it possible that these inconsistencies will not be resolved by the next open enrollment period, which starts in November of 2014? 

Ms. DALY. Well, we have work ongoing in that area right now, 

but I really don’t know about any definite timetable, nor when they 

may be fully operational at that time. 

Mr. PITTS. Ms. Greenleaf, did you want to add to that? 

Ms. GREENLEAF. I would add that in CMS’ comments to our report they indicated that they had implemented an interim manual 

system to address the inconsistencies that they were unable to address during the period of our report, and CMS reported to us that 

it would have an automated system by the end of the summer. We 

have not followed up as yet, but we do have a tracking system in 

place to monitor the implementation of the recommendations. 

Mr. PITTS. Thank you. The OIG is focusing on several areas of 

work to conduct oversight over spending under the Affordable Care 

Act. Understanding that much of the scope of the work is fluid, can 

you highlight some of the specific areas of work your office intends 

to focus on? 

Ms. DALY. I would be glad to do so, sir. Our office has embarked 

on a strategic approach to looking at the marketplaces, and we 

have developed a strategy we refer to as PECS, and that stands for 

payment accuracy, eligibility, contracting, and security. And with 

that, we have some works planned and already underway looking 

at payment accuracy, how accurate are the payments that are 

going out to insurers, and also we are starting work looking at payments within the context of providing subsidies and things of that 

nature. 

Further, with our eligibility work, this is just the first and other 

jobs that we have planned and underway to look at eligibility. We 

17 

started work at other State-based marketplaces to understand 

what their systems were and then doing additional work at the 

Federal marketplace also. 

For contracting, we are looking at several aspects of the contracting that were involved in the development of HealthCare.gov. 

And then finally with security, we are looking at the information 

security that is designed to protect the information in these marketplaces. 

Mr. PITTS. All right. The OIG report states that the administration did not have effective controls in place to perform basic tasks. 

Can you elaborate on this and tell us what HHS has done to date 

to alleviate this problem, either one of you? 

Ms. DALY. Well, I would be glad to talk about some of the issues 

that were in our mandated report. For the Federal marketplace, we 

found that some Social Security numbers were not always validated through the Social Security Administration, and CMS has 

advised that they are following up on these issues and trying to 

identify any particular issues that were causing that from the systemic approach. 

With that, also there were the inconsistencies in eligibility data 

that we had talked about, and we have already identified that they 

said they had put in an interim system and were continuing to address those inconsistencies and that a more formal process will be 

in place later. 

Last, we saw that there was not the system functionality to allow 

enrollees to update their information that was in the system. CMS 

advised us in agency comments that they had taken steps to allow 

the functionality so that that information could be updated. So we 

have not had a chance to go back and look at how well that is functioning at this time. 

Mr. PITTS. Ms. Greenleaf, can you elaborate a little? 

Ms. GREENLEAF. I would just reiterate what I said previously regarding the inconsistencies. That was the priority concern in the 

report that dealt with the inconsistencies, and we called on CMS 

to fix that and make public a plan, and we will be monitoring their 

response to that through our formal tracking system. 

Mr. PITTS. My time has expired. 

The chair recognizes the ranking member, Mr. Pallone, 5 minutes for questions. 

Mr. PALLONE. Thank you, Mr. Chairman. 

It is not a surprise anymore that my Republican colleagues never 

want to talk about the good news with the Affordable Care Act. 

Eight million signed up for private plans, 6.7 million newly enrolled in Medicaid, 3 million young adults on their parents’ plans. 

The list goes on. 

For years now, the GOP have ignored the financial assistance 

available through the marketplaces. They put out misleading analyses claiming massive premium increases, and they have never 

once admitted that the vast majority of enrollees will qualify for assistance and that coverage will become extremely affordable. 

But here are some facts. This year, tax credits cut the average 

enrollee premium by 76 percent. The average premium consumers 

are actually paying for dependable comprehensive coverage is $82 

per month. Seventy percent of people getting financial assistance 

18 

pay less than $100 a month. Fifty percent pay less than $50 per 

month. 

And this is incredible news, and that is why the Republicans of 

course don’t want to talk about it. Instead, they claim there is 

widespread fraud in who is getting the financial assistance. And 

the reports our witnesses are discussing today address the eligibility checks on the front end. And as we have heard, an inconsistency does not necessarily mean an individual is getting an incorrect subsidy. 

So I will say, Ms. Greenleaf, but whoever can answer, isn’t it correct that your report states, ‘‘Inconsistencies do not necessarily indicate that an applicant provided inaccurate information or is enrolled in a qualified health plan or is receiving financial assistance 

inappropriately?’’ 

Ms. GREENLEAF. That is correct. Inconsistencies can occur for 

both eligible and ineligible applicants. 

Mr. PALLONE. Thank you. 

An inconsistency on an application should not be a surprise. 

Automatically checking dozens of pieces of application data against 

a variety of Federal databases is not a simple thing. In fact, a family of 4 could generate 21 different inconsistencies on their application. And that is why the lead contractor responsible for resolving 

these inconsistencies said he was not surprised by the number of 

inconsistencies. 

If the consumer includes a hyphen in their name on their application which does not appear in Federal databases, that could generate an inconsistency. If the consumer had recently moved, that 

might generate an inconsistency. But those are clearly not examples of fraud or misrepresentation. They are harmless. Similarly, 

with regard to income, the marketplace checks individual income 

off of 2012 tax data, so it would not be a surprise if their 2014 income data was different than 2012. 

Again, Ms. Greenleaf, isn’t it true that an income inconsistency 

does not necessarily mean an individual is getting too much or too 

little financial assistance? 

Ms. GREENLEAF. It doesn’t necessarily mean that, no. As I mentioned previously, both eligible and ineligible applicants can have 

inconsistencies, and the law anticipated the existence of inconsistencies. What is concerning is the number of unresolved inconsistencies. 

Mr. PALLONE. OK. Now, again, CMS has resolved more than 

460,000 inconsistencies and has a process in place to resolve the remaining inconsistencies this summer. So, Ms. Greenleaf, CMS concurred with your recommendation to make public their plan to resolve inconsistencies. Isn’t that correct? 

Ms. GREENLEAF. We have not received CMS’ official response 

outside of what is in the actual report yet, so they have a certain 

amount of time to respond to the recommendations officially. In its 

comments to our report, they did indicate that the interim manual 

system will fully automate later this summer, so we will be monitoring that closely through our formal tracking system. 

Mr. PALLONE. And isn’t it correct that in their response to your 

recommendations they wrote, and I quote, ‘‘The FFM now has in 

place an interim manual process that allows it to reconcile inconVerDate Nov 24 2008 14:35 Feb 06, 2015 Jkt 037690 PO 00000 Frm 00024 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-161 CHRIS
19 

sistencies and plans to implement the automated functionality this 

summer’’? 

Ms. GREENLEAF. CMS did say that in its response to our report. 

Mr. PALLONE. I am just pleased that the IG is monitoring the 

agency’s work, but the progress CMS has made to address these 

issues is important. 

And I guess, look, I am just so frustrated by the fact that the 

Republicans are ignoring all this in order to score political points. 

I mean, again, we are talking about middle-class people here. We 

are talking about someone who is trying to fill out a form. We are 

talking about people whose income is, what, $25,000, $30,000 to 

$80,000 or $90,000 for a family of four. This is the middle class 

that supposedly all of us want to build and provide a decent 

healthcare benefit package for. 

I am not saying we shouldn’t have the hearing, obviously, but I 

just think that there is so much emphasis on the GOP side on the 

fact that some average person is going to commit fraud, and that 

is not the case here. This is not a huge problem that is being presented. 

Thank you, Mr. Chairman. 

Mr. PITTS. The chair thanks the gentleman. 

Now recognize the gentlelady from North Carolina, Mrs. Ellmers, 

5 minutes for questions. 

Mrs. ELLMERS. Thank you, Mr. Chairman. 

And thank you, Ms. Daly and Ms. Greenleaf, for being with us 

today. 

Your study shows that 85 percent have not been resolved, and 

that is an incredibly large number of applicants’ application process 

that is in question. And that certainly doesn’t mean that there was 

fraud perpetrated. It just means that there are inconsistencies and 

those inconsistencies need to be addressed. And it goes to the larger problem of eligibility and how are we ensuring the American 

taxpayers their hard-earned dollars are being utilized to the best 

possible. And we want to see everyone have affordable health care. 

We need to make sure that it is done right. And starting at this 

point is a good place. 

So I guess what I need to know is, what happens now? I mean, 

what happens? I know that you said, Ms. Daly, you talked about 

a formal tracking system going into place, which that is very, very 

good, making sure that payments that are going out are accurate 

and being accounted for. But then in relation to those who might 

be in a situation of getting subsidies that might not have qualified, 

how can we address that issue? I am glad that there is a tracking 

system in place for the payments, but how is that going to help us 

get to the bottom of the issue? 

And, Ms. Greenleaf, I would like for you to weigh in as well, if 

you would like. 

Ms. DALY. Well, thank you very much for that question. 

I think the inconsistency periods, that was set up as part of the 

law and the regulations surrounding ACA because, indeed, there 

can be some variations in some of the information. So it gives an 

opportunity to try to clarify all that. 

During that period, people are conditionally enrolled in the program until that is cleared up. I think the rules state that if there 

20 

does turn out to be a case where perhaps someone may have gotten 

a subsidy that they were not entitled to of whatever nature, financial assistance of whatever nature, there are plans in place for obtaining resolution on that. So that, for example, with the tax credit, 

that would be worked out when the consumer files his tax return 

next year, and this is all supposed to be reconciled at that point 

in time. 

Mrs. ELLMERS. How would it be reconciled, though, because basically aren’t they paying a certain premium amount or getting a certain tax credit at that level? Because would they or would they not 

be paying more for their healthcare coverage if there is an inconsistency that is found to be accurate, essentially meaning that they 

did find the inconsistency? How do you make up that difference? 

Ms. Greenleaf. 

Ms. GREENLEAF. I think that happens, it is my understanding, 

through the reconciliation process with the IRS. So it could be that 

some applicants would be owed money and others would in fact 

owe money. So it could be determined either way. They come fully 

enrolled during the 90-day inconsistency period, after which a redetermination is supposed to be made. 

Mrs. ELLMERS. OK. And then I guess there again, from what you 

are saying, the IRS then becomes the enforcing body that will 

make sure that this happens. 

Ms. DALY. That is my understanding, yes. 

Mrs. ELLMERS. OK. 

Well, thank you. 

And I really, Mr. Chairman, I don’t have any more questions, so 

I yield back the remainder of my time. 

Mr. PITTS. The chair thanks the gentlelady. 

Now recognize the gentleman from Texas, Mr. Green, 5 minutes 

for questions. 

Mr. GREEN. Thank you, Mr. Chairman and Ranking Member 

Pallone and our witnesses for their testimony today. 

I am going to start by echoing my colleagues: Inconsistencies are 

not the same as errors or fraud. It is incorrect and deliberately 

misleading to refer to them that way. According to John Lau, vice 

president of Serco, the contractor responsible for obtaining the necessary information to address enrollment inconsistencies, 99 percent of the inconsistencies in marketplace applications are innocuous. 

And it is also disingenuous to suggest such inconsistencies are 

specific to the Affordable Care Act. Federal and State programs 

where eligibility must be verified, such as Medicaid, all face the 

challenges of reconciling inconsistent data in applications. However, in Medicaid eligible applicants are put on a waiting list while 

the discrepancy is sorted out, forced to go without health coverage 

for however long it takes. Under the ACA, Americans can enroll 

and get coverage immediately. 

The inconsistencies, which I repeat are 99 percent innocuous in 

ACA applications, are going to be resolved at some point, but we 

feel it is better for people to get coverage after applying instead of 

going on a waiting list indefinitely. 

21 

Ms. Daly and Ms. Greenleaf, other Federal programs have to 

verify individuals’ eligibility through an application process. Isn’t 

this correct? 

Ms. DALY. Yes, sir. 

Mr. GREEN. OK. So inconsistencies in applications are not unique 

to exchanges created under the Affordable Care Act? 

Ms. DALY. Yes, sir. 

Mr. GREEN. Thank you. 

In the Medicaid program, eligible applicants are put on a waiting 

list until their inconsistency is fixed and an applicant can access 

coverage. That is partly why we have a massive backlog in Medicaid applications in States around the country. That is not a solution at all. Given the unknown nature of health care, you never 

know when you will need it. It is long overdue that we move beyond efforts to undermine, repeal, or create unwarranted alarm for 

political gain about the ACA and get back to the business of serving the American people. 

I have some time left. Can you give me examples of other programs that maybe the GAO has investigated that you go back in 

and have inconsistencies? 

Ms. DALY. I am sorry, but just nothing is coming to mind at this 

point in time. But I would be glad to get back with you on that. 

Mr. GREEN. OK. If you would and share it. 

Ms. GREENLEAF. Nothing comes to my mind either. Thank you. 

We can get back to you if we identify anything. 

Mr. GREEN. Were there any specific recommendations that either 

of your agencies made to Health and Human Services to correct 

some of the problems? 

Ms. DALY. In our report, sir, we had identified a number of weaknesses at both the Federal, Connecticut, and California marketplaces, and we made specific recommendations to fix the underlying systems, of course, that were prompting such errors, and then 

we also asked them to fix the specific cases that we had found. And 

they were generally amenable to doing so, so that was very helpful. 

Mr. GREEN. Have you followed up with that to see both on the 

national exchange and the Connecticut and California if that is 

what they are doing if they agreed to correct those inconsistencies? 

Ms. DALY. Well, we do have work that we are getting underway 

right now to do additional work at the Federal exchange to look at 

some other issues there and plan, as part of that, to do additional 

follow-up on the status of the recommendations we had made in 

this report. 

Mr. GREEN. OK. So this is not something that we are going to 

sweep under the rug, we want to deal with it, because, again, the 

ACA is a valuable tool for people in our country to get health care, 

and we want to make sure it is done right. And I appreciate your 

agencies for doing that, and hopefully Congress will get back to 

what we want to do, which is make sure it gets done right. 

Mr. Chairman, I will yield back my time. 

Mr. PITTS. The chair thanks the gentleman. 

I now recognize the gentleman from New Jersey, Mr. Lance, 5 

minutes for questions. 

Mr. LANCE. Thank you very much, Mr. Chairman. 

22 

This committee has spent a great deal of time and effort discussing the inadequacies of the healthcare law’s rollout. Some people believe that the worse is behind us and many of the most important serious problems have been resolved. However, I believe, as 

your report has pointed out, many of our constituents may be in 

for a rude awakening when their tax bill comes due. 

I am also greatly concerned, and this is not an area for you to 

address, but I wish to place on the record the fact that there is the 

significant constitutional and statutory issue regarding subsidies 

for the Federal exchange as opposed to subsidies for the State exchanges. That issue will be resolved in the courts. I did ask Secretary Sebelius about that very significant matter at a previous 

hearing, and let me predict that that case is likely to go to the Supreme Court, although it is now in the various circuits. 

Regarding the issue this morning, it is my understanding that 

you did not review certain eligibility issues because you did not 

have access to Federal taxpayer information at the time of your 

audit. Would you please update the committee on your access to 

that information now? Ms. Daly. 

Ms. DALY. Yes, sir. Yes, as we were performing our work, we 

learned that you could not have the access to the Federal taxpayer 

data. So we immediately began to discuss the issue with IRS and 

have worked very closely with them. They have been very agreeable in helping us sort through the issues. 

At this time we have been advised that we can access the Federal taxpayer information that is provided to the Federal marketplace, and so that is going to be one of the key areas we are following up on to do the similar work that we had done looking at 

other aspects of determining eligibility to also look at verifying the 

income. And with that, we are also continuing to discuss with IRS 

obtaining access to the state marketplaces, too. 

Mr. LANCE. And do either of those matters require statutory 

change or can you do that administratively? 

Ms. DALY. Well, to date, we have had success in doing that administratively, but if it looks like we may need to have a statutory 

change, we would be glad to get back and work with you and your 

staff to try to bring about such a change. 

Mr. LANCE. Do you have a timeframe, Ms. Daly, when you will 

receive that information regarding both the Federal exchange and 

the state exchanges with the IRS? 

Ms. DALY. Well, for the Federal exchange we have received the 

authorization to go in and review that. We are just going through 

some more logistic issues of ensuring that we have appropriate 

safeguards in place to protect that taxpayer data while it is in our 

possession. 

And for the timeframe, for completing the work on the Federal 

exchange, I believe it is in the spring of 2015 we should have the 

results out on that assessment there. And with the States, we are 

continuing to work with them, so I can’t provide you with an assessment right now of when that may be available. 

Mr. LANCE. Thank you. I hope you are able to provide us with 

that when you do get that information. 

Regarding the fact that the Federal exchange information with 

the IRS may be available in the spring of 2015, next spring, I wish 

23 

to make sure that my constituents understand the implications of 

these problems that were highlighted in your report. If the eligibility verification system produces a determination for an applicant 

with an inaccurate exchange subsidy, am I accurate that the IRS 

is required by law to claw back that money from the individual? 

Ms. DALY. Sir, if you are referring to the tax credits and so forth, 

yes, sir, that would be part of the IRS’ responsibility. 

And I would also like, if I could, to take a second to clarify that 

our work that we plan to be doing at the Federal exchange, that 

is when we would have completed the work, would be in the spring 

of 2015, so we can provide the results at that time to the august 

members of this body. 

Mr. LANCE. Thank you. I am not suggesting necessarily that 

there is fraud on the part of those who may have provided inaccurate information. I would imagine in most cases it is not a matter of fraud, it simply may be a matter of inaccurate information. 

And all of us as human, we all make mistakes. 

I do believe that there is a potential that there are going to be 

many unhappy surprises come tax time next spring, in the spring 

of 2015. Only time will tell. But certainly that impresses me as 

being a possibility. 

Thank you, Mr. Chairman. 

Mr. PITTS. The chair thanks the gentleman. 

Now recognize the gentlelady from Illinois, Ms. Schakowsky, 5 

minutes for questions. 

Ms. SCHAKOWSKY. Thank you. Mr. Chairman, I have a statement 

and a request to make. I hope I will still have time for some questions. 

But we have had a lot of good news about the Affordable Care 

Act in recent weeks: 8 million enrolled in private coverage, 6.7 million enrolled in Medicaid, the number of uninsured dropping by 10 

million people, and the rate of uninsured in states around the 

country dropping by 30, 40, even 50 percent in just 1 year. Actually 

that is pretty amazing. And I want to put two articles in the record 

that discuss some of this good news and what I believe is the 

warped Republican reaction to it. 

The first is a column in the New York Times. The columnist 

writes, ‘‘What you get whenever you suggest that things are going 

OK with the ACA, there is an outpouring not so much of disagreement as of fury. People get red in the face, angry, practically to the 

point of incoherence over the suggestion that it is not a disaster.’’ 

He goes on to say, ‘‘I suspect there is now an element of shame if 

this thing is actually working. Everyone who yelled about how it 

would be a disaster ends up looking fairly stupid.’’ 

The next piece I want to highlight is from health reporter Sarah 

Kliff, who listed out, ‘‘7 Predicted Obamacare Disasters That Never 

Happened.’’ Here is the list. One, the Web site will never work. 

Two, nobody wants to buy coverage. Three, the ACA would not 

meet enrollment goals. Four, only people who already had coverage 

are signing up. Five, there would be a net loss of insurance. Six, 

premiums will skyrocket. And finally, seven, that the law just 

won’t work. People won’t get doctors’ visits, insurers will drop out, 

et cetera. 

24 

And, Mr. Chairman, each and every one of these predictions has 

proven flat wrong. Ten million people have gained coverage this 

year because of the ACA. Surveys indicate that they like their coverage. There are none of the increased wait times or skyrocketing 

premiums Republicans claimed, especially when you factor in the 

financial assistance that is available. More and more insurers are 

participating in the marketplaces next year, increasing choice and 

competition. 

So, Mr. Chairman, I would like to put these two articles in the 

record. 

Mr. PITTS. Without objection, so ordered. 

[The information appears at the conclusion of the hearing.] 

Ms. SCHAKOWSKY. Thank you. 

And I just want to say about this hearing, if this were a good 

faith effort to really find and fix some of the problems that are in 

the Affordable Care Act, I would be more than happy to fully participate in every way in those kinds of efforts. Anybody knows that 

such an ambitious piece of legislation is going to have to be 

tweaked. I don’t think anybody would disagree that there aren’t 

ways that we can make this better. But time after time in this 

committee what we do is look for ways to simply attack the law, 

suggesting that it is just horrendous, it is unworkable, when we 

know that it is helping millions and millions of people. Seventyfour percent of Republicans who have signed up said they like that. 

I would say that is pretty good. I mean, there is still a quarter 

of the people who say that they are not happy. Let’s figure out why 

and try and make that better. But I don’t feel like this is the spirit 

of these hearings. We are talking now about lawsuits that are 

going to go to the Supreme Court. We could as a Congress, as a 

committee, address some of these problems and actually suggest 

changes that we could vote out and then present to the full House 

of Representatives and make those things better and work. 

Our ranking member expressed frustration, and I feel that, too. 

The reason that I am in public service is because my hope was that 

at the end of my career I could say that I helped provide health 

care to all Americans. What could be more basic than wanting to 

do that? Is that really what my colleagues across the aisle are looking for or is it to nitpick and ultimately sue? 

I mean, think about this lawsuit that is being considered today. 

We are talking about the President being sued for not enforcing the 

Affordable Care Act, that hated law by the Republicans, for not enforcing it fully, and for not enforcing, they are saying, a provision 

that perhaps was the most hated, the employer mandate. So I am 

just really, really confused. 

I am sorry. I appreciate the witnesses. I appreciate that you are 

looking into these problems and trying to help us solve them. That, 

to me, ought to be the goal of all of us here. 

And I yield back. 

Mr. PITTS. The chair thanks the gentlelady. 

And now recognize the gentleman from Kentucky, Mr. Guthrie, 

5 minutes for questions. 

Mr. GUTHRIE. Thank you, Mr. Chairman. I thank the ranking 

member. And I thank the witnesses for being here today. 

25 

It is not just providing the information that has to be checked 

as well. I have heard from multiple groups that represent employers that haven’t been notified a single time by CMS, as required 

by law, that an employee has received an advanceable premium tax 

credit. And I understand how the process is supposed to work is 

that CMS should be verifying up front whether the employee has 

access to affordable coverage prior to authorizing a subsidy, and to 

me, this step is critical. As we know, certain coverage offered by 

an employer would make individuals ineligible for tax credits. 

Do you see how this process was working? Or was it working? 

My understanding, employers are not being contacted to see if they 

offer affordable coverage. 

Ms. DALY. Well, yes, sir, that was part of the audit work that we 

did in performing our tests, and as part of that, of course, it varied 

across the marketplaces how that worked. For the Federal marketplace, they were checking other Federal organizations such as to 

determine whether there was coverage offered for, like with OPM, 

with the Department of Defense, and other places that offer health 

insurance. For other cases, there would be attestation, bringing in 

information from the employer to do that check itself. 

Mr. GUTHRIE. Is that happening the way it should be happening? 

I know what is supposed to happen. How is it happening? Yes, I 

am sorry. 

Ms. DALY. No, perfectly fine. No, that is actually how it is happening now because the issue is that there is no national database 

in which you could quickly go check, so that was the approach that 

was taken. 

Mr. GUTHRIE. Well, the problem is, if it is done inaccurately, 

then employers, as a couple of my colleagues have said, then employees will be receiving thousands of dollars of inaccurate tax 

credits, and they will be required, as we established earlier, to pay 

it back. 

I read the report, too, I went to the report, and I understand 

what you are saying, they were trying to make this provision work, 

but it doesn’t seem to have a good way to do it, and therefore we 

are going to have people being ineligible to receive credits they are 

receiving, and they are going to have to pay it back. Like I said, 

not in any malice are they doing it. They are just following, hey, 

I can sign up for health care. I have heard it in on the TV, radio, 

if you are in Kentucky, see it on billboards, and they go sign up, 

and if it is not verified, then later on they will have to pay back. 

And I said, they are not doing it on purpose, but that can happen 

to them, and it is a lot of money to have to pay back at one time 

when they find that. 

So as we move forward, you are doing further tests, I think that 

is an area you really need to look at. Do you have, Ms. Greenleaf, 

any comments on that process? 

Ms. GREENLEAF. I don’t have anything to add to that. 

Mr. GUTHRIE. OK. Well, thank you, and I yield back. 

Mr. PITTS. The chair thanks the gentleman. 

Now recognize the vice chair of the full committee, Mrs. 

Blackburn, 5 minutes for questions. 

Mrs. BLACKBURN. Thank you, Mr. Chairman. 

26 

I want to thank you all for being here. We have got an interesting hearing going on downstairs also, as you all are probably 

aware, with the problems with the HHS CDC labs, et cetera. So I 

have been back and forth from that. 

I think that as we talk about this verification system it is important to remind everybody that Secretary Sebelius, on January 1, 

2014, certified, verified that the exchanges were indeed verifying 

eligibility. And while the Secretary certified a verification system, 

there is still no real system in place. And even HHS, the watchdog, 

reports that the administration does not have effective controls in 

place to perform basic tasks, such as validating Social Security 

numbers, correctly identifying applicants, and verifying citizenship. 

And, again, this has not been corrected. 

So for some of us who have lived through some of the government-run healthcare programs, and for Mr. Pallone’s benefit I always have to bring up TennCare, because it thrills him when I 

bring up TennCare and the failed experiment in Tennessee with 

government-run health care. And if Congressman Green wanted 

examples of inconsistencies and how they were or were not dealt 

with, I can give him a laundry list. And so I am sure Mr. Pallone 

will have him come talk to me about those. 

But I find it so curious, and Ms. Daly, I will come to you, how 

do you certify a verification system when there really isn’t a 

verification system in place, and what are the detailed, step-by-step 

components of this verified, certified verification system? 

Ms. DALY. OK. Well, with that the Secretary was responsible for 

providing such a certification on the report—I am sorry, on the system that was in place—and she did indeed provide one. Now, we 

haven’t reviewed that report in detail. We did use it for informational purposes to learn more about the regulations and law and 

so forth that was in there. So I can’t really speak to what the Secretary relied on or used for making such a certification. 

Mrs. BLACKBURN. Well, let me ask you this. Ms. Greenleaf, does 

it make sense that you would certify a verification system when 

you didn’t have a verification system? 

Ms. GREENLEAF. I am not familiar with the process that the Secretary used to take a look at that system. 

Mrs. BLACKBURN. So what you are telling me is there is no 

standard operating procedure or there are no benchmarks, there 

are no written expectations for what the system will be. Is that correct, Ms. Greenleaf? 

Ms. GREENLEAF. I am not familiar with what the benchmarks or 

systems for operation would be for that. 

Mrs. BLACKBURN. Ms. Daly. 

Ms. DALY. Yes, Congresswoman. Yes, there are regulations that 

are in place that went through the full vetting process that all Federal regulations go through for determining what is appropriate to 

have in such a system. They help in designing the system. 

Mrs. BLACKBURN. OK. So you have got regulations. 

Ms. DALY. Yes. 

Mrs. BLACKBURN. Do you have a plan for a full end-to-end system for verification processing? 

Mrs. BLACKBURN. There was a plan that was put in place for determining the system. 

27 

Mrs. BLACKBURN. Is it active and operational? 

Ms. DALY. Well, there is a system that is operational at this 

time. 

Mrs. BLACKBURN. Is it functioning? 

Ms. DALY. Our report identified that some of the controls in that 

system were functioning as they were planned to do so within 

the—— 

Mrs. BLACKBURN. Some were? 

Ms. DALY. Some were, some were not. 

Mrs. BLACKBURN. OK. So still, they don’t have their verifications 

processes in place end to end? 

Ms. DALY. That would be fair, yes, because we identified some 

that weren’t operating as they should at that point in time. 

Mrs. BLACKBURN. So as long as we have that systemic failure, we 

cannot certify that the subsidies are working appropriately and 

people that are receiving taxpayer money—and this is something, 

I think, everybody needs to remember. This is not Federal Government money that is making the subsidies. It is taxpayer money 

that is sent to the Federal Government by hard-working taxpayers 

that is going into these subsidies, into a system that does not have 

a verification process in place end to end. 

In Tennessee, when it didn’t work, Democrat governor had to 

come in and remove 300,000 people from the program—300,000. 

Now, you say that times 50, and you see the problems we are going 

to be up against because we don’t know who is getting the money. 

I yield back. 

Mr. PITTS. The chair thanks the gentlelady. 

Now recognize the gentleman from Virginia, Mr. Griffith, 5 minutes for questions. 

Mr. GRIFFITH. Ms. Daly, I am going to pick up a little bit where 

Mrs. Blackburn left off, and appreciate her questions. The administration, when dealing with criticisms about the implementation of 

the Web site, likes to come back and say, well, it is better now, and 

in October they did not have a fully operational back-end eligibility 

system. And yes or no, based on your testimony here today, it 

sounds like to me they do not currently have a fully operational 

back-end eligibility system, isn’t that correct, yes or no? 

Ms. DALY. It depends on the time. The timeframe that we looked 

at covered the period through December of 2013, so that is what 

we focused on. 

Mr. GRIFFITH. OK. But you indicated that some were working 

and some weren’t, but it is not working right now completely, isn’t 

that correct? 

Ms. DALY. I can’t speak to what is working right now, sir. I am 

sorry. 

Mr. GRIFFITH. All right. But if they did have a system, you 

wouldn’t have expected the document from CMS to have been released last month indicating the number of individuals enrolled in 

the exchange plan. And when the committee received that document, if you could read the part, I believe it has been given to you, 

or Ms. Greenleaf, on page 3 of that document provided by CMS to 

the committee. And that last statement says, if you would read 

that for us, please? 

28 

Ms. DALY. Yes, sir, I did receive that document, and I just wanted to acknowledge that I have not had a chance to analyze this, 

and these aren’t the IG’s data, by any means. But I would be glad 

to read it for you. 

Mr. GRIFFITH. Yes, ma’am. 

Ms. DALY. ‘‘Current data indicates that 2.1 million people who 

are enrolled in a qualified health plan, or QHP, as it states on the 

document, are affected by one or more inconsistency.’’ 

Mr. GRIFFITH. All right. Now, if there was in fact a fully operational back-end eligibility system on January 1, we should not 

have this problem, isn’t that correct, yes or no? On January 1. 

Ms. DALY. I would say that that would be a fair statement, that 

we would have a fully operational system on January 1, and our 

work showed that that was not in place. 

Mr. GRIFFITH. That was not in place. And so then when Secretary Sebelius certified to Congress that that system did in fact 

work, she would have been mistaken, isn’t that correct? 

Ms. DALY. I really can’t respond to that. 

Mr. GRIFFITH. I am not asking you whether she was doing anything intentional or whether she was given bad information. I am 

just saying she said it worked, it didn’t work, you know it doesn’t 

work, therefore she had to be mistaken, isn’t that correct? 

Ms. DALY. Well, I think the issue is that the—— 

Mr. GRIFFITH. It is yes or no, either she was mistaken or she was 

correct. If she was correct, it worked fine. You have already told 

us it didn’t work fine, so the answer should be yes, shouldn’t it? 

Ms. DALY. Well, I think what—— 

Mr. GRIFFITH. I know you don’t want to say she was mistaken. 

But wasn’t she mistaken? 

Ms. DALY. Well, I would have to read very carefully how that certification was worded. Quite frankly, I have not done so. 

Mr. GRIFFITH. All right. That being said, let me take a minute, 

Mr. Chairman, if I might, to respond to some of the things that 

were said earlier about Obamacare not being a disaster. 

My constituents feel it is a disaster. Let me go through a few of 

the things that were raised in the point by the gentlelady previously. 

Talking about the suit for the President, she indicated that we 

were suing the President for not going forward with Obamacare in 

parts that we didn’t care for. While that is true, the real reason for 

the suit is that the President is not faithfully executing the laws 

passed by Congress. 

Whether I like the law or not, the President ought to execute the 

laws passed by Congress and not suspend the law and then re-insert his own legislation into that. 

Further, I would say, Mr. Chairman, she said that, you know, we 

could fix it. I would submit that Dr. Frankenstein couldn’t fix his 

monster. We are not capable of fixing Obamacare. 

For people who she said the premiums are not skyrocketing, I 

don’t know about her district, but in my district, people are finding 

that their premiums are going up at a substantial rate. They would 

tell me—and they do on a regular basis—that it is, in fact, skyrocketing. 

29 

And then she said that it was working. Look, for my folks—and 

I represent what I call the cornucopia of Virginia, that part that 

comes out of the deep southwest and spills out into the rest of the 

State. 

We border the states of North Carolina, West Virginia, Tennessee and Kentucky. We have split cities in two, Bluefield, Virginia/West Virginia, and Bristol, Virginia/Tennessee, where the 

main commerce street is State Street and the line is right down the 

middle of the main street of commerce. 

But you can’t go to a hospital if you live on one side of State 

Street that is more than one county out if you are in the 

Obamacare plan. You can’t go to a hospital in West Virginia. 

If you live in Martinsville or in Galax, Virginia, you can’t go to 

Bowman Gray in North Carolina or Duke any longer. You want to 

say a system is working when people have been able to go to teaching hospitals in the past and now they have to drive a lot farther 

to get to one because of Obamacare. It is not working. 

I submit that the gentlelady in that case was wrong as well. And 

I yield back. 

Mr. PITTS. The chair thanks the gentleman and now recognizes 

the gentlelady from Washington, Cathy McMorris Rodgers, for 5 

minutes for questions. 

Mrs. MCMORRIS RODGERS. Thank you, Mr. Chairman. And I appreciate you both being here today. 

I wanted just to reinforce before I went to my question that the 

administration didn’t make a pledge to prevent fraudulent payments. 

The law states that only certain individuals are able to qualify 

for subsidies and that they must be able to prove citizenship. And 

it is just another example of the administration ignoring the rule 

of law. 

My questions. First, the secretary has refused to release any 

more enrollment reports after the one they released in May. 

Do you think continuing the issuing of these reports to Congress 

and public would be helpful? 

Ms. DALY. I am not certain that the secretary is compelled to do 

so under any law or anything of that—— 

Mrs. MCMORRIS RODGERS. Do you think it would be helpful? 

Ms. DALY. I think it would be helpful. 

Mrs. MCMORRIS RODGERS. OK. Thank you. 

After your analysis of the Federal marketplace and the two state 

marketplaces, do you think these exchanges are able to start reporting on who has actually been paying their premiums? 

Ms. DALY. I am sorry. I am not in a position to answer that at 

this time on the current status of what is going on at the marketplaces. 

Mrs. MCMORRIS RODGERS. Do you know how soon we will have 

a sense as to who is actually paying their premiums in these exchanges? 

Ms. DALY. Well, we do have a variety of work that is planned 

and underway looking at further operations of the marketplaces, 

but I think we are going to be looking at the state marketplaces. 

We have already got that work started on the ones we had not 

already reviewed, and that work is going to be coming out probably 

30 

sometime in the winter and spring of next year. And it could be— 

because there are quite a few, there is a number of reports that 

will be coming on that. 

Mrs. MCMORRIS RODGERS. Is it the goal to better clarify actually 

who has been paying premiums and not? Is that going to be part 

of the goal? 

Ms. DALY. Well, I think who is paying the premiums on the insurance—we are looking at this time at how the premiums that are 

being paid—if they are going to the right insurers. 

But whether the insuree, the person that has gotten the insurance, is making their premium payments is not an issue that we 

had focused on at this time. 

But we would be glad to work with your staff to understand more 

about some of the implications surrounding that and see if we can 

get the resources to work that into our work plan. 

Mrs. MCMORRIS RODGERS. Now, I know that your report focused 

on the Federal marketplace and the State marketplaces in Connecticut and California. 

However, I represent Washington State. And I was curious as to 

the extent of OIG’s office and their monitoring of the State exchanges beyond California and Connecticut. 

Recently the Washington healthplanfinder—that is our exchange—had to explain to customers why some of them received an 

August invoice for twice the amount they owed. 

Now, you think about the impact on the middle class and the uncertainty that they face and the confusion that they continue to 

face and whether or not they are paying double their premiums or 

not. Others received no invoice. And some received an invoice with 

a zero balance, even though they owed a monthly premium. 

So are there procedures in place in Washington and other State 

marketplaces to quickly remedy these types of errors? 

Ms. DALY. Unfortunately, our work hasn’t looked at that particular issue at this point in time. So I am sorry. I can’t respond 

directly to your question. 

Mrs. MCMORRIS RODGERS. Well, is the Office of Inspector General ever going to look at this question as to who is actually paying 

these premiums and whether or not it is accurate? 

These are hardworking middle-class families quite often that are 

in need of health insurance, are trying to figure out how to stretch 

their paychecks to pay for oftentimes increasing premiums. 

Are we ever going to assure them that they are actually paying 

accurate premiums? Or how are we going to address when there 

is a double bill and those kind of issues? 

Ms. DALY. Well, those are important issues. And again, we would 

be glad to work with you and your staff to help see if we can design 

some work that would be able to address those areas of concern. 

Mrs. MCMORRIS RODGERS. So my final question. 

What is going to happen to someone when they are either confused or they accidentally don’t pay or if they pay double, whatever 

the situation? Are they going to be cut from coverage or will they 

receive a refund? How is this going to be remedied? 

Ms. DALY. I am sorry. If you could just help clarify for me—— 

31 

Mrs. MCMORRIS RODGERS. OK. My question is: You are an individual. You have either been charged double or maybe you accidentally didn’t pay. How is this going to be remedied? 

Ms. DALY. Right. I am just not positioned to respond to that 

today simply because our work hasn’t focused in that particular 

area as yet. So—— 

Mrs. MCMORRIS RODGERS. Is there a plan to ever address these 

questions? 

Ms. DALY. I just don’t have any information available for you at 

this time, but we would be glad to try to get back with you on that. 

Mrs. MCMORRIS RODGERS. And the weeks go by and individuals 

are out there still looking for answers, too. 

Thank you, Mr. Chairman. 

Mr. PITTS. The chair thanks the gentlelady. 

I now recognize the gentleman from Georgia, Dr. Gingrey, 5 minutes. 

Mr. GINGREY. Mr. Chairman, thank you. 

I haven’t been here for the entire hearing because we have one 

going on concurrently downstairs, very important as well, but the 

little bit that I have heard since I have been here really disturbs 

me. 

My term in Congress—my 12th year, my 6th term—will come to 

an end at the end of the 113th Congress. I am looking for something else to do and I think I am going to apply for a job as an 

Inspector General in the Federal Government because the hours 

seem good and, obviously, there is no heavy lifting. 

Your responses so far, both of you, have indicated to me that you 

don’t seem to really be on the ball in regard to InspectorGeneraling in a non-biased, unbiased way, which is what you are 

supposed to be doing. 

And when I talk to the people in the 11th Congressional District 

of Georgia, there is no way that I can give them any confidence 

that you are doing your job so that people who are undeserving, 

unqualified to receive part of the million—excuse me—trillion dollars’ worth of subsidies in this ultra-expensive program are getting 

to the right people. 

So let me specifically ask you—and you can comment on my comments as well—but the OIG’s work has revealed a number of problems, as I have heard this morning, in CMS’s process of verifying 

whether an individual is eligible for part of the estimated $1 trillion in exchange subsidies that will be spent over the next 10 

years. 

And I would like to ask if OIG has found problems in resolving 

inconsistencies in the following areas: An applicant’s Social Security number, an applicant’s legal status, an applicant’s income and 

all these income set-asides that exist by virtue of waivers in the 

Medicaid program and everything across the various and sundry 50 

States and territories, other sources of coverage for an applicant, 

such as employer-sponsored income. 

Can you give us a little insight on any of that? And, for goodness’ 

sakes, isn’t that what you are supposed to be looking at? 

Ms. GREENLEAF. Thank you for the question. 

In fact, when we looked at the marketplaces, we did find problems with their abilities to resolve inconsistencies in all those areas 

32 

that you identified. The most common inconsistencies that were not 

resolved did concern citizenship and income. 

You had also mentioned Social Security number. There was some 

ability of the Federal marketplace to resolve those, but, in the end, 

the marketplace resolved very few. 

So these inconsistencies don’t necessarily equate to an improper 

enrollment or an improper subsidy, but they are concerning, and 

we made recommendations that CMS resolve these and make its 

plan public on how and when it will do so. 

Mr. GINGREY. Well, have they made that public? You made the 

recommendations that they do so. But as far as you know to this 

point—— 

Ms. GREENLEAF. We are tracking their response. In their comments to our report, CMS indicated that it had implemented an interim manual process to resolve inconsistencies and was making 

progress, and we will be following up with them in a formal way 

to track their responses over the next couple of months. 

Mr. GINGREY. Well, I don’t have any other questions. 

Ms. Daly, did you want to respond to that as well? 

Ms. DALY. No, sir. But thank you for the opportunity. I think Ms. 

Greenleaf did a fine job. 

Mr. GINGREY. Well, yes. She did OK. 

Honestly, Mr. Chairman, I think we would have done well this 

morning to have somebody from GAO here as well to tell us what 

kind of a job they think the Office of Inspector General is doing in 

regard to this program. 

Look, I am not picking on the witnesses. I mean, this is an opportunity for us to get information. There are people out there that 

need and deserve these subsidies. 

After all, the PPACA was put in place for the supposedly 15 to 

20 million people who through no fault of their own couldn’t afford 

health insurance because of low income. 

And, yet, if we have got people gaming the system, other people 

are suffering because of it. They are not on the program, maybe. 

And then those that are not eligible for a subsidy, it just simply 

means that their premiums, their deductibles, their co-pay, are 

going through the roof, and they are just going to throw up their 

hands and say, ‘‘I am not going to buy into the system. I will pay 

the fine and go bare.’’ 

And I, as a physician, know how bad that is. We don’t want that 

to happen. So that is why I am being a little hard on the witnesses, 

but I don’t think too hard. 

And I thank them for being here this morning. 

I yield back, Mr. Chairman. 

Mr. PITTS. The chair thanks the gentleman and now recognize 

the gentleman from Florida, Mr. Bilirakis 5 minutes for questions. 

Mr. BILIRAKIS. Thank you, Mr. Chairman. 

This report that the IG issued is troubling to me. It is further 

evidence that the administration wasn’t ready—— 

Mr. PITTS. You want to pull your mic down a little bit. 

Mr. BILIRAKIS. Thank you. 

The 2.6 million unresolved inconsistencies exist because CMS’s 

eligibility system was not fully operational. This means that people 

may have received a subsidy that they are not legally entitled to, 

33 

or people could be receiving too much. When they file their taxes 

next year, people could receive a shock when they have to repay 

parts of their subsidy to the government. 

I knew that this system was not going to work. I knew that it 

was broken. Last year I introduced the No Taxation Without 

Verification Act. My bill would have prevented any tax provisions 

from being implemented until there was a working verification system in place. 

It wasn’t enough that the administration had a process. They 

should have to meet certain metrics, in my opinion. Unfortunately 

and predictably, the administration made a mess of verification, in 

my opinion, and the entire back end of the Web site, just like they 

made a mess, in my opinion, of the healthcare.gov. 

Ultimately, this hurts the American taxpayer. That is the bottom 

line. And I do have a couple questions. 

In the OIG report, you recommend that CMS develop a public 

plan and set a deadline to clear the current backlog of inconsistencies and resolve the problems. 

This is the question: When does CMS need to have the plan and 

deadline release to address these pressing problems? 

And do you think it is necessary to provide time to test the 

verification changes in the system before the next open enrollment 

period begins? 

Ms. GREENLEAF. We will be tracking—we have a formal tracking 

system for monitoring CMS’s response to our recommendations. 

So over the next couple of months—I believe within 6 months 

they have to have a formal plan back to us, though it could well 

be sooner. 

Mr. BILIRAKIS. Are you going to press them? 

Ms. GREENLEAF. Yes. We will be following up both formally and 

informally. The Office of Inspector General leadership meets regularly with the CMS leadership. 

And this is a high-priority recommendation, and the bottom line 

is inconsistencies need to be resolved so we can have confidence 

that the determinations about eligibility are accurate. 

Mr. BILIRAKIS. Thank you. 

Next question. The OIG reports that applicants are given a 90- 

day period to resolve inconsistencies after a notice is sent to a consumer. 

This 90-day period can be extended, generally, by the Secretary, 

but cannot be extended in instances involving citizenship and immigration status. 

Do you know if HHS is holding applicants to this standard? Can 

you answer that question first? 

Ms. GREENLEAF. That was a little bit outside the scope of our review. 

And you are correct. There is the 90-day inconsistency period 

during which an applicant can lawfully enroll, and the inconsistency is supposed to be resolved during that time. 

But we did not collect information on how often it is being extended or how that is being managed at the marketplaces. 

Mr. BILIRAKIS. Ms. Daly, can you respond to that? 

Ms. DALY. No, sir. I am sorry. I can’t add anything to that either. 

34 

Mr. BILIRAKIS. Well, I have another question. I would like to get 

this information from you immediately, I mean, within the next 

couple days, please. 

Is HHS actually terminating coverage, if you can answer that, or 

withdrawing subsidies if an applicant has failed to provide documentation to address an inconsistency regarding citizenship or 

legal status within the 90-day period? Can you try to respond to 

that, please? 

Ms. GREENLEAF. I think we will have to get back to you on that 

to try and answer that. I don’t have that information. 

Mr. BILIRAKIS. So you are not sure? 

Ms. GREENLEAF. That is correct. 

Mr. BILIRAKIS. Is that correct, Ms. Daly? You are not sure? 

Ms. DALY. Yes, sir. I am not certain at this time. 

Mr. BILIRAKIS. Please get back to us. This is vital. I really would 

appreciate it. Thank you very much. 

I yield back, Mr. Chairman. 

Mr. PITTS. The Chair thanks the gentleman. 

Now recognize the gentleman from Louisiana, Dr. Cassidy, 5 

minutes for questions. 

Mr. CASSIDY. Hello. I am sorry to have come in late. So people 

may have asked my questions. I apologize. 

Looking at your testimony on pages 3 and 4, I gather a sample 

was done of California, Connecticut, the Federal exchange, a sample of 45. 

Now, as best as I can tell on Page 4, the second bullet point refers specifically to California. Verifying citizenship, 7 out of 45, it 

was unclear that their citizenship was verified. 

I gather that is 15 percent of those in California who signed up 

we cannot confirm that they are U.S. citizens. Is that a correct 

reading of this? 

Ms. DALY. Yes, sir. That finding indicates that, of the 45 applicants that we selected for sampling in California, 7 of those 45 did 

not have their information run through the system as it was supposed to occur. 

Mr. CASSIDY. Now, I am told that California had roughly 1.5 million people sign up through their Cover California exchange. 

So potentially 15 percent of those, or 225,000, were not citizens? 

Ms. DALY. I would caution against—— 

Mr. CASSIDY. Accept that. 

Ms. DALY [continuing]. Trying to extrapolate those results. The 

type of sampling that we did wasn’t the type that you could use 

for extrapolation purposes. It was simply to provide a ‘‘yes’’ or ‘‘no’’ 

answer. Was the action done? Yes or no. 

Mr. CASSIDY. But it was a random sample, I presume. 

Ms. DALY. Yes, sir. 

Mr. CASSIDY. So as a random sample, theoretically, representative of the whole—granted, maybe they just didn’t provide—but, 

nonetheless, potentially as many as 15 percent of those who signed 

up through California were not citizens, potentially. Fair statement? 

Ms. DALY. Well, given the type of sampling that we have done, 

I can’t make that extrapolation. 

Mr. CASSIDY. There is a margin of error. 

35 

Ms. DALY. Yes. 

Mr. CASSIDY. There is a margin of error, but nonetheless—so this 

being the case—wow—have you done a follow-up sample, larger 

and more statistically significant? 

Ms. DALY. At this time we have not had an opportunity to follow 

up with California on this. 

Mr. CASSIDY. Now, Ms. Daly, that just seems to beg to be done. 

I mean, if it is a potential—granted, a small sample size with a 

large margin of error. 

But if 15 percent of the people may not be citizens, that actually 

seems like kind of moves up list of follow-up actions taken on this 

sample size. Am I missing something? 

Ms. DALY. Well, sir, I think it is really important to recognize 

that this was a system design issue, and I think California told us 

that they were following up to try to get that addressed. 

And I think that is an important point to make, that when there 

is a systemic issue where it is a problem with the programming—— 

Mr. CASSIDY. California actually has a vested interest in, frankly, 

not addressing this because the subsidy is coming from the United 

States taxpayer, not in general, not just Californians. So as I am 

also told, 90 percent of those who signed up on California exchanges received subsidies. 

Now, if that’s the case, again, just back of envelope, that means 

over 200,000 people on the California exchange potentially are receiving generous subsidies and they are not citizens. 

Now, that seems more the purview of the Federal Government 

as an overseer as opposed to the Californians, who may not care. 

Again, am I missing something? 

Ms. DALY. Well, the point is that our sampling approach was 

more of a compliance sample in which you are either identified as 

yes or no, you meet that or do not meet that. 

Mr. CASSIDY. I accept that. You have explained that methodology. 

But I am—we have got hardworking taxpayers who are barely 

making it and we were told by those who promoted this that only 

citizens would be allowed to sign up. 

Now, in a random sample size in California—which, if it was 

truly chosen randomly, statistically, that will probably represent 

the whole with a given margin of error—as many as 15 percent of 

those aren’t citizens. 

If I am a taxpayer in Louisiana, I am thinking, ‘‘What the heck. 

We were told this would only be for citizens. Now my tax dollars 

are going to subsidize someone here illegally, potentially.’’ 

I guess I am wondering, does the administration—your kind of 

view of this—and I don’t mean to overread—seems a little nonplussed. ‘‘Yes. Might be. But we will trust the Californians to pull 

it together.’’ And I say that not to indict, but only to observe. 

Again, am I wrong on this? 

Ms. DALY. Well, I think we are concerned, and that is why we 

have done the work that we have done to provide you, the overseers for this program, among others, the information that you 

need to provide that oversight. 

Mr. CASSIDY. Well, I thank you for that. 

36 

Ms. DALY. I think you know the challenges that the marketplaces 

were facing. 

Mr. CASSIDY. I am almost out of time. 

I recognize that. But, nonetheless, the challenges the marketplaces were facing did not excuse them from executing the law, 

which is only citizens shall sign up. 

And it does seem as something that should require HHS to follow 

aggressively, if only to keep at least this measure of commitment 

to the American people, that only citizens would be allowed to do 

so. 

I am out of time. Thank you all for your testimony. 

Mr. PITTS. The chair thanks the gentleman. 

The Chair now recognize the gentleman from Illinois, Mr. 

Shimkus, 5 minutes for questions. 

Mr. SHIMKUS. Thank you. 

And thanks for coming. 

I am sorry I was absent for a lot of it. That is why I waited in 

line to hear some of the exchange and the questions. 

From the Inspector General’s Office of Health and Human Services. Right? So you are doing an internal review of the signups, 

proper or improper, and you have proffered a report. 

And I think that is where some of the frustration is, is some of 

these things come out in the report. What would compel the HHS 

or CMS to rapidly respond to fix these deficiencies? I guess that is 

the concern. 

You are the OIG. All you can do is report. Right? You can’t go 

to the new secretary or the former secretary and say, ‘‘Act. Here’s 

a major problem.’’ 

But I guess, from the tone of some of my colleagues, they are not 

convinced that there was red flags flying that this was a problem 

and that there may have been a delay. 

So let me go to the question. I mean, I am just trying to put my 

observation in the few minutes I have been here, trying to think 

through the line of questioning. 

So when CMS failed to put a fully operational eligibility system 

in place, it had—we believe it had major consequences. 

And I think your report highlights that, yes, there are some 

major problems when you don’t have a fully operational system. 

We have learned that the verification process to resolve inconsistencies often did not start until May—right?—even though, in 

fact, it could be very likely that these inconsistencies contained in 

the applications submitted in October—is it safe to say that they 

languished for months without resolution? 

Ms. GREENLEAF. May is outside the period that we report on. 

And during the period that we report where we say 2.6 million inconsistencies were unresolved is through October—October through 

mid-February for the Federal exchange. 

Mr. SHIMKUS. So we could say it languished through that period 

of time at least? 

Ms. GREENLEAF. For that period of time, yes, they were unable 

to resolve inconsistencies, in particular regarding citizenship. 

Mr. SHIMKUS. Do you think that we can—you don’t know for 

sure. But, again, going on some of the lines of the questions, is it 

37 

safe to guess that some of these inconsistencies that you identified 

are still unresolved? 

Ms. GREENLEAF. We don’t have information to that effect. We 

will be tracking CMS’s response and ask CMS to report back to us 

in our recommendations regarding—— 

Mr. SHIMKUS. I guess that is part of this whole debate and a little bit of frustration. 

So we got the answer that there is an interim pamphlet. Right? 

But, I guess, isn’t this compelling enough to say give us more information now? 

What kickstarts that additional review by you to see that there 

is not—that the inconsistencies that you raised based upon the 

February time frame—and maybe we assume May—that they are 

still not inconsistencies and that they have been resolved? 

Ms. GREENLEAF. Well, we will be monitoring their response to 

our report and—— 

Mr. SHIMKUS. Wait. Wait. Wait. That is the frustration, ‘‘We will 

be monitoring.’’ 

Are you monitoring? I mean, that is the problem. I mean, don’t 

you understand? ‘‘We will be.’’ No. A lot of us think you should be. 

This monitoring should have been done, especially with these gross 

inconsistencies. 

Ms. Daly. 

Ms. DALY. Yes, sir. Thank you for the opportunity. 

I think that, you know, we will do—as my colleague here pointed 

out, we do follow up on our recommendations. And at the same 

time we already are beginning extra work out at the Federal marketplace. 

And as part of that we can be assessing whether—the status of 

addressing those inconsistencies that we currently are aware of. I 

would be very interested in learning the new processes that are in 

place. Of course that work is going to really—— 

Mr. SHIMKUS. OK. So we are—please. I guess we would like you 

to try. Not wait. I mean, that is our frustration. 

These inconsistencies are as large as they might be, and we have 

had a long time. We want this present tense, not future tense. Does 

that make sense? It should be going on now. 

Aren’t we coming right now to another signup? Right? Enrollment is coming. 

If we haven’t fixed the original signup and the inconsistencies— 

we have identified the problems. We don’t have follow-up. We don’t 

know if they have been fixed. 

Aren’t we at risk of having the same problem in the next enrollment? If they haven’t addressed it, will we have the same problem, 

Ms. Greenleaf? 

Ms. GREENLEAF. If CMS doesn’t address our recommendations, 

we would be concerned that additional inconsistencies would remain unresolved, and that could lead to inaccurate determinations. 

Mr. SHIMKUS. OK. You have been very helpful, at least for my 

part. Just remember—I will leave on this, Mr. Chairman—present 

tense, not future tense, and we would all be a lot happier. 

Mr. PITTS. The chair thanks the gentleman. 

That concludes the questions of the Members who are in attendance. There will be a lot of other questions from other members as 

38 

well to follow up, and we will submit those to you in writing. We 

ask that you please respond promptly. 

I remind Members that they have ten business days to submit 

questions for the record. Members should submit their questions by 

the close of business on Wednesday, July 30. 

I have a UC request. I would like to insert into the record an article in the New York Times from October 16, 2013, where Secretary Sebelius is quoted as saying, ‘‘I think we are on target. We 

are on track to flip the switch on October 1 and say to people come 

on and sign up.’’ 

Without objection, so ordered. 

[The information appears at the conclusion of the hearing.] 

Mr. PITTS. And the Ranking Member has a UC request. 

Mr. PALLONE. Mr. Chairman, I would ask unanimous consent to 

enter into the record a letter from June 4 from Ranking Member 

Waxman to Chairman Upton. 

Mr. PITTS. Without objection, so ordered. 

[The information appears at the conclusion of the hearing.] 

Mr. PITTS. Very interesting hearing. Thank you. We look forward 

to working with you to get more information. 

Without objection, the subcommittee is adjourned. 

[Whereupon, at 11:44 a.m., the subcommittee was adjourned.] 

[Material submitted for inclusion in the record follows:] 

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