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STATUS OF THE AFFORDABLE CARE ACT 

IMPLEMENTATION 

HEARING 

BEFORE THE

COMMITTEE ON WAYS AND MEANS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

FIRST SESSION 

OCTOBER 29, 2013 

Serial No. 113–FC13 

Printed for the use of the Committee on Ways and Means 

( 


ralbany on LAP520R082 with HEARINGS
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COMMITTEE ON WAYS AND MEANS 

DAVE CAMP, Michigan, Chairman 

SAM JOHNSON, Texas 

KEVIN BRADY, Texas 

PAUL RYAN, Wisconsin 

DEVIN NUNES, California 

PATRICK J. TIBERI, Ohio 

DAVID G. REICHERT, Washington 

CHARLES W. BOUSTANY, JR., Louisiana 

PETER J. ROSKAM, Illinois 

JIM GERLACH, Pennsylvania 

TOM PRICE, Georgia 

VERN BUCHANAN, Florida 

ADRIAN SMITH, Nebraska 

AARON SCHOCK, Illinois 

LYNN JENKINS, Kansas 

ERIK PAULSEN, Minnesota 

KENNY MARCHANT, Texas 

DIANE BLACK, Tennessee 

TOM REED, New York 

TODD YOUNG, Indiana 

MIKE KELLY, Pennsylvania 

TIM GRIFFIN, Arkansas 

JIM RENACCI, Ohio 

SANDER M. LEVIN, Michigan 

CHARLES B. RANGEL, New York 

JIM MCDERMOTT, Washington 

JOHN LEWIS, Georgia 

RICHARD E. NEAL, Massachusetts 

XAVIER BECERRA, California 

LLOYD DOGGETT, Texas 

MIKE THOMPSON, California 

JOHN B. LARSON, Connecticut 

EARL BLUMENAUER, Oregon 

RON KIND, Wisconsin 

BILL PASCRELL, JR., New Jersey 

JOSEPH CROWLEY, New York 

ALLYSON SCHWARTZ, Pennsylvania 

DANNY DAVIS, Illinois 

LINDA SA ́ NCHEZ, California 

JENNIFER M. SAFAVIAN, Staff Director and General Counsel 

JANICE MAYS, Minority Chief Counsel 


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C O N T E N T S 

Page 

Advisory of October 29, 2013 announcing the hearing ......................................... 2 

WITNESS 

Ms. Marilyn Tavenner, Administrator, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services, Washington, DC ....... 6 


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STATUS OF THE AFFORDABLE CARE ACT 

IMPLEMENTATION 

TUESDAY, OCTOBER 29, 2013 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON WAYS AND MEANS, 

Washington, DC. 

The committee met, pursuant to call, at 10:04 a.m., in Room 

1100, Longworth House Office Building, the Honorable Dave Camp 

[Chairman of the Committee] presiding. 

[The advisory of the hearing follows:] 


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HEARING ADVISORY 

FROM THE COMMITTEE ON WAYS AND MEANS 

Chairman Camp Announces Hearing on the 

Status of the Affordable Care Act Implementation 

1100 Longworth House Office Building at 10:00 AM 

Washington, October 22, 2013 

House Committee on Ways and Means Chairman Dave Camp (R–MI) today announced that the Committee will hold a hearing on the problems Americans are experiencing with the Obama Administration’s launch of the Affordable Care Act 

(ACA). The Committee will hear testimony from Marilyn Tavenner, Administrator 

of the Centers for Medicare & Medicaid Services (CMS) at the U.S. Department of 

Health and Human Services (HHS). CMS is the Federal agency that oversees the 

operation of the Exchanges through the Center for Consumer Information and Insurance Oversight (CCIIO). The hearing will take place on Tuesday, October 

29, 2013, in 1100 Longworth House Office Building, beginning at 10:00 A.M. 

In view of the limited time available to hear from the witnesses, oral testimony 

at this hearing will be from the invited witness only. However, any individual or 

organization not scheduled for an appearance may submit a written statement for 

consideration by the Committee and for inclusion in the printed record of the hearing. 

BACKGROUND: 

President Obama has acknowledged that the October 1 launch of the health care 

Exchanges was unacceptable. Americans have been unable to create accounts, and 

individuals continue to receive repeated error messages and inaccurate information 

from www.healthcare.gov. According to Consumer Reports, only 1 in 35 individuals 

were able to create an account on www.healthcare.gov. Recently, the Administration 

announced a ‘‘tech surge’’ of the ‘‘best and the brightest’’ to fix the problems, but 

experts have warned the ‘‘online system required such extensive repairs that it 

might not operate smoothly until after the December 15 deadline for people to sign 

up for coverage starting in January.’’ 

The Ways and Means Committee has conducted extensive oversight of the implementation of the Affordable Care Act to ensure that the Administration is implementing the law as promised. Despite significant reports about the difficulties they 

were encountering in building the Exchanges, Administration witnesses dismissed 

such reports. Instead, they repeatedly assured the Committee that warnings from 

nonpartisan independent auditors were wrong, including the Government Accountability Office, which reported the Administration was behind schedule and at risk 

of experiencing enrollment problems. 

The significant and ongoing problems with the launch of the Exchanges further 

exacerbates the challenges facing American families. Individuals are unable to create accounts, navigate the website and receive accurate information about cost and 

choices, while insurers are receiving inaccurate enrollment data. Despite these ongoing malfunctions, millions of Americans will be forced to deal with these challenges 

as they attempt to either comply with the individual mandate to buy coverage or 

pay a tax. 

This hearing will examine the status of efforts by CMS, HHS and the Obama Administration to identify the problems plaguing the launch of the Exchanges and the 

specific plans to fix the design flaws. The hearing will seek answers to why the Exchanges are not working, whether the Exchanges will be ready to fulfill all of their 

required functions and what steps are being taken to ensure that CMS and HHS 

will be able to accurately verify subsidy eligibility—prior to the distribution of premium tax credits and cost sharing subsidies. 

In announcing the hearing, Chairman Camp stated, ‘‘After spending over $600 

million, the American people want answers to some very basic questions 


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about the launch of ObamaCare. Why doesn’t the website work? Why were 

the American people told everything would be ready, when it was clear 

that was not the case? How deep are the problems and how long will it 

take to get those problems fixed? And most importantly, if people can’t 

navigate such a dysfunctional and overly complex system, is it fair for the 

IRS to impose tax penalties?’’ 

FOCUS OF THE HEARING: 

The hearing will focus on the status of the Obama Administration’s implementation of the Affordable Care Act. 

DETAILS FOR SUBMISSION OF WRITTEN COMMENTS: 

Please Note: Any person(s) and/or organization(s) wishing to submit for the hearing record must follow the appropriate link on the hearing page of the Committee 

website and complete the informational forms. From the Committee homepage, 

https://waysandmeans.house.gov, select ‘‘Hearings.’’ Select the hearing for which you 

would like to submit, and click on the link entitled, ‘‘Click here to provide a submission for the record.’’ Once you have followed the online instructions, submit all requested information. ATTACH your submission as a Word document, in compliance 

with the formatting requirements listed below, by the close of business on Tuesday, November 12, 2013. Finally, please note that due to the change in House 

mail policy, the U.S. Capitol Police will refuse sealed-package deliveries to all House 

Office Buildings. For questions, or if you encounter technical problems, please call 

(202) 225–1721 or (202) 225–3625. 

FORMATTING REQUIREMENTS: 

The Committee relies on electronic submissions for printing the official hearing 

record. As always, submissions will be included in the record according to the discretion of the Committee. The Committee will not alter the content of your submission, 

but we reserve the right to format it according to our guidelines. Any submission 

provided to the Committee by a witness, any supplementary materials submitted for 

the printed record, and any written comments in response to a request for written 

comments must conform to the guidelines listed below. Any submission or supplementary item not in compliance with these guidelines will not be printed, but will 

be maintained in the Committee files for review and use by the Committee. 

1. All submissions and supplementary materials must be provided in Word format and MUST 

NOT exceed a total of 10 pages, including attachments. Witnesses and submitters are advised 

that the Committee relies on electronic submissions for printing the official hearing record. 

2. Copies of whole documents submitted as exhibit material will not be accepted for printing. 

Instead, exhibit material should be referenced and quoted or paraphrased. All exhibit material 

not meeting these specifications will be maintained in the Committee files for review and use 

by the Committee. 

3. All submissions must include a list of all clients, persons and/or organizations on whose 

behalf the witness appears. A supplemental sheet must accompany each submission listing the 

name, company, address, telephone, and fax numbers of each witness. 

The Committee seeks to make its facilities accessible to persons with disabilities. 

If you are in need of special accommodations, please call 202–225–1721 or 202–226– 

3411 TTD/TTY in advance of the event (four business days notice is requested). 

Questions with regard to special accommodation needs in general (including availability of Committee materials in alternative formats) may be directed to the Committee as noted above. 

Note: All Committee advisories and news releases are available on the World 

Wide Web at http://www.waysandmeans.house.gov

f 

/. 


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Chairman CAMP. This hearing will come to order. 

Good morning. I would like to welcome Marilyn Tavenner, the 

Administrator at the Centers for Medicare and Medicaid Services 

at the U.S. Department of Health. 

Welcome to the committee today. I look forward to your testimony, and I look forward to the hearing to really get an honest, 

straightforward assessment of the status of the health care law. 

Six months ago, Health and Human Services Secretary Sebelius 

told this committee a dozen times that the administration will be 

ready on October 1. We now know the administration was not 

ready, and just last week Secretary Sebelius suggested they could 

have used 5 years to get the exchanges up and running. 

Despite having more than 3 years to get the system up and running, officials at the Centers for Medicare and Medicaid Services 

who are charged with implementing the exchanges added, and I 

quote, ‘‘Due to a compressed time frame, the system wasn’t tested 

enough.’’ And, frankly, 3 years should have been enough. And had 

the administration provided more forthcoming answers and shared 

in a transparent manner the reality of the challenges it was encountering in the implementation process, I suspect many of these 

glitches could have been avoided. 

While the Web site can eventually be fixed, the widespread problems with Obamacare cannot. Almost daily we hear reports of 

Obamacare increasing costs, harming job creation, and forcing 

Americans off their current plan. These problems can’t be fixed 

through a technical surge or tech surge, and they are not just a 

glitch in someone’s health care coverage or job. 

Not a week goes by that I don’t hear examples from the people 

I represent in Michigan and job creators about the increasing costs 

and how Obamacare is making it harder for businesses to invest, 

grow, and hire people. Just last month, Meridian Public Schools in 

my district announced that it would be cutting the schedules of 

hourly workers to fewer than 30 hours per week as a result of 

Obamacare. And this month, the Detroit Free Press reported that 

at least 146,000 Michiganders have received cancellation notices 

for their current health plan due to Obamacare. In fact, based on 

what little information the administration has disclosed, it turns 

out that more people have received cancellation notices for their 

health care plans this month than have enrolled in the exchanges. 

The widespread acknowledgement that the health care exchanges 

were not tested months in advance as promised is cause for concern, but the concerns don’t stop there. The Treasury Inspector 

General warned in August that it was not confident about the IRS’ 

ability to protect confidential taxpayer information or to prevent 

fraud, and neither am I. 

On top of that, the exchange does not give individuals the information they need to make an informed health care decision. When 

going through the options, how are Americans able to see if they 

are even eligible to be in the exchange, if their current doctor is 

in the plan, what the real costs of their premiums will be, and how 

much their copay will be? 

No amount of Web site fixes can make right the President’s broken promises that health care costs will be lowered by $2,500 or 

that Americans will be able to keep the plan they have and like. 


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Those are worthy goals, reducing costs and maintaining coverage, 

and they are ones that we should all work together to accomplish. 

I would be remiss if I didn’t remind my colleagues that the alternative put forward by Republicans at the time was the only plan 

scored by the nonpartisan Congressional Budget Office as actually 

reducing premiums. Democrats chose to go down another path, and 

that is where it has led us. Instead of plowing forward with this 

unworkable law, the administration should at a minimum seriously 

consider delaying the law for families and individuals, just as it 

has done for big business. If they fail to do so, I fear we could see 

a fundamental breakdown of the insurance market, where premiums will skyrocket, pricing millions of Americans out of health 

care, yet still be forced to pay the individual mandate tax. 

Administrator Tavenner, we cannot solve a problem until we realize the full extent of the problem. Your answers today and in the 

future will be critical to this committee’s oversight of the health 

care law and, more importantly, to our work to make sure Americans have access to affordable health care. 

Before I recognize Ranking Member Levin for the purpose of an 

opening statement, I ask unanimous consent that all members’ 

written statements be included in the record. And without objection, so ordered. 

Chairman CAMP. I now recognize Ranking Member Levin for his 

opening statement. 

Mr. LEVIN. Thank you, Mr. Chairman and colleagues. 

And, Marilyn Tavenner, a warm welcome. 

We start this hearing facing a basic reality: Democrats want to 

make the Affordable Care Act work, congressional Republicans 

don’t. That reality has been reflected in 40-plus efforts by Republicans to repeal, dismantle, or defund the Affordable Care Act. That 

reality was reflected in their zeal shutting down the government 

and jeopardizing the full faith and credit of our Nation, damaging 

our Nation’s global standing and leading to enduring harm, costing 

our economy $24 billion, tens of thousands of jobs, a dramatic drop 

in consumer confidence. 

Now, having still failed to derail the ACA, the Republican focus 

of attack has shifted. The new front relates to HealthCare.gov. 

There very clearly are challenges to implementing new, pioneering 

access to health care. Consider these headlines. You can see them 

there. For example, ‘‘Problems Plague Rollout,’’ NPR reported. 

‘‘Plagued by Delays and Confusion Over Coverage,’’ said the San 

Francisco Chronicle. 

These headlines are from 2005 as Medicare Part D was launched. 

That year, in dramatic contrast to the Republican conduct to date, 

Democrats who had opposed that law worked to make it a success, 

working with Republicans on a bipartisan basis, Republicans who 

had passed that law to address many problems, and most importantly, we worked with our constituents to ensure they could sign 

up. 

The reality is that the Affordable Care Act, which Republicans 

are failing to work on with Democrats, is working quite effectively 

in States running the marketplaces. You can see from that slide. 

[Slide] 


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Mr. LEVIN. In Kentucky, more than 26,000 people have enrolled 

for coverage. In New York, more than 37,000 have signed up. And 

in Washington State, more than 35,000 people had enrolled as of 

a week ago. And the irony is that Republicans have erected hurdles 

to States throughout the Nation taking responsibility for implementing the law. 

The Web site for the Federal insurance marketplace must be 

fixed, and it is being fixed. This gentleman from Salt Lake City, 

Mr. Sherburne, is among those who have enrolled. A self-employed 

father of three, he has been uninsured for years, paying cash for 

doctor visits and the occasional trip to the emergency room, he told 

his local newspaper. Once he got into the marketplace Web site, he 

compared 38 plans and got coverage for his family for $123 a 

month. And I quote, ‘‘Once they get the bugs worked out, it will 

work well and bring peace of mind to a lot of people,’’ end of quotes. 

And he added, ‘‘I am thrilled to have coverage, period.’’ 

Prior to this year, what awaited Mr. Sherburne and tens of millions of other Americans who don’t get health insurance through 

their employer, but rather had to sign up on their own, was a maze 

of invasive personal medical history questions within applications 

that seemed to never end. When individuals did get through the 

process, too often a preexisting condition, no matter how minor, 

was used to deny coverage, to charge exorbitantly high premiums, 

or to exclude needed benefits. Thankfully, these days are behind 

us. They are behind us. 

This hearing provides a chance for every Member of this committee to proceed in a constructive, not a destructive manner, and 

for the Administrator to lay out how the Web site is being fixed, 

as it must be, and for everyone on this committee to join in this 

effort to make available, not to prevent access to quality, affordable 

coverage for every American. I yield back. 

Chairman CAMP. Thank you. 

Today we will hear from the Administrator for the Centers for 

Medicare and Medicaid Services at the U.S. Department of Health, 

Marilyn Tavenner. 

Your written statement will be made part of the record and 

members have received it, but you will be recognized for your oral 

testimony for 5 minutes. Welcome. 

STATEMENT OF MS. MARILYN TAVENNER, ADMINISTRATOR, 

CENTERS FOR MEDICARE & MEDICAID SERVICES, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Ms. TAVENNER. Thank you, Chairman Camp, Ranking Member 

Levin, and Members of the Committee. 

On October 1st, we launched one of the key provisions of the Affordable Care Act, the new marketplace, where people without 

health insurance, including those who could not afford it and those 

who were not part of a group plan, could go to get affordable coverage. 

We know that consumers are having difficulty enrolling via the 

marketplace Web site. It is important to note that the Affordable 

Care Act, however, is more than just a Web site. It creates a new 

market which allows people to access quality affordable health 

care, it allows them to have insurance options, it creates a pooling 


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of consumers into Statewide group plans that can spread the risk 

between sick people and healthy people, between young and old, 

and then bargains on their behalf to get them the best deal on 

health insurance. By creating competition where there wasn’t competition before, insurers are now eager for new business and they 

have created new health care plans with more choices. The premiums for coverage were lower than expected and millions of 

Americans will also qualify for tax credits to make the coverage 

even more affordable. 

We know that consumers are eager to purchase this coverage, 

and to the millions of Americans who have attempted to use 

HealthCare.gov to shop and enroll in health care coverage, I want 

to apologize to you that the Web site has not worked as well as it 

should. We know how desperately you need affordable coverage. I 

want to assure you that HealthCare.gov can and will be fixed, and 

we are working around the clock to deliver the shopping experience 

that you deserve. We are seeing improvements each week and, as 

we have said publicly, by the end of the November the experience 

on the site will be smooth for the vast majority of users. 

Over the past month, millions have visited HealthCare.gov to 

take a look at new health care coverage under the Affordable Care 

Act, and in that time nearly 700,000 applications for coverage have 

been submitted across the Nation. More than half of those are in 

the Federal marketplace alone. This tremendous interest confirms 

that American people are looking for quality affordable health care 

coverage. 

We know that the consumer experience has been frustrating for 

many Americans. Some have had trouble creating accounts and logging into the site, while others have received confusing error messages or had to wait for slow response times. This initial experience 

has not lived up to our expectations or the expectations of the 

American people, and it is not acceptable. 

We are committed to improving performance and have already 

made progress. In the first few days when the site went live, few 

customers could create an account. Now over 90 percent can. We 

have updated the site several times, fixing bugs and improving the 

HealthCare.gov experience, and we have added more capacity in 

order to meet demand. 

We are pleased with these quick improvements, and parts of the 

system are already working well. For example, the data hub, the 

routing tool that provides an efficient and secure way to verify information submitted by consumers, is sending determinations to 

the marketplace in less than 1.2 seconds. Social Security has reported 4.2 million transactions with the hub and the IRS has responded to more than 1.3 million requests. 

Even with this success, we know there is still significant work 

to do, and we have called in a team of experts, led by Jeff Zients, 

to analyze the site, identify and prioritize fixes. We have spent the 

last week going over that. And while these problems will require 

a lot of hard work, the bottom line conclusion is this 

HealthCare.gov site is fixable. 

To get the job done, we have identified a clear path forward, a 

lot of fixes that will be undertaken one by one. To ensure the work 

is done as quickly and as efficiently as possible, we have enlisted 


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the help of QSSI to serve as general contractor for this project. 

They are familiar with the complexity of the system and the work 

they have provided for HealthCare.gov, the Federal data hub, is 

working well and performing as it should. QSSI has the skills and 

expertise to help us address these problems. They will work with 

leadership and contractors to prioritize the needed fixes and make 

sure they get done. 

We are committed to improving the consumer experience with 

HealthCare.gov. While we continue this work, I encourage people 

to continue to apply by phone, by mail, or by finding local help in 

their community. 

The fact is the product of the Affordable Care Act, a marketplace 

for quality affordable health insurance, will work. The product is 

not going away and the people are not going to continue to wait. 

We know the price is not changing. We know Americans have time 

to apply and enroll in affordable coverage. 

Thank you, Chairman Camp. 

[The prepared statement of Ms. Tavenner follows:] 


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Chairman CAMP. Well, thank you. 

Administrator Tavenner, how many people have enrolled in the 

exchanges? 

Ms. TAVENNER. Chairman Camp, that number will not be 

available till mid-November. We have over 700,000 who have completed applications. 

Chairman CAMP. So you know the applicants, but do you know 

the enrollees? Do you have an idea of how many of those applicants 

became enrollees? Because that is really the number that matters. 

Ms. TAVENNER. We will not have that till mid-November. We 

have people who are shopping now. We expect the initial number 

to be small, and I think you have seen that in our projections, and 

that was the Massachusetts experience as well. 

Chairman CAMP. I have to tell you, the numbers I am hearing 

from insurers in my home State of Michigan are not good, of enrollees, it’s a very small number. In fact, I think I could have a meeting in my office, and have all of them fit in, of the people who have 

successfully enrolled in the plans. I understand that CMS’ stated 

goal is 7 million enrollees by the end of March. Is that correct? 

Ms. TAVENNER. That is correct. 

Chairman CAMP. And I think critically important, of that 7 million, 2.3 million of those need to be young and healthy. I think 

those are your metrics. Is that correct? 

Ms. TAVENNER. I don’t have that metric with me, but I will 

check on it. 

Chairman CAMP. Okay. I believe those are numbers that CMS 

has put out. 

The Associated Press reported in early September that there was 

a memo prepared by the Assistant Secretary for Planning and 

Health. Are you aware of that press story and that memo? I think 

it went through your office to Secretary Sebelius. 

Ms. TAVENNER. That went through the enrollment numbers? 

Chairman CAMP. Yes. And it said that there were month-tomonth predictions of enrollment numbers showing a path to the 7 

million that I mentioned. 

Ms. TAVENNER. Right. 

Chairman CAMP. Could you make that memo available to the 

committee? 

Ms. TAVENNER. Certainly. 

Chairman CAMP. According to the press report, the memo estimated that 494,620 people would sign up for health insurance 

under the program by October 31st. Now, we are obviously very 

near that date. Have you met that estimate? 

Ms. TAVENNER. I will not have those numbers available till 

mid-November. 

Chairman CAMP. So do you not know? Do you not have any idea 

of how many people have enrolled or are you—— 

Ms. TAVENNER. Folks are still in the process of enrolling both 

in the State-based exchanges and in the Federal exchange, and we 

will have those numbers available in mid-November. 

Chairman CAMP. Are you getting those numbers? 

Ms. TAVENNER. Am I getting those numbers? Not yet. Not from 

the States. 


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Chairman CAMP. You have no numbers on who is enrolled? So 

you have no idea? 

Ms. TAVENNER. We will have those numbers available in midNovember. 

Chairman CAMP. So no one is forwarding even weekly updates 

on how the system is working? 

Ms. TAVENNER. I think we have seen some of the press, and 

I think that was on the graph earlier, about what States have listed. We will get those numbers in mid-November. 

Chairman CAMP. I understand you are not publicly releasing 

those numbers, but I am asking do you have any idea of on a weekly basis how many people enroll? I mean, how do you not know how 

many people have enrolled? 

Ms. TAVENNER. Chairman Camp, we will have those numbers 

available in mid-November. 

Chairman CAMP. But is your staff updating you on those? Are 

you getting those on a periodic basis? I realize you are not prepared to give this to the committee, even though this is a government program and we are trying to do oversight here and we are 

trying to understand what the problems are, but do you have some 

idea of what those problems might be in terms of the numbers? 

Ms. TAVENNER. I am not quite sure what you are asking me. 

Chairman CAMP. Well, you have said that 700,000 people have 

completed the application process, so clearly you are getting some 

information. Do you have any idea of how many of those can move 

to the next step of enrolling, looking at plans, how many are eligible, how many have decided to enroll? 

Ms. TAVENNER. Once individuals complete the application, 

then they go into the shopping experience, where they can look at 

plans. We do get numbers on the number of applications, and then 

we need to break those out. And that is why I have said, this is 

part of the rollout that we will give in mid-November for the October data. 

Chairman CAMP. Okay. So you do have the applications, which 

is the 700,000 number—— 

Ms. TAVENNER. Yes. 

Chairman CAMP [continuing]. But you don’t have how many 

people successfully enrolled. 

Ms. TAVENNER. I am saying people are still in the process of 

enrolling. 

Chairman CAMP. Of those 700,000, do you know how many of 

those are eligible for Medicaid at this point? 

Ms. TAVENNER. We have some information on who is eligible 

for Medicaid, and then obviously States have their own information 

about that, and it depends on whether a State has expanded or not 

and what is going on inside. It is very State specific. 

Chairman CAMP. Can you share with the committee the information you have about those that have enrolled that are eligible 

for Medicaid? 

Ms. TAVENNER. We will also have that information available in 

mid-November as well. 

Chairman CAMP. Because that would mean of those 700,000, a 

significant portion would not be in the exchange if they are qualifying for Medicaid. Isn’t that correct? 


ralbany on LAP520R082 with HEARINGS
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Ms. TAVENNER. We will have that information available to you 

in mid-November. 

Chairman CAMP. Yeah, but the law is that if they are eligible 

for Medicaid they are not enrolling in the exchange. That is my 

question. 

Ms. TAVENNER. Correct. 

Chairman CAMP. So there could be a significant portion of that 

700,000 that would not be enrolling in an exchange. Is that correct? 

Ms. TAVENNER. There could be numbers in there that will be 

eligible for Medicaid, that is correct. 

Chairman CAMP. Do you know how many of the 700,000 have 

qualified employer-sponsored insurance and therefore will not be 

eligible for the exchange? 

Ms. TAVENNER. Those individuals who have employer-sponsored insurance, usually at the end of the application they are 

asked that, and if that is the case, they usually don’t proceed. 

Chairman CAMP. Do you know how many of those 700,000 are 

young adults, say, under the age of 26 who might choose to stay 

on their parents’ plan if it is cheaper? 

Ms. TAVENNER. I do not. 

Chairman CAMP. And do you know how many are undocumented aliens and who may not be eligible to enroll in the exchange? 

Ms. TAVENNER. So as you are aware, we actually have a connection through the data hub to check for that, and if they are not 

eligible, they do not complete the application and they do not go 

on to shop. 

Chairman CAMP. But of these 700,000, do you have any idea 

how many are just looking and how many are trying to enroll? 

Ms. TAVENNER. We actually look at the people who are shopping, and obviously the majority of the people who are completing 

applications are there to actually purchase insurance, and so they 

continue to go through the shopping experience. 

Chairman CAMP. Well, there are media reports that say as 

many as 80 percent of that 700,000 number are actually eligible for 

Medicaid. Is that a number you would dispute? 

Ms. TAVENNER. I don’t know where that media report is or how 

they would get that information. 

Chairman CAMP. Well, if that is true, I mean, that is the only 

information we are getting, frankly, today. I, frankly, would have 

hoped for a little bit more from you. But if that is true, then less 

than 140,000 of these applicants are potentially enrollees in the exchange, and that is assuming they don’t have employer-provided 

coverage, that is assuming they can’t stay on their parents’ plan or 

are otherwise ineligible in some other way. But that means you are 

likely to hit less than one-quarter of this October estimate of 

494,620. How many people did you estimate would enroll between 

November 15th and December 15th, which we are 2 weeks off from 

that period? 

Ms. TAVENNER. I don’t have that in front of me. I will be happy 

to get you that information. 

Chairman CAMP. If you could get that to the committee, I would 

certainly appreciate that. 


ralbany on LAP520R082 with HEARINGS
20 

But I think given that the back end systems aren’t working and 

insurers have resorted to manually enrolling people one by one, I 

just think the system literally doesn’t have the human resource capacity to manually enroll the numbers that are being projected 

here. 

I assume that many people who are holding off are the young 

and healthy, so the risk pools in these exchanges are not going to 

align with the projections. So I think not only are we going to miss 

the 7 million enrollee target, it appears that we are going to miss 

the demographic makeup as well, and that is going to be very important to have a functioning system. If the demographics are 

wrong and there aren’t as many young people enrolling, what happens then, what happens to premiums? 

Ms. TAVENNER. I think the premiums are locked down for 

2014, so obviously the next 6 months of enrollment are critical. And 

I will remind you that enrollment does occur till March 31st of 

2014. I will also remind you that the Massachusetts experience was 

very slow initially and that it started to ramp up over time. We expect the same type of projections. 

Chairman CAMP. But it doesn’t look like you are even meeting 

your own projections that you had prepared. 

Ms. TAVENNER. I have not listed any information on enrollment. I think there are some assumptions you are making. 

Chairman CAMP. Well, I am just referring to this Associated 

Press memo that I appreciate you are willing to give to the committee that said that half a million people would sign up by October 31st and that they would enroll. But if we don’t meet this demographic of 2.3 million young people, I mean, it is very clear that 

premiums will go through the roof, whether in the next few months 

or in the future. And if that is where we are headed, and it appears 

that we are, how will you provide relief to individual Americans 

who don’t want or can’t afford this insurance, and how do we prevent the premium spike in 2015 as insurers will readjust their 

prices to reflect the actual enrollee demographic? 

Ms. TAVENNER. Currently, if you look at the premiums for 

2014, we did not see premium spikes, we actually saw a very competitive marketplace. In fact, we have over 200 issuers just in the 

Federal exchange alone who have offered more than 3,000 plans at 

very competitive prices. So markets have as many as 54 plans in 

a market. We have also seen 25 percent new issuers in markets. 

So far what we have seen is the absolute opposite of what you are 

suggesting. 

Chairman CAMP. Have you enrolled in the plan? 

Ms. TAVENNER. I have employer-sponsored insurance. I would 

not be eligible for the plan. 

Chairman CAMP. From the Federal Government? Is that what 

you mean? 

Ms. TAVENNER. Yes. 

Chairman CAMP. So you are not participating in Obamacare? 

Ms. TAVENNER. I am participating in employer-sponsored insurance, which 85 percent of the country does. 

Chairman CAMP. So you have government insurance. Have you 

gone on the site and tried to enroll or tried to shop for plans? 


ralbany on LAP520R082 with HEARINGS
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Ms. TAVENNER. I haven’t gone on to shop for the plans. I went 

on, actually signed up for an account just to see what it looked like 

and go through the application process, but did not sign up for coverage. I am not eligible for coverage, nor did I shop. 

Chairman CAMP. I just want to mention to you a letter that I 

received from my district. And this man wrote me and said, ‘‘My 

wife has been recently informed by her insurance carrier that her 

health care policy does not comply with the Affordable Care Act. 

Now we must purchase a new policy to get the same coverage at 

an 18 percent increase in our premium.’’ So what happened to the 

if you like your insurance you can keep it question? What would 

you say to that individual? 

Ms. TAVENNER. Well, I would take them back to pre-Affordable 

Care Act days where in fact if you were in the individual market, 

you were living at a 50 percent churn. Half the people in the individual market prior to 2010 didn’t stay on their policies. They were 

either kicked off for a preexisting condition, they saw their premiums go up at least 20 percent a year, and there were no protections for them. And sometimes they were in plans that they 

thought were fine until they actually needed hospitalization; then 

they found out it didn’t cover hospitalization or it didn’t cover cancer. 

So I would take them back to the fact that since 1986, health 

care costs and coverage have been the number one issue for small 

businesses for the last 20 or 30 years and we have been talking 

about it for the last 20 or 30 years. That is actually why I came 

into this job, is to try to deal with this issue. 

So now what I would say is this: Now if, in fact, the issuer has 

decided to change the plan, didn’t have to, plans were grandfathered in, in 2010. If they didn’t make significant changes in cost 

sharing and this sort of thing, they could keep the plan that they 

had. But some insurance companies have decided, and I think that 

is what you were referring to in your opening statement, that they 

want to offer new plans. And if they offer new plans, they have to 

come into the requirements of the Affordable Care Act, which are 

you have to offer the 10 essential coverage benefits, you cannot 

judge people on preexisting, you cannot discriminate based on sex. 

There are lots of things that are required under the Affordable 

Care Act that actually protect consumers. 

But these premium increases were going on a long time prior to 

the Affordable Care Act, and, in fact, we have seen the most premium moderation in the last 3 years than we have seen probably 

in 15 or 20 years. That is what I would say to them. I would try 

to explain to them the real issues. 

Chairman CAMP. Well, the carrier told them that the plan didn’t 

comply. But nothing you said had anything to do with how they 

can get their costs down. And I think that is the real problem that 

we are seeing here, is that the costs are—— 

Ms. TAVENNER. Right. So what I would tell that individual is 

if their carrier is telling them they are changing the plan and they 

are offering an increase, that they would need to go take a look at 

what is available in their State and in their market, which is certainly something that is available to them through the exchange. 

Chairman CAMP. Yeah, at an 18 percent increase. 


ralbany on LAP520R082 with HEARINGS
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All right. With that, I will recognize Mr. Levin. 

Mr. LEVIN. Well, thank you. 

A warm welcome. 

The chairman talked about the Web site, and you said it is going 

to be fixed. And I might say, if everybody would pitch in to make 

it work, the goals that have been set would be more readily met. 

That is what happened with the prescription drug program. We all 

pitched in to make it work. And it had major problems at the beginning, and instead of standing in the way we said, we didn’t vote 

for it, let’s make it work, and it began to work. If we all had the 

same spirit about ACA, it would be more than helpful. 

But then the chairman asked you about the notices that are coming from the insurance companies, and I would like to ask you 

about that. A gentleman from Michigan who had an $800 Blue 

Cross plan got this notice from Michigan Blue Cross, went into the 

Web site with the help of navigators, and ended up with a Blue 

Cross Silver HMO plan with tax credits in that case. And instead 

of $800 a month, it is $77 a month. 

And let me refer you to the interview on ‘‘Meet the Press’’ with 

the Blue Cross Florida Chief Executive Officer. He was asked by 

David Gregory, in Florida the oldest and largest health care plan 

provider, Florida Blue Cross, confirmed it is cutting 300,000 policies. And this is what the chairman of Blue Cross of Florida said: 

‘‘We are not cutting people,’’ and I quote. ‘‘We are actually 

transitioning people. What we have been doing is informing folks 

that their plan doesn’t meet the test of the essential health benefits; therefore, they have a choice of many options that we make 

available through the exchange, and, in fact, with subsidy, many 

people will be getting better plans at a lesser cost.’’ 

So this has become a matter of legitimate discussion, and I think 

all of us would appreciate your addressing it. 

Ms. TAVENNER. Yes, sir. Again, going back to prior to the Affordable Care Act days, these individuals in a small group or individual market had no protections, they had no guarantees of coverage, and they were still being charged somewhere between 20 

percent or more of premium increases year over year. So they could 

be kicked out at any time for a preexisting condition. Sometimes 

they thought they had coverage when they did not, and when they 

went in and had a cancer diagnosis or a cardiac diagnosis, they 

found out maybe they had a $5,000 hospital limit or they had certain disclaimers. Then, of course, there was always, if you were diagnosed with asthma or high blood pressure or some other chronic 

disease, you might not be able to get coverage at all. So that is 

what is different. So that is the first part. 

The second part is in 2010 we told issuers to try to give some 

transition time, if they wanted to keep policies as they were currently defined, whether they were in a group market or an individual market, they could. And so some of them elected to do that. 

Now some of them are moving to the new standards, and the 

standards under the Affordable Care Act are pretty simple. You 

have to have the 80 percent MLR. So you can’t be taking money 

more than the 20 percent to marketing, advertising, profit. You had 

to meet the 10 essential health benefits. You had to define copay, 

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ple would know what they were buying. You had to have choices 

among plans. And then there are folks in the individual market 

who when they go on the site may qualify for tax credits. Some in 

some States may actually qualify for Medicaid expansion. 

But this problem existed long before the Affordable Care Act. 

Now folks are transitioning to the new standards of the Affordable 

Care Act, which guarantee you can’t be denied, you won’t be kicked 

off of a policy because you develop a problem, you may be eligible 

for tax credits depending on your income. So these are important 

protections that are now available through the Affordable Care Act, 

and I think that is important. 

Mr. LEVIN. Thank you. 

I yield back. 

Chairman CAMP. All right. Mr. Johnson is recognized. 

Mr. JOHNSON. Thank you, Mr. Chairman. 

Ms. Tavenner, thank you for being here. 

You know, I have been hearing from folks back home who, rightfully so, are very serious about their concerns and fears about their 

health care. Steven from Plano tried to purchase insurance through 

the exchange, but ended up more confused and frustrated. Operators on the 1–800 line didn’t have answers to his specific questions. 

They simply reiterated that anyone could sign up for the exchange, 

but he should wait until later that evening or the next day to apply 

since the systems were having technical difficulty. 

Worse, a single father and police officer in Plano went to renew 

his 11-year-old daughter’s plan. She has no medical problems, yet 

her premiums doubled—doubled. Those are the real stories of fathers, mothers, sons and daughters who have to live with a law 

that up to now has completely failed them. 

Ms. Tavenner, the administration delayed the employer mandate 

for 1 year. The Treasury witness before the committee testified the 

reason the administration granted big business a 1-year delay is, 

quote, ‘‘Employers and their representatives have requested transition relief for 2014 because of concerns about the difficulty or costs 

of complying with the employer mandate.’’ 

Secretary Sebelius appeared before this committee and repeatedly said Obamacare was ready. It clearly wasn’t. 

Doesn’t the failed launch indicate many individuals are going to 

have to at least have as much difficulty complying with the individual mandate as big business had with the employer mandate? 

Yet from the announcement last night, you have only given individuals a 6-week delay. CMS announced 700,000 people had submitted applications for exchange coverage nationwide, but with all 

the challenges you have been facing, there are some serious questions about what these applicants know. 

CBS news reported, quote, ‘‘The shop and browse feature is not 

giving consumers a real picture. In some cases, people could end 

up paying double what they see on the Web site.’’ So how many applicants applied based on the wrong premium information? Do you 

know? 

Ms. TAVENNER. The completed applications were done, the 

700,000. These were individuals who completed applications and 

figured out if they were eligible for a tax credit. I do not know 


ralbany on LAP520R082 with HEARINGS
24 

where CBS news is getting their information about erroneous tax 

credits, so I can’t address that. 

I will say that in the individual mandate issue, that folks can 

apply through March 31st. We have said publicly that we will have 

the Web site in good working order by the end of November. We 

have always predicted that folks would increase their interest in 

enrollment in December and probably again in March, and so we 

believe that we are in good shape to handle that. 

Mr. JOHNSON. Well, if you have identified the problem and are 

taking steps to identify who received faulty price information, 

apologize—and provide the right information—are you doing that 

now? 

Ms. TAVENNER. Yes, sir. If we have given people the wrong information, we will certainly correct it, but I am not sure what CBS 

news is referring to. 

Mr. JOHNSON. I would like to bring to your attention a story 

which ran last week in Mother Jones with the headline, quote, 

‘‘How HealthCare.gov Could Be Hacked.’’ Let me just quote from 

the article. ‘‘Security experts say the Federal health insurance Web 

site is vulnerable to a common technique that hackers use to steal 

personal information.’’ 

As you may know, I am chairman of the Social Security Subcommittee, and one of my longest outstanding priorities has been 

to protect Americans’ Social Security numbers. So for the record, is 

the Obamacare Web site 100 percent safe from hackers who could 

steal Americans’ personal information, including their Social Security numbers, yes or no? 

Ms. TAVENNER. We follow all the standards to protect information, including Social Security numbers. 

Mr. JOHNSON. Are you trying to say yes? 

Ms. TAVENNER. Am I trying to say yes that we follow the 

standards to protect information? Yes, sir. 

Mr. JOHNSON. You know, folks are confused and scared. They 

have heard the horror stories and are now experiencing them firsthand. How can they trust the Federal Government to not only fix 

the Web site, but more importantly, give them the assurance that 

their personal information will be safe and their health care will 

be affordable, that if they want to keep their current plan, they can 

do so? 

The problems don’t stop at the technical failures of a Web site. 

The real problem stems from the colossal failure to deliver what 

this law promised the American people. 

Thank you, Mr. Chairman. 

Chairman CAMP. All right. Thank you. 

Mr. Rangel is recognized. 

Mr. RANGEL. Thank you so much, Mr. Chairman. 

And welcome to our distinguished committee. You may wonder 

why the administration appears to be under such severe attack by 

some Members of this committee, especially as it relates to our goal 

to provide health care for 30 million Americans that can’t afford or 

don’t have access to it, but it should give you some small comfort 

to know that historically the Republican Party always fought vigorously against these types of programs. I don’t think that one ReVerDate Sep 11 2014 03:35 Dec 10, 2016 Jkt 021119 PO 00000 Frm 00028 Fmt 6633 Sfmt 6602 I:\WAYS\OUT\21119.XXX 21119

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publican voted for the Social Security Act, even though those old 

enough to enjoy the benefits. 

Chairman CAMP. That is not accurate. 

Mr. RANGEL. Well, we will see maybe one or two. I don’t know. 

Chairman CAMP. No. 

Mr. RANGEL. But they opposed Medicare. I spoke with President Johnson, and he shared with me at the ranch people that had 

signed off on Medicare. And anyway, it is big government. Even if 

it saved lives, who cares. You are against big government. So why 

should Obama be spared the attack because he wants Americans 

to be healthy and strong and productive? We have to be consistent, 

and you guys and ladies have been. 

What I don’t understand is that people aren’t born as Republicans and Democrats, and there has to be somebody, regardless of 

party label, that has suffered the embarrassment and the pain of 

being denied an insurance policy because they have been sick before. The people who actually need health care the most are too 

high a risk for some of the insurance companies, and this body, Republicans and Democrats, allowed things like this to happen. 

When I was a kid, if my mother took three of us, three children 

to see a doctor and we weren’t sick, they would think she was 

crazy, because you couldn’t afford a doctor. Now health care will 

provide you getting the type of treatment to avoid you being sick 

and having to lose your dignity in impersonal emergency rooms 

that provide the most expensive health care that we have. But Republicans, who have always been admired for being fiscal conservatives, have certainly seen the price of health care, the lack of 

quality that we may have today, soar to become such a part of our 

national budget that, in my opinion, it is a threat to our national 

security, because as prone as some of you are to enter into conflict 

with other countries, you need healthy young people to fight these 

wars. And health care is important from birth throughout one’s life. 

So I don’t know how you are going to explain when this program, 

which is destined to succeed, how politically you are going to explain your positions today. And since your entire political program 

is locked into hatred for the President and this program, it seems 

to me that we have to find other ways for us to politically combat 

each other, because I hate to see the day that there is no Republican Party and I have to rely just on my party for justice and fair 

play. And so we have to come together some kind of way to see 

what is best for America. 

Now, you may not like this program, and it certainly has been 

disappointing as a start, but what I want to see more from this 

committee is how can we improve and get quality health care for 

all Americans. This has to be a part of the goal that all of you 

have. And you also have to recognize that when we are lucky 

enough to have public servants to work for the administration, 

whether Democrat or Republican, that they are servants the same 

way we are and they deserve some dignity as well. 

And so for America, I hope and have every reason to believe, like 

Social Security, like Medicare, that the goodness of the program 

will prevail. And if there is anything that we can do to help you, 

and there may be some Republicans that will join with me, to make 

certain that we get rid of what is not working and make certain 


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everyone has access to health care, I wish I could see the politics 

involved in this, because I am a partisan, but a stronger America 

means a stronger party, and that is what we are here for. And I 

just want to thank you for your dedication and for you to recognize 

that it is all political and we have to do our job and get on with 

it. Thank you for your service. 

Chairman CAMP. All right. Thank you. 

Mr. Brady is recognized. 

Mr. BRADY. Just a quick fact check on the blast from the past. 

Republicans did support Social Security and Medicare, and more 

recently Republicans were the ones that reformed Medicare to add 

that important prescription drug benefit so we could have seniors 

lead healthier lives, stay out of hospitals, and enjoy their grandchildren more. 

What has become abundantly clear, the flaw is not the Web site, 

the flaw is the law itself. This is what happens when you inject 159 

new Federal agencies, bureaucracies, and commissions between you 

and your health care. And this was supposed to be the easy part. 

Just wait until you see the government making decisions about patient care, about reimbursements and treatments that you receive 

from your local doctor and hospital. 

Ms. Tavenner, I have a great deal of respect for you, and I suspect many Republicans do, yet the White House, Secretary 

Sebelius, you, and your staff made repeated claims to the American 

public and to Congress that everything would be ready on time, everything was a go. None of that proved to be true. Now we are told 

everything will be okay very soon. So why should the American 

people believe you now? 

Ms. TAVENNER. Congressman Brady, I would go back to what 

has worked in the last 31⁄2 years since the Affordable Care Act was 

implemented. We have been able to make a difference in the lives 

of coverage of young people, we have been able—— 

Mr. BRADY. But specifically on the Web site and the exchanges, 

why should the American people believe you now? You have had 

nearly 4 years to get it ready. Now you are saying in 4 weeks more 

it will be great. So what is different? Why should anyone believe 

these claims? 

Ms. TAVENNER. Because I think we have identified two major 

problems. One had to do with the initial volume. And despite our 

best volume projections, we underestimated the volume, the interest in the site. 

Mr. BRADY. But you know that the volume isn’t the same as the 

applicants in the enrollment, that you, yourself, visited the site. 

Clearly you weren’t shopping for it. Others did as well. 

Ms. TAVENNER. Right. 

Mr. BRADY. So to Chairman Camp’s point, the number of applicants, the number of enrollees, apparently still not known, is pretty 

modest. Wouldn’t you agree? 

Ms. TAVENNER. Well, but I would tell you that the number of 

visitors to the site and the number of people interested in completing applications was larger than even our initial projections. 

And we worked our projections off of the 7 million number that 

Chairman Camp mentioned. We also worked it off our history with 


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Medicare Part D. So we have added capacity to the system and we 

have improved system performance. So that is the first thing. 

The second thing is we have found some what I will call functional or glitches, as we call them in the public term, in the actual 

application itself which we are repairing, and that is the gradual 

improvements that you will see over the next 4 weeks and that is 

why I am confident about the end of November. 

Mr. BRADY. Well, can I tell you, my constituents are frightened. 

Like millions of Americans, they are now being forced out of the 

health care plan that they like. The clock is ticking on a Web site 

that is broken. Their health care isn’t a glitch. It is what they depend upon. 

So, you know, you have been described as the quarterback of the 

Obamacare rollout. I am sure that is not the term you chose for 

yourself. But can you guarantee no American will experience a gap 

in their health care? 

Ms. TAVENNER. So what I can guarantee is that we have a system that is working. We are going to improve the speed of that system—— 

Mr. BRADY. Excuse me. 

Ms. TAVENNER. Yes? 

Mr. BRADY. You are saying the system right now is working? 

Ms. TAVENNER. I am saying it is working, it is just not working 

at the speed that we want and at the success rate that we want, 

and those are the things we are working on. We also have alternative methods for folks. They can use the call center, they can use 

paper applications, and then we have in-person assistants available 

in each State. So I can guarantee you that we can reach out to each 

individual and help them select a plan and enroll. So, yes, sir. 

Mr. BRADY. But to my point, this is not supposed to be fixed 

until November 1st. People have just 2 weeks to apply, enroll, be 

confirmed. So what happens on January 1st, when they have an illness, they need patient care then, they have not heard back from 

the government? What do they do then? 

Ms. TAVENNER. They have until March 31st to enroll. 

Mr. BRADY. No, but their plan has been cancelled, as millions 

of Americans have found out. 

Ms. TAVENNER. You are talking about people who—— 

Mr. BRADY. What my constituents want to know, what happens? 

Ms. TAVENNER. The individuals who have received notices from 

their issuers is a different situation. They can certainly obviously 

sign up, transfer, as we talked about earlier with Blue Cross of 

Florida, or they can go on the exchange or call the call center—— 

Mr. BRADY. But my point is, it has been cancelled, they don’t 

have health care, they have tried to get on the Web site unsuccessfully, they don’t know if they are enrolled, it is January 1st, they 

are facing a gap in coverage. What do you tell them? 

Ms. TAVENNER. I am telling you they can call the call center 

today and we will help them. They can go online, and if they are 

not successful, we can help them through the call center. We also 

have people in their individual markets that can help them in person. So there are more methods than just the Web site, and I think 

that is important. 


ralbany on LAP520R082 with HEARINGS
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Mr. BRADY. I think what has become clear as well is Obamacare 

is not ready. The question is, why don’t we make it voluntary? Why 

don’t we give Americans a choice so they are not forced into this 

health care that they don’t want? 

Mr. Chairman, yield back. 

Chairman CAMP. Mr. McDermott is recognized. 

Mr. MCDERMOTT. Thank you, Mr. Chairman. 

Mr. Rangel has asked me to correct something. The vote coming 

out of this committee was on a party line vote. There were no Republicans who voted for it when it left this committee. When Social 

Security—— 

Chairman CAMP. Will the gentleman yield? 

Mr. MCDERMOTT [continuing]. There were 81 who finally voted 

for it, mostly progressives, but there are none less in the Congress. 

Chairman CAMP. Yes, 84 percent of Republicans voted for the 

Social Security act 77 years ago. I am glad we are debating current 

events here, Mr. McDermott. 

Mr. MCDERMOTT. Reclaiming my time, Mr. Chairman. With 

the way my Republicans colleagues have been fretting over the success of the Affordable Care Act exchanges, you would never know 

they spent $24 billion shutting down the country to get rid of it. 

Suddenly they seem desperate to see a bill that they didn’t want 

actually work. It is like the ‘‘Annie Hall’’ joke: The exchanges are 

terrible and not enough people can enroll. 

Now, this is one of the biggest reforms our country has ever 

made and we are only 4 weeks into it. Medicare wasn’t built in a 

day. Part D didn’t roll out without snags along the way. As others 

have mentioned, many of the Republicans who are now calling for 

blood over this rollout were begging for patience on Part D. The 

kinks of that rollout were easily brushed off by many GOP alarmists who sit on this dais. We waited 6 months to hold an oversight 

hearing on Part D. We are barely 4 weeks into this one, and we 

are already declaring it dead. It is premature death. 

We would have all loved to see this launch be seamless and 

smooth, but we can’t get caught up in the glitches and the technical difficulties and lose our perspective. Help lines are up and 

running. I want to put the first chart up, because I think that you 

need to know that it is working in some States in this country. We 

have had a health plan finder in the State of Washington that has 

been out on the street before October 1. In Washington State we 

were ready to go and we have got 92,000 people who have now enrolled. 

Now, there is a difference between enrolling and being approved, 

having your plan approved, because you have to make your first 

payment. So when you talk about enrollment, you may be talking 

about something different. You are not comparing apples and oranges. 

But there are States in which it is working. People can sign up 

by mail, in person. We had actually a mobile signup van that is 

going around the State stopping in small towns and giving people 

a chance to talk to somebody. And 49,000 people are already in the 

program, not just finished the application. 

Now, there have been some glitches, even in our State, but we 

got around them. Our country does have a serious problem, howVerDate Sep 11 2014 03:35 Dec 10, 2016 Jkt 021119 PO 00000 Frm 00032 Fmt 6633 Sfmt 6602 I:\WAYS\OUT\21119.XXX 21119

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ever, with access to quality health insurance, and it is not being 

caused by Web sites. All of the computer programmers in the world 

aren’t going to be able to help the 180,000 Hoosiers that fall into 

the affordable coverage gap because Indiana isn’t expanding its 

Medicaid. Of course, that is nothing compared to Georgia’s 400,000 

people who aren’t going to get anything, or Florida’s 760,000. 

And then, of course, there is Texas. Texas is always the best and 

they are not going to be outdone. Texas boasts 1,460,430 people 

who will simply get nothing, no Medicaid, and I guess they can 

come to the government exchange, which people here want to kill. 

That is over a million Texans, working poor with minimum wage 

jobs, multiple of them, and they are just trying to get by. 

Now, they could be covered at no cost to themselves or the State 

of Texas, but instead the GOP wants to see this President fail because they would rather let their constituents go uninsured than 

compromise. Those Texans and Floridians and Hoosiers are simply 

out of luck. 

Meanwhile, in other red States, like Kentucky, they have enrolled already 26,000 people through the State exchange or expanded Medicaid. Arkansas, now, they don’t want it, either, and 

they don’t want to accept the Medicaid money. They constructed 

their own way, in cooperation with the Federal Government, and 

they have got 56,000 people enrolled in Arkansas. Now, here is a 

red State that worked very hard to partner with the Federal Government and arrive at a solution that is working for its residents. 

It is time really to start working together. Forty-four attempts to 

repeal this law. It is now law, folks. It is now up and running. It 

is going to run. And it is time to stop this kind of sniping and get 

together and figure out how to make it work. No one on our side 

thinks the law is perfect. 

Chairman CAMP. All right. Thank you. Time has expired. 

Mr. Ryan is recognized. 

Mr. RYAN. Thank you. And thanks for being here. 

I think what we are seeing here are all these rude awakenings 

that the American people are waking up to find; you know, promises made and promises broken. We had a hearing here in this 

room on August the 1st with the IRS, and the IRS confirmed that 

the delay in the employer reporting requirements would mean that 

the IRS would not have the data on the so-called back end from 

employers until 2016 to verify if an individual had been given an 

offer of affordable employer-sponsored health insurance in 2014. 

Now, the reason this matters is that determines whether a person 

is eligible for a taxpayer-funded subsidy or not. 

To mitigate this, Dan Werfel, the IRS Commissioner, told us 

that, quote, ‘‘We are going to help the individual at the front end 

when they are navigating through the exchange to understand 

whether they have an employer plan.’’ 

Let me ask you this: Of the 700,000 applicants you have received, how many of them did you verify whether or not they have 

been offered employer-sponsored insurance? 

Ms. TAVENNER. The verification of employer-sponsored insurance is part of the application process. So if, in fact, that was available to them, they would not go on and complete the application. 


ralbany on LAP520R082 with HEARINGS
30 

Mr. RYAN. So it is just a self-attestation. Is that what you are 

saying? You had no way of corroborating this? 

Ms. TAVENNER. We actually ask some additional questions. If 

you have gone online and go through the application, it actually requests some additional information. And we have ways of verifying 

whether or not employer-sponsored coverage was offered. So it is 

not just as simple as yes or no. If they don’t have it, it is a no, and 

so we accept that. If it is a yes, then we try to work with them to 

see if they are eligible for anything or not. 

Mr. RYAN. Okay. So I look at yesterday, you released a report 

that purported to talk about premiums for young adults. The report 

admits, quote, ‘‘These estimates do not take into account the tax 

credit eligibility requirements relating to other minimum essential 

coverage or tax filing requirements.’’ Young adults on their parents’ 

plans. 

Let me ask you this. Are you proactively finding out if individuals under the age of 26 who are eligible to stay on their parents’ 

plan are doing that or not? Because they are not eligible for a subsidy then as well. 

Ms. TAVENNER. Right. So what we have seen is since the Affordable Care Act we have over 3 million young adults who are getting coverage through their parents’ plans, which is pretty much 

the pool that we anticipated. So they are going through their parents’ plan. 

Mr. RYAN. No, but when they go on the Web site, are you 

verifying whether or not their parents have a plan that they are 

eligible for before determining whether they, themselves, get a subsidy? 

Ms. TAVENNER. It is part of the application process. I can get 

you more information on that. 

Mr. RYAN. Well, here is the point. Look, 2 weeks ago in the CR 

we passed a law that President Obama signed, quote, ‘‘Prior to 

making such credits and deductions available, the Secretary shall 

certify to Congress that the exchanges verify such eligibility consistent with the requirements of the act.’’ 

Here is the question. Are we really verifying at the front end 

whether a person is actually eligible for these subsidies or not? 

Here is why this matters. If they are not eligible for the subsidy, 

and then once we reconcile these records, they get taxed the money 

back off of their refund. 

And so this is what I mean when I say rude awakenings. People 

are signing up for insurance, they are getting tax credit subsidies 

funded by taxpayers. The IRS is already telling us they are confused about how to do this. You are not telling us whether or not 

you are proactively determining whether, say, an under-26-year-old 

is actually eligible for the subsidies you are trying to sell them. 

And the problem is once we learn whether or not they were eligible, and if they weren’t, people in good faith will be signing up for 

subsidies that they are actually not eligible for. 

Ms. TAVENNER. I think you are asking a different question, 

which is, are we doing 100 percent income verification on everyone? 

Mr. RYAN. And subsidy eligibility verification. 

Ms. TAVENNER. Yes. So part of the question in the application 

process is, are you dependent on your parents? Are you dependent 


ralbany on LAP520R082 with HEARINGS
31 

on your parents’ tax plan? So that is part of the questioning that 

goes on. And if so, we move them in that direction. But more importantly, part of what you are asking is the income verification, 

which is done in 100 percent of the cases. 

Mr. RYAN. I am not asking about income verification. 

Ms. TAVENNER. Okay. 

Mr. RYAN. I am asking about, if a person signs up, were they 

offered credible employer insurance? Because the employer mandate has been delayed you don’t have that verification tool, so you 

had to come up with a new verification tool to determine their eligibility for subsidies. Because if a person is offered insurance at their 

job—— 

Ms. TAVENNER. Right. 

Mr. RYAN [continuing]. That meets your definition of credible insurance, then they can’t get Obamacare subsidies. 

Ms. TAVENNER. That is correct. 

Mr. RYAN. If a person is 25 years old and they go on the Web 

site and they say their income is X, and that is eligible for subsidy, 

they can get that subsidy. But if they were eligible to be on their 

parents’ plan they are not allowed to get that subsidy. 

Ms. TAVENNER. That is right. 

Mr. RYAN. The question is, are you filtering that? 

Ms. TAVENNER. Yes. 

Mr. RYAN. Because here is the problem. If you get this wrong, 

the way the law works is you have to take that money back in their 

tax refund. Tax refunds matter. People plan their lives around 

their tax refunds. 

Ms. TAVENNER. I understand that. 

Mr. RYAN. They plan their spring breaks for their kids. They 

plan their car payments, their bills. And what people in this country don’t yet know is that if you get this wrong, which you have 

already acknowledged you are not doing it right, they are going to 

get their tax refund taken away from them because they will have 

signed up for a subsidy that they weren’t eligible for which they 

didn’t even know. 

Ms. TAVENNER. And if you have been on the site, this is part 

of the clear instructions to folks, including the under age 26, including the fact that you are basically completing this application 

under penalty of perjury. It is very clear. There is also help instructions on each site to explain each process, what is credible employer coverage, what happens if you are under 26. It is all available on the Web site. 

Mr. RYAN. Okay. So if they get it wrong, they are the one who 

is going to get taxed. 

Chairman CAMP. Okay. Time has expired. 

Mr. Lewis. 

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

Thank you, Madam Administrator, for being here. Thank you for 

all your hard work and for your years of service. 

I happen to believe that health care is a right and not a privilege, that it is not just for the fortunate few, but all citizens of 

America. 

Now, the Affordable Care Act is the law of the land. It was 

passed by the Congress, signed into law by the President of the 


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32 

United States, and upheld by the United States Supreme Court. 

There have been more than 40 attempts to repeal the act, and it 

did not succeed. And by attempting to repeal it, Members of this 

body, Members on the other side of the aisle closed down this government and threatened the economy of the United States, costing 

us more than $24 billion. 

This reminds me of another period in our history not so long ago. 

During the 1950s, many Southern Senators signed the Southern 

Manifesto after the Supreme Court decisions of 1954. And those 

Senators, along with many Southern governors, subscribed to the 

doctrine of interposition and nullification, and some even massive 

resistance. That is what we saw on the part of the Republican 

Members of the House and some of the Republicans in the Senate. 

The Affordable Care Act is working. It is helping to make health 

care affordable and accessible to hundreds, thousands, and millions 

of our citizens who never had it before. When I was growing up in 

rural Alabama, we couldn’t afford to see a doctor. None of the poor 

people in Alabama, in Georgia, in Kentucky, in Arkansas, and all 

across the Deep South can see a doctor. We must do what is right, 

what is fair, and what is just. 

Now, Madam Administrator, I have a chart here this morning, 

and I want you to walk us through this chart. And I want to use 

my remaining time for you to explain to the Members of the Committee the success and the benefits of the ACA. There have been 

a deliberate and systematic attempt on the part of the majority in 

the House and the minority in the Senate to make it impossible for 

all Americans to receive quality health care. And some of us will 

not stand for it. We will stand up and fight for what is right, for 

what is fair, and what is just. Health care is a right and not a 

privilege. Walk us through the chart. 

Ms. TAVENNER. Let me start with the 78 million consumers 

saving $3.4 billion on their premiums. This is due to some of the 

work that was done around the medical loss ratio. These were benefits that actually went in forms of checks to individuals. I actually 

got thank you notes from people that I have never heard of, that 

I have never met thanking me for getting a rebate back. It could 

go to the individual or it could go back into their premium for the 

following year. 

Seventeen million children with preexisting conditions used to be 

able to be denied coverage, this goes back to the flaws in the individual market that existed prior to the Affordable Care Act; 6.6 

million young adults able to stay on their parents’ health insurance 

plan, that is critical, particularly at the time with what we were 

going through with our economy; 7.1 million seniors in the donut 

hole. And let me remind you that in addition to that, you saw our 

release yesterday about the Part B premium being flat for next 

year. That is some of the work of the Affordable Care Act in controlling costs. 

And let me just say, going back to your point, Congressman, is 

that if we had the highest outcomes, if we had the lowest infant 

mortality, if we had the longest lifespan, maybe what we were paying would be worth it. But it is not the case. As you know, our 

country does not look good in terms of overall health statistics, and 


ralbany on LAP520R082 with HEARINGS
33 

certainly the South is suffering from that more than the rest of the 

country. 

Mr. LEWIS. Thank you very much. 

With that, I yield back my time. 

Chairman CAMP. All right. Thank you. 

Mr. Nunes. 

Mr. NUNES. Thank you, Mr. Chairman. 

Madam Administrator, just in response to Mr. Ryan’s question, 

we went through the Web site, and we don’t see anywhere where 

it shows that if you are under 26 that there is a verification. 

Ms. TAVENNER. So let me also say one thing that I had wrong. 

As a young adult you can stay on your parents’ policy and you can 

get your coverage that way. 

Mr. NUNES. But the question was there was no check on the 

subsidy. 

Ms. TAVENNER. Or you may go as an individual and you would 

be eligible for a subsidy. There is no penalty. 

Mr. NUNES. Well, if you are 26, if you are under the age of 

26—— 

Ms. TAVENNER. You can go either way. 

Mr. NUNES [continuing]. To Mr. Ryan’s point, you can get a free 

subsidy and get that back on your tax return. That was the point 

Mr. Ryan was making. And there is nowhere—— 

Ms. TAVENNER. You are eligible for a subsidy, yes. 

Mr. NUNES. You are eligible. So you can be on your parents’ 

health care. And you are still eligible for a subsidy. 

Ms. TAVENNER. But I will remind you part of what you complete on the application is do you have coverage. You are also 

under penalty of perjury. So you have to tell the truth on your application. That is kind of a requirement. 

Mr. NUNES. Okay. In your submitted testimony you attributed 

the problems to HealthCare.gov Web site to a subset of contractors. 

Is that correct? 

Ms. TAVENNER. I don’t think I said that it was due to a subset 

of contractors. I said we had two issues that we were dealing with. 

The first was capacity, in that our first few days the volume was 

more than we anticipated, so we had to add capacity. We had a 

problem with account creation, with the email account creation, 

which was subsequently fixed. 

Mr. NUNES. So on your August 1 testimony to the House Energy and Commerce Committee, to Congressman Pitts’ question, do 

you remember this question? 

Ms. TAVENNER. You will have to ask the question. 

Mr. NUNES. He asked, and I quote, ‘‘Do the contractors who 

HHS is paying to build these exchanges have certain targets or 

milestones that they have to meet?’’ You replied, ‘‘Absolutely.’’ Congressman Pitts then asked you, ‘‘Can you tell us today that every 

contractor has met these targets and is on time?’’ You replied, ‘‘Yes, 

sir, I can.’’ 

So it seems there are two possibilities here. First, the exchanges 

were progressing fine for years, just as you repeatedly told Congress, and the breakdown resulted solely from problems with a few 

contractors that suddenly occurred 60 days before Obamacare was 

open to the public. Or the second possibility is, is that there were 


ralbany on LAP520R082 with HEARINGS
34 

problems much earlier that were being reported in the press, but 

you did not tell Congress about these. Which is closest to the truth? 

Ms. TAVENNER. If I remember the questions correctly, what 

Congressman Pitts was asking me related to the hub, and the hub 

was progressing on time and on schedule. It still is. The hub has 

actually operated pretty much flawlessly. And most of the questions were around the hub. 

Mr. NUNES. So it has been also reported that neither criminal 

background checks nor high school diplomas will be required for socalled navigators to be hired to help Americans access the exchanges. Is this true? 

Ms. TAVENNER. Could you repeat that? I am sorry. 

Mr. NUNES. Neither high school diplomas nor criminal background checks will be done on the folks that you hire to help Americans navigate the Obamacare Web site. 

Ms. TAVENNER. I don’t think that that is true. Are you talking 

about through the navigator program? There are standards, and I 

can get you those standards. 

Mr. NUNES. Okay. Well, it has been a press report. 

Has anyone in the White House or anyone else asked you to 

delay divulging enrollment numbers as it regards to Mr. Camp’s 

question at the beginning? 

Ms. TAVENNER. No. I think if you remember, we had said all 

along that we were going to release our first numbers the middle 

of November. 

Mr. NUNES. So no one at the White House, no one in the entire 

Obama administration has asked you not to release those numbers. 

Ms. TAVENNER. We have made a group—we made the decision 

that we were not releasing the numbers till mid-November. 

Mr. NUNES. And you don’t know, you have no idea what those 

numbers are at this point? 

Ms. TAVENNER. I told you we would release the numbers in 

mid-November. 

Mr. NUNES. Okay. I will take that as you don’t want to answer 

the question. 

Did you ever argue to Secretary Sebelius, or to anyone at the 

White House, or to anyone else that the exchanges would not be 

ready October 1 and that a delay in launching them would be warranted? 

Ms. TAVENNER. I did not ever argue that we should delay the 

exchanges. What I did present to the Secretary in September is 

that there were certain functions that we should delay beyond October 1, and I think those have been very much in the press. That 

had to do with the automation of SHOP. It had to do with the 

Spanish-language Web site. It had to do with Medicaid account 

transfers. So that was presented in September as things we would 

not bring live October 1. 

Mr. NUNES. Before my time expires, I want to yield quickly just 

5 seconds to Mr. Ryan. 

Mr. RYAN. Look, I find it puzzling we have to explain to administration officials how the law works. The law is if you are under 

the age of 26 and you are eligible to stay on your parents’ plans 

you cannot receive subsidies. 

Ms. TAVENNER. You are right. 


ralbany on LAP520R082 with HEARINGS
35 

Mr. RYAN. And there is nothing, nothing on your Web site that 

tells an under-26-year-old those facts. So you are encouraging people to sign up for insurance and a subsidy that they may not be 

eligible for and they don’t even know this. 

Ms. TAVENNER. Congressman Ryan, I am happy to go back and 

check on that and get you information. 

Mr. NUNES. Yield back. 

Chairman CAMP. All right. Thank you. Time has expired. 

Mr. Neal. 

Mr. NEAL. Thank you, Mr. Chairman. 

I think one of the differences here in the legislative modeling is 

the way that we attempted to repair the drug prescription benefit, 

known as Part D, in terms of addressing the donut hole. We didn’t 

suggest that we wanted to repeal the law. We simply said to repair 

it. And I remind everyone that part of it was gimmickry as it related to the donut hole as well. But our position was let’s improve 

it. And in the Affordable Care Act, I think that you could safely say 

that that has happened. 

Now, I want to go to a broader argument here, and that is that 

97 percent of the people in Massachusetts are covered, and virtually every child in Massachusetts is covered. We are in the midst 

of marketing the open enrollment plan. And I got to tell you the 

marketing is terrific. 

But I want to come to another point, and that is the following. 

There is a great picture at Faneuil Hall, where much of the American Revolution was designed and hatched, of Governor Romney— 

or as we know him on this committee, Paul Ryan’s running mate, 

the other guy on the ticket—Ted Kennedy, the Heritage Foundation, and the governor sets his hand to this legislation, which has 

become a model for applicability, efficiency, and success. Hardly 

perfection. But what a grand possibility. Why, in your estimation, 

has the Massachusetts plan worked? 

Ms. TAVENNER. I think the Massachusetts plan over time has 

allowed individuals to not have to worry about preexisting. It is required that they have insurance. It is required that they participate in group coverage, a group market. It is the same principles 

we have applied through the Affordable Care Act. And it has been 

a huge success. They started out very slowly. It took them years 

to get to where they are today. But they do have good coverage. 

And if you look at their outcome, they have got excellent outcomes 

in health care as well. 

Mr. NEAL. The business community worked with the governor, 

worked with a Democratic legislature that has three Republicans 

in the State Senate, and they came to the conclusion that using the 

discipline of the marketplace could be part of the solution. And getting everybody in was the ideal. And then we would argue about 

many of the other matters. But getting everybody signed up was 

a key component, and we would use the private sector to discipline 

price. Correct? 

Ms. TAVENNER. That is correct. 

Mr. NEAL. So I guess the argument we have here is, why 

wouldn’t we be trying to sand the edges of the ACA to make it 

work as opposed to this determination to make sure that it doesn’t 

work? 


ralbany on LAP520R082 with HEARINGS
36 

Yield back my time. 

Chairman CAMP. Thank you. 

Mr. Tiberi is recognized. 

Mr. TIBERI. Thank you, Mr. Chairman. 

Thank you, Ms. Tavenner, for coming today. You have got a 

great reputation. Thank you for your service. You have got a very 

difficult job to do. Best of luck in doing it. 

I want to just make a note to you and to the members of the audience here. On September 30, the Republican House passed a continuing resolution that funded government and delayed for 1 year 

the individual mandate and the implementation of this bill. That 

was on September 30. That died in the Senate, delaying this for 1 

year. 

The reasons why we believe that was the right policy, and I 

think history will show that it is, is what we have seen in the 28 

days since, and that is the disastrous unveiling of this bill. You 

don’t have to be a Member of Congress and talk to constituents to 

understand the difficulty that the implementation has caused in 

people’s daily lives. And as Mr. Brady said, the nervousness and 

the fear. 

You have been telling us that there are other options, in addition 

to the Web site. The President actually has gone out and sold that 

pretty well. So if a constituent of mine goes and makes the phone 

call to try to find out some information, can she find out by calling 

the phone number if the doctor in her current network is covered? 

Ms. TAVENNER. She cannot find out through the phone call if 

the doctor—and that is I think true—that was true in the market 

prior to the Web site. 

Mr. TIBERI. Can she find out if the plan costs more than her 

current plan? 

Ms. TAVENNER. Yes, I think she can find that out. 

Mr. TIBERI. By calling the phone number? 

Ms. TAVENNER. Yes. What happens is they work them through 

the application. The call center would help them. 

Mr. TIBERI. She has to actually apply before she can shop. 

Ms. TAVENNER. Well, yes, that is important because it is important to understand if she is eligible for a tax credit, because 

that affects the prices that she would pay. 

Mr. TIBERI. So can she find out the cost of a plan without signing up or comparison shop without signing up? 

Ms. TAVENNER. So if you are not interested in the tax credit 

and you just want to know what rates are available, we actually 

have on the Web site the ability to do that. So, yes. 

Mr. TIBERI. But the Web site is not working. 

Ms. TAVENNER. No, this is actually on the front end. What is 

not working sometimes are some of the pieces inside the application. But if she is just interested in rates in her market, that is 

available through the Web site. There is also the ability, and we 

have a link with that on the Web site, to use Kaiser’s site that also 

allows them, if they believe they are eligible for tax credits, to actually go in and simulate what that would be like for them. 

But if they want to know, if they are not interested in tax credits, they just want to know what is available to them, which I have 

had several friends who have said to me, I know I am not eligible 


ralbany on LAP520R082 with HEARINGS
37 

for a tax credit, I just want to see what rates are available in the 

individual market. 

Mr. TIBERI. But they have to sign up to do that. 

Ms. TAVENNER. No, they do not. 

Mr. TIBERI. You are positive on that. 

Ms. TAVENNER. I am positive on that. 

Mr. TIBERI. Isn’t the person who is on the phone with my constituent who is trying to find out if their doctor is in network 

or—— 

Ms. TAVENNER. No, you asked a different question. Doctor in 

the network I said is not available through the Web site. 

Mr. TIBERI. Right. So the person who is making the phone call, 

my constituent is talking to somebody on the other line, aren’t they 

accessing the same information on the Web site that our constituents are encouraged not to do because the Web site is not working? 

Ms. TAVENNER. So two different issues. If they are completing 

an application then they would complete the application and we 

would give them information. But if you are just interested in 

knowing what the insurance rates are in your area, that is actually 

available without completing an application. You can just go on the 

Web site and get that information. 

Mr. TIBERI. But if they are accessing the phone network because they can’t access the Web site—— 

Ms. TAVENNER. They can give them that information. 

Mr. TIBERI. Isn’t that person they are talking to accessing the 

same Web site? 

Ms. TAVENNER. Yes. But it is not inside the application. 

Mr. TIBERI. So we are asking people to call and talk to a person 

who is accessing the same Web site that we are encouraging our 

constituents not to use because it is not working right. 

Ms. TAVENNER. Let me try this again. The problem that we 

have in the Web site sometimes is in the application process itself. 

Inside the application people were getting stuck in the application 

process. What you asked me is can you get plan information without completing the application process, therefore not getting into 

the problems. And the answer to that is yes. 

Mr. TIBERI. Okay. Let me just tell you the concern that I 

have—— 

Ms. TAVENNER. Okay. 

Mr. TIBERI [continuing]. That you are going to have to deal 

with, and the members of the other side of the aisle won’t acknowledge. We understand the Affordable Care Act is the law of the 

land. We do. But we also understand from our constituents that 

there is a disaster of a rollout that is occurring, not a hiccup, but 

a disaster of a rollout that is occurring. I have constituents who 

have said to me their doctor is not going to be covered in the new 

plan. Their plan is going to be more expensive. And finally, a constituent who said, let me get this straight, Congressman, you guys 

passed a bill that tells me that I am transitioning, you are telling 

me to transition to another plan, and you are telling what that 

plan is going to be. It is not going to have the same benefits that 

I have now. I am going to pay more. But you are going to give me 

a tax credit back so I can pay less, even though it is going to cost 

more. 


ralbany on LAP520R082 with HEARINGS
38 

That is just crazy. And for us not to acknowledge that is crazy 

is just so disappointing and discouraging. 

I yield back. 

Chairman CAMP. The time has expired. 

Mr. Doggett. 

Mr. DOGGETT. Thank you, Mr. Chairman. 

While I am troubled by the determination of our Republican colleagues to destroy the rights of Americans to access affordable 

health care, I recognize that the promise of affordable health care 

can also be denied through a management failure. I share some of 

the concerns that have been raised here this morning. And if there 

were even one Republican Member of this committee who wanted 

to fix the shortcomings in the act and to learn lessons from the rollout about how to improve access, we could have a constructive 

hearing that focused on those limitations and how to address them. 

At the top of the list for any Texan would surely be the million people that, when we thought we were providing protection when we 

enacted this law, who are getting absolutely nothing out of it. 

The limitations with the Web site are a part of the concern that 

I have. Let me ask you specifically, will the SHOP Web site for 

small businesses that was delayed be fully functional during November? 

Ms. TAVENNER. Yes. We will institute the SHOP component at 

the end of November. 

Mr. DOGGETT. Will the twice-delayed Spanish-language version 

of HealthCare.gov be fully operational in November? 

Ms. TAVENNER. By the end of November, yes, sir. 

Mr. DOGGETT. There are estimates that three out of four eligible individuals for the Web site need some in-person assistance— 

eligible for tax credits—will need some assistance in person to access that. That is why the navigators, for one, are so very important. In large measure because of the statute, people in Maryland 

get 15 times as much money per individual uninsured eligible for 

the exchange for the tax credits as do people in Texas. People in 

California get about four times as much. It makes it all the more 

important that the navigator system work as well as the Web system works. 

I have had some concerns about the way that navigator system 

works and have been asking whether it is possible to get prompt 

reports about whether the navigators are doing their job and 

whether they are accessing people, whether by paper, phone, or 

Web. I have been told that there are no progress reports that will 

be available on those navigators and what they are doing until 

after the beginning of the year. Surely, there are some reports that 

you can make available that will tell us whether these navigators 

are doing any more than the little I have seen them do in my part 

of Texas. 

Ms. TAVENNER. Yes, sir. You should not have to wait till the 

first of the year. 

Mr. DOGGETT. You can get us progress reports? 

Ms. TAVENNER. Yes, sir. 

Mr. DOGGETT. When you announced the navigator grants for 

Texas, there was an indication in the original notice that there 

would be a second round of navigator grants. Instead, it appears 


ralbany on LAP520R082 with HEARINGS
39 

that contracts were reached with two national firms to provide enrollment assistance, and those firms are at least required to provide in some cases weekly reports on their progress. In what way 

are those enrollment assistance two companies—I believe the one 

for Texas is called Cognosante, they got a total of about $30 million, much more than any individual entity as a navigator in 

Texas—in what way are they being integrated with the local navigators and assistance counselors to reach out to the uninsured? 

Ms. TAVENNER. And I can get you that information. But I will 

tell you that there are navigators inside each of the Federal exchange States that we awarded contracts to. But in addition to 

that, there are volunteers through the Texas Hospital Association 

and others. And I can get you a full report of that. 

Mr. DOGGETT. Okay. Well, I am interested, and today is not the 

first time I have asked for a full report as to how these enrollment 

assistance folks came into being and how they are involved with 

local folks. We have had to set up, in San Antonio and in Austin, 

our own network to try to make up for what we did not get in the 

way of Federal assistance at the local level. And these new enrollment assistance people, I am interested in getting prompt progress 

reports on them also to see what they have actually done, if they 

have actually signed anyone up, and what kind of people they are 

signing up, and whether this is, the navigator system, the enrollment assistance system, the certified counselors are any better organized and coordinated than the Web site and the 55 contractors 

have been. 

Another area of concern—— 

Chairman CAMP. Time has expired, Mr. Doggett. 

Mr. Reichert is recognized. 

Mr. REICHERT. Thank you, Mr. Chairman. 

This law started out on a troubling note right from the beginning. Republicans were not a part of the process, weren’t asked to 

be a part of the process in building this law. And Nancy Pelosi herself said we must pass the law to find out what is in the law. 

And as one of my colleagues mentioned this morning, let’s just 

sand around the edges. We have done some sanding around the 

edges. And that is basically due to the fact that the Republicans 

have been calling attention to some of the issues that now we are 

becoming aware of because people are now beginning to read the 

law and finding out what is in it. So three programs have been 

completely halted since the law has passed. Seven others have been 

repealed and have had funding rescinded, and they have been 

signed into law. Now, that takes Republicans and Democrats and 

the President of the United States to agree to all those things for 

those things to happen. 

I think that most people feel right now it is not time for any 

sanding to take place, but the chainsaw needs to come out. So we 

are going to keep on, and we are going to be persistent. 

Were you working for CMS on January 29, 2010? 

Ms. TAVENNER. January 29? 

Mr. REICHERT. Were you part of the process in working to help 

implement Obamacare? 

Ms. TAVENNER. I actually was not working for CMS January 

29, 2010. 


ralbany on LAP520R082 with HEARINGS
40 

Mr. REICHERT. Okay. When did you start working to implement the health care law? 

Ms. TAVENNER. I actually came to CMS late February of 2010. 

Mr. REICHERT. Late February. Do you know if you can keep 

your health care plan if you like it? 

Ms. TAVENNER. Do I know that I can keep my health care 

plan? 

Mr. REICHERT. Do you know if it is true, as the President has 

said and many Democrats have said, if you like your health care 

plan you can keep it? Is that a true statement? 

Ms. TAVENNER. There were health care plans that were grandfathered—— 

Mr. REICHERT. Is that a true statement? 

Ms. TAVENNER. It is a true statement that plans were grandfathered in. 

Mr. REICHERT. Okay. Thank you for that answer. So if you like 

your doctor you can keep your doctor, too. Is that a true statement? 

Ms. TAVENNER. I think doctors come and go inside networks. 

Mr. REICHERT. So if a person has a doctor and they want to 

go to that doctor and the doctor is in the network, they can still 

go to that doctor? They can keep their doctor if they like their doctor? 

Ms. TAVENNER. If that person is in a plan where that doctor 

is in the network, they can keep that doctor. 

Mr. REICHERT. On January 29, 2010, and it has been reported 

even today in some of our papers, the President knew years ago 

you are not going to be able to keep your health care plan. You are 

not going to be able to keep your doctor in this health care plan. 

He talked to the Republican retreat on January 29, 2010, and he 

said, when he was asked the question about keeping your doctor 

or your health care plan, he said, quote, ‘‘For example, you know, 

we said from the start that this was going to be important for us 

to be consistent in saying to people if you can have your—if you 

want to keep your health insurance you have got it, you can keep 

it, that you are not going to have anybody getting in between you 

and your doctor and your decision-making.’’ And then he says, ‘‘And 

I think that some of the provisions that got snuck in might have 

violated that pledge.’’ 

Are you aware of some of those provisions that got snuck in that 

might have violated that pledge? 

Ms. TAVENNER. I do not know what you are talking about. 

Mr. REICHERT. I just gave you a quote from the President of 

the United States, your boss. 

Ms. TAVENNER. No, you are asking me the provisions that were 

snuck in, and I don’t know. 

Mr. REICHERT. Yeah. Are you not familiar with the health care 

law? 

Ms. TAVENNER. I am very familiar with the health care law. 

Mr. REICHERT. The President apparently is aware of some provisions that were snuck into the law that says that, you know 

what, you are not going to be able to keep your health care plan, 

you are not going to be able to keep your doctor. But yet you just 

said you can. So you must not be aware. You didn’t read the law, 


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as Nancy Pelosi said you should, when the thing was passed. Otherwise, you would know about those provisions. 

You know, in Washington State my constituents can’t keep their 

health care plan; 290,000 individuals in Washington have received 

notices canceling their health care plan. Do you know that that is 

happening? Have you heard those stories? 

Ms. TAVENNER. I am aware that there are issuers in States 

who are canceling their old plans, which were grandfathered in, 

and moving to new plans which have to meet the requirements. 

Mr. REICHERT. So what you just said about keeping your 

health care plan isn’t true. 

Ms. TAVENNER. No, they could keep it. The issuers chose—— 

Mr. REICHERT. No, they can’t keep it. They just got cancellation 

notices. You can’t keep it. The President says you can’t keep it. 

Why are you saying you can? I don’t understand. 

Chairman CAMP. All right. Time has expired. 

Mr. Thompson is recognized for 5 minutes. 

After that, in order to make sure everyone has an opportunity to 

question, Mr. Levin and I have agreed to go to 3 minutes. 

So you are recognized for 5 minutes. 

Mr. THOMPSON. Can you start the clock again? They started it 

when you recognized me. 

Chairman CAMP. All right. We will give you those 10 seconds 

back. There you go. 

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

Ma’am, thank you very much for being here. 

I want to thank my colleague from California who earlier pointed 

out that it wasn’t you or CMS that set up this computer system, 

that you used private sector outside vendors. And I think that that 

speaks to an issue that at some point we need to look at, and that 

is our Federal procurement process, which is in part responsible for 

a lot of the problems that we have seen. 

And I also want to thank Mr. Neal for pointing out that in fact 

when we work together we can avoid a lot of the problems that we 

are seeing. And we should be working together to make sure people 

have access to quality affordable health care rather than trying to 

find fault and blame and trying to defund or derail or sabotage a 

program that is designed to help people have access to quality affordable health care. 

And nowhere is that seen better than looking at what we are 

doing in some of the States. And it is my understanding, and some 

of my colleagues have pointed it out today, that we have some 

States that are doing a pretty good job with their delivery of the 

Affordable Care Act. My home State of California has something 

called Covered California. And I understand that we have had 

about 125,000 applications that have been submitted, about 2 million unique visits to the Web site, and about 150,000 calls daily to 

Covered California, because people really do want to have coverage. 

There has been many benefits in my home State. About 200,000 

people are covered with preventive care. About 40,000 kids who 

have preexisting conditions now have coverage. About 100,000 seniors are getting preventive care under Medicare. I have had a number of people who have contacted me, and I will just mention two, 


ralbany on LAP520R082 with HEARINGS
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Samuel Calicura from Martinez, who said that he was paying $131 

a week, and now he is paying $45 a month for his coverage. Cynthia Adams from Santa Rosa was paying 600 bucks a month. Now 

she is paying $134 a month. 

Now, in full disclosure, as I have mentioned to you privately, I 

have had some terrible messages from people who are experiencing 

some real problems with the system. Usually it is insurance companies, as some of my colleagues on the other side of the aisle have 

mentioned, are canceling their grandfathered-in programs and policies and issuing new policies. And I have even had a community 

college in my district that is using the Affordable Care Act to reduce hours of part-time employees. So just about everything that 

has happened that has been bad in the last 3 years has been associated with Obamacare. 

And I think we need to be able to draw the distinction and point 

people to these exchanges so they can do some comparison shopping and get these policies that will provide them with insurance. 

And I would like to see you guys do a more aggressive job in regard 

to that. 

I would like to know from you, ma’am, how are the State exchanges working? And what effects are the problems of the Federal 

Web site having on State-run exchanges? And how are the new upgrades and the Web site fixes going to affect State-run exchanges 

such as Covered California? 

Ms. TAVENNER. Let me say that the State-based exchanges are 

doing a very good job. And California, as you mentioned, has been 

a really nice success story. But there are large and small States. 

Obviously, California and New York are huge States that are having great success. 

Where we have been able to work closely with them, and we talk 

with them daily, is obviously they use the hub for verification of 

information, and the hub has worked pretty much flawlessly. And 

I always knock on wood when I say that. So they have been able 

to get information. The problems that we are seeing inside the application process do not affect the State-based exchanges. So the information they need from us they are able to get. 

You all may have been aware that there was an incident over the 

weekend with Verizon that took the whole site down. And when it 

did, it also took down the hub. So States were impacted during the 

day on Sunday and into Monday with an issue with Verizon. But 

other than that, they have been able to come and go and access the 

hub without difficulty. 

Mr. THOMPSON. Thank you, Mr. Chairman. I yield back my 

time. 

Chairman CAMP. Thank you. 

Dr. Boustany is recognized for 3 minutes. 

Mr. BOUSTANY. Thank you, Mr. Chairman. 

Welcome. Good to see you. 

I think in answering Chairman Camp earlier you established the 

fact that of the Nation’s 2.7 million uninsured from 18 to 35 years 

of age, you are not going to reveal numbers on who has enrolled 

in that age group until sometime in mid-November. Is that correct? 

Ms. TAVENNER. Yes, sir, mid-November. 


ralbany on LAP520R082 with HEARINGS
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Mr. BOUSTANY. Okay. Same goes for applicants? You will have 

no metrics on the number of applicants in that age group? 

Ms. TAVENNER. We will release our metrics in mid-November. 

Mr. BOUSTANY. Okay. How confident are you that those in this 

age group will actually sign up for the exchanges given that they 

don’t actually get information on the plans unless they actually go 

through the application process? 

Ms. TAVENNER. You know, we have actually had feedback from 

individuals who have worked through the application process, who 

have signed up, and there has been good representation, good stories in the young age group as well. 

Mr. BOUSTANY. I mean this is a tech-savvy group. They are already being confronted with a major barrier with the Web site 

problems. And as you said earlier, ACA is much more than a Web 

site. I mean, we all know that they are going to see higher premiums, particularly in that age group. There has been a number 

of reports and studies that demonstrate that is going to be the 

case. 

Clearly, the penalty is much lower than the cost of the insurance. 

And knowing something about the behavior of this age group, I 

have real concerns that we are going to see some adverse selection. 

Ms. TAVENNER. Well, Congressman, I would remind you in this 

age group many of them will be eligible for tax credits. So that will 

also help with their premium costs. And also for those under the 

age of 30, there is an alternate catastrophic plan. 

Mr. BOUSTANY. I understand. But if the premiums go up, then 

that means the subsidies go up. Is that correct? 

Ms. TAVENNER. Well, the subsidies are based on your income. 

Mr. BOUSTANY. Right. But if your income is what it is, and 

your premiums are going up, and we know there is upward pressure on premiums, then subsidies go up. 

Ms. TAVENNER. But I will remind you what we saw in the premiums, which are locked and loaded for 2014, has actually been 

about 18 percent below what CBO estimates were for premium increases. So we have a good story to tell there. 

Mr. BOUSTANY. But we see other evidence going longer term 

that we are going to see upward pressure on premiums as a result 

of the construct of this law. I have spent 30 years in medicine. I 

understand what this is going to do. And I have very deep concerns 

about what we are going to see with premium costs. But as premium costs go up, subsidies go up. That means the burden on the 

taxpayer goes up. That means deficits go up. 

Ms. TAVENNER. So I will remind you that premiums were going 

up at double-digit increases prior to the Affordable Care Act. And 

what we are actually seeing is a moderation in premium increases 

for the last 3 years. 

Mr. BOUSTANY. That is a false dichotomy, I mean, because 

there are other solutions to getting premiums down and actually 

lowering costs. So I don’t accept that as a complete answer on the 

cost of these premiums. 

Let me ask you this. Transparency is clearly very, very important. And will you or HHS or CMS, somebody in the administration 

provide information on the taxpayer’s cost with regard to these 

subsidies for 2015 and beyond? 


ralbany on LAP520R082 with HEARINGS
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Ms. TAVENNER. I am sure that part of our information in reports we produce will include that information to you, yes, at the 

time. 

Chairman CAMP. All right. Thank you. 

Mr. Larson. 

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

I would like to associate myself with the remarks of Mr. Thompson and Mr. Neal, and focus on an area that I think this committee 

could become eminently involved in. 

First, I would like to point out what a success Connecticut has 

been. I want to commend Governor Malloy and Lieutenant Governor Wyman, who have headed that up with Kevin Counihan. Tremendous success, including more than a third of the people that 

have signed up for the program are under age 35. And so it demonstrates that when you are working together and cooperating, 

that indeed these things can work. 

And as Mr. Neal pointed out, the thing that is astonishing from 

a Democratic view, if Democrats were to have their way in health 

care we would have had Medicare for all or a single-payer system. 

Instead, we opted for coming together and ending up with a program that was idea of the concept was the Heritage Foundation, 

piloted by a Republican governor in a Democratic State. And so we 

come up with a private sector initiative. 

Here is the deal. The deal is this: that if this committee were to 

approach this issue the same way we did tax reform and say the 

following, we are going to take the very best of the public health 

system, the very best that the public health system can offer, including the National Institute of Science, the National Institute of 

Health, the Center for Disease Control, everything that our public 

health systems within our State has brought together over these 

many years, and then do that in combination with the private sector so that we can take the entrepreneurial advantage that the private sector can bring to this remedy, and then take science and 

technology, most notably the genomic project that is currently 

going on that has untold benefits. 

What the American people want to see is to help them out, to 

solve their problem, to help them get better health care. They don’t 

want to see this endless tastes great, less filling debate from the 

committee. I challenge the chairman, let’s do what we did with tax 

reform. Let’s break down into individual groups and solve this 

problem together so that we are taking the best of the public sector, the best of the private sector, and all that innovation, technology can bring to bear on changing the paradigm for the American citizen so it is their health and well-being that becomes the 

focus, not the ideology of either party, but the health and wellbeing of the American citizen. 

That is what this should be about. And we can do it. And by taking both sides of what both parties and both ideas can bring to this 

discussion, the best of the private sector, the best of the public sector, and everything that science and technology and innovation can 

provide. 

There is more than $800 billion annually in waste and inefficiency. This is the most inefficient economic system in the world. 

Can’t we come together to solve that? Use this committee to lead 


ralbany on LAP520R082 with HEARINGS
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the way and set the example for what regular order can provide by 

challenging everybody to sit down, as we have in tax reform, and 

come up with a solution for the American public, not this ongoing 

debate. 

Chairman CAMP. The time has expired. 

Mr. Roskam. 

Mr. ROSKAM. Thank you, Mr. Chairman. 

Administrator, thanks for your time today. 

So I have an independent recollection of driving around 

Chicagoland, I represent the western suburbs, and it was June of 

2009. President Obama was in town giving the speech to the AMA. 

I knew I was going to be called on to make some comments afterwards. So I am listening to it on the radio. I am on Michigan Avenue, downtown Chicago, I am listening, I am listening, I am listening. And the President says this. It is a paragraph that you are familiar with, but I want to revisit it with you now in light of constituent contacts that I have had. He said this: ‘‘I know that there 

are millions of Americans who are content with their health care 

coverage. They like their plan and they value their relationship 

with their doctor. That means that no matter how we reform 

health care, we will keep this promise: If you like your doctor, you 

will be able to keep your doctor, period.’’ No parentheses, no exclamations, no asterisks, period. 

Continuing: ‘‘If you like your health care plan, you will be able 

to keep your health care plan, period. No one will take it away no 

matter what. My view is that health care reform should be guided 

by a simple principle: Fix what is broken and build on what 

works.’’ 

That was a declarative statement by the President of the United 

States selling, in anticipation, the passage of the Affordable Care 

Act. That deeply resonated with a lot of folks. He repeated it, repeated it, repeated it. Made other claims, like it is going to save 

$2,500 on average per family and so forth. 

So here is my point. Diane Isser from Hoffman Estates is a 57- 

year old breast cancer survivor. It was reasonable for her to assume, based on the plain language of the President, not subsequent 

parsing, but the plain language of the President, that she would 

get to keep her coverage. And here is her new reality. She gets the 

letter from Blue Cross Blue Shield that says that they are unable 

to offer that coverage. Her rate goes from 363 a month to 713 a 

month, almost doubling. Now, she had a preexisting condition, so 

this is not a question of whether her breast cancer was covered or 

not. She is being moved into a Gold plan, which presupposes that 

she had decent coverage from before. 

Can you understand the level of frustration and concern about 

what many Americans perceive to be a false claim from the administration? Not that it was somehow changed or now that, well, we 

have got this wonderful plan for your life that says we know better 

than you, we are going to tell you what kind of coverage you want. 

Diane knows exactly the type of coverage she wants. So that is one 

concern. 

The other concern is, you have alluded to it, is the Web site. I 

have got another constituent, Denise Banages, from Lake in the 

Hills, who is a professional in this arena and has spent countless 


ralbany on LAP520R082 with HEARINGS
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hours advising clients. And, you know, the advice is take screen 

shots, protect yourself, and so forth. 

My time has expired. But can you understand at least the level 

of frustration based on the claim of the President of the United 

States that people were going to be able to keep what they had and 

it is not turning out to be true as they understood that statement? 

Ms. TAVENNER. I understand that for about 86 percent of 

America that had employer-sponsored insurance and they were satisfied with those plans and they still have those plans. What we 

were dealing with in the Affordable Care Act is the individual market where the constituent you talk about is lucky, she was able to 

have insurance. Many people were blocked out due to preexisting, 

due to other issues. And that is what we were trying to fix. That 

is what I understand. 

Chairman CAMP. All right. 

Mr. Blumenauer is recognized. 

Mr. BLUMENAUER. So if I ask a 3-minute question will the Administrator have a chance to answer also? 

Chairman CAMP. Give it a try and we will see. 

Mr. BLUMENAUER. Thank you, Mr. Chairman. 

I would like to just dive in a little bit to follow up on what my 

friend Peter was talking about, and, frankly, the sheriff who was 

acting like a district attorney with you a little while ago. Have we 

ever had the ability to force a doctor to stay in a particular plan? 

Is that sometimes beyond the control of the patient and the doctor 

in terms of networks? 

Ms. TAVENNER. That is correct. Doctors have always had to individually negotiate. 

Mr. BLUMENAUER. So we can have a framework, but you are 

not going to be able to force doctors to stay or insurance companies 

to keep them. They change all the time, don’t they? 

Ms. TAVENNER. That is correct. 

Mr. BLUMENAUER. And this notion that somehow we would 

force insurance companies to never change policies. Haven’t we 

seen a third to two-thirds of the individual market change in the 

course of a year for the typical patient? 

Ms. TAVENNER. Absolutely. 

Mr. BLUMENAUER. So it is not anything that my friend from 

the State of Washington, which has 7 million people, arguably at 

least a million households are either uninsured or in the individual 

market, that they would see several hundred thousand people 

every year who would have those individual policies change. Is that 

not true? 

Ms. TAVENNER. That is true. Prior to the Affordable Care Act, 

what they were assured of is they had to worry about were they 

going to lose their coverage, what was going to happen with premiums. And they were still going through a churn of at least 50 

percent a year. What we have done is we have stabilized the premiums, we no longer allow denial for any preexisting, and we are 

creating a more competitive market. And Washington is a great example. 

Mr. BLUMENAUER. And many of these people who are subject 

to the churn, it is because they find out that they actually try and 

use the insurance—— 


ralbany on LAP520R082 with HEARINGS
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Ms. TAVENNER. That is right. 

Mr. BLUMENAUER [continuing]. And they find out, wait a 

minute, it is great insurance until you get sick, or until you bump 

up against artificially low caps, or having moving targets as insurance companies do deeper dives about eligibility. Isn’t that part of 

the churn? 

Ms. TAVENNER. That is true. 

Mr. BLUMENAUER. Is that going to be possible anymore, that 

people will have limits and get thrown off, that people will be able 

to go back into the history and throw them off? 

Ms. TAVENNER. They will not. They will not be able. 

Mr. BLUMENAUER. Mr. Chairman, part of what is I find a little disconcerting is that people are in a never never world where 

they think that in the past we have been able to force insurance 

companies to continue to offer, that they have been able to force 

doctors to be in the networks. And this is entirely consistent with 

the intent of the Affordable Care Act, is to give them superior insurance without those problems. And I do think that we are not 

really talking about apples and oranges. 

Thank you, Mr. Chairman. I will yield back. 

Chairman CAMP. Thank you. 

Mr. Gerlach for 3 minutes. 

Mr. GERLACH. Thank you, Mr. Chairman. 

Thank you for testifying today, Ms. Tavenner. 

First, I want to go back to a question raised by Congressman 

Nunes, who was following up on a question by Chairman Camp 

about the release of the numbers as the total number of enrollees 

to date, and you said bottom line you are not going to release those 

numbers until mid-November. Then in response to Congressman 

Nunes’ question, you specifically said we made a group decision not 

to do that, not to release them until mid-November. Who was part 

of that group to make that decision? What were the individuals 

that were part of that group’s decision? 

Ms. TAVENNER. I think it was in response to the question was 

did the Secretary or the White House direct me. And the answer 

to that was no, this was a group decision. We actually sat down 

with the Secretary and talked about what would make sense in 

terms of when we would release. 

Mr. GERLACH. So who was the group. That is what I am asking. Individually, who made up that group? 

Ms. TAVENNER. These were different components within HHS, 

different operating divisions. And then obviously we had conversations with White House staff as well. 

Mr. GERLACH. Okay. And who was the White House staff you 

had conversations with? 

Ms. TAVENNER. This would be members of the Domestic Policy 

Council, it could have been members of the budget office. 

Mr. GERLACH. Who are their names? Do you recall? 

Ms. TAVENNER. No, I don’t recall. These were different series 

of meetings where we had a discussion about this. 

Mr. GERLACH. Aware of any memos or email exchanges to that 

regard between the different component group members? 

Ms. TAVENNER. I am not sure, but I am happy to go back and 

take a look at that. 


ralbany on LAP520R082 with HEARINGS
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Mr. GERLACH. Okay. If you can take a look at all of those 

emails and memos, and if you have those please share those with 

the committee if you would. 

Secondly, in your testimony you indicate that the problems that 

are being experienced with the Web site is based, quote, ‘‘Unfortunately, on a subset of contracts for HealthCare.gov that have not 

met expectations.’’ Is it the contracts that have not met the expectations or is it the contractors implementing the contracts that 

have not met expectations? 

Ms. TAVENNER. I am not sure which quote you are referring to. 

Mr. GERLACH. It is on the bottom of page two of your testimony. 

Ms. TAVENNER. Okay. All right. 

Mr. GERLACH. Quote, ‘‘Unfortunately, a subset of those contracts for HealthCare.gov have not met expectations.’’ So is it the 

contracts that have not met expectations or was it the specifications of those contracts were not properly developed and properly 

executed or properly implemented? Or is it the contractors themselves that took a good contract and have not performed properly? 

Ms. TAVENNER. So I think that in the case of the FFM site is 

what I was referring to, and we have been working with the contractor. We have had some issues with timing of delivery. 

Mr. GERLACH. Who is that contractor? 

Ms. TAVENNER. That contractor is CGI. 

Mr. GERLACH. Okay. So it is the contractor in that instance 

that is not meeting expectations? 

Ms. TAVENNER. Yes. But we are working with them. 

Mr. GERLACH. Okay. Are there provisions in the contract with 

that company that if it fails to perform in any substantive way that 

it is to repay or refund back to the government for funds that you 

have allocated to it for the purpose of performance? 

Ms. TAVENNER. I can get you the details on that. 

Mr. GERLACH. Okay. There is also a tech surge underway. 

Chairman CAMP. I am afraid time has expired. 

Mr. Pascrell is recognized. 

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

Despite our Democrats’ opposition to Part D 10 years ago, we 

committed to making the best of the program. And because of all 

the changes that have occurred on the Part D prescription program, 90 percent of seniors right now are satisfied. And why are 

they satisfied? Well, in my district, before that vote, I made seniors 

know that I was going to vote no and oppose, and I told them the 

two reasons. The gap, the donut hole when you are paying for premiums and you are not getting any benefits. That was horrendous. 

And number two, an outside source was not sitting down and being 

the third party to negotiate the prices of prescription drugs. 

So it lost. We lost the policy fight. And what did we do? We went 

back to our districts and we told our seniors, although we voted no, 

we personally believe and will work with the Bush administration 

to make it work. That is what we did. And how many of you stood 

up to do that? None. Zero. Zero. 

Let’s talk. Let’s not water the wine here. Let’s say it like it is. 

You refused to expand, many of these governors, Medicaid, they refused to set up State marketplaces, and leaving millions of dollars 


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in outreach on the table and education funding. And what happens? 

Well, to those I say this, and to you I say this, who I deeply respect, here and off the floor of the committee and off the floor of 

the House: What are you going to do about the approximately 17 

million children with preexisting conditions who can no longer be 

denied health insurance coverage? You want to go back? You want 

to say you are no longer covered any longer? You are going to tell 

the parents of those kids? Which one of you is going to stand up 

and tell the parents of those children the game is over, sorry, that 

was just a phase we were going through? 

Mr. GRIFFIN. Will the gentleman yield? 

Mr. PASCRELL. Yes, I will. 

Mr. GRIFFIN. I would just tell you that—— 

Mr. PASCRELL. Where are you? 

Mr. GRIFFIN. Right here. You asked a question, I am going to 

answer it. It is a false choice to say it is Obamacare or nothing. 

There are numerous proposals, including the one that I am a cosponsor of that deals with preexisting conditions. 

Mr. PASCRELL. Let me take back the time, sir. Let me take the 

time back. Are you serious, what you just said? Are you really serious? After what we have gone through, after what we have gone 

through in the last 31⁄2 years? You can sit there and say that you 

had a legitimate alternative after these years? We have gone 

through 44 votes, 48 votes now of you trying to dismantle this legislation. You call that cooperation? I don’t. I don’t call that cooperation. 

Mr. GRIFFIN. Will the gentleman yield? You are asking a question. 

Chairman CAMP. The gentleman’s time has expired. 

Dr. Price is recognized. 

Mr. PRICE. Thank you, Mr. Chairman. 

Welcome, Madam Administrator. I appreciate your testimony 

today and the work that you are doing. I think the American people are looking in at this hearing and just shaking their heads. I 

spent over 20 years taking care of patients, and this is about patients. And what we on this side of the aisle want is the highest 

quality of care for all Americans, a system that is affordable and 

accessible and provides the greatest number of choices and continues innovation in our health care arena so that folks can have 

the highest quality of care. 

But our belief is firmly, and I think that it is playing out now, 

is that the ACA violates every one of those principles. That is why 

we oppose this policy. 

There is not enough time, Mr. Chairman, to correct all of the 

record that has been stated, but here is an article from the New 

York Post I would like to insert into the record. Elderly New Yorkers are in a panic after getting notices that insurance companies 

are booting their doctors from the program as a result of the shifting landscape under Obamacare. Quote, ‘‘UnitedHealthcare told Dr. 

Leibowitz that because of ‘significant changes and pressures in the 

health care environment’ he would be getting the ax on January 1.’’ 

Not that they were trying to force him into it, but that he would 

be getting kicked off the program. 


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Forcing insurance companies to change their plan? You bet they 

are. Here is from CareFirst Maryland. An individual sent me this 

letter. Quote, ‘‘The ACA requires you to pick a new plan to maintain coverage because your current plan will cease to exist at the 

time of your renewal through the ACA.’’ 

Chairman CAMP. Without objection, the letters will be in the 

record. 

[The information follows:] 


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Mr. PRICE. Thank you, Mr. Chairman. 

I have some specific questions I would like to have you answer. 

When did CMS become aware of the problems with the Web site? 

Ms. TAVENNER. I think CMS became aware of the problems 

within the first week, when we had the volume surge. 

Mr. PRICE. CMS didn’t have a clue that there was going to be 

a problem on October 1, when the Web site went live. Is that correct? 

Ms. TAVENNER. The problems that we saw in the first week we 

attributed to volume. Once the volume started to back down—— 

Mr. PRICE. How about before October 1, was there any sense at 

all that there were going to be problems with the Web site? 

Ms. TAVENNER. No. There are always going to be issues with 

a new Web site, what I would call the customary glitches that you 

see, but no, not this. 

Mr. PRICE. Did you have any meetings with the White House 

prior to the rollout date on October 1 to inform them of any problem that you anticipated? 

Ms. TAVENNER. No, not of any problems I anticipated. I talked 

earlier about programs that we decided to delay, the SHOP, the 

Spanish. 

Mr. PRICE. Have you been involved with any conversations with 

Secretary Sebelius or the administration about delaying the individual mandate? 

Ms. TAVENNER. About delaying the individual mandate? No. 

We have discussed the individual mandate at some degree, but not 

about delaying it. 

Mr. PRICE. There was a hearing last week in Energy and Commerce. CGI, one of the contractors, said that there is hidden source 

code on the site that says applicants have no reasonable expectation of privacy and that this was due to a decision that CMS made. 

Did you all make that decision? 

Ms. TAVENNER. I will have to get back to you on that. I am 

not sure what they were talking about in that comment. 

Mr. PRICE. Thank you. My time has expired. 

Chairman CAMP. Thank you. 

Mr. Crowley. 

Mr. CROWLEY. Thank you, Mr. Chairman. 

Ms. Tavenner, I think you have noticed, and I have lost count at 

22, I think you were asked 22 times when the information will be 

available. Just to clarify for the last time, that information will be 

available sometime at the end of November. Is that correct? 

Ms. TAVENNER. That is what I said, mid-November, many 

times. 

Mr. CROWLEY. I want to make this clear to all my colleagues. 

The information, so we can be clear, will be available at the end 

of November. Is that correct? 

Ms. TAVENNER. Mid-November. 

Mr. CROWLEY. Mid-November. I am sorry. I was a little early. 

Mid-November. I had to get it straight for myself as well. I appreciate that. 

Now, you understand that this is from the same party that attempted to repeal the Affordable Care Act over 40 times? You understand that, don’t you? 


ralbany on LAP520R082 with HEARINGS
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Ms. TAVENNER. I do understand that. 

Mr. CROWLEY. So you understand that repetition is a part of 

the rote here, that the more you ask it, the more you try to repeal 

things, maybe you feel better about it, but I wanted to be cognizant 

of that. 

Ms. Tavenner, you mentioned that over 700,000 people have completed the application that then allows them to shop and compare 

plans with their exact prices and available tax credits. So does that 

show the system is working even with the problems that you have 

already started addressing? 

Ms. TAVENNER. Yes, sir. The system is working. We would like 

it to work better, and that is what we have committed to do by the 

end of November. 

Mr. CROWLEY. So really the key measures right now are the interest in the site is so impressive in terms of how many people are 

beginning to take the first steps of the process to for the first time 

afford insurance for themselves in this country. Is that correct? 

Ms. TAVENNER. That is correct. 

Mr. CROWLEY. Ms. Tavenner, you are aware that every Member on that side of the aisle, the Republican side of the aisle, to a 

person is opposed to the Affordable Care Act? 

Ms. TAVENNER. Yes, sir. 

Mr. CROWLEY. You don’t have to answer the question. I am 

being a little rhetorical. 

Do you understand that they don’t want you to succeed? You 

don’t have to answer that question. They shut down the government of the United States of America in an attempt to repeal the 

Affordable Care Act. It doesn’t pass the laugh test that they somehow care about getting this right, or you in your performance as 

Administrator, of getting this right and making sure that this 

health care law is enacted properly. 

We Democrats are looking for problems to fix. My Republican colleagues, when it comes to this issue of the Affordable Care Act, 

they are looking for problems to exploit. 

We can fix a broken Web site. What we cannot fix are broken 

ideas and a broken agenda, and that is what they have offered to 

the American people. I am not asking you to comment. I am just 

making a rhetorical statement and questions to you. But it is very 

sad. They have nothing to offer, and therefore they will attack and 

tear down. It is much easier to tear down the building than to 

build a building up. And I appreciate the work that you are doing 

to get this right, to make it work for the American people. 

And with that, I yield back the balance of my time. 

Chairman CAMP. All right. Thank you. 

Mr. Buchanan and then I will go to Mr. Smith. So Mr. Buchanan 

is recognized. 

Mr. BUCHANAN. Thank you, Mr. Chairman. 

And welcome, Madam Administrator. 

Last week in Florida—I represent a part of Florida, but obviously 

looking at Florida as the only member of the Ways and Means 

there—we had over 300,000 people have been notified, some cancellations, some adjustments, they claim, to their thing. That is one 

carrier, Blue Cross Blue Shield, so it is probably hundreds of thousands more than that. And it seems it is this one group in general, 


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not just in Florida, but across the country got reported yesterday, 

I think, which are independent contractors. You might look at a 

group like realtors, for example, that are self-employed, that they 

are the most at risk in terms of their insurance or trying to find 

insurance. They are getting the cancellations. 

And then a part of that report, as you probably know or read, 

is that they have known about it for 3 years, the administration 

has known about it. Are they going to come forward and just express the concern about this one category, I think it is 16 million 

people, up to 80 percent are at risk that might lose their insurance? 

Ms. TAVENNER. I am not sure what question you are asking. 

Mr. BUCHANAN. I am just talking about people that are independent contractors, like realtors, one segment that are getting notices from Blue Cross Blue Shield. 

Ms. TAVENNER. Right. 

Mr. BUCHANAN. One of the gentleman mentioned from Washington, but in Florida last week we got 300,000 notices from Blue 

Cross Blue Shield. It seems like it is concentrated on the small 

business person, you know, someone that is a sole proprietor or an 

independent contractor. 

Ms. TAVENNER. I think the individuals who are getting these 

notices tend to be small business or individually insured. But I am 

not aware of realtors or any one group, but I can check into that. 

Mr. BUCHANAN. The other thing I wanted to mention, you said 

that you thought in the last couple, 3 years that rates have moderated. I can just tell you they have been going up 20, 25 percent 

in my district, in the last 3 years on average. They have got them 

down somewhat, they have made some adjustments. 

The other point I just wanted to mention, I think you said, I am 

trying to quote what you said, you thought the system is working? 

Did you say that, that you thought the system, the ACA, is working? 

Ms. TAVENNER. I think we have seen a lot of improvements in 

the ACA, yes, sir. 

Mr. BUCHANAN. Let me tell you, it is a public relations nightmare. I hope that you honestly don’t feel that you think the system 

is working. This is just an incredibly bad rollout. There is a lot that 

needs to be done. I can’t imagine how you could think that the system is working. 

And my concern is, frankly, with such bad experience, so many 

people going to the site, trying to get on and get insurance, why 

would they want to get involved in a product, if they have had such 

a bad experience up front, I have been in business 30 years, why 

would you want to get involved in a company or a product that in 

the next 2 or 3 years, or you have a concern or an issue, that you 

might get the same treatment where you can’t get ahold of anybody? 

Ms. TAVENNER. Well, I think if you talk to individuals who 

have successfully enrolled, they will tell you they are quite satisfied 

with what they were able to get in terms of pricing and product. 

Mr. BUCHANAN. My sense, 70, 80 percent of people have not 

been able to get through. And I don’t know how they can feel good 


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about moving forward with health care if they can’t get even get 

online to do business. 

Chairman CAMP. All right. Mr. Smith is recognized. 

Mr. SMITH. Thank you, Mr. Chairman. 

And thank you to Administrator Tavenner for sharing your insights here today. And I have heard from many citizens about this 

transition, and they are seeing higher premiums, higher 

deductibles, higher copays, and yet we hear that you are saying the 

premiums are actually going down. 

Could you assure some of these Americans that are seeing higher 

premiums, virtually less coverage than they were previously experiencing, could you assure them that their premiums will be going 

down over time? 

Ms. TAVENNER. So I can tell you that what I said is that compared to CBO estimates the premiums had actually come in about 

18 percent less than CBO estimates. The other comment that I 

made is, if you look at large group insurance, that what we are seeing are some of the lowest trends in terms of premium increases, 

somewhere between 4 and 5 percent. So I can tell you based on 

trends, yes, it is coming down. 

Mr. SMITH. Now, I have also heard from some citizens who went 

to the Web site with employer-provided coverage for that employee, 

but that employee had a family and he wanted to investigate in 

terms of whether or not in qualifying the exchange for the subsidy, 

and was virtually unable to do so. 

Ms. TAVENNER. So what we have encouraged, there are some 

complicated families who are always going to need assistance, and 

that is why we have encouraged the use of the call center. There 

are some folks that when they complete the application they are 

going to have some difficult question and they are going to need to 

work with an in-person assistant. And so that is why the call center exists, and it is available 24/7, and a lot of folks are using it. 

Mr. SMITH. The tax credit that you mentioned, basically suggesting that it is a remedy for some of the increased costs through 

the ACA, is that accurate? 

Ms. TAVENNER. I didn’t say it was an increased remedy. I said 

it is assistance to those individuals at lower income levels. If you 

talk to people about why they don’t have health insurance, there 

are two reasons: they can’t afford it and they are embarrassed to 

admit that they don’t have it. So we are trying to help both. We 

are trying to get information out there that it is available to everyone and we are trying to help them with the cost. 

Mr. SMITH. On the dates that you established, the mid-November for the numbers of participants—— 

Ms. TAVENNER. Yes. 

Mr. SMITH [continuing]. Reaching coverage through the Web 

site, and then also November 30th for other problems being rectified—— 

Ms. TAVENNER. Yes. 

Mr. SMITH [continuing]. How did you arrive at those dates? 

Ms. TAVENNER. So we have said all along that we would have 

information available on enrollment and other metrics after the 

end of the first month. So the first month closes obviously this 

Thursday, so we will work with States to put together metrics that 


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will be available in mid-November. That is something we have 

talked about for months internally. That was an operations decision. 

And then the second question, how we came about identifying 

the problems in the system and deciding the end of November is 

actually sitting down and looking at the problems, deciding how 

long it would take us to correct them, how long it would take for 

us to add the other issues, which are the issues of SHOP, Spanish, 

et cetera, and that is how we came up with the end of November. 

It wasn’t just us. We also worked with the technical experts. That 

is part of the tech surge that you have read about. 

Mr. SMITH. All right. Thank you. 

Chairman CAMP. Ms. Schwartz is recognized. 

Ms. SCHWARTZ. Thank you. 

And thank you for this opportunity. And thank you for being 

here. We didn’t talk about it too much, but a bit this morning, but 

really the purpose of this hearing is to really acknowledge the difficulties and really a deeply troubling initial rollout of the Web site 

that is supposed to enable all of our constituents and Americans to 

access health care coverage in these health care marketplaces. And 

the fact is, and you acknowledged some of this, there have been inexcusable and unacceptable rollout of the launch of this marketplace. And as you know, millions of Americans, and they are in all 

of our districts, are anxious to obtain the information on the options for affordable coverage with the consumer protections that 

you have pointed out. 

We saw this interest when millions of Americans went online on 

1 day, October 1, 2013. And the fact is that the administration 

really failed these Americans. They really had an experience they 

should not have had. Americans failed to be able to access the information on these options and to be able to enroll the way they 

expected to and hoped for. 

The administration has failed to properly test the Web site, at 

least that is the way it has been reported, failed to take action to 

recognize and fix these problems along the way. And you did in the 

beginning acknowledge that this initial experience was not a positive one and essentially apologized. So I appreciate that, and I 

think so do they. 

But you also have to acknowledge that that initial experience has 

actually done some damage to Americans’ confidence in this Web 

site, in the marketplace, and even potentially the options that they 

would have available to get health coverage. So this is not only an 

opportunity for millions of uninsured and underinsured Americans 

to get affordable, meaningful health coverage, but it is also an obligation under law to make sure that this Web site works, because 

that is the way they are going to find out their options and to be 

able to enroll. 

So, you know, going forward, there can be just no more excuses. 

We need to hear from you that there is actually a path forward. 

And you can be as specific and explicit as you possibly can be with 

us and with the public to help regain our confidence and the 

public’s confidence in the ability of the administration and these 

subcontractors and contractors to get this right. 


ralbany on LAP520R082 with HEARINGS
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We have heard reports of a lack of coordination in implementing 

these different contracts. Can you speak to—and, again, if you 

could be specific about this—because I want to be able to go home 

and to be able to say this is going to work. And it has to work, because that is the way Americans will access this information and 

be able to sign up. And we all know those people who are underinsured, uninsured, and they are looking for these options. 

So you need to give us some more explicit information about how 

you are going to better implement and better coordinate these contractors to get this right for the American people. 

Ms. TAVENNER. And that is the information in my opening 

statement. We obviously brought on QSSI to serve in the general 

contractor role. We at CMS have been doing that, which is not 

unique. CMS tends to oversee most programs. But because of what 

I consider the failures in the initial rollout, we felt we needed to 

bring on additional expertise, so we have brought that on in terms 

of QSSI, which will be accountable to me. Obviously I am accountable for this. So I think that is one of the big things. 

The second thing is we have identified two what I will call category issues. One had to do with system performance and speed. 

So these were actually people who could complete applications and 

do the work, yet the system was just slow. And we are an impatient society. So we have added capacity and other things to deal 

with that. And persistent performance. And I have some metrics 

there. 

But on the other side are what I will call the defects, like the 

sticking in the application, where we are actually going through 

punch lists. And we are starting, and I hope you have noticed this, 

to do daily tech blogs, daily tech updates with the press to try to 

be more transparent about the problems and how we are fixing 

them so that you see continuous improvement. 

Ms. SCHWARTZ. Which we appreciate. 

Chairman CAMP. All right. And time has expired, so you will 

have to supplement anything further. 

Ms. SCHWARTZ. It will be helpful to have that. Thank you. 

Chairman CAMP. Thank you. 

Mr. Paulsen. 

Mr. PAULSEN. Thank you, Mr. Chairman. 

Ms. Tavenner, thanks for being. I know you have got a tough job. 

You know, before October I think much of the public was looking 

at the whole debate about Obamacare or the Affordable Care Act 

as some big political heated argument up on Capitol Hill, and, you 

know, many independent analysts for a long time, many years have 

been predicting that there are actually going to be higher premiums, these cancellations were going to be coming, you weren’t 

going to be able to keep your doctor or your health insurance even 

though that was the promise that was laid out by the President in 

his State of the Union speech a long time ago. 

And now these are being confirmed from our constituents. I 

mean, directly from our constituents we are hearing these stories 

about these challenges and their own expenses. And I look at Tricia 

from Bloomington, who contacted me, and she says her rates are 

going up 30 percent in January, and she has been looking at the 

exchange options and the available plans, but they are even more 


ralbany on LAP520R082 with HEARINGS
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expensive. I have also heard from Susan and Roger who are in 

Chanhassen. They like the plan they are on, they have been on it 

for a few years, the rates have been going on previously, but now 

they are going to go up another 20 percent. And the insurance company notes that a lot of that is due to the regulations associated 

with the Affordable Care Act. And they have looked at plans on the 

exchange as well, and they are more expensive, it is not the coverage they want. And they also have concerns about keeping their 

information private. And they don’t qualify for the subsidies that 

are offered as well. 

But let me ask this question, because I want to better understand how the administration came up with the November 30 date 

or deadline, because that is the new date, the October 1 has been 

moved to November 30. Jeff Zients has been hired now as kind of 

leading the effort. He said he has hired a new general contractor, 

they have a punch list of things to get done. So they have got milestones, testing dates, specific projects that need to get done. 

Can you tell us a little bit more about what the administration 

did to lead to the conclusion that the exchanges now would be 

ready to go on November 30 and can you provide a list of the punch 

list items to the committee? 

Ms. TAVENNER. So, yes, I can provide a punch list and some 

of the work that we are doing, that is not a problem, and I can give 

regular updates to the committee. 

But how we came up with the November 30 date is we actually 

pulled in a team of external experts to take a look at the system, 

look at the problems, say, is it fixable and how long does it take? 

So that is the process. So you will see continuous improvement 

week over week, and we can give you some of those milestones. 

Mr. PAULSEN. Okay. So for 3 years we have been preparing for 

October 1. Now we have got 2 months going into November 30. 

How do you know the schedule is going to be kept on November 

30, and what happens if you miss that date? What happens if you 

miss November 30? 

Ms. TAVENNER. The system is working. It is just not working 

as smoothly or as consistently as we want. So the system is built. 

The hub is working. We were able to correct the create account 

issue, which was a big sticking point in the beginning, and so now 

we are doing the rest of the fixes and improving system performance. 

Mr. PAULSEN. If you could provide a punch list to the committee, I think that would be very helpful as we move forward to 

the November 30 deadline. 

I yield back, Mr. Chairman. 

Chairman CAMP. Mr. Marchant. 

Mr. MARCHANT. We have reached out to our constituents to 

find out what they are experiencing trying to comply with the law. 

These are people that recognize it is the law, they are trying to 

comply, and they are frustrated. 

The first group basically is getting on the Web site, sometimes 

it is taking hours, sometimes it is taking several days, but they are 

finally getting on there, and they are finding that they can get 

care, but that their premiums are raised significantly, sometimes 

double. That is the first group that we are hearing from. 


ralbany on LAP520R082 with HEARINGS
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The second group is a group that is receiving a cancellation from 

their insurance company. That prompts them to begin to think 

about it. They begin to think about complying with the law. These 

are not rebellious people. These are people that really sincerely are 

trying to comply with the law. And they are finding out that they 

can’t keep their insurance company, they can’t keep their doctor, 

and they genuinely believed the President when he said that they 

could. And these are people that now are very, very frustrated. 

They are going through this process. They are very angry, to begin 

with. Then they are very frustrated. And then they get into a very 

fearful state, because they are realizing that they have been told 

that the Web site will be up and running by November the 30th, 

but they are also confusing—maybe they are confusing the date 

that they must be signed up by December the 15th to have their 

policy go into effect on January the 1st. And most of them are experiencing some fear that they are going to genuinely have a gap in 

their service; regardless of the prices and the conditions, that they 

are going to have a gap in their service. And I think that is something you should really be concerned about, that there is going to 

be a huge gap. 

The last group that I am hearing from, in Texas, we have worked 

for years to come up with a high risk pool, and we have a group 

of people that are not on Medicare, they are not on Medicaid, they 

are uninsurable, they have chronic illnesses, and they are very vulnerable. 

Is there some effort being made by your organization to reach out 

specifically to those State high risk pools and give them some additional assistance and pay some close attention to that group? Because that group in many instances is the most vulnerable of any 

group in America. 

Ms. TAVENNER. Yes. And let me remind you, this is the group 

that in previous years, before the Affordable Care Act, would have 

had no options, and now they are insurable. And these are folks 

that we are reaching out to. We are running the high risk pools in 

many States, but we also coordinate that with States who are running their own to help them transfer into—— 

Mr. MARCHANT. But in my—— 

Chairman CAMP. All right. Time has expired. 

Mr. Davis. 

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

Thank you very much for being here and answering our questions. 

In Illinois, quite frankly, the launch has gone extremely well. As 

of October the 21st, almost 300,000 unique visitors had gone to get 

covered at Illinois.gov, with 132,344 visitors participating in the 

plan comparison screener on the Web site. Over 8,000 people called 

the Get Covered call center since its launch. The Medicaid expansion has been a huge success, as evidenced by approximately 

100,000 people signing up for CountyCare prior to the October 1 

launch date. This is a special waiver through which residents of 

Cook County can enroll early and start receiving health coverage 

in 2013 through Cook County facilities. In January, they will be 

rolled over into the regular Medicaid program. 


ralbany on LAP520R082 with HEARINGS
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Another innovative program in Illinois was an express enrollment process for SNAP recipients. In August, the State of Illinois 

sent a notice to about 123,000 SNAP recipients, that is, households 

with single adults, not disabled, offering them an option for express 

enrollment in the newly eligible group by signing and returning a 

form. As of October the 21st, the State had received about 46,000 

of those forms back and about 26,000 people have been enrolled, 

and they are in the process of enrolling the rest. 

Finally, the State has launched a new smart online application 

system called ABE.Illinois.gov, Application for Benefit Eligibility. 

The new site was launched October the 1st, and the Web site has 

been functioning smoothly. The most recent data shows that 47,766 

accounts have been created on ABE, and 28,729 applications have 

been submitted for processing. 

And we looked at how our newspapers have expressed their analysis of what was taking place. The Northwest Herald reported that 

through only 2 days, Get Covered Illinois had more than 230,000 

visitors and nearly 800,000 page views with more than 5,000 applications. The Associated Press stated that Chicago hair stylist and 

bartender Mike Leon called the Federal call center after he tried 

the Federal Web site 5 days in a row and couldn’t get it to work. 

The call center staff helped him, and he got through in 2 minutes. 

So our experiences have been perhaps different. 

I thank you very much and yield back. 

Chairman CAMP. All right. Thank you. 

Ms. Black is recognized. 

Mrs. BLACK. Thank you, Mr. Chairman. 

And thank you, Ms. Tavenner, for being here today. 

I want to go back to what Dr. Price said. This is really is about 

patients. And as a caregiver for over 40 years, I certainly know and 

have heard from my patients over the years about preexisting conditions. And I do think that we probably could have fixed that 

without having a total government takeover, as we are seeing here. 

It is not about politics, it is about patients. 

And I want to go to something from my State. Since the October 

1 launch date, I have received overwhelming number of stories 

from my constituents with concerns about the health care law. In 

fact, in my own hometown newspaper, The Tennessean, they reported that more than 28,000 Tennesseans are now losing access 

to the State-sponsored insurance program, which covered those 

with preexisting conditions, seniors, children, and small businesses. 

And one small business owner, Greg, from my district in Fairfield 

Glade, shared this story with me, and I want to share it with the 

committee: Diane, I operate a small painting business, and was 

very happy with the Cover Tennessee program for small businesses 

and their employees. It had a small copay and covered up to 

$25,000 each year. It covered 12 doctors visits and an annual physical at a reasonable cost. And this program is being cancelled effective January 2014 because it does not meet the minimum requirements of Obamacare. This directly contradicts the promise made by 

President Obama that we could keep our existing program. 

They had affordable health care that they liked, but they didn’t 

get to keep that. And I ask, is this right or is this just for this 

group of people? These 28,000 citizens of Tennessee are now forced 


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to find new coverage plans on the health care Web site that doesn’t 

work. So I think when we talk about fairness and justice, we have 

got to remember, there are people out there that this is not fair 

and this is not just for. 

But let me turn to another piece, and that is the implementation. 

We understand that the contractors who made the Web site did 

their own unit testing, but CMS was responsible for the end-to-end 

testing, or the system’s integrated testing, making sure that each 

unit worked properly with the next unit. Now, that testing failed. 

And every contractor has said that CMS made that decision to 

move forward with the launching of the Web site. And you claim 

that you didn’t know that there were surge problems with the Web 

site. But CMS is the project manager on this and CMS called the 

shots. So either there was incompetent management on your part 

or CMS’ part, those that you work with, or you ignored those fundamental concepts that were taken into account when the Web site 

of this complexity and size was built. 

I want to know why if sufficient systems integrated testing was 

not conducted and you made the decision to move forward with the 

Web site. So was there a systems integration testing that was actually done? 

Ms. TAVENNER. So the testing was actually done. We started 

testing almost immediately. It was kind of continuous testing. I 

think what you are asking is did we do the testing across the hub 

and all the agencies—— 

Mrs. BLACK. That is right. 

Ms. TAVENNER [continuing]. And the answer to that is yes. 

And so that was done. And then the question inside the FFM, did 

we do end-to-end testing in the FFM, and the answer to that is yes, 

that was done. 

Mrs. BLACK. Okay. So those tests were done, stress tests, load 

tests, how you accounted for and tested for peak hours? 

Ms. TAVENNER. Yes. So stress testing and load testing were 

done. In retrospect, the volume was we were projecting about three 

times the volume that we ever saw on the Medicare Part D experience, because we were dealing with a much smaller population. So 

in the first few hours of the site it had probably five times the volume that we ever projected. So in retrospect, we could have done 

more about load testing. 

Mrs. BLACK. Mr. Chairman, I want to know if we can get a copy 

of those tests so that we can actually see what was done. 

Chairman CAMP. If you can make those results available to the 

committee, we would appreciate it. 

Ms. TAVENNER. [Nonverbal response.] 

Mrs. BLACK. Thank you. 

Chairman CAMP. Thank you. 

And Mr. Young is recognized. 

Mr. YOUNG. Thank you, Mr. Chairman. 

And thanks so much for being here, Ms. Tavenner. 

Ms. Tavenner, as a former project manager and management 

consultant, I am perplexed as to the genesis of some of these problems with respect to the Web site and the broader rollout, and so 

I would like to explore with you maybe what the problems were. 


ralbany on LAP520R082 with HEARINGS
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Let me step back and talk about the issue of openness and transparency. It was CBS News that last week reported that as we went 

into the summer of 2012 there were certain key regulations that 

contractors were waiting on, they had to be issued in order for 

them to continue to do their work, put forward requirements for 

their IT systems and put together HealthCare.gov. Could we put 

up a slide, please, to illustrate some of the regulatory issuance pattern? 

[Slide] 

Mr. YOUNG. We see that over the couple of years preceding the 

summer of 2012, we had 109 proposed regulations put forward by 

HHS. Then starting in the summer before the Presidential election 

we had zero regulations, all the way through the election. And 

since that time period we have seen 60 regulations put forward by 

HHS. 

So my question to you, Ms. Tavenner, is that—and CBS News 

did indicate that some of the rules were ready to go back in June 

or July, according to one insider that they quoted in their report— 

so why did HHS stop issuing regulations, as the person on the inside, the so-called quarterback of this Web site? 

Ms. TAVENNER. So the regulation process, I don’t know that at 

any point we stopped issuing regulations. As you can see, it has 

been a continuous process. The regulations, we were basically—— 

Mr. YOUNG. But there was a gap you see right up there. 

Ms. TAVENNER. I do see that gap. 

Mr. YOUNG. How do account for that? 

Ms. TAVENNER. That is like a 2-month gap. And I don’t know 

that that would be unusual. If we were to go back, and I am happy 

to go back and map the last 4 years, we have probably had 2- 

month gaps at other intervals. 

Mr. YOUNG. So you think CBS News missed that? 

Ms. TAVENNER. No. I don’t know what CBS News did. I am 

just telling you. We have had a continuous regulatory process going 

on. We have worked with the public. There is obviously a lot of 

back and forth between us and OMB in the regulation process. It 

is not unusual for a reg to take 2 months, 4 months, or longer. 

Mr. YOUNG. So you can assure us that partisan politics played 

absolutely no role in that? 

Ms. TAVENNER. I think, again, the regulatory process was continuous. At no point were we not either working on white papers, 

proposed regs—— 

Mr. YOUNG. Right. 

Ms. TAVENNER [continuing]. Just getting the work done. 

Mr. YOUNG. As you know, as you have heard here today, there 

are real consequences to our constituents for the failures and shortcomings of this Web site. You have acknowledged that. 

Ms. TAVENNER. Let me talk to you about the Web site. 

Mr. YOUNG. Well, I have got limited time, so I am going to 

move on. 

Ms. TAVENNER. Well, I thought you wanted me to explain the 

problems with the Web site. 

Mr. YOUNG. One of my constituents—— 

Ms. TAVENNER. Do you want me to explain the problems with 

the Web site? 


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Mr. YOUNG. Submit supplemental material. 

Ms. TAVENNER. First of all, I would just say it is not a Web 

site, it is an insurance program. Okay? 

Mr. YOUNG. Okay. 

Ms. TAVENNER. And sometimes I think we think it is like a 

Web site. 

Mr. YOUNG. Right. 

Ms. TAVENNER. Web site just, like, looks at things. 

Mr. YOUNG. Right. 

Ms. TAVENNER. This is a complicated program tied to 34 

States, including very individualized Medicaid programs. People 

need to understand. 

Mr. YOUNG. Thank you, Ms. Tavenner. I would like to go back 

to HealthCare.gov, which is the Web site associated with signing 

up for required government-sanctioned health care. And Marvin, 

one of my constituents, writes on behalf of his wife, who was told 

by her insurer that due to health care reform, effective 1/1/14, the 

policy in the name of said citizen has been or will be terminated 

as of January 1, 2014. 

When can she sign up for her health care, Ms. Tavenner? 

Ms. TAVENNER. And does it go on to talk about other policies 

or just says she is cancelled and that is it? 

Mr. YOUNG. It goes on to say she is cancelled. 

Ms. TAVENNER. She is eligible and she can sign up for a new 

plan—— 

Mr. YOUNG. She needs to sign up through the Web site. 

Ms. TAVENNER. She can sign up through the Web site or she 

can go to that individual issuer. 

Chairman CAMP. All right. Time has expired. 

Mr. Becerra. 

Mr. BECERRA. Thank you, Mr. Chairman. 

Ms. Tavenner, thank you very much. Appreciate you being here. 

And I think it has become very clear, and I hope that in all the 

hearings that take place further that we understand that we have 

to work together, because it is unacceptable to have an important 

part of the health insurance program, this Web site, not work the 

way it should. 

In fact, let me give you a quick example. There is a gentleman 

from Los Angeles, 34-year-old male, Andrew Stryker, and he had 

been reported in a number of press reports. He waited 3 hours to 

try to get on the Web site and finally had a chance to apply, and 

he says that that was tough. The good news for Mr. Stryker is that 

he is saving $6,000 as a result of being able to apply for the plan. 

So it is unacceptable for anyone to have to wait even 3 hours. 

And even though he says that he would have waited all day given 

the result he got, what we want is for everyone to experience the 

$6,000 savings, maybe not that much, maybe more, but we want 

them to experience savings and to finally have the health security 

that you, every single Member on this committee has when it 

comes to health care. We don’t have to worry about going bankrupt 

if we have to take our child to the doctor or to the hospital. And 

that is what Andrew Stryker now will have. And so let’s fix this 

Web site. Let’s not fixate on the Web site, let’s fix the Web site. 


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Now, if I can have, I will put on the screen the application process. 

[Slide] 

Mr. BECERRA. Today if you apply for the Affordable Care Act 

insurance, you have essentially three pages, and the third page is 

really more a signature page than anything else, to apply to get 

onto a health insurance policy, a health insurance plan. 

If we can have the next slide. 

[Slide] 

Mr. BECERRA. This is what the process was before the Affordable Care Act. You had some 12, 13 pages that you would have to 

fill out, many of them asking all sorts of very personal questions, 

very deep medical probing that was done, from strep throat, allergies, if you have ever suffered that, acne, all the way of course to 

whether you had cancer, heart disease. You could even be asked if 

you had learning disabilities. 

Now, can you explain why it is that all of a sudden we can go 

from a 13-or-so-page application that really probes into your personal life to one that is only three pages long? 

Ms. TAVENNER. I think as you are well aware, thanks to the 

changes in the Affordable Care Act, there is no longer the preexisting denial, everyone is entitled to insurance, which was part 

of the goal. 

The other thing that I will say is people may talk about the Affordable Care Act, or Obamacare, but once you get through that 

and you actually talk to folks about what is going on for them, if 

they had a child with a preexisting condition, most of them had 

issues with insurance, they had to go through this complicated 

process, they like what they are getting now. 

Mr. BECERRA. Yeah. So no longer will I get asked if I have 

heart disease or acne. I can apply and I won’t have to worry about 

what my personal lifestyle is, I will be able to get insurance. And 

this 13-page application is now history for all those folks who go 

ahead and apply through the individual insurance market. So what 

I hope they will do is, again, fix the Web site so we can get to the 

process of giving folks like Andrew Stryker a $6,000 saving. 

Chairman CAMP. All right. 

Mr. BECERRA. Thank you very much. I yield back. 

Chairman CAMP. Mr. Griffin and then Mr. Schock. 

Mr. GRIFFIN. Thank you, Mr. Chairman. 

Thank you so much for being here. I have heard a lot of good 

things about your work from Leader Cantor, Eric Cantor. So thank 

you for being here, and I wish you well. 

I first wanted to say that as I tried to indicate earlier, it is really 

a false choice to say it is Obamacare or all the things that were 

never fixed in the health care world have to continue. There are 

many different options in between there. I have signed on to legislation that would also deal with preexisting conditions. 

So I just want to make clear to the public, to imply that you have 

to take all of what Obamacare delivers to get to address preexisting 

conditions or you get none of that addressed, that is just not true. 

And we can have that debate. 

I have heard from a lot of Arkansans. I want to read a message 

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tle Rock. She says, quote, ‘‘I am an Arkansas State employee, government worker. We received a newsletter from the Employee Benefits Division during open enrollment. Our insurance covers less 

now and costs more. It says, ‘These changes were made to more 

closely align the plans with the Affordable Care Act.’ ’’ And in another sentence, quote, ‘‘Because of this, the value of the plans were 

lowered to be more in line with the law,’’ end quote. ‘‘I am quite 

disgusted. Just because the Federal Government is starting a 

health insurance marketplace doesn’t mean that my coverage needs 

to change, but it has, and it has changed for the worse. If you need 

a copy of this newsletter, please let me know. Thank you for working on this problem.’’ I have a copy of the newsletter here. 

So there are a lot of people that tell that story, and I have pages 

of it. Yes, there are people that are getting covered because of preexisting conditions. My point is, you don’t have to do it this way. 

And that is why a lot of us continue to have a problem with the 

law. Yes, we have voted 43 times or so, but what the talking points 

don’t tell you is seven of those votes became law because the President agreed to those things. So the idea that we have had the same 

exact vote 44 times is talking point nonsense. 

But I guess what I would ask you is, are these increased premiums and increased copays, is that just the cost of providing more 

access to health care? What do I say to people who ask, why am 

I paying more? Do I just tell them, hey, that is a tax? We didn’t 

call it a tax, but that is a tax you got to pay so that more folks 

have access. Is that fair? Is that what it is really? 

Ms. TAVENNER. What I would say to those folks is it is going 

to depend on their individual, you know, situation, because if they 

are in a group market where they already had group employersponsored insurance, that is a different situation. If they are in an 

individual market, what you can say to them now is they now have 

access to health care and they now have a competitive market. 

Mr. GRIFFIN. So if you are paying—— 

Chairman CAMP. All right. Time has expired. 

Mr. Schock. 

Mr. GRIFFIN. I appreciate you. Thank you. 

Mr. SCHOCK. Thank you. With all this discussion about Web 

sites that don’t work, let’s talk about a Web site that does. On 

WhiteHouse.gov right now, if you go to WhiteHouse.gov, ‘‘Health 

Insurance Reform Reality Check.’’ Headline: You can keep your 

health insurance if you like it. Currently on the Web site. Linda 

Douglass of the White House Office of Health Reform debunks the 

myth that reform will force you out of your insurance plan if you 

like it, force you to change doctors, period. To the contrary, reform 

will expand your choices, not eliminate them. 

WhiteHouse.gov then cites three sources to substantiate their 

claim. One of them is a blog post by Linda Douglass, one of them 

is a video of a press conference that the President gave in July, and 

one of them is a teletownhall hosted by AARP. And if you click on 

them, interestingly, the first question that the President was asked 

at the teletownhall came from a woman named Margaret in Greeley, Colorado, and she says, ‘‘Mr. President, I have heard I could 

lose the health insurance that I have currently.’’ And the President 

says to that question, and I am quoting: ‘‘Here is a guarantee that 


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I have made: If you have insurance that you like, then you will be 

able to keep that insurance, period.’’ That is on WhiteHouse.gov 

Web site today. ‘‘Reality Check,’’ is their headline, ‘‘on Health Insurance Reform.’’ 

Let me tell you, Ms. Tavenner, the reality check that millions of 

Americans in my district are getting. Michelle York from Triple 

Digit Trucking in Jacksonville, Illinois, just sent me this letter 

today, and it is from Blue Cross Blue Shield. ‘‘All plans must be 

compliant with the new health care law. Therefore, Blue Cross 

Blue Shield health insurance plan that you currently have now will 

no longer be available after December 31. Your premiums will go 

from $474 to $865, effective January 1, a nearly 100 percent increase.’’ 

She writes to me, Ms. Tavenner, ‘‘I do not understand how my 

current policy can legally be cancelled since I am already doing 

what I am supposed to do.’’ What am I supposed to say to Ms. York 

in Jacksonville, Illinois? 

Ms. TAVENNER. The first thing I would do is I would encourage 

her to go talk to the Web site or go to the call center and see what 

is available in the market. 

Mr. SCHOCK. So wait a minute. She is told by the President, 

the WhiteHouse.gov today says if you have health insurance that 

you like, you will be able to keep it. She has health insurance that 

she likes, she has been paying her premiums, she wants to keep 

it, but she can’t. Isn’t that a lie? 

Ms. TAVENNER. You know, there has always been the issue 

where issuers had the ability to stop offering a policy or change a 

policy. 

Mr. SCHOCK. No, this is the not the issuers wanting to stop to 

offer a policy. The issuer is saying we are being mandated that we 

can’t continue to offer this policy. It is a yes-or-no question. The 

WhiteHouse.gov Web site says if you want to keep the health insurance that you have got, you can keep it, and now they are being 

told they can’t. That is a lie. 

Ms. TAVENNER. Those issuers were grandfathered in, in 2010, 

and they are choosing to make a different decision now. 

Chairman CAMP. All right. 

Mr. Kind. 

Mr. KIND. Thank you, Mr. Chairman. 

Ms. Tavenner, thank you so much for your patience and your indulgence here today. Let me ask you to end on a high note, shall 

we speak. I think all the questions surrounding the ACA Web site 

have been asked and answered and exhausted. I know Secretary 

Sebelius will be here again tomorrow answering a lot of the same 

questions you just had. But really the key to all this, what we are 

trying to do is make sure that all Americans have access to quality 

affordable health care coverage in their life, period. There may be 

different ways of doing it and that, but the real key is affordable. 

What can we do to help bend the cost curve within the health care 

system so it is more affordable for all Americans. 

Cost containment. You have been given a lot of tools under the 

Affordable Care Act for cost containment, trying to get better value, 

good quality of care at a much better price. What are you seeing 


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out there right now in that regard and whether or not it is sustainable in the future? 

Ms. TAVENNER. That is a great question. What we have seen 

in our early work with the Innovation Center, and obviously chiefly 

targeted at the Medicare population, is the more we tie quality and 

outcomes to payment, the better results we are getting for the individual and the lower the cost trend. We have had probably 3 years 

of the lowest cost trend in Medicare that we have seen in the last 

50 years. That doesn’t mean that we don’t have to keep fighting it 

every day. We also work with issuers on the private side so that 

they align their quality programs and their indicators the same as 

we so that the trend is just not a Medicare trend, it is across the 

entire environment. 

Early success encouraging; a lot of work to do. 

Mr. KIND. Yeah. I see recent data just came out about per-beneficiary costs for Medicare being revised downward yet again, and 

really that is going to be the key to our long-term unfunded liabilities that we are facing that are driving these budget deficits, these 

rising health care costs. I think there is a lot that is going. 

And, Mr. Chairman, I would respectfully recommend that at 

some future hearing we call Ms. Tavenner back, mainly focused on 

cost containment within the health care system, so we can delve 

into it in greater detail. I yield back. 

Chairman CAMP. I am sure she will be anxious to come back. 

We have two more, Mr. Reed and then Mr. Kelly. 

Mr. Reed. 

Mr. REED. Thank you, Mr. Chairman. 

And thank you, Ms. Tavenner. And we have worked together before, and I appreciate that relationship. And you have demonstrated to me in that relationship in those prior dealings a very 

high level of competence. And I have been listening to your testimony today, and I really want to focus on my oversight responsibilities on this committee. 

You had indicated to Mr. Buchanan, Ms. Tavenner, that you 

were not aware prior to October 1 of any problems with the Web 

site. Did I misinterpret your response to Mr. Buchanan’s question? 

Ms. TAVENNER. No. We had tested the Web site and we were 

comfortable with its performance. Now, like I said, we knew all 

along that there would be, as with any new Web site, some individual glitches we would have to work out. But the volume issue 

and the creation of account issues was not anticipated and obviously took us by surprise and did not show up in testing. 

Mr. REED. So that didn’t show up in testing. So when I read the 

New York Times article that talked about confidential progress reports from Health and Human Services Department showing senior 

officials repeatedly expressed doubts that the computer systems for 

the Federal exchange would be ready on time, blaming delayed regulations, a lack of resources, and other factors, is that New York 

Times report inaccurate? 

Ms. TAVENNER. We were working in a compressed time frame 

for sure, but how we chose to resolve some of that is some of the 

things that we delayed, the programs that we delayed, which I 

have been through, SHOP, Medicare account, transfer, Spanish, 

there were three or four programs that we said, okay, we will not 


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be able to adequately test those. We went through testing on the 

remainder of the Web site. We also had independent validation. 

Obviously your initial testing, you find areas, you correct them, you 

improve, but we went through the testing process. 

Mr. REED. And I appreciate that. So you made some determinations to delay and suspend some of the programs. 

Ms. TAVENNER. Yes. 

Mr. REED. And then you had mentioned that you had done that 

through a group decision-making process. And then there were 

some question as to who was involved in that group decision-making process, and you were very hesitant to give any names involved 

in that group. Do you know the names of the people that were involved in that group? 

Ms. TAVENNER. So the program delay recommendations were 

CMS. We made those recommendations to the Secretary in September. And I think I indicated—— 

Mr. REED. And then did she unilaterally make that decision to 

delay it or did she inform the White House of any indication—— 

Ms. TAVENNER. So I informed White House staff, I informed 

the Secretary of our decisions, and they supported it. 

Mr. REED. Perfect. So who on the White House staff did you inform? 

Ms. TAVENNER. I would be glad to get you that information. 

Mr. REED. Why can’t you give me that information? 

Ms. TAVENNER. I am just saying it was staff within the White 

House. I am happy to get you that information. I just want to give 

you accurate—— 

Mr. REED. You don’t know the name of the staff member? As 

you sit here today, you don’t know the name of the staff member 

you directed that to? 

Ms. TAVENNER. So I was talking to several staff. I am happy 

to get you that list. 

Mr. REED. Why can’t you tell me that name here? 

Ms. TAVENNER. Because I would want to give you the entire 

list, I would want to give the date, I would want to give you correct 

information. I think that is appropriate, Mr. Chairman. 

Chairman CAMP. All right. 

Mr. Kelly. 

Mr. KELLY. Thank you, Mr. Chairman. 

Ms. Tavenner, thanks for being here. I know you have a great 

deal of experience in the private sector. You have done things. And 

I know we have had a lot of talk about how it is not working, but 

this failure to launch is really troubling to me, and it is all about 

the process. So my question, who is in charge of this? Was it you? 

Ms. TAVENNER. Yes. I am in charge of the program. 

Mr. KELLY. All right. So there is a little saying out there, you 

have got to inspect what you expect. Were there any expectations 

at all? Because we keep hearing that we just didn’t expect this 

level, we didn’t expect this level of volume. It is incredible for me 

to sit back and understand that that is possibly the case. 

I think this was designed for failure from the beginning, and I 

tell you why I think that. It was never achieved to achieve success. 

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ess, the people that got the final bid to build this site, there is no 

bid process, right? 

Ms. TAVENNER. There was a bid process, yes. 

Mr. KELLY. All right. So they competed against other people to 

get this bid? 

Ms. TAVENNER. Yes. 

Mr. KELLY. All right. Is there a performance bond included in 

that? 

Ms. TAVENNER. Yes, I am sure there is, but I need to check on 

that. 

Mr. KELLY. Okay. Well, I want to get an answer to that, because to my knowledge there was absolutely no performance bond. 

Ms. TAVENNER. And I am not the contracting specialist. 

Mr. KELLY. No, no, no, no, no. Well, but you are in charge of 

it. You have got to have oversight. And I am deeply disturbed that 

we are talking about a site that started off with an expectation of 

cost. It has gone way off the charts, and there is no concern about 

that. Right? This is not about health care. This is about a Web site 

that from the very beginning, after 3 years and all this investment, 

we still can’t get up and onto it. And if I asked you a question, who 

is in charge, and you say you are, I am expecting to get answers 

from you as to who actually was there, how did these people get 

the bid, were they held accountable for their lack of performance, 

and is there a performance bond in there that allows the American 

people to recover some of their money, because not one penny came 

from the government, it came out of taxpayers’ pockets. 

Ms. TAVENNER. So I am happy to get you that information. 

Mr. KELLY. Well, I got to tell you, and again, this has nothing 

to do with you. These cost overruns are off the chart, and the idea 

that somehow there is an answer in the future is unacceptable. We 

have driven the gap between what the American people expect, and 

what they expect do now expect is so little from the government. 

You know, my little town of Butler, Pennsylvania, they had a bid 

for police cars. Do you know part of that bid was a 10 percent bid 

bond, performance bond that was included? I can’t understand how 

a little town that has a $7.8 or $7.9 million budget can ask for 

those types of guarantees from bidders, responsible bidders, and 

the United States Government cannot. 

And the cost of this, if it is actually true, and I want to get to 

the bottom of it, if it really started off and you expected somewhere 

around $100 million to be spent, and it is now up over $600 million 

and that doesn’t include any of the other rollout costs, can we actually sit here and talk to the American people with any degree of 

confidence and saying, we have got your best interests at heart 

here. We have also got your wallets, and we are going to drain 

them. 

This is an absolute incredible, incredible lack of efficiency and responsibility on behalf of the administration, and it doesn’t surprise 

me. This is the way they operate with every single thing. And I 

can’t believe that everybody is finding this out because of what 

they read in the newspaper. If you read the model, if you had the 

model, if you had the tests going, you couldn’t possibly sit here 

today and say it is going exactly the way we expected. 

Chairman CAMP. All right. Thank you. Time has expired. 


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As a reminder, any member wishing to submit a question for the 

record will have 14 days to do so. And if any members submit questions at this hearing, I would ask that the administrator respond 

in writing in a timely manner. 

Chairman CAMP. Again, I want to thank Administrator 

Tavenner for her testimony today, and appreciate your continued 

assistance as we answer some of the questions that were raised at 

this hearing. And I appreciate your offer of regular updates as we 

move forward. 

With that, this committee is adjourned. 

[Whereupon, at 12:56 p.m., the committee was adjourned.] 

Æ 


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