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87–107 2014

TWO WEEKS UNTIL ENROLLMENT: QUESTIONS 

FOR CCIIO 

HEARING 

BEFORE THE

SUBCOMMITTEE ON OVERSIGHT AND 

INVESTIGATIONS 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

FIRST SESSION 

SEPTEMBER 19, 2013 

Serial No. 113–84 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 

(II) 

COMMITTEE ON ENERGY AND COMMERCE 

FRED UPTON, Michigan 

Chairman 

RALPH M. HALL, Texas 

JOE BARTON, Texas 

Chairman Emeritus 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOSEPH R. PITTS, Pennsylvania 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE ROGERS, Michigan 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

Vice Chairman 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

ROBERT E. LATTA, Ohio 

CATHY MCMORRIS RODGERS, Washington 

GREGG HARPER, Mississippi 

LEONARD LANCE, New Jersey 

BILL CASSIDY, Louisiana 

BRETT GUTHRIE, Kentucky 

PETE OLSON, Texas 

DAVID B. MCKINLEY, West Virginia 

CORY GARDNER, Colorado 

MIKE POMPEO, Kansas 

ADAM KINZINGER, Illinois 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

BILL JOHNSON, Missouri 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

HENRY A. WAXMAN, California 

Ranking Member 

JOHN D. DINGELL, Michigan 

Chairman Emeritus 

FRANK PALLONE, JR., New Jersey 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

MICHAEL F. DOYLE, Pennsylvania 

JANICE D. SCHAKOWSKY, Illinois 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

JOHN BARROW, Georgia 

DORIS O. MATSUI, California 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

JERRY MCNERNEY, California 

BRUCE L. BRALEY, Iowa 

PETER WELCH, Vermont 

BEN RAY LUJAN, New Mexico 

PAUL TONKO, New York 

(III) 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

TIM MURPHY, Pennsylvania 

Chairman 

MICHAEL C. BURGESS, Texas 

Vice Chairman 

MARSHA BLACKBURN, Tennessee 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

GREGG HARPER, Mississippi 

PETE OLSON, Texas 

CORY GARDNER, Colorado 

H. MORGAN GRIFFITH, Virginia 

BILL JOHNSON, Ohio 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

JOE BARTON, Texas 

FRED UPTON, Michigan (ex officio) 

DIANA DEGETTE, Colorado 

Ranking Member 

BRUCE L. BRALEY, Iowa 

BEN RAY LUJAN, New Mexico 

JANICE D. SCHAKOWSKY, Illinois 

KATHY CASTOR, Florida 

PETER WELCH, Vermont 

PAUL TONKO, New York 

GENE GREEN, Texas 

HENRY A. WAXMAN, California (ex officio) 

(V) 

C O N T E N T S 

Page 

Hon. Tim Murphy, a Representative in Congress from the Commonwealth 

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

Prepared statement .......................................................................................... 3 

Hon. Henry A. Waxman, a Representative in Congress from the state of 

California, opening statement ............................................................................. 4 

Hon. Michael C. Burgess, a Representative in Congress from the State of 

Texas, opening statement .................................................................................... 6 

Hon. Diana Degette, a Representative in Congress from the State of Colorado, 

opening statement ................................................................................................ 8 

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

prepared statement .............................................................................................. 66 

WITNESSES

Gary Cohen, Deputy Administrator and Director, Center for Consumer Information and Insurance Oversight, Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services ..................................... 17 

Prepared statement .......................................................................................... 19 

Answers to submitted questions ...................................................................... 72 

SUBMITTED MATERIAL

Minority memorandum ........................................................................................... 10 

Article entitled, ‘‘Randolph Hospital dismisses flap over navigator grant letter 

from Congress,’’ the Business Journal, September 12, 2013, submitted by 

Mrs. Ellmers ......................................................................................................... 67 

Majority memorandum ............................................................................................ 69 

(1) 

TWO WEEKS UNTIL ENROLLMENT: 

QUESTIONS FOR CCIIO 

THURSDAY, SEPTEMBER 19, 2013 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS, 

COMMITTEE ON ENERGY AND COMMERCE, 

Washington, DC. 

The subcommittee met, pursuant to call, at 10:19 a.m., in room 

2123 of the Rayburn House Office Building, Hon. Tim Murphy 

(chairman of the subcommittee) presiding. 

Members present: Representatives Murphy, Burgess, Gingrey, 

Scalise, Harper, Olson, Gardner, Griffith, Johnson, Long, Ellmers, 

Shimkus, DeGette, Butterfield, Castor, Welch, Tonko, Green, 

Yarmuth, Dingell, and Waxman (ex officio). 

Staff present: Sean Bonyun, Communications Director; Karen 

Christian, Chief Counsel, Oversight; Noelle Clemente, Press Secretary; Julie Goon, Health Policy Advisor; Brad Grantz, Policy Coordinator, Oversight & Investigations; Sydne Harwick, Legislative 

Clerk; Brittany Havens, Legislative Clerk; Sean Hayes, Counsel, 

Oversight & Investigations; Andrew Powaleny, Deputy Press Secretary; John Stone, Counsel, Oversight; Tom Wilbur, Digital Media 

Advisor; Phil Barnett, Democratic Staff Director; Brian Cohen, 

Democratic Subcommittee Staff Director, Senior Policy Advisor; 

Hannah Green, Democratic Staff Assistant; Elizabeth Letter, 

Democratic Assistant Press Secretary; Karen Nelson, Democratic 

Deputy Staff Director; Stephen Salsbury, Democratic Special Assistant; and Matthew Siegler, Democratic Counsel. 

OPENING STATEMENT OF HON. TIM MURPHY, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA 

Mr. MURPHY. Good morning. I convene this hearing of the Subcommittee on Oversight and Investigations. Well, in less than 2 

weeks enrollment in qualified health plans under the Patient Protection Affordable Care Act will begin. It is the law of the land. 

Today we hope to discuss the many challenges and issues that may 

arise over the coming weeks. Most of the concerns about the law 

currently can be reduced to one question: Is the Administration 

ready? 

Since passage of the President’s Healthcare Law, the Administration has consistently told us that the government will be ready 

when open enrollment begins on October 1 and the exchanges start 

on January 1. Yet our experience has shown that rosy predictions 

2 

about the future of the Healthcare Law often given way to the results of this rushed and rocky implementation. 

The law has many problems and so much so that half of it was 

simply done away with for a year. While individuals must comply 

with the law’s requirements starting on January 1 or pay a penalty, this is not so for businesses and companies who are able to 

delay the employer mandate for a year. 

Despite the Administration’s promises about lower premiums, 

evidence continues to mount that some individuals will face extreme rate hikes when the exchanges open, as much as double the 

price they are currently paying. And the Administration’s promise 

that if you like your coverage you can keep it rings especially hollow now with news reports almost every day about businesses moving the spouses and families of their employees or their retirees 

into the exchanges. If the President’s promises were true, we 

wouldn’t hear stories about major airlines losing millions of dollars 

to the Healthcare Law, and we wouldn’t hear about the spouses of 

thousands of employees losing their coverages. 

Meanwhile, any sort of oversight over the Healthcare Law remains taboo for the law’s defenders. Last month this committee 

sent letters to many of the recipients of federal funding to participate in the Navigator Program under the law. We asked some fairly basic questions. How many people are you hiring? What are you 

paying them? Are you performing background checks? We should 

expect that groups receiving federal dollars to enroll people in exchanges should have answers to those questions as enrollment begins in less than 2 weeks. 

In the course of this investigation the committee has had many 

productive calls with recipients of Navigator funding. I have had 

some personal meetings myself which have been very fruitful. In 

fact, many of the organizations were prepared to answer our questions we believe will be ready to properly perform their Navigator 

duties. Yet, we have also seen that the Navigator Program, like 

many of the programs created under the Healthcare Law, has been 

impacted by the Administration’s delay in implementing the law. 

According to a GAO report issued in June, the Administration 

issued the Navigator grants 2 months behind schedule. The Administration had planned to issue the first round of awards in June 

but did not end up issuing them until August. The Administration 

had originally planned to begin Navigator training in July, but 

HHS did not finalize the training programs until August 29. This 

delay naturally reduced by almost half the time available to Navigators to begin training and preparing for enrollment. 

So today we will ask Mr. Gary Cohen, the Director of the Center 

for Consumer Information and Insurance Oversight, to explain how 

the abbreviated training schedule for Navigators will affect the program. We will also ask Mr. Cohen to address some of the concerns 

we have identified in our review of the grant applications. 

We learned that some Navigators are planning on going door to 

door to conduct enrollment activities. A report issued yesterday by 

the Oversight and Government Reform Committee indicates that 

CCIIO representatives are aware of problems linked to door-to-door 

outreach activities such as scammers knocking on doors and falsely 

3 

representing that they are Navigators, and yet this activity is still 

permitted under the Navigator Program. 

We have also learned that the return on taxpayer dollars varies 

wildly among Navigator grant recipients. The Administration is 

paying one Navigator $80,000 to enroll 312 people. That is $80,000 

of taxpayer funding to enroll not even a person a day. 

On the other hand, other groups clearly have incredibly high expectations. Another applicant estimated that they would enroll approximately 75 percent of the individuals directly contacted, resulting in hundreds of thousands of enrolled individuals. There is a 

wide difference in expectations and workload. 

Our concerns over the safety of consumer data and health information remain as well. One Navigator plans to survey and track 

those who attend community meetings and another promises additional pay if a Navigator enrolls a certain amount of individuals. 

I have concerns about paying for that. 

Meanwhile, one Navigator told committee staff that they believe 

background checks are important, yet these are not a required action. Our responsibility in conducting oversight of Federal programs is to identify waste, fraud, and abuse, and the best case, 

asking questions about Federal spending and shining a light on 

programs can identify problems before taxpayer dollars are wasted 

and allow those problems to be corrected. A wait-and-see approach 

to oversight of the Healthcare Reform Law does not seem appropriate when its implementation has been regularly botched by 

delays and uncertainty. 

Let me add to this. As a clinician and psychologist myself, it was 

hardly ever appropriate for me or my colleagues in the medical 

field to wait until problems were at a severe or critical level. We 

like to know problems early and take action. That is the appropriate thing to do, and any claims that we are doing otherwise are 

inappropriate and spurious at best. 

So I welcome Mr. Cohen, and I look forward to asking questions 

about what we can expect in the coming weeks. 

[The prepared statement of Mr. Murphy follows:] 

OPENING STATEMENT OF THE HON. TIM MURPHY

In less than two weeks enrollment in qualified health plans under the Patient 

Protection and Affordable Care Act will begin. Today we hope to discuss the many 

challenges and issues that may arise over the coming weeks. Most of the concerns 

about the law currently can be reduced to one question: ‘‘Is the administration 

ready?’’ 

Since passage of the president’s health care law, the administration has consistently told us that the government will be ready when open enrollment begins on 

October 1 and the exchanges start on January 1. Yet, our experience has shown that 

rosy predictions about the future of the health care law often give way to the results 

of the administration’s rushed and rocky implementation. 

The law is so problematic that half of it was simply done away with for a year. 

While individuals must comply with the law’s requirements starting on January 1or 

a pay a penalty, this is not so for businesses and companies who were able to delay 

the employer mandate for a year. Despite the administration’s promises about lower 

premiums, evidence continues to mount that some individuals will face extreme rate 

hikes when the exchanges open—as much as double the price they are currently 

paying. Finally, the administration’s promise that ‘‘if you like your coverage you can 

keep it’’ rings especially hollow now, with news reports almost every day about businesses moving the spouses and families of their employees, or their retirees, onto 

the exchanges. If the president’s promises were true, we wouldn’t hear stories about 

4 

major airlines losing million of dollars to the health care law, and we wouldn’t hear 

about the spouses of thousands of employees losing their coverage. 

Meanwhile, any sort of oversight over the health care law remains taboo for the 

law’s defenders. Last month, this Committee sent letters to many of the recipients 

of federal funding to participate in the Navigator program under the law. We asked 

some fairly basic questions: how many people are you hiring? What are you paying 

them? Are you performing background checks? We should expect that groups receiving federal dollars to enroll people in exchanges should have answers to these questions, as enrollment begins in less than two weeks. In the course of this investigation, this Committee has had many productive calls with recipients of Navigator 

funding-in fact, many of the organizations were prepared to answer our questions 

and we believe will be able to properly perform their Navigator duties. 

Yet, we have also seen that the Navigator program, like many of the programs 

created by the president’s health care law, has been impacted by the administration’s delay in implementing the law. According to a GAO report issued in June, 

the administration issued the Navigator grants two months behind schedule. The 

administration had planned to issue the first round of awards in June—they didn’t 

end up issuing them until August. The administration had originally planned to 

begin Navigator training in July—but HHS did not finalize the training program 

until August 29. This delay naturally reduced by almost half the time available to 

Navigators to begin training and preparing for enrollment. 

Today, we will ask Mr. Gary Cohen, the Director of the Center for Consumer Information and Insurance Oversight, to explain how the abbreviated training schedule for Navigators will affect the program. We will also ask Mr. Cohen to address 

some of the concerns we have identified in our review of the grant applications. We 

learned that some Navigators are planning on going door-to-door to conduct enrollment activities. A report issued yesterday by the Oversight and Government Reform 

Committee indicates that CCIIO representatives are aware of problems linked to 

door-to-door outreach activities, such as scammers knocking on doors and falsely 

representing they are Navigators. And yet, this activity is still permitted under the 

Navigator program. 

We have also learned that the return on taxpayer dollars varies wildly among 

Navigator grant recipients. The administration is paying one Navigator $80,000 to 

enroll.312 people. That’s $80,000 of taxpayer funding to enroll not even a person a 

day. On the other hand, other groups clearly have incredibly high expectations: another application estimated that they would enroll approximately 75 percent of the 

individuals directly contacted, resulting in hundreds of thousands of enrolled individuals. 

Our concerns over the safety of consumer data and health information remain as 

well. One Navigator plans to ‘‘survey and track...those who attend community meetings’’ and another promises additional pay if a Navigator enrolls a certain amount 

of individuals. Meanwhile, one Navigator told Committee staff that they believe 

background checks are important, yet these are not a required action. 

Our responsibility in conducting oversight of federal programs is to identify waste, 

fraud, and abuse. In the best case, asking questions about federal spending and 

shining a light on programs can identify problems before taxpayer dollars are wasted—and allow those problems to be corrected. A ‘‘wait and see’’ approach to oversight of the health care reform law does not seem appropriate when its implementation has been regularly botched by delays and uncertainty. 

I welcome Mr. Cohen and I look forward to asking him questions about what we 

can expect in the coming weeks. 

# # # 

Mr. MURPHY. I now recognize Ranking Member DeGette for her 

opening statement, but she is going to yield to Mr. Waxman because he has another commitment this morning. 

OPENING STATEMENT OF HON. HENRY A. WAXMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA 

Mr. WAXMAN. Thank you, Mr. Chairman. Thank you, Representative DeGette, for yielding to me this time to make an opening 

statement. 

5 

Oversight is important and valuable, but the Affordable Care Act 

oversight of the last 3 years has not been to enlighten the committee or improve the law. It appears to be part of the efforts by 

the Republican party to engage in partisan attacks on this law and 

if they could do it, even sabotage the Affordable Care Act. 

I released a report last month highlighting the unprecedented 

Republican campaign to undermine the law. Forty-one repeal votes, 

refusals to expand Medicaid to cover millions of low-income Americans, and the imminent threat to shut down the entire Federal 

Government or force a catastrophic government default if the law 

is not repealed. There is no legitimate purpose served by the letters 

to 51 Navigators who are community groups, food banks, community health providers, and many similar non-political organizations 

tasked with trying to help inform the public about the Affordable 

Care Act benefits. This request was ill-timed and a serious mistake, and I find it amazing to hear the Chairman talk about how 

they haven’t had enough time to do their job but now we are trying 

to, by the committee, divert them from doing their job by answering all sorts of questions. 

The letters sent to them were without a predicate or evidence of 

wrongdoing. They serve only to burden and intimidate these organizations just as they are beginning their critical work. My staff 

yesterday released an analysis of the Navigator Program. Our investigation found that Navigators will help millions obtain health 

insurance coverage, that they have extensive experience assisting 

individuals with federal and state benefit programs, and they have 

effective privacy protections in place. 

In short, the Republican rhetorical attacks on the Navigator Program I believe are unjustified and inconsistent with the facts. It is 

hard to escape the conclusion that it was designed to intimate 

these groups and discourage participation in the program. Thanks 

to the Affordable Care Act millions of Americans will be able to get 

high-quality, affordable insurance. The worst abuses of the insurance companies have been ended. This Republican approach, I believe, is bad for the country. 

I want to now yield the balance of my time to the gentleman 

from North Carolina, Mr. Butterfield. 

Mr. BUTTERFIELD. Thank you, Mr. Waxman, for yielding time, 

and thank you for your extraordinary leadership. You not only 

wrote the Affordable Care Act, but you got it through this committee. Thank you very much. 

Mr. Chairman, I am pleased to announce that tens of thousands 

of my constituents in North Carolina have already benefited from 

the Affordable Care Act. One-hundred and thirty thousand seniors 

are now eligible for Medicare preventative services, 41,000 children 

can no longer be denied coverage based on pre-existing conditions, 

8,200 young adults now have coverage on their parents’ plans. It 

has been a long path, and we are almost there with the beginning 

of open season on October 1, less than 2 weeks away, we will be 

one step closer to helping many Americans receive affordable and 

quality healthcare. The opening of the marketplace, the education 

and support provided by, yes, the Navigators and the outreach by 

HHS will help directly enroll 1.1 million uninsured people and asVerDate Nov 24 2008 14:17 Aug 06, 2014 Jkt 037690 PO 00000 Frm 00011 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-84 CHRIS
6 

sist an additional 7.3 million uninsured people to receive health insurance. 

But instead of touting the success of soon having nearly every 

American insured, my Republican friends have forced more than 40 

votes to dismantle and defund the Act. The chairman of this committee in my opinion abused his investigatory authority by launching a fishing expedition of Navigators who received funding solely 

for the purpose of discrediting the program. This, Mr. Chairman, 

distracts the Navigators’ attention. You know it, and I know it, 

from their mission of helping families to access health insurance. 

Someone said that many of these Navigators will be going door 

to door. I hope they will be going door to door to enroll every uninsured American. A North Carolina newspaper recently reported 

that one of my North Carolina Republican colleagues who serves on 

this committee said that she would be pleased if the Congressional 

Navigator inquires stymies the non-profit is Navigator work, and 

she is quoted in that article as saying, ‘‘If this ended up resulting 

in a delay, I wouldn’t be unhappy about it.’’ 

This is an outrage, Mr. Chairman. I would hope that October 1 

that we would unite and make sure that every American gets access to affordable healthcare. The American people deserve it, and 

we need to bring this debate to a close. 

Thank you, Mr. Waxman. I will yield back to you, sir. 

Mr. MURPHY. The gentleman yields back. I now recognize for 5 

minutes the gentleman from Texas, Dr. Burgess. 

OPENING STATEMENT OF HON. MICHAEL C. BURGESS, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. BURGESS. Well, thank you, Mr. Chairman. I appreciate the 

recognition, and here we are a dozen days from the start date of 

October 1 where the open enrollment is going to occur. I don’t know 

a whole lot more than I did the last time Mr. Cohen was here at 

the end of April of this year. Since that time I have been told time 

and time again by officials from Health and Human Services, Center for Medicare, Medicaid Services, Treasury, the White House, 

and of course, even you when you were here, Mr. Cohen, that the 

exchanges would definitely be ready to go live on October 1, 2013. 

In addition, the federal hub that is supposedly going to be operational in a couple of days we have not had made available to us 

any of the testing data that reportedly has been done, and that obviously is an important aspect that many of us continue to have a 

great deal of interest. 

Even more concerning is the fact that federal officials have assigned much of the responsibility for the education and outreach to 

federally-funded Navigators. 

Now, similar to the Administration’s other delays, while Health 

and Human Services had initially planned to issue the first round 

of Navigator grants in June and begin training in July, the grants 

were issued on August 15, and a training program was not available to the Navigators until the end of that month. You got $67 

million, $13 million more than originally budgeted, $67 million of 

taxpayer money taken by threat by the IRS from taxpayers across 

this country, $67 million has been given out to Navigators across 

the Nation, and we don’t know the purpose of that money. 

7 

Now, I am going to reference an article from August 4 of 2012, 

so this is over a year ago it appeared in the ‘‘New York Times.’’ The 

article says, ‘‘Federal officials are looking for private contractors to 

provide in-person assistance to consumers and to operate call centers. A contractor will also help the government decide who gets 

federal subsidies, expected to average $6,000 a person, and who is 

exempt from the tax penalties that will be imposed on people who 

go without insurance.’’ 

Again, this is August 4 of 2012, so it is not like the agency didn’t 

know this was coming. The article goes on to say, ‘‘Mr. Hash, the 

Director of the Federal Office of Health Reform, said that federal 

exchanges will operate essentially in the same manner as the statebased exchanges, however, they differ in a significant way. States 

have done their work in public, but planning for the federal exchanges has been done almost entirely behind closed doors.’’ 

I think that is one of the problems that many of us on this committee have with that. 

‘‘Sabrina Corlette,’’ continuing in the article, ‘‘Sabrina Corlette, a 

Research Professor at Health Policy Institute of Georgetown University, said the federal exchanges were much more opaque than 

the state exchanges.’’ You have to wonder what value is there in 

opacity in that situation from an Administration who said it valued 

transparency. 

Yesterday morning people who received their copy of the ‘‘Wall 

Street Journal,’’ were greeted with the headline, ‘‘Burden Shifts on 

Insurance. Firms Change Health Coverage, Walgreen to Give 

Workers Payments to Buy Plans.’’ You know, when the healthcare 

law was sold by the President across this country, it was sold with 

the admonition if you like what you have, you can keep it. If you 

like your doctor, you can keep your doctor. If you like your health 

plan, you can keep your health plan but apparently not if you work 

for Walgreen’s. 

You know, we get criticized on this side of the dais because of 

attempts to reign in the Affordable Care Act. No apology for the 

number of times that legislation has come to the floor of the House 

to try to pull this thing back. It has never been popular, it has 

never enjoyed popular support, it is becoming increasingly clear 

how dangerous this law is to people’s health and healthcare, how 

dangerous it is to our economy. 

But seven times the President has signed one of those bills into 

law. So gone are the 1099 provisions, gone are the Class Act, gone 

are several other things. But here is a point that people miss. 

Seven other times the President has decided himself that parts of 

the law were unimportant, and the law that he signed was not, in 

fact, going to endure. What about the Pre-Existing Condition Program? This law was sold on the backs of people with pre-existing 

conditions across this country, and yet when someone showed up 

on February 1 of this year to enroll in the PECP Program, they 

were told, sorry, sister, the program is closed. So for 11 months 

people with pre-existing conditions who had been promised relief 

are just simply wondering the country wondering what they are 

supposed to do. 

The shop exchanges were supposed to open January 1, 2014. You 

put it off to 2015. Removing the reporting requirements and relying 

8 

on self-attestation, delaying final contracts with contractors, delaying the employer mandate, removing out-of-pocket caps, no premium information. This was promised to me by the Administrator 

of CMS—— 

Mr. MURPHY. The gentleman’s time—— 

Mr. BURGESS [continuing]. In July in this committee, that I 

would have this information by September 15. Mr. Cohen, we are 

going the long way now to September 15 and if you go—— 

Mr. MURPHY. The gentleman’s time—— 

Mr. BURGESS [continuing]. To the Web site today on 

healthcare.gov, it says come back and see us in a few weeks. We 

are busy trying to get it ready. 

Thank you, Mr. Chairman, for your indulgence. I will yield back 

my time. 

Mr. MURPHY. Thank you. Now go to Ms. DeGette for 5 minutes. 

Ms. DEGETTE. Thank you very much, Mr. Chairman. Before I 

make my opening statement I would like to recognize the newest 

member of the Energy and Commerce Committee, Congressman 

John Yarmuth from Kentucky. We are very glad to have him. 

[Applause.] 

Ms. DEGETTE. And I would ask unanimous consent to allow him 

to participate in the hearing today. He doesn’t have subcommittee 

assignments yet, but we know he is going to be on this fabulous 

subcommittee very soon. 

Mr. MURPHY. Without objection. 

OPENING STATEMENT OF HON. DIANA DEGETTE, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF COLORADO 

Ms. DEGETTE. Thank you very much. 

Mr. Chairman, we have spent more than our share of time in 

this subcommittee on the Affordable Care Act talking about implementation. It is our seventh hearing this year, and we really 

haven’t seen any problems come up in all the hearings. So I want 

to thank Mr. Cohen for coming back again during a very busy time 

in his schedule as the exchanges open on October 1. 

On this subcommittee it is our job to unearth the facts in an objective and non-partisan manner. So with 2 weeks to go before the 

marketplaces go live, I want to talk for a moment about what we 

have seen this year. 

We have obtained documents and conducted extensive investigation of health insurance premiums under the ACA, and what did 

we find out? The ACA is going to allow millions of Americans to 

obtain affordable insurance for the first time ever. HHS this week 

released a new report showing that nearly six in ten currently uninsured Americans, 23.2 million people, would be eligible to get insurance coverage for under $100 a month. A Kaiser Family Foundation study released earlier this month concluded that premiums 

are generally lower than expected. A new RAM study reached similar conclusions. 

The facts also show that individuals with health insurance coverage are already benefiting from the Act. The HHS revealed that 

6.8 million customers saved an estimated $1.2 billion on their premiums in 2012, due to the rate review provisions in the ACA. 

9 

This committee also conducted an investigation into the contractors responsible for implementing the ACA’s marketplaces. This 

was one of my favorite hearings because what did the facts show? 

They showed that the contractors will be ready on October 1, that 

they are taking appropriate steps to protect consumer privacy, and 

as an added benefit, they are creating thousands of jobs. 

Last month, Mr. Chairman, you opened an investigation into the 

ACA Navigator Program. That is what we are here today for. You 

sent dozens of letters to dozens of civic and community groups that 

received grants to help their neighbors sign up for ACA benefits. 

In a letter to Chairman Upton, Ranking Member Waxman expressed his concern that this investigation was designed not to enlighten the committee but to intimidate the Navigators, and I am 

sorry to say I kind of agree with those criticisms. 

There seems to be little reason to put these burdens on the Navigators just as they were starting to get their work going with the 

public, and the Committee’s investigation shows there is no basis 

for the allegations about the Navigators. 

Yesterday the minority staff released a supplemental memo summarizing its review of the Navigator documents. Mr. Chairman, I 

would like to ask that that be made part of the record. 

Mr. MURPHY. Without objection. 

[The information follows:] 

10 


87107.004
11 


87107.005
12 


87107.006
13 


87107.007
14 


87107.008
15 


87107.009
16 

Ms. DEGETTE. The investigation found that Navigators would 

help millions of people obtain health insurance coverage. They have 

extensive experience assisting individuals with federal and state 

benefit programs. Most Navigators are non-profit, non-partisan 

community service providers, and they have effective privacy provisions in place. Those are the facts, and they show good news. 

Mr. Chairman, you talked in your opening statement about these 

false Navigators that are going door to door, and that is a concern. 

That is why we have to have the real Navigators in place so they 

can sign people up, and just yesterday HHS, DOJ, and the FTC announced a massive anti-fraud effort. I would suggest we all work 

together to stop any kind of fraud in the system and with that, Mr. 

Chairman, I want to yield the balance of my time to Representative 

Castor. 

Ms. CASTOR. Well, I thank the Ranking Member for yielding 

time. 

I wanted to relay today the enthusiasm I am hearing back home 

from so many of my neighbors, particularly when it comes to now 

the bar against discrimination for our neighbors who have pre-existing conditions. Just over the past few weeks I have met with 

leaders and communities with multiple sclerosis, diabetes, HIV 

Aids, cancer that now see hope. They have hope because they will 

be able to get insurance for a change and not be discriminated 

against. 

Now, since September of 2010 children with these chronic diseases and chronic conditions have been able to get insurance in the 

greater Tampa Bay area. That has meant 237,000 children have 

been able to get insurance where before they couldn’t. Now, beginning January 1 this will apply to adults. So they are particularly 

enthused, but at the same time they are very troubled by the Republican obstruction and sabotage. They don’t understand why now 

people are going to block access to the doctor’s office and affordable 

care. 

So I look forward to discussing that today. 

Mr. MURPHY. Thank you. The gentlelady’s time has expired. 

By the way, I also want to recommend the Chairman of Environment and the Economy here, Mr. Shimkus, is going to sit on this 

hearing. Thank you for being here. 

I will now swear in the witness. 

I will introduce him. Mr. Cohen is the Deputy Administrator and 

Director of the Center for Consumer Information and Insurance 

Oversight, recently served as General Counsel for California 

Health Benefits Exchange, and we will swear in the witness. 

[Witness sworn.] 

Mr. MURPHY. You are now under oath and subject to the penalties set forth in Title XVIII, Section 1001 of the United States 

Code. You may now please give a 5-minute summary of your written testimony. 

17 

TESTIMONY OF GARY COHEN, DEPUTY ADMINISTRATOR AND 

DIRECTOR, CENTER FOR CONSUMER INFORMATION AND INSURANCE OVERSIGHT, CENTERS FOR MEDICARE AND MEDICAID SERVICES, U.S. DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Mr. COHEN. Good morning, Chairman Murphy, Ranking Member 

DeGette, and members of the subcommittee. I look forward to answering your questions regarding CMS’s ongoing work to implement the Affordable Care Act, including the Navigator Program. 

As we approach the beginning of open enrollment, CMS and all 

of our partners across the country are focused on helping people 

sign up for affordable healthcare coverage that begins on January 

1. We are already seeing competition works. The creation of new 

marketplaces is encouraging insurers to offer plans at competitive 

rates. 

As a result, in 16 states preliminary rates are 19 percent less expensive than the CBO projected. States are using their improved 

rate review powers to help keep rates affordable and, according to 

recent estimates as Congresswoman DeGette mentioned, many consumers may be able to pay $100 or less per person per month for 

coverage in 2014. 

When open enrollment begins on October 1, it is one more step 

toward putting in place one of the core promises of the Affordable 

Care Act: affordable, accessible health coverage that begins next 

year. We are working hard to ensure that consumers have the information they need about their coverage options. Healthcare.gov 

has received more than 3 million unique visits since its re-launch 

this summer, and as required by the law, CMS has awarded grants 

to over 100 organizations to serve as Navigators. 

These grantees are groups and organizations with a proven ability to reach out to likely marketplace consumers in their local communities. Navigators include the Pennsylvania Association of Community Health Centers, which since 1981 has been supporting community health centers across the state in their mission of providing 

access to quality primary healthcare. There are organizations like 

Ascension Healthcare, which is the Nation’s largest Catholic and 

non-profit health system; the Martin Luther King Health Center, 

which has been serving the people in Shreveport, Louisiana, since 

1986; the University of Mississippi Medical Center; the United 

Way of Metropolitan Tarrant County, which will be collaborating 

with 17 other organizations in assisting Texas residents and which 

has been helping people in the Fort Worth and Arlington areas for 

90 years; and the University of Georgia, which was founded in 

1785, as the Nation’s first state-chartered university. 

I find the suggestion that these organizations, that the United 

Way or the University of Georgia or any of the rest are going to 

prey on people by stealing their identities to be utterly without 

foundation. Helping people is the reason that these organizations 

exist. 

Navigators are prepared to provide accurate and impartial assistance to consumers shopping for health insurance coverage. They 

will be required to adhere to strict privacy and security standards 

including how to safeguard a consumer’s personal information. 

Navigators will be required, the individuals will be required to 

18 

complete approximately 20 hours of initial training to be certified, 

will take additional training throughout the year, and will renew 

their certification yearly. 

The work they will be doing is similar to work that has been 

done for years by SHPS to help Medicare beneficiaries understand 

their options. I find it really unfortunate that many of these organizations are facing distracting scrutiny while they prepare to 

begin this important work. 

One organization, a group prepared to serve individuals in four 

states, withdrew from the program as a result of this scrutiny. This 

type of scrutiny risks creating an insinuation that these well-respected organizations and institutions like food banks, large state 

universities, and United Way chapters have somehow done something inappropriate before they have spoken to a single consumer. 

These groups are trying to do the same type of work they have 

done in their communities for years and in some cases decades, and 

it is unfortunate that they are the subject of inquiries that suggest 

they are doing something wrong by helping people in their communities enroll in healthcare coverage. They are feeling obligated to 

spend time responding to inquiries and insinuations that they are 

hiring unqualified staff or won’t follow federal grant regulations instead of beginning the task of helping people in their communities. 

It is disappointing that their resources and attention have been diverted at this critical time. 

I have been asked countless times over the last year whether we 

will be ready for day one, and it often brings to my mind the implementation of Medicare Part D. Now, I wasn’t at CMS during Medicare Part D implementation, but I read the news stories like everyone else, and I understand that there were some serious challenges; seniors not enrolled correctly in plans, beneficiaries turned 

away from pharmacies without their medications. But CMS solved 

these problems, and the Part D Program is now strong and successful. 

And if you ask beneficiaries about Part D today you won’t hear, 

oh, that is the program that had so many problems when it 

launched. Instead you will hear, that is the program that helps me 

afford my medication. 

And I believe that will be the story of the Affordable Care Act. 

The people actually benefiting from the law won’t be talking about 

what happened on October 1 or on January 1. They will talk about 

how their child can get health coverage even though he has a preexisting condition. They will talk about how they no longer have to 

pay more for premiums just because they are women. They will 

talk about how they finally decided they could retire because they 

can now afford coverage they buy on their own. They will talk 

about the security of not having to face bankruptcy due to a diagnosis. 

We may encounter some bumps when open enrollment begins, 

but we will solve them because it is what we do. We are here to 

help people get health insurance, and we at CMS take this responsibility very seriously. 

Thank you, and I am happy to answer your questions. 

[The prepared statement of Mr. Cohen follows:] 

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Mr. MURPHY. Thank you. I now recognize myself for 5 minutes 

and start out by saying, Mr. Cohen, I want you to understand the 

function of this committee. Lack of readiness or preparation on 

your part does not constitute a reason that Congress gives up its 

responsibilities to have oversight. So I hope you have an open mind 

as we go through this. You have previously been here at a hearing 

before. You told us everything was fine. It was like the scene in 

‘‘Animal House,’’ where the person is saying, remain calm, all is 

well, while chaos reigns. 

So let me ask you a few things here. On July 22 members of this 

committee wrote to Secretary Sebelius requesting information on 

the price of health insurance to be offered in the federal and federal state exchanges. HHS still hasn’t announced the approved 

plans and premium prices. Am I correct? 

Mr. COHEN. That is true. 

Mr. MURPHY. OK. Now, that letter was sent requesting what 

plans and prices would be available to consumers in the federal exchanges. When will this information be made public? 

Mr. COHEN. Consumers will be able to go online and see what 

plans are available to them on October 1. 

Mr. MURPHY. So are you able today with less than 2 weeks before enrollment begin to provide any information on prices and 

availability for federal exchanges? 

Mr. COHEN. My understanding is that we will be putting out 

some information on rates soon. 

Mr. MURPHY. And certainly it is important for the Navigators to 

know what kind of products they are selling, and training was essential for that. So they do not have this information, yet, either? 

Mr. COHEN. Navigators will not be selling any products. 

Mr. MURPHY. They will be advising people about products that 

they can then choose themselves. Am I correct? 

Mr. COHEN. They will be advising, providing information, impartial information about consumers’ options for purchasing affordable 

healthcare through the marketplaces. Yes. 

Mr. MURPHY. I understand that, which is advising them of the 

things the person can then choose. 

So turning to the Navigators more, now, originally this program was intended to cost $54 million. Correct? 

Mr. COHEN. At one time we put out a funding opportunity an- nouncement for $54 million. 

Mr. MURPHY. That is right, and then you ended up spending $67 

million. Correct? 

Mr. COHEN. We increased in order to be able to provide more outreach—— 

Mr. MURPHY. Right. 

Mr. COHEN [continuing]. And more help for people across—— 

Mr. MURPHY. Well, in June, 2013, a GAO report stated CMS expected to spend $54 million in the program. Are you familiar with 

that report? 

Mr. COHEN. There have been a lot of GAO reports. 

Mr. MURPHY. Well, this relates to what you do for a living, so I 

would hope you would see that one. On July 21, 2013, CMS Administrator, Marilyn Tavenner, wrote to this committee answering 

some questions we had about the Navigator Program. In that letter 

31 

she stated that the Navigator Program would cost $54 million. Two 

weeks later HHS announced that the Navigator grants would total 

$67 million, a $13 million increase. 

So when did HHS make that decision to increase funding for the 

Navigator Program? Do you have any idea of the date of that? 

Mr. COHEN. I do not. 

Mr. MURPHY. And what funding did HHS use for this 13 million 

increase in the budget for what you do? 

Mr. COHEN. I am sure we can get that information for you. 

Mr. MURPHY. You have no idea? Suddenly it appeared and you 

don’t know where it came from? 

Mr. COHEN. No. I know that we have had an ongoing interest in 

making sure that we can do as much outreach and help as many 

people get enrolled in coverage as possible, and additional resources were—— 

Mr. MURPHY. Yesterday the Administration announced new initiatives to combat fraud under the Healthcare Law by creating a 

call center along with rapid-response measures to address privacy 

and cyber security issues. Can you address what these will entail? 

Mr. COHEN. I know that we have a call center now. The call center is live now. I think the announcement was that there will be 

a way for people to report any instances of fraud, and we are working interagency to work with the FDC, for example, to make sure 

that the appropriate people get that information. 

Mr. MURPHY. So you agree the potential for fraud exists then? 

Mr. COHEN. There has actually been fraud before the Affordable 

Care Act, and so this is not the first program that has ever been 

subject to fraud, and I imagine that there will be fraud that occurs. 

Mr. MURPHY. But you are aware it is a possibility, and you are 

going to watch this very carefully? 

Mr. COHEN. We are. 

Mr. MURPHY. We will be following up on that. Now, privacy is 

extremely important. Are the Navigators bound by the HIPAA laws 

with regard to the laws for healthcare people and—— 

Mr. COHEN. Well, the Navigators will have absolutely no access 

to personal health information. 

Mr. MURPHY. But they may get some in the process. Someone 

may say which plan will cover, I have this kind of an illness, I have 

this sort of problem. They may get that not necessarily soliciting 

it, and so will there be any laws binding them to confidentiality in 

not keeping those records. 

Mr. COHEN. Well, the terms of the grant and the terms of the 

cooperative agreement that we have with Navigators spells out 

very clearly their obligations with respect to keeping—— 

Mr. MURPHY. Correct, but I know I talked to one navigator group 

from Pennsylvania who I think is going to do a good job on this 

because they are already bound by HIPAA laws but not all have 

that in terms of how they will keep their records, what they will 

tell employees to do. And so my question is are there any laws in 

place that prevent people from maintaining or sharing information 

that may be healthcare related? 

Mr. COHEN. So there are, and the Affordable Care Act in par- ticular provides a $25,000 fine per occurrence if anyone uses any 

information obtained in the course of helping someone. 

32 

Mr. MURPHY. That is obligation for the Navigators? 

Mr. COHEN. Yes. 

Mr. MURPHY. OK. Will Navigators be going door to door? 

Mr. COHEN. We will be issuing instructions to Navigators that 

they should not be going door to door. 

Mr. MURPHY. So that will be the ruling you will have with 2 

weeks left, they will not be doing that? 

Mr. COHEN. That is right. 

Mr. MURPHY. They will remain in other public places? 

Mr. COHEN. They can’t be enrolling anyone now because no one 

can be enrolling now, so in terms of going door to door to solicit 

people to enroll in coverage, they will be instructed not to do that, 

and it is timely because no one can be going door to door enrolling 

anyone because no one can enroll today. 

Mr. MURPHY. Thank you. 

I now recognize Ms. DeGette for 5 minutes. 

Ms. DEGETTE. Thank you, Mr. Chairman. 

Now, briefly, Mr. Cohen, what is the purpose of the Navigator 

Program? 

Mr. COHEN. The purpose of the Navigator Program is to educate 

people with respect to the benefits under the Affordable Care Act 

and then to provide objective, impartial help to them if they want 

it, in finding out what they are eligible for and enrolling in coverage. 

Ms. DEGETTE. And can you move your mike a little closer? 

Thanks. And who decides who these certified Navigators are going 

to be? 

Mr. COHEN. We had a grants process much like every grants 

process that is—— 

Ms. DEGETTE. So you had a panel that edited the applications, 

and they tried to choose people who had experience and some kind 

of presence in the community. Correct? 

Mr. COHEN. First they were screened by the Office of Grants 

Management at CMS and then there was an independent panel 

that selected the ones that had scored—— 

Ms. DEGETTE. OK, and in order to receive a Navigator grant, the 

applicant has to demonstrate they have existing relationships or 

could establish relationships with employers. Is that correct? 

Mr. COHEN. Correct. 

Ms. DEGETTE. And Navigator awardees have to complete a training program, including 20 to 30 hours of an HHS-developed program. Is that right? 

Mr. COHEN. That is true. 

Ms. DEGETTE. And they have to pass an exam. Is that right? 

Mr. COHEN. Yes. 

Ms. DEGETTE. And part of that exam includes understanding privacy and affordability programs. Is that right? 

Mr. COHEN. Yes. 

Ms. DEGETTE. So those people to get the Navigator grants, they 

have to certify that they are going to comply with any privacy of 

HIPAA or any other law. Is that correct? 

Mr. COHEN. Right. 

Ms. DEGETTE. Now, under the Affordable Care Act—let me back 

up. Right now when somebody signs up before the ACA, when they 

33 

signed up for health insurance, people would often have to fill out 

applications as long as 35 pages. Is that correct? 

Mr. COHEN. That is right. 

Ms. DEGETTE. And those applications included divulging all 

kinds of personal medical information because that was necessary 

for the insurance companies to figure out what the insurance rates, 

because they could discriminate on pre-existing condition and gender and all kinds of other issues. Right? 

Mr. COHEN. Yes. 

Ms. DEGETTE. But right now under the ACA none of that preexisting condition information is even relevant. Isn’t that right? 

Mr. COHEN. That is true. 

Ms. DEGETTE. So to sign up on the marketplaces and exchanges, 

people aren’t even going to have to divulge that kind of information. Is that right? 

Mr. COHEN. That is true. 

Ms. DEGETTE. So even if a navigator went to the door and was 

trying to explain to somebody about the exchanges, they wouldn’t 

have to get that information from somebody. Right? 

Mr. COHEN. It is not part of the application. Correct. 

Ms. DEGETTE. Right, but even if somebody just kind of offhandedly talked about their information, the Navigator would be 

trained that that is private. Right? 

Mr. COHEN. Correct. 

Ms. DEGETTE. OK. Now, I want to ask you some other questions 

about the marketplaces. Now, are the marketplaces going to be up 

and going on October 1? 

Mr. COHEN. They will. 

Ms. DEGETTE. Is the federal exchange going to be up and going 

on October 1? 

Mr. COHEN. It will. 

Ms. DEGETTE. And that goes, as I understand, people can go on 

the marketplace for a 6-month period to sign up. Is that correct? 

Mr. COHEN. That is true. 

Ms. DEGETTE. So if somebody wanted, somebody like, for example, a member of Congress, wanted to go on the federal marketplace and look and see what plans were available, they could go on 

October 1. Right? 

Mr. COHEN. They will. 

Ms. DEGETTE. But then they would have some additional time to 

sort through all those plans and figure out what they wanted. Is 

that right? 

Mr. COHEN. Yes. 

Ms. DEGETTE. Now, if they do sign up, their coverage starts January 1, 2014. Is that right? 

Mr. COHEN. That is the earliest they can start. Yes. 

Ms. DEGETTE. Right. Now, 23 states including Colorado and the 

District of Columbia are either running their own marketplaces or 

they are doing a marketplace in partnership with the Federal Government. Is that correct? 

Mr. COHEN. Yes. 

Ms. DEGETTE. Will those states be ready for enrollment for the 

start of coverage on January 1? 

34 

Mr. COHEN. My understanding from our communications with 

the states is that all of them will be opening for open enrollment 

on October 1. 

Ms. DEGETTE. OK. Now, can you give me a sense of the milestones and benchmarks that this subcommittee should be looking 

at to measure the progress over the next few weeks and months, 

because we keep hauling people in here. Everybody says they are 

ready. So I would like to know what are the benchmarks that we 

should be looking for? 

Mr. COHEN. Well, I think that there are two types of benchmarks. One are the sort of internal types of benchmarks, how is 

the call center response time working, how is the Web site working, 

you know, those kinds of things that just—how are our systems 

functioning, and then, of course, there are the external—how many 

people are getting enrolled. I would say that we don’t anticipate a 

huge amount of enrollment necessarily in October because as 

you’ve pointed out coverage starts in January, and people have 

until December 15 to pay their premium. 

Ms. DEGETTE. Right. OK, and I guess you are prepared if there 

are glitches to address those glitches quickly. Is that right? 

Mr. COHEN. Absolutely. We are very well mobilized. 

Ms. DEGETTE. Mr. Chairman, I just want to say one more thing. 

I said this before, but when we did Medicare Part D, even though 

I voted against it and I opposed it, I did outreach to my constituents, and I got my newsletter that I sent out to everybody. I will 

let you look at it if you want to. We can put it in the record, but 

I would suggest to everybody on both sides of the aisle, it is incumbent to all of us as elected officials to try to get as many people 

enrolled in this program as we can who don’t have insurance now. 

I think it would be a good idea. I hope it works, and I think we 

should all hope it works. 

Thank you. 

Mr. MURPHY. Thank you, and I hope that all those people from 

IBM, Xerox, and UPS who have been cut from their insurance plan 

will be able to look at that. 

I now yield 5 minutes to Mr. Burgess. 

Mr. BURGESS. Thank you, Mr. Chairman. 

Mr. Cohen, if I heard correctly in response to a question from 

Chairman Murphy, you said that the Navigators would not be 

going door to door. Is that correct? 

Mr. COHEN. The federal grantees will be getting instructions that 

Navigators are not to go door to door for the purposes of enrolling 

anyone. Yes. 

Mr. BURGESS. Could I ask you? You have an evidence binder 

there next to you. Could I ask you to turn for a moment to Tab 

2 in that binder? All right. In that project abstract summary, so I 

assume this is the summary that the company or the group provided you in their application to receive monies from the Navigator 

Grant Program. The second paragraph of that summary reads, 

‘‘The proposed program will deploy 25 exchange Navigators in each 

of the targeted counties. Exchange Navigators will seek out uninsured eligible country residents by going door to door.’’ 

Is that consistent with your statement to Chairman Murphy that 

the Navigators would not be going door to door? 

35 

Mr. COHEN. Sure. We are going to tell them they shouldn’t be 

going door to door, and I am sure they are going to abide by our 

terms and conditions. 

Mr. BURGESS. But they applied for a grant, and they told you 

that they are going to seek out eligible individuals by going door 

to door. Did you read the application? 

Mr. COHEN. So first of all I want to say I have never seen this 

before. I had no role at all in the grant award process, so I am seeing it for the first time now. I understand that that is what they 

said in there. I see those words. They are going to be instructed 

from us as part of our agreement with them not to go door to door, 

and I am confident, Congressman, they will obey that instruction. 

Mr. BURGESS. Well, then I have this question for you. Do you 

know how many money they received in their grant? 

Mr. COHEN. I would have to look it up. 

Mr. BURGESS. It was $1.2 million. I will help you. My next question is can we have the money back? They provided an application 

to you which was approved in the Navigator Program and yet they 

outlined an activity which you said is going to be expressly prohibited. 

Mr. COHEN. I am confident they will find other activities that 

will be very well suited to helping people get enrolled in coverage 

and that they will be a wonderful grantee. 

Mr. BURGESS. I am confident the taxpayer would like to have their $1.2 million back if the grant application was approved based 

on information which you said would make it ineligible for approval. 

Mr. COHEN. I didn’t say that, Congressman. 

Mr. BURGESS. Let me ask you this, and I have a series of questions, and in the time-honored tradition of this committee, I am 

going to ask for a yes or no response. Will the enrollment process 

be ready October 1 of this year? 

Mr. COHEN. Consumers will be able to go online, they will be 

able to get a determination of what tax subsidies they are eligible 

for, they will be able to look at the plans that are available where 

they live, they will be able to see the premium net of subsidy that 

they would have to pay, and they will be able to choose a plan and 

get enrolled in coverage beginning October 1. 

Mr. BURGESS. Let me rephrase the question. Will the enrollment 

process be ready by October 1 of this year? 

Mr. COHEN. I have nothing further to add to my answer. 

Mr. BURGESS. Your answer sounded as if it could be a yes but 

left room for a no. So we will mark down an equivocal response to 

that question. 

Will the excahnges be ready on January 1 of 2014? 

Mr. COHEN. Consumers will be able—it is the same answer. 

Mr. BURGESS. Consumers will be able—— 

Mr. COHEN. To go online, get a determinant of what they are eligible for in terms of the subsidy, find out what the subsidy amount 

is. They will then be able to go and look at the plans that are available to them where they live, and they will be able to—see the premium net of subsidy, and they will be able to choose a plan and 

get enrolled in a plan beginning October 1. 

Mr. BURGESS. And that will be ready on January 1 of 2014? 

36 

Mr. COHEN. That will be ready on October 1. That is my understanding. Yes. 

Mr. BURGESS. Not your understanding. I need a yes or no answer. You are in charge. 

Mr. COHEN. Well, my answer is based on what I have been told 

by the people who are building the IT System. So it is my understanding. 

Mr. BURGESS. Will full implementation of the law on January 1 

cause employers to alter or drop coverage for their employees? Yes 

or no? 

Mr. COHEN. I don’t know the answer to that question. I know 

that employers make lots of decisions for lots of reasons. 

Mr. BURGESS. OK. 

Mr. COHEN. Some having to do with the Affordable Care Act, 

many having nothing to do with the Affordable Care Act. 

Mr. BURGESS. I guess that is a no. Will full implementation of 

the law on January 1 result in reduced costs for all Americans as 

routinely promised by their President? 

Mr. COHEN. Without accepting your characterization of what the 

President said, I think what we are seeing that competition in the 

marketplace is causing competitive rates to be available to many 

consumers. 

Mr. BURGESS. After full implementation of the law on January 

1, will all Americans still be able to keep their current coverage if 

they like it as promised by the President? 

Mr. COHEN. Again, without accepting your characterization of 

what the President said, grandfather plans are allowed to continue 

to exist without change under the Affordable Care Act. It is up to 

private insurance companies what products they offer in the market. 

Mr. BURGESS. Thank you, Mr. Chairman. I hope we have time 

for additional questions, but I will yield back at this point. 

Mr. MURPHY. The gentleman yields back. 

Mr. Dingell, you are now recognized for 5 minutes. 

Mr. DINGELL. I commend you for these hearings. It is important 

that we have proper, friendly, sympathetic, and intelligent oversight to get this program off its feet and going in the direction that 

we want it to go. This subcommittee has a long and successful 

record of conducting such oversight, and it has informed the full 

committee of the Congress of critical facts. Used properly, strong 

congressional oversight will lead to much good for the American 

people. 

I am fearful that this current investigation into the Navigator 

Program might be turning into something less desirable, and I 

hope that we will work together to avoid it. One of Michigan’s 

Navigators is a group called Access, a community-based social services organization I have worked with for more than 40 years. There 

is nobody that knows our communities better than them, and this 

is exactly the type of group that we should be empowering to help 

people sign up for health coverage. They are an institution which 

believe it or not serves all parts of the society, all racial groups, all 

religious groups, and does so without discrimination whatsoever. 

37 

My questions are going to focus on strong protections that exist 

in the Navigator Program and the status of ACA implementation. 

My questions will elicit yes or no answers. 

I am assuming, Mr. Cohen, that all of your Navigators meet all 

of the standards of any Federal Government contractor. Is that 

right? 

Mr. COHEN. It is a grant program. Yes. 

Mr. DINGELL. In regards to discipline, integrity, and proper behavior. Is that right? 

Mr. COHEN. Yes. 

Mr. DINGELL. All right, and I hope as you need you will submit 

additional answers and responses to the questions for the record. 

Are there grants CMS recently awarded to Navigators required 

by the Affordable Care Act? Yes or no? 

Mr. COHEN. Yes. 

Mr. DINGELL. Is the training Navigators must go through comparable to the training of agents and brokers who currently sell 

health insurance? Yes or no? 

Mr. COHEN. Yes. 

Mr. DINGELL. Does the Navigator training include information as 

to how to protect the privacy and security of consumers? Yes or no? 

Mr. COHEN. Yes. 

Mr. DINGELL. Are Navigators subject to the same kind of careful 

screening as other entities seeking to do business with the Federal 

Government? Yes or no? 

Mr. COHEN. Yes. 

Mr. DINGELL. Will the Navigator grantees be overseen in the 

same way as other CMS grantees are overseen and held to the 

terms of their grants? 

Mr. COHEN. Yes. 

Mr. DINGELL. Now I would like to move to talking more about 

the opening of the new marketplaces which are less than 2 weeks 

away. 

In 2012, were insurers much less likely than in previous years 

to request rate increases of 10 percent or more? Yes or no? 

Mr. COHEN. Yes. 

Mr. DINGELL. Would you submit for the record why that is so? 

Mr. COHEN. Yes. 

Mr. DINGELL. Do you believe that the rate review provision in 

the Affordable Care Act is a factor which led to this behavioral 

change on the part of insurers? Yes or no? 

Mr. COHEN. Yes. 

Mr. DINGELL. Do you believe that the marketplaces are working 

as intended by making insurers compete over price on the business 

of consumers? Yes or no? 

Mr. COHEN. Yes. 

Mr. DINGELL. Is it your expectation that the consumers will have 

more and better information because of the structure of the marketplaces? 

Mr. COHEN. Yes. 

Mr. DINGELL. Would you submit some additional thoughts on 

that, please. 

38 

Now, in the 16 states for which we have data, our preliminary 

rates for health insurance in the marketplace, 19 percent less expensive than predicted. 

Mr. COHEN. Yes. 

Mr. DINGELL. Would you submit additional comments on that 

point, please. 

Have some insurers submitted bids to participate in the marketplace only to revise these bids and reduce their prices when other 

insurers’ rates came in lower? Yes or no? 

Mr. COHEN. Yes. 

Mr. DINGELL. Would you submit additional information on that 

question, please. Will nearly half of consumers likely be able to pay $100 or less 

per person for coverage in 2014? Yes or no? 

Mr. COHEN. Yes. 

Mr. DINGELL. Would you submit additional information for the 

record on that point, please. 

Now, is it correct that eight and ten marketplace consumers are 

expected to qualify for subsidies to make health coverage more affordable? Yes or no? 

Mr. COHEN. Yes. 

Mr. DINGELL. Would you submit additional comments on that, 

please? 

Now, we are just a few days away from seeing the full implementation of the Affordable Care Act. I know that there may be some 

bumps in the road, but we are headed for the right direction. 

American people are suggesting us to set politics aside and work 

together for the common good. I am hopeful that we will take this 

as an opportunity to work together in a bipartisan manner. Our 

constituents expect nothing less than that. 

One thing happened the other day. A spokesman for our good 

friend, former member of this committee, Tom Coburn, now in the 

Senate, said a government shutdown would be committing ritual 

suicide on the order of bad strategy, said his communications director in the ‘‘National Journal Daily.’’ The idea that we can fully 

defund ObamaCare through the continuing revelation is a Washington gimmick to advance political funding goals. 

I yield back the balance of my time. 

Mr. MURPHY. The gentleman’s time has expired. 

I now recognize Mr. Olson for 5 minutes. 

Mr. OLSON. Thank you, Mr. Chairman, and welcome, again, Mr. 

Cohen, for returning to answer our questions. I know it is a busy 

time for you, so I appreciate your time this morning. 

Since the last time you appeared before this committee, I have 

been home talking to the people of Texas 22 about the pending 

ObamaCare enrollment on October 1. Most hadn’t heard of open 

enrollment. They haven’t heard if their employer will continue to 

provide healthcare under ObamaCare, and now the ones who are 

working 40 hours per week and working for minimum wage are 

hearing that they are going to get their wages cut by 25 percent, 

down to 30 hours or less per week. 

But they have heard about Navigators, and they are scared. They 

have a lot of questions as, you can imagine, they want me to ask 

you, so please give me a direct response and not a filibuster. 

39 

The first question, there are now 104 entities that are Navigators. Is that correct? 

Mr. COHEN. I know it is more than 100. That sounds right. 

Mr. OLSON. OK. We will assume that is correct. How many of 

these Navigators have hired people for the Navigator position or 

currently have people in place to be Navigators that fulfill these requirements? Any idea? 

Mr. COHEN. Oh, I don’t have the answer to that, but I am sure 

we can work with you to get you that information. 

Mr. OLSON. So we are 7 business days away from this. We have 

no idea how many Navigators, how many people have been hired 

as Navigators. 

Mr. COHEN. No. I didn’t say that. I said I don’t know, but we 

have project officers that are in contact with the Navigators on a 

regular basis and at least weekly, and I am sure we have that information and would be happy to work with you to get it to you. 

Mr. OLSON. About the ones that have been hired, now, you don’t 

know that, but do you know how many have completed or begun 

their training yet? 

Mr. COHEN. I do not know. 

Mr. OLSON. OK. About their training, can you provide me some 

details about their training? I understand it is a 20-hour syllabus, 

and there is some exam at the end. Is that a multiple choice? How 

does that exam work? Some details about the qualifications process. 

Mr. COHEN. It is an open book. It is a 20-hour exam. It is an online course. You go through the course. As you go through the 

course, you’re asked questions about the material, and you have to 

score an 80 percent on each section in order to pass and get certified. 

Mr. OLSON. Are applicants required to undergo background 

checks like I am sure you did to have your job, like I did in the 

Navy? Did Navigators have to have a background check? 

Mr. COHEN. So the organizations obviously went through a very 

rigorous scrutiny process in order to receive the grants. The Federal Government has not required that background checks for the 

individuals be given, but some states have adopted that as a requirement as they are permitted to do. 

Mr. OLSON. And so the people on the street aren’t required to get 

background checks? You are telling me that the entities of employment are, but the people actually knocking on doors, not knocking 

on doors but getting information out, are not required to have a 

background check? 

Mr. COHEN. Like the CHIP Program, there is no federal requirement for there to be background checks. People have been helping 

people with Medicare for many, many years, no background check 

requirement by the Federal Government. States, like the CHIP 

Program, are able to impose that requirement if they think that is 

something that is important in their communities. 

Mr. OLSON. How about a drug test? You can’t get a job out in 

the Texas oil fields without a drug test. How about a Navigator? 

Mr. COHEN. There is no requirement that individual Navigators 

be subject to a drug test. No. 

40 

Mr. OLSON. How about guidelines? How much do Navigators get 

paid, the people out in the streets? Any idea what the range of 

their salary is? 

Mr. COHEN. It is determined by each of the grantees. It is part 

of the budget that they presented, and the budget proposals were 

subject to review by the Office of Grants Management at CMS like 

every grantee to make sure that the amounts being paid were reasonable. 

Mr. OLSON. Does the program have some quality assurance 

checks, like a so-called secret shopper, somebody that checks up 

and sees what they are being told is accurate? Do you have some 

sort of program to make sure that people give accurate information? Are you checking up on that? 

Mr. COHEN. We will be doing ongoing monitoring and oversight 

of the Navigator Program, and it could include secret shopper. 

Mr. OLSON. And one final question. I was a panelist for the 

Chamber of Commerce Board back home talking about the rollout 

of ObamaCare, and we had a couple State Representatives from 

Texas on that panel with me. One said that he has heard that the 

Navigators who are hitting the streets will have voter registration 

cards. Have you heard that? Is that true or false? 

Mr. COHEN. The Federal Voter Registration Law requires that 

any, that a public program like Medicaid, any application, people 

be given, offered information about voter registration. That is a federal law requirement, and because the application covers both Medicaid and CHIP and subsidies under the exchanges, we are required to provide information about voter registration to people. 

Mr. OLSON. Thank you. I am out of my time, and I yield back. 

Mr. MURPHY. Thank you. I now recognize Ms. Castor for 5 minutes. 

Ms. CASTOR. Well, thank you, Mr. Chairman, and thank you for 

calling the hearing. 

Mr. Cohen, we are not even in the month of Halloween and yet 

the Republicans, one of their favorite scare tactics that we hear regarding the ACA is that the Affordable Care Act is going to lead 

to higher health insurance premiums and rate shock, but while my 

Republican friends have made every effort to convince Americans 

that everyone’s health insurance premiums are going up on January 1, now we have the data that demonstrates that that is untrue. 

These assertions that health insurance rates are going up simply 

is not borne out by a number of analyses that have been conducted. 

So let’s walk through the information on the Affordable Care Act 

health insurance premiums, starting at the beginning. Mr. Cohen, 

when people shop for coverage through the marketplaces, they will 

be able to compare plans and then select a plan, sign up for the 

either private insurance or if they have a state that expanded Medicaid, Medicaid. Is that correct? 

Mr. COHEN. That is right. 

Ms. CASTOR. And if they have a household income below 400 percent of the poverty level, so if you are an individual at about 

$46,000 or a family of four at about $94,000 on a sliding scale, you 

will be eligible for tax credits. Is that correct? 

Mr. COHEN. That is right. 

Ms. CASTOR. Or Medicaid possibly. 

41 

Mr. COHEN. Correct. 

Ms. CASTOR. Well, this week HHS released an analysis and census data on the 41 million uninsured Americans. Twenty-five percent of Floridians are uninsured. So you can see why these new 

marketplaces will be a Godsend for them, but 41 million uninsured 

Americans who will be eligible to enroll in coverage through the 

marketplaces. Can you tell us in broad terms what the analysis 

said? 

Mr. COHEN. The analysis said that about eight in ten will be eligible for tax credits through the marketplaces. 

Ms. CASTOR. And did it say 23 million will be able to purchase coverage for less than $100 a month? 

Mr. COHEN. That is correct, including the subsidy. Yes. 

Ms. CASTOR. I mean, that is pretty remarkable. Did you have an 

idea that the coverage would be that affordable? 

Mr. COHEN. You know, I think there were lots of predictions 

about what rates would be. I think we have been just enormously 

pleased that the marketplace and competition is working, and we 

are seeing the availability of low-cost, affordable plans in many 

places throughout the country. 

Ms. CASTOR. And these findings have been echoed in recent studies by the non-partisan RAND Corporation and the non-partisan 

Kaiser Family Foundation, two of the most respected, non-partisan 

health policy analysts. Are you familiar with these studies from 

RAND and Kaiser? 

Mr. COHEN. I am generally. Yes. 

Ms. CASTOR. Tell us in broad terms what those studies found? 

Mr. COHEN. Well, Kaiser Family Foundation estimated that in 

the 18 rating areas, so that is specific geographic locations that 

they looked at, 15 would have premiums below the latest projections that the CBO had made of what rates would be, and they 

talked about a premium for a 40-year-old in the second lowest 

called Silver Plan being $320 a month nationally. That is before 

the application of subsidies. 

Ms. CASTOR. And, Mr. Cohen, are the plans available on the Affordable Care Act in the marketplaces, are they a good deal for the 

quality of coverage that is being offered? 

Mr. COHEN. Well, that is one of the most important things because these plans all have to have the essential health benefits 

that are required by the Affordable Care Act, and they cannot have 

annual limits or lifetime limits. So they are going to be there to 

provide coverage when people need it. 

Ms. CASTOR. And at the beginning of the hearing I shared with 

you and my colleagues the enthusiasm at home, especially among 

many of our neighbors who have chronic conditions that have been 

barred from insurance coverage. If you have had diabetes or I 

talked with a gentleman with multiple sclerosis, HIV, AIDS. I 

mean, we all have neighbors or family members that have been 

barred from coverage because of these pre-existing conditions, and 

this is really going to, like I said, it is giving them hope. They can 

finally now obtain coverage, and so will this high-quality coverage 

that is available for the same price, will it be available for the 

same price even for many of our neighbors that have those pre-existing conditions? 

42 

Mr. COHEN. That is exactly right. They cannot be charged more 

because of the pre-existing condition. 

Ms. CASTOR. So every Republican announces premiums under 

the ACA. If you noticed, they ignore these key facts that coverage 

has gotten better, that bar against discrimination for our neighbors 

who have these pre-existing conditions now will go away for 129 

million Americans, and they ignore the tax credits. In my State of 

Florida they said, let’s conduct a study, and we will show you that 

it is not affordable, but then they didn’t build into the study the 

tax credits that are available for families and neighbors and small 

businesses, too. And then the one that really takes the cake, do you 

know in my home state, I love my state, but we need help when 

it comes to healthcare coverage, but one of the things they did that 

probably wins the award for obstruction and sabotage is they actually took away the Insurance Commissioner’s ability to regulate 

rates and negotiate rates. 

Is there any other state that has done that to your knowledge? 

Mr. COHEN. I don’t believe so, and I was a State Regulator as 

General Counsel to California Insurance Department, and I know 

Kevin McCarty very well, and it is an excellent insurance department, and it is unfortunate that their authority was taken away. 

Ms. CASTOR. Thank you very much. 

Mr. MURPHY. The gentlelady’s time has expired. 

Now got Mr. Johnson of Ohio for 5 minutes. 

Mr. JOHNSON. Thank you, Mr. Chairman. 

Mr. Cohen, first of all, good morning. Thank you for being here 

today. 

First question for you, whose department is responsible for overseeing and administering these grants to the Navigators? 

Mr. COHEN. It is a combination of my office and our Office of 

Grants Management, both within CMS. 

Mr. JOHNSON. OK, but you are responsible for overseeing that 

process. Correct? You are the director. 

Mr. COHEN. When you say process—— 

Mr. JOHNSON. Yes. The grant process. 

Mr. COHEN. The process of selecting the grantees or the process 

of overseeing the grantees and their work? 

Mr. JOHNSON. Process of overseeing and selecting. 

Mr. COHEN. Well, so I personally had no role in the selection 

process. We do that through an independent review panel. 

Mr. JOHNSON. OK, but you oversee it. Correct? 

Mr. COHEN. Well, I had no role on the selection process. 

Mr. JOHNSON. No. Who oversees the grant process? What is your 

role in the grant process? 

Mr. COHEN. So in the grant selection process I had no role. 

Mr. JOHNSON. What is your role in the grant process? I didn’t say 

the grant selection process. What is your role in the grant process? 

Mr. COHEN. My office is responsible for overseeing the grantees’ 

performance now that they have received the grant. 

Mr. JOHNSON. OK. Did you review the criteria for the grant applications to be reviewed? 

Mr. COHEN. I did. 

43 

Mr. JOHNSON. You did? OK. Well, because earlier when you were 

asked, you said I don’t know. Repeatedly you said I don’t know, 

didn’t have anything to do with that. 

Mr. COHEN. No. That is not what I said. I didn’t review the applications. I certainly was part of putting together what the program would be because that is part of my job but—— 

Mr. JOHNSON. OK. The criteria for reviewing the grants—you 

stated in your answer to Dr. Burgess that when he asked you if 

we could get the money back for those that are doing processes like 

door to door that are going to be prohibited, you said that you were 

confident that they would find other activities. 

You know, I find this rather an odd way of going about spending 

the taxpayer dollars because, I mean, if you don’t know where you 

are going, obviously any road will get you there. This is consistent 

with the theme of let’s pass the healthcare law so we can see what 

is in it. Now you are trying to tell the American people that we 

ought to award millions of dollars in grants and then find out how 

they are going to spend it. I would submit to you that that is exactly the kind of irresponsible governance and irresponsible administration that the American people have become so frustrated with. 

And leaders who purport themselves to be directors, head of agencies that fane, I don’t know, and try to shrug our shoulders and 

say, I didn’t have anything to do with that, it is disingenuous, Mr. 

Cohen. 

Mr. COHEN. Well, I respectfully—— 

Mr. JOHNSON. First question, when you were evaluating—— 

Mr. COHEN [continuing]. Disagree with your characterization of 

what I said. 

Mr. JOHNSON. Reclaiming my time, Mr. Cohen. Let me ask you 

a question. When you were evaluating the Navigator Grant Program, were there standards on the appropriate amount of grant 

spending per enrollee or per individual contacted about enrollment? 

You told me you reviewed the criteria, so were there any standards 

about that? 

Mr. COHEN. I reviewed the criteria for the program. I was—— 

Mr. JOHNSON. Then you should answer yes or no. 

Mr. COHEN [continuing]. Not involved in the budget discussions 

with each grantee over what their costs would be. 

Mr. JOHNSON. Was there in the grant process, you told me you 

reviewed the criteria, you just got done saying that, were there any 

standards on the appropriate amount of grant spending per enrollee? That is a very simply question. 

Mr. COHEN. And I don’t recall. 

Mr. JOHNSON. You don’t recall. You don’t know. 

Mr. COHEN. I don’t recall. 

Mr. JOHNSON. It goes back to my first statement. Were there any 

standards or minimums on the number of health fairs attended or 

individuals contacted via advertisements? 

Mr. COHEN. I doubt that the funding opportunity announcement 

was—— 

Mr. JOHNSON. Tell me what you know about the criteria. You reviewed the criteria. Tell me what you know about the criteria. 

Mr. COHEN. We put out a funding opportunity announcement 

that describes the program. 

44 

Mr. JOHNSON. No. I don’t want you to tell me what you did. I 

want you to tell me what the criteria was. What is the criteria for 

a grant? 

Mr. COHEN. I don’t know how to answer that. 

Mr. JOHNSON. You don’t know. 

Mr. COHEN. I don’t know how to answer your question. 

Mr. JOHNSON. No, you don’t know. 

Mr. COHEN. No. 

Mr. JOHNSON. And that is appalling to me. Turn to Exhibit 1, 

please. I think it is reprehensible that you would come before the 

American people as a director of a department and you don’t know. 

You sit there and tell me that you reviewed the grant process, you 

reviewed the criteria, and yet you don’t know. You can’t give the 

first sentence about that criteria. 

Turn to Exhibit 1, please. 

Mr. COHEN. I have it. 

Mr. JOHNSON. OK. This is a Navigators grant application provided to the committee by the Administration. It shows a Navigator 

applicant who expects to facilitate enrollment of 312 people into 

qualified health plans. You awarded this organization approximately $80,000 of taxpayer money for only 300 people. Now, I acknowledge you said you didn’t have anything to do with the grant 

award, but you set up the criteria. 

Do you believe that this is an efficient use of taxpayer dollars? 

I can do the quick math. 

Mr. MURPHY. The gentleman’s—— 

Mr. JOHNSON. It is $266 per person. 

Mr. MURPHY [continuing]. Time has expired. We may go to a second round, so if you have more questions, I will let you come back 

to it. 

Mr. JOHNSON. Am I—— 

Mr. MURPHY. We will let you answer. 

Mr. JOHNSON. Oh, I am not even checking the clock. Sorry, Mr. 

Chairman. I yield back. 

Mr. MURPHY. We can go back. 

Mr. COHEN. As I said I literally have not seen this before today. 

I am happy to go back and look at it and answer your questions. 

I just can’t do that today. 

Mr. JOHNSON. I am not surprised you haven’t seen that information. I am not surprised at all. 

Mr. COHEN. Because I was not part of the grant application and 

award process for reasons that I am sure you will understand. 

Mr. MURPHY. We will follow up with that. 

Mr. Waxman is now recognized for 5 minutes. 

Mr. WAXMAN. Mr. Cohen, do you approve the budgets of the 

Navigators? 

Mr. COHEN. I did not. 

Mr. WAXMAN. No. Do you? 

Mr. COHEN. No, I don’t personally. 

Mr. WAXMAN. You don’t. Your agency doesn’t? 

Mr. COHEN. Yes. 

Mr. WAXMAN. Your agency does. 

Mr. COHEN. Yes. 

45 

Mr. WAXMAN. OK. So what you did is help establish the criteria 

for awarding these grants to Navigators who will help people know 

what insurance options are available to them and help them sort 

through a new law that they have heard a lot of negative things 

about from partisan Republicans who want to demonize the idea 

that people will be able to get insurance. I think that the questions 

you just had were off the mark and not appropriate for Congress. 

I don’t think we ought to beat up on people because they don’t like 

the law. 

So the criteria is to select people who can do the job as Navigators. Right? 

Mr. COHEN. Yes. 

Mr. WAXMAN. And you have something to do with that? 

Mr. COHEN. Correct. 

Mr. WAXMAN. OK, and then the grants that are made to different 

applicants to be the Navigators, who decides that? 

Mr. COHEN. We have a process where our Office of Grants Management, this is the same as every grant, CMS awards a lot of 

grants. 

Mr. WAXMAN. Yes. 

Mr. COHEN. Every grant goes through a screening process where 

they review the application, they review the management of the applicant, they review the budget, they score them. That then goes 

to an independent review committee that makes the selections 

based on the criteria and the purposes of the program. 

Mr. WAXMAN. So no one has basis for criticizing you for what an 

independent grant committee reviews and decides. Isn’t that correct? 

Mr. COHEN. I agree with you. 

Mr. WAXMAN. OK. Look, I don’t even know what this hearing is 

all about. We have had so many hearings by the Republicans to 

beat up on the Affordable Care Act. They don’t like it. I got the 

idea. When they wanted to repeal it, they could have gotten the 

message out by asking us to vote for it five times. Instead they 

voted 41 times. It is because they have nothing else to do but attack this Affordable Care Act. And why do they want to do that? 

Because they want to confuse people. They want to scare people. 

That is what this hearing is all about, and in fact, the people who 

are doing the work of Navigators they are called, are now being intimidated by the Republicans, who are getting a long list of questions, asking them did they do something wrong, I gather. That 

seems to me so unfair. You have got a clinic, you have got people 

that work in a homeless shelter, you have got people who work 

with an ethnic community, people who are there in the community 

and know the community well, and they have been selected and 

had to go through tests and classes to be good Navigators, and they 

are going to do their job. And now they get letters from members 

of Congress asking them to fill out answers to a long list of questions. Do you know what kind of questions they have been asked? 

Mr. COHEN. They have been asked very detailed questions about 

both the application process and about what their plans are for 

what they are going to do before they have even started work, before they have even hired their staff. 

46 

Mr. WAXMAN. This is nothing but intimidation by this committee. 

Congress has a lot of power. When the Chairman or a member gets 

the chance to ask questions, that is a lot of power, but what we 

need to do is restrain ourselves from abusing that power, and I 

haven’t seen much restraint around here, and I understand one 

Navigator has already dropped out of the program because they 

just said we don’t have enough money to do the work of answering 

questions from Congress as well as reaching out to the community. 

Isn’t that right? 

Mr. COHEN. Yes. That is true, and I have heard from others that 

are very concerned. They don’t know what to do with, in response 

to this, to these inquiries that they have gotten. 

Mr. WAXMAN. I just think this is such an abuse of power to intimidate Navigators who are going to explain the new law to people. In California we are running the program, and we license people who sell private insurance, and the state has taken over the responsibility of approving the Navigators, hasn’t it? 

Mr. COHEN. Yes. 

Mr. WAXMAN. So they have a job to do, they have been checked 

out to be sure they are people who are capable of doing the job. We 

don’t call in private insurance salesmen to ask them a whole bunch 

of questions, but when they are trying to just get the community 

to understand something new, this committee abuses its power and 

wants to ask all sorts of questions, and at a time when they are 

trying to run this program with a couple of weeks left before the 

opening of the exchanges. 

Mr. COHEN. And I would just add if I might that any state that 

wanted to run their Navigator Program had the ability to do that 

either by operating its own marketplace or by being a consumer assistance partner with us. They could have taken over the whole 

thing. 

Mr. WAXMAN. Well, my state is doing a good job. We are going 

to have a great success in California. I think we are going to have 

success around the country unless Republicans intimidate people, 

whether it is at the state level or the federal level, to scare them 

about the idea that they can get insurance that has been denied 

them in the past, and the Republicans said nothing about it but denied them in the past because they had pre-existing medical conditions—— 

Mr. MURPHY. The gentleman’s time has expired. 

Mr. WAXMAN [continuing]. Or they couldn’t afford the insurance 

policy. And so I don’t know what this hearing is all about except 

to intimidate people, and I resent it, Mr. Chairman, and I resent 

the kind of questions that our witness has just been subjected to 

by my colleague. 

Yield back my time. 

Mr. MURPHY. Yield for question and query. You had made a reference to California is taking over these things, and they also have 

laws for insurance agents who sell these policies. 

Mr. WAXMAN. Yes. 

Mr. MURPHY. Are you saying that it would be under the same 

guidance or rules or regulations as an insurance agent? Could you 

clarify that for the record? 

47 

Mr. WAXMAN. Well, Mr. Cohen could probably do it better, but 

as I understand it, California is going by the standards set by the 

Federal Government. Isn’t that right? Why don’t you answer? 

Mr. COHEN. California because it is operating its own marketplace has its own Navigator Program, and it is not requiring Navigators to be agents and brokers. We have issued regulations saying 

that states may not do that, but it has put in additional requirements above and beyond the federal requirements as states may 

do. 

Mr. MURPHY. Just for clarification I am just confused because I 

know many states have rules about continuing education, 

fingerprinting, background checks, licensing tests for agents. So if 

they are under the California Program they are not going to be 

part of those same sort of rules? There is a separate level? 

Mr. COHEN. I am not 100 percent familiar with what California 

is doing, but I believe that California is requiring backgrounds 

checks and fingerprints. 

Mr. MURPHY. Could you just let us know? 

Mr. COHEN. Sure. 

Mr. MURPHY. Thank you very much. 

Now recognize Mr. Scalise for five questions—5 minutes. 

Mr. SCALISE. Hopefully I can get to more than five questions, but 

I will do my best to get through the questions I have, and Mr. 

Chairman, I want to thank you for having this committee. I think 

it is important that we have oversight over a program that is involving not only $67 million of taxpayer money but a new program 

where these Navigators, people will be going throughout America 

trying to sign people up for the President’s Healthcare Law that 

has missed so many deadlines, that has had so many problems. For 

somebody to kind of insinuate that we should not be asking real 

tough questions, American people have tough questions. That is 

why they sent us here. I would hope, Mr. Cohen, you are here to 

give straightforward answers to the questions that people have, 

and anybody who thinks that sunshine and transparency will undermine the law, maybe they are right. Maybe the fact the more 

people find out about this law they don’t like it. That is not our 

fault. That is the fault of such a bad law that the more people find 

out about it they don’t like it. 

Mr. COHEN. I always do my best, Congressman, to answer the 

questions. 

Mr. SCALISE. I appreciate that, and do you think any of these are 

unfair questions? 

Mr. COHEN. I think I better not respond to that one. 

Mr. SCALISE. Not only are you under oath, but the President that 

you work for, the President said on a campaign promise that he 

would be the most transparent President ever, and all of the sudden we start asking basic questions, and people are feigning that 

we shouldn’t be asking tough questions, because, boy, that poor 

President, it might make his law look bad if people find out just 

what is in it. 

Mr. COHEN. Congressman, I have no problem with answering 

questions of me. This is the seventh time that I have testified before a Congressional committee or subcommittee since December. I 

have always done my best to answer the questions. I have always 

48 

done my best to provide additional information when I wasn’t able 

to answer the question. 

Mr. SCALISE. OK. I just want to make sure—— 

Mr. COHEN. The concern that I have—so any questions you have 

for me or for us as a department—— 

Mr. SCALISE. I want to ask you about background. 

Mr. COHEN [continuing]. The concern that I have is for the scrutiny that these Navigators groups were put under even before they 

ever—— 

Mr. SCALISE. Let me ask you. If a Navigator—— 

Mr. COHEN [continuing]. Started their work. 

Mr. SCALISE [continuing]. And I want to ask you to get the committee the name of any Navigators who dropped out of the program 

because of scrutiny, I would ask you can you get that information 

to this committee? 

Mr. COHEN. Yes. 

Mr. SCALISE. Because if any Navigator dropped out of the program because they didn’t want to be held accountable for the taxpayer money they are receiving, they don’t belong in the program. 

They ought to get out of the program. 

Mr. COHEN. That wasn’t the reason. 

Mr. SCALISE. Well, then let’s see the names of those people, and 

we will follow up. 

Mr. COHEN. The reason that it was—— 

Mr. SCALISE. We are asking real questions. They ought to be providing answers just like you should. 

Mr. COHEN. That wasn’t the reason. 

Mr. SCALISE. They are getting taxpayer money. I want to ask you 

about criminal background checks. This is a big concern of a lot of 

people I know in my district and when I talk to colleagues, others. 

Why is it that you did not choose to include background checks on 

people that are going to be going around asking people for very secured, personal information about their health? 

Mr. COHEN. First of all, they are not going to be asking people 

information about their health. 

Mr. SCALISE. These people will be having—— 

Mr. COHEN. That is wrong. 

Mr. SCALISE [continuing]. Conversations with Navigators about 

healthcare. 

Mr. COHEN. They are not going to be asking—— 

Mr. SCALISE. They are going to be trying to give them advice, 

aren’t they, about what kind of healthcare options they have in 

these exchanges? Is that what—— 

Mr. COHEN. They are not going to be asking people for information about their health. That is not part of the application. 

Mr. SCALISE. They will be asking them healthcare questions. 

Mr. COHEN. They are not going to be asking them for information 

about their health. It is not part of the application. 

Mr. SCALISE. So let me ask you this. If somebody just got released from prison for a conviction on identity theft, would that 

person be eligible to be a Navigator? Yes or no? You are under 

oath. 

Mr. COHEN. I am confident that the organizations that we have 

given grants to—— 

49 

Mr. SCALISE. Can they be eligible? Are they eligible? It is a yes 

or no question. I am sure what you hope, if you hope that they are 

not eligible, why didn’t you make that a rule? Am I incorrect in 

saying that a person who was just released from prison on identity 

theft can be a Navigator under your rules? Is that an inaccurate 

statement? 

Mr. COHEN. We have had—— 

Mr. SCALISE. Because I am making that statement right now. 

Your rules allow someone who committed identity theft to be eligible to be a Navigator. If I am saying anything incorrect, you just 

correct me right now. 

Mr. COHEN. We have had experience for many, many years with 

the CHIP Program. There was no federal requirement for background checks in the CHIP Program. 

Mr. SCALISE. OK. So my statement is correct. 

Mr. COHEN. I am not aware—— 

Mr. SCALISE. If you correct me, then I will stop saying it, but I 

just made a statement. If I said anything inaccurate, please correct 

me, but if you don’t, I will keep making that statement. 

Mr. COHEN. There is no federal requirement for background 

checks or criminal record checks—— 

Mr. SCALISE. OK. Stop right there. 

Mr. COHEN [continuing]. In the Navigator Program. Some 

states—— 

Mr. SCALISE. Was there a concern—— 

Mr. COHEN. Excuse me. 

Mr. SCALISE. No. That is my time. He didn’t answer my question. 

Mr. WAXMAN. Point of order. The gentleman ought to be given 

the courtesy to answer the question. 

Mr. SCALISE. Well, he will be given the courtesy. I will ask one 

follow-up question, and then I will let you have the time. 

Mr. COHEN. Congressman, I ask for your support here in being 

able to answer these questions. 

Mr. MURPHY. One more question. 

Mr. SCALISE. The question I have is were you concerned that invoking criminal background checks might limit the number of people that would apply to be Navigators? 

Mr. MURPHY. Mr. Cohen, you may answer the question. 

Mr. COHEN. We want to get as many—we had a number of factors. It was not clear to us that we have the authority to require 

the criminal background checks, and we wanted to make, we left 

it up to the states to determine whether that was a requirement 

that they wanted to impose. 

Mr. SCALISE. So that was a yes or no question I asked. I would 

just ask if you could give a yes or no answer to a yes or no question. Were you concerned that invoking criminal background checks 

might limit the number of people that would apply to be Navigators? 

Mr. COHEN. The cost and the difficulty of doing criminal background checks, yes, we were concerned about that. 

Mr. MURPHY. The gentleman’s time has expired. 

Mr. Cohen, would you be able to at some point in the near future 

provide information on, you said some states have it, some states 

don’t, just so we can have that. 

50 

Mr. COHEN. Sure. I would be happy to. 

Mr. MURPHY. And those issues are obviously a concern I think 

from members on both sides of the aisle to make sure that the people coming through are trustworthy. 

Now recognize Mr. Tonko for 5 minutes. 

Mr. TONKO. Thank you, Mr. Chair, and Mr. Cohen, thank you for 

returning to the committee and for your diligent work thus far in 

trying to implement probably the biggest reform to our Nation’s 

healthcare system in our history. This is no small task, and so we 

all appreciate, I would hope we all appreciate the commitment and 

grace you have shown in taking on this work, and I have some 

questions, and I will allow you to answer them and not talk over 

you. 

We have understandably heard a lot already today about the exchanges which are the most visible piece of the ACA. So I wanted 

to take the time to ask you about some of the other insurance reforms under ACA that your center is responsible for. 

Under the ACA the center is charged with providing support to 

consumers when insurance companies deny payment for a service 

or treatment which have coverage guaranteed under ACA such as 

preventative services. One such example of a guaranteed benefit 

under ACA is BRCA testing and genetic counseling for women 

meeting certain risk criteria for heredity breast and ovarian cancer. 

However, I have heard reports of several women in New York 

who have been denied BRCA testing despite meeting the criteria 

for testing and receiving medical advice to have the testing done. 

My understanding is that this should not happen and that your 

center is charged with ensuring that it doesn’t. 

What resources and assistance does the center offer for consumers who need to appeal health insurance claims decisions, and 

where could consumers gain easy access to these resources? 

Mr. COHEN. So there is a requirement under the Affordable Care 

Act for an external appeal process after someone goes through the 

process through their insurance carrier, and New York is probably 

running that appeals process. I would have to go back and look. 

Some states are doing it. In some cases it is the Federal Government that is doing it if the state doesn’t have a process that meets 

the required standard. 

In addition, we work very closely with the state departments and 

insurance when we learn of something that is a systemic problem, 

so if it is not just, you know, one particular individual or two, you 

know, but it looks as though a particular carrier or even more 

broadly all the carriers in a market or whatever are not abiding by 

the provisions of the Affordable Care Act, we work very closely 

with state insurance departments to make sure that they do. 

Mr. TONKO. Thank you, and perhaps if you could look more closely at that specific situation, I would appreciate it. 

Mr. COHEN. We would be happy to. 

Mr. TONKO. As you know, the implementation of the Affordable 

Care Act will extend federal parity protections from Mental Health 

Parity and Addiction Equity Act to more than 62 million Americans. However, given the delay in issuing final parity regulations, 

it is doubtful the American people will enjoy the full protections of 

51 

mental health parity consistent with the spirit of that legislation 

as the ACA goes into full effect in 2014. 

With another terrible tragedy unfolding again this week here in 

DC, the need for a robust national commitment to mental health 

has been highlighted yet again. We have heard from numerous Administration officials that a final mental health parity regulation 

would be finished by the end of the year, a date which is rapidly 

approaching. 

Can you provide us with any more details on when to expect any 

such final parity rule? 

Mr. COHEN. So we have committed that there will be a rule out 

by the end of the year. I am confident there will be. I know work 

is ongoing. I have been to meetings where we have been reviewing 

the provisions of the final rule. It is moving through our process. 

I can’t give you an exact date of when it will be coming out, but 

it will be coming out by the end of the year. 

Mr. TONKO. OK, and can you describe in detail the current investigation and enforcement process that your office goes through 

when it receives a complaint about parity violations? 

Mr. COHEN. Sure. So as with many federal law provisions, 

HIPAA, and mental health parity, again, the states are the principle primary enforcer. So what we typically do when we hear 

about problems, and we do have a hotline where people can call 

and, you know, tell us about problems they are having with their 

insurance company, we generally will reach out first to the state 

department. There have been some instances since I have been at 

CCIIO where the state has told us that they are not able to deal 

with the problem, and we have dealt directly with the insurance 

companies to make sure that they are complying. 

Mr. TONKO. Yes. 

Mr. COHEN. We have also done some outreach and education because I know that the requirements of the Mental Health Parity 

Law are not as well-known and understood, and so we have been 

doing some outreach and education both to the issuer community 

and to the state insurance departments to make sure they understand the provisions of the law. 

Mr. TONKO. When these investigations, Mr. Cohen, of parity violations are conducted, are the results of these investigations made 

public? 

Mr. COHEN. It depends. What we try to do normally is get compliance, and if we are able to get compliance, then—and there is 

no administrative action that is begun, then typically that would 

not be public. 

If we go to the point of actually beginning administrative action 

and the possible imposition of civil monetary penalties, that would 

be public. 

Mr. TONKO. I know my 5 minutes are up, and with that I—— 

Mr. MURPHY. I recognize Mr. Harper for 5 minutes. Thank you. 

Mr. HARPER. Thank you, Mr. Chairman. Mr. Cohen, good to see 

you again, and I have some questions. If I could get you to look in 

the notebook and turn to Exhibit 4 for just a moment, please. Exhibit 4. And if you will look at that, you will see that number 14 

says, incentives for quality connections and the second sentence 

states they, meaning Navigators, have the opportunity to earn 

52 

$200 additional per quarter if they meet a standard of 300 enrollments or screenings during the quarter. Do you see that? 

Mr. COHEN. I do. 

Mr. HARPER. Do you believe it is appropriate to pay Navigators 

for the number of individuals enrolled? 

Mr. COHEN. In the federal program we are not permitting Navigators to be paid by the number of enrollments. I understand this 

is an application, and it may be what they thought that they were 

going to do, but we are not permitting that. 

Mr. HARPER. So what are they getting? Just a straight salary or 

a straight—so they get paid the same, you are saying. This is not 

true? 

Mr. COHEN. This is an application. 

Mr. HARPER. OK. 

Mr. COHEN. But I am telling you that in the federal program 

Navigators are not being paid by the number of enrollees. 

Mr. HARPER. OK, but didn’t you approve this application? 

Mr. COHEN. I did not, but there is a budget process that—— 

Mr. HARPER. Somebody approved the application. 

Mr. COHEN. We did. We did. OK. So there is a budget process 

that goes through before a grant is awarded, and I don’t know the 

specifics of this particular applicant, but I am confident that the 

budget that was worked out with this applicant did not include 

payment per enrollee. 

Mr. HARPER. Can you check that—— 

Mr. COHEN. I can. 

Mr. HARPER [continuing]. To be 100 percent sure and get back 

with us in writing on that? 

Mr. COHEN. I would be happy to. 

Mr. HARPER. So is there another application, another form that 

we should be looking at? 

Mr. COHEN. Well, there is a grant award, there is a cooperative 

agreement between the grantee and CMS. Yes. 

Mr. HARPER. All right. 

Mr. COHEN. This is just the application. 

Mr. HARPER. Let me at least—— 

Mr. COHEN. Part of the application. 

Mr. HARPER [continuing]. Let me ask you this. If this were true, 

would you believe that we should be incentivizing Navigators to go 

enroll as many people as possible? 

Mr. COHEN. In the federal program we made the decision not to 

permit compensation based on number of enrollees. 

Mr. HARPER. OK. Well, but this is a document that you provided 

to us if I am not mistaken. 

Mr. COHEN. It is an application. 

Mr. HARPER. OK. Well, and that is what I am referring to is the 

document. So just so I am clear are you saying then that no Navigator is being paid additional money or bonus money by the number of people signed up? That is what you are saying? 

Mr. COHEN. In the federal program. Correct. 

Mr. HARPER. All right. Well, what about in any other program 

or other entity? 

Mr. COHEN. My understanding is that there may be some states 

that are paying some portion of compensation for enrollees. 

53 

Mr. HARPER. And you would know which states those are. Correct? 

Mr. COHEN. We can get that information. 

Mr. HARPER. Would you do that and—— 

Mr. COHEN. Sure. 

Mr. HARPER [continuing]. What amounts and if they are paying 

all Navigators the bonus based upon numbers, I would want to 

know that. 

All right. Are you going to issue any type of statement or standards for Navigators or to the states directing them not to do this? 

Mr. COHEN. No. We have left, I mean, the states as throughout 

the Affordable Care Act we have given the states a lot of flexibility 

to design their programs in the way that they think is best for 

their state, and so we are not telling states that they can’t do it. 

In the federal program Navigators are not being paid per enrollee. 

Mr. HARPER. All right. Following up on other questions, my understanding of what you are saying is that Navigators are not subjected to or a criminal background check is not done. Correct? 

Mr. COHEN. There is no federal requirement for a criminal background check. Some states are imposing a criminal background 

check requirement on Navigators. 

Mr. HARPER. But it is not your requirement, a federal requirement to do that. 

Mr. COHEN. Right. 

Mr. HARPER. The Navigators are going door to door in some situations. Correct? 

Mr. COHEN. Navigators will be told that they should not go door 

to door to solicit people to enroll in coverage. 

Mr. HARPER. They are being told not to. 

Mr. COHEN. Not to. 

Mr. HARPER. OK. Do you know if they are doing that on any 

state level? 

Mr. COHEN. I don’t. 

Mr. HARPER. OK. Can you let us know that, too, please—— 

Mr. COHEN. I can try to find that out. 

Mr. HARPER [continuing]. As one of the things here. If I could get 

you now to turn to Exhibit number 8. Exhibit 8 is a work plan from 

one approved Navigator. If you look through, you will see it promises a complete 24,000 robo calls in the first quarter, 72,000 robo 

calls in the second quarter, another 72 in the third, and 72,000 

more in the fourth quarter. 

Do you see that document? 

Mr. COHEN. Yes. 

Mr. HARPER. Do you believe that Navigators should be using taxpayer dollars to fund robo calls? 

Mr. COHEN. I am going to have to check to see what our instructions are going to be about that. My understanding generally is 

that our expectation is that when it comes to enrollment assistance, we are expecting that people are going to come to the Navigators rather than the Navigators going to them. 

Mr. HARPER. Sure, but this is an application that was approved. 

So this was an approved application, was it not? 

54 

Mr. COHEN. This grantee was awarded a grant. It doesn’t meant 

that every single thing in the application was, ended up in the final 

end award. 

Mr. HARPER. All right, but they awarded a grant, and that application did call for robo calls that you saw. 

Yield back. 

Mr. MURPHY. Thank you. The gentleman’s time has expired. 

I now go to Mr. Green for 5 minutes. 

Mr. GREEN. Thank you, Mr. Chairman. 

Mr. Cohen, let me explain to you the district I represent. I have 

a very urban district in Houston, and it has some of the highest 

in the country of uninsured. Hidalgo County in South Texas, the 

numbers in my district compare to some of the poorest counties in 

the country. Some of the questions you are hearing in looking at 

the exhibits, I know my Navigators are not going door to door. 

They are prohibited from doing it. But Enroll America, which is a 

non-profit group, is doing that. In fact, I asked them to do that in 

my district. I want them to be out there making people know that 

this law is available. 

What you are hearing today is folks who don’t like the law, and 

that is OK. They didn’t vote for it, but they are trying to keep it 

from actually working, and in a district like I have, this is the way 

those folks can go and have insurance for their families. 

And so it is frustrating to me when they were talking about, you 

know, fingerprinting. You know, under state law maybe my insurance agents are fingerprinted and do background checks. I am not 

sure, but it is not in the federal law to do that, and so in the State 

of Texas that is not an issue. Now, insurance agents may be able 

to, but we don’t hold these Navigators to a higher standard than 

the federal law is. 

So, again, their complaint is is that they really don’t want the 

Navigators to do their job to sign people up who come in. 

Also, I would be offended if I had to ask my insurance agent, by 

the way, do you have a background check. You know, that is just 

amazing that some of my colleagues would do it, but, again, their 

point is they don’t like the law, and they are trying to stop, use 

any way they can to discredit it, but it is working. I did an event 

in our district. We are doing more events in our district because 

we want that outreach to be there. 

Let me ask you something. One of the questions about the Navigators being paid incentives, and I am looking at Exhibit number 

4 on page 10. Navigators are paid a base wage of $10 an hour with 

the expectation of meeting basic performance guidelines they will 

have the opportunity to earn $200 more per quarter if they meet 

300 enrollment screenings. Federally-qualified health center employees, I know in my district or actually they have physicians to 

be able to sign people up, we are talking about some of the folks 

who make some of the lowest wages that we can imagine. And it 

sounds like to me it would be a Republican thing to incentivize 

them to actually go out and do it correctly, and that is what I think 

that is, you know, welcome to Congress. 

But let me talk a little bit about one of the issues that have come 

up, and I have heard it a lot. On the floor last week we were forced 

to vote on a bill that would force the HHS IG to take an unpreceVerDate Nov 24 2008 14:17 Aug 06, 2014 Jkt 037690 PO 00000 Frm 00060 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-84 CHRIS
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dented role of certifying marketplace verification systems before 

people could get financial assistance. I want to ask you a series of 

questions about that. 

When an individual applies for financial assistance through the 

marketplaces, what steps are taken on the front end to verify that 

they are not under-reporting their income in order to get financial 

assistance? 

Mr. COHEN. We check against available sources of data including 

Internal Revenue Service data, including Social Security Administration data, and if necessary, private employer data through a 

database that is also part of that system to see whether—— 

Mr. GREEN. So you have access to the IRS database, and you also 

can be checked against Equifax, for example, for current information? 

Mr. COHEN. That is right. 

Mr. GREEN. So there is upfront verification. What about on the 

back end? If an individual’s taxes at the end of the year indicate 

they are not eligible for that financial assistance, what do they 

have to do? 

Mr. COHEN. The IRS is going to require that they reconcile that 

at the end of the tax year, and if they have to pay money back, 

they will have to pay money back. 

Mr. GREEN. Well, and I know most folks, the last thing they 

want to hear is that the IRS is going to come audit you because 

you claimed less income than you actually earned, and you are 

going to pay this back. Is there a penalty for them under, I assume 

under IRS regs? There is probably a penalty that would be added 

not only to the back taxes but to the penalty. 

Mr. COHEN. And in addition, the information that they provide, 

it says right on the application it is being provided under penalty 

of perjury and that there are penalties just for submitting false information if it is done, you know, intentionally. 

Mr. GREEN. My Republican friends have repeatedly asserted the 

ACA would be right with fraud and suggested people would be lining up in property to get financial assistance. First of all, the financial assistance provided through the marketplace may only be used 

to purchase health insurance. 

Mr. COHEN. That is right. 

Mr. GREEN. It is not correct they get a direct cash assistance or 

sent to people’s homes. That is incorrect. 

Mr. COHEN. The money goes directly from—to the insurance company that they have chosen. 

Mr. GREEN. The carrier. 

Mr. COHEN. Yes. 

Mr. GREEN. And since they won’t even see the money, it would 

be credit applied against insurance premiums, it seems unlikely 

that people are out there waiting to profit from this program and 

to put money in their pockets when they won’t even see the money. 

Can you tell us about the uninsured who are using the exchanges 

in particular, and again, the State of Texas, we have to have a national exchange, and I appreciate other states who took the incentives on their own, but I also know HHS is supposed to put more 

resources in states that don’t have a state partner. So I appreciate 

that coming to Texas. 

56 

In particular I want to address the allegation I heard that people 

who buy insurance in exchanges are fraudsters and deadbeats. Is 

there any information on that? All people are looking for is to be 

able to cover their families with healthcare, and this is an opportunity to do it. 

Mr. COHEN. They just want to take care of themselves and their 

families. That is right. 

Mr. GREEN. Thank you, Mr. Chairman. 

Mr. MURPHY. Thank you, Mr. Green. 

Ms. Ellmers, you are recognized for 5 minutes. 

Mrs. ELLMERS. Thank you, Mr. Chairman, and thank you, Mr. 

Cohen, for being with us again. I think you said this is the seventh 

time. Is that correct? 

Mr. COHEN. Not before this committee obviously, but, yes, this is 

the seventh time I have testified since December. 

Mrs. ELLMERS. On the Hill. 

Mr. COHEN. Yes. 

Mrs. ELLMERS. OK. Well, first off, I do want to go back to one 

of the comments that you made about how you believe that there 

is competition that is being created amongst the insurance companies with the exchanges. 

You know, very recently, I believe as recent as last week, in 

North Carolina in my district, First Carolina Care Insurance Company announced that they will not be part of the exchange. They 

supply health insurance to thousands in my district. This means 

less options for my constituents and now I believe for North Carolina there are only two insurance companies. How does this provide 

competition? 

Mr. COHEN. So the results are different from state to state. In 

many states we have seen new entrants coming in and a lot of 

choice, and in other states we have seen less. 

Mrs. ELLMERS. OK. 

Mr. COHEN. As I think you probably know, the existing market 

is extremely highly concentrated in some states. 

Mrs. ELLMERS. So but for my, reclaiming my time, my North 

Carolina constituents, though, will have less competition. 

Mr. COHEN. Well, I don’t know what’s available to them off the 

marketplace. 

Mrs. ELLMERS. Let’s move on because they live in North Carolina. 

I would like for you to move to Exhibit 7, and this is part of the 

approved application process. Now, in Exhibit 7 it says that the applicant basically is going to spend money on participant incentives 

by purchasing and giving out gift cards to obtain consumer feedback on assistance provided and consumer knowledge from the satisfaction of the event. 

Do you believe that this is inappropriate use for the Navigators 

to entice individuals with gift cards? 

Mr. COHEN. Well, it doesn’t sound as though it is enticing. It 

sounds like they want to get feedback, and in order to encourage 

people to give them feedback, they are going to give them—— 

Mrs. ELLMERS. So are you sure that the idea of the gift card, so 

you know for sure that they would be basically given the information and then you don’t see that as enticement? 

57 

Mr. COHEN. That is what it looks like to me from here, but I can 

check. 

Mrs. ELLMERS. So just to clarify, you don’t believe that is enticement. 

Mr. COHEN. It doesn’t look like it. No. 

Mrs. ELLMERS. OK. Well, I would like to go back to a couple of 

the other issues. You know, now we have seen repeatedly that 

there are many questions based on the letter that we put out asking the Navigators, and of course, you know, those on the other 

side of the aisle are saying that this is intimidation, and certainly 

they have quoted me as well, and I don’t believe that Congress asking questions and doing oversight is intimidation at all. We are 

charged with making sure that taxpayer dollars are utilized correctly, and I know that oversight is very important for you as well. 

I would like to also go to the point here where it says in a response, and I would like to submit this for the record although we 

have it, that basically HHS reported that we trust that our responsibility addresses your questions about the Navigator Program and 

the guidelines and controls in place to monitor the work of the 

awardees. 

Now, there are a number of these situations where you are going 

to be getting back to us with answers. Is that correct? Some of the 

different applicants, the questions that have been posed to you. It 

is unclear at this point how it is being implemented, and you have 

repeatedly said that you would get back with information and written statements. 

Mr. COHEN. Right, and I have no objection or questions whatsoever about—— 

Mrs. ELLMERS. OK. So I guess—— 

Mr. COHEN [continuing]. Questions about this program directed 

to us. 

Mrs. ELLMERS. OK. So do you not see that as a basis for a delay 

at this point, that we would just continue to move on with this 

process even though it is very, very unclear as to how these applicants are really going to be utilizing good, hard-earned taxpayer 

dollars? 

Mr. COHEN. No, I don’t. 

Mrs. ELLMERS. So you believe that we should continue as is? 

Mr. COHEN. Absolutely. 

Mrs. ELLMERS. Regardless of being able to report back to Congress on this issue so that we can make sure that the taxpayers 

of this country know that their dollars are being utilized? 

Mr. COHEN. I don’t think that your questions are a basis for 

delay. 

Mrs. ELLMERS. So if I were, I am a taxpayer obviously. So if you 

were speaking to one of my constituents right now, a little lady 

that lives down the street from me, would you say based on all of 

these questions that have been posed that her taxpayer dollars are 

being utilized well? 

Mr. COHEN. Absolutely, and I would say that—— 

Mrs. ELLMERS. OK. Thank you. 

Mr. COHEN [continuing]. She should be very proud—— 

Mrs. ELLMERS. You have answered my question, but I would also 

like to submit for the record to the points about the issue of underVerDate Nov 24 2008 14:17 Aug 06, 2014 Jkt 037690 PO 00000 Frm 00063 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-84 CHRIS
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mining and you know, being aggressive in this effort. There is an 

article in the ‘‘Business Journal,’’ Thursday, September 12, 2013, 

and I would like to submit this for the record, where my office actually reached out to Randolph Hospital who is a Navigator 

applicantee, and let me just read a quote from them. ‘‘From my 

perspective and the hospital’s perspective we just see this as a they 

are doing their due diligence and making sure the organizations 

that receive these funds are going to be used, and the funds in the 

manner in which they were intended, said Devin Griffith, Vice 

President of Care Continuum and Support Services in Randolph.’’ 

We don’t foresee this as being a problem. 

Thank you very much. I yield back the remainder of my time. 

Mr. MURPHY. The gentlelady yields back and now our new member, Mr. Yarmuth, is recognized for 5 minutes. 

Mr. YARMUTH. Thank you very much, Mr. Chairman. I appreciate the courtesy of the committee, and I am very honored to be 

a part of the committee, even though it appears I just joined a 

game of Trivial Pursuit that we are worried about $10 gift cards 

when we are talking about a law that will affect 300 million Americans. 

Before I get into one line of questioning, I would like to plug my 

home State of Kentucky. Kentucky has embraced the Affordable 

Care Act. Our governor has taken the opportunity to provide insurance to 640,000 Kentuckians who are currently uninsured. We 

have an exchange that is a model I think for the country. It is 

called Kynect, K-y-n-e-c-t, and one of the great ironies of this debate is that during our state fair last month Kynect had a booth. 

A lot of people curious about what was available to them under the 

law, and after talking to the people at Kynect they walked away, 

many of them saying, wow, this is a lot better than ObamaCare. 

So that is kind of what we are dealing with. 

There have been a couple of comments earlier today that related 

to moves that certain corporations have made, and Republicans 

have pounced on them as kind of making an argument that they 

were somehow precipitated by the Affordable Care Act and somehow resulted in a negative outcome. 

One of them is UPS. UPS is not based in my district but the 

global hub is there. They are our largest employer. So when I 

heard about the fact that they were asking those employees who 

had spouses who were eligible for coverage through another employer to take their coverage there, and they were going to stop 

providing dependent coverage to them, that this was somehow 

something that the Affordable Care Act forced them into. Republicans pounced on that. My Senator Mitch McConnell did. So I 

talked to the UPS executives about this, and they actually said, no, 

we are very upset about the way Republicans have used us because 

what the Affordable Care Act did was allow us to make this business move, which a number of companies have done, and preserve 

our coverage at current rates and current contributions for our employees, about 15,000 out of the 770,000 lives that they insure. 

So it basically was nothing that the Affordable Care Act did that 

resulted in a negative outcome, but my question to you, Mr. Cohen, 

is before the Affordable Care Act, could UPS have done what they 

did? 

59 

Mr. COHEN. I am not familiar with that particular circumstance, 

but I don’t believe so. 

Mr. YARMUTH. But UPS could have dropped their coverage entirely before the Affordable Care Act? 

Mr. COHEN. Oh, of course. 

Mr. YARMUTH. UPS could have made any changes they wanted 

to, could have—— 

Mr. COHEN. Yes. Yes. 

Mr. YARMUTH [continuing]. Given, provided inferior coverage, 

anything they wanted to. 

Mr. COHEN. Correct. 

Mr. YARMUTH. And we all know that, I think most of us know 

that when President Obama said if you like your coverage, you can 

keep it, what he meant was that nothing in the Affordable Care 

Act would force an employer to change their coverage. Not that 

there might not be changes. In fact, some might be an improvement, and the issue of Walgreen’s was mentioned earlier today. 

Walgreen’s has decided to set up a private exchange for its employees, not shoving them into any government exchanges, so they have 

just chosen to make an alternative arrangement for providing insurance for their 160,000 employees. Isn’t that correct? 

Mr. COHEN. That is what I understand. 

Mr. YARMUTH. And when they announced it, they said the reason 

we were able to do that, the reason we wanted to do it is because 

of the private exchanges, we can actually take, expand the options 

that were available for our employees. Right now they said there 

are only two high deductible plans, so we could improve their situation. 

So you could actually make an argument, I think, and I will 

make the argument that because of the Affordable Care Act and 

the creation of exchanges and the success that the exchanges seem 

to project in terms of increased competition and lowering costs, 

that this gave Walgreen’s an opportunity to improve the situation 

with their employees. Would you agree you could make that argument? 

Mr. COHEN. I agree, and I think it is important to recognize that 

for many, many years employers have been struggling with the 

ever-increasing costs of healthcare and of health insurance, doubledigit increases year after year, and what we have seen in the last 

few years are significantly lower increases in the cost of health premiums, and I think we will continue to see that even more when 

the Affordable Care Act is fully implemented and is a lot less uncompensated care that all businesses have to pay for in their rates 

because more people will have coverage. 

Mr. YARMUTH. And as a reminder when we go back to the year 

that this law was being debated in 2009, premiums for businesses 

were going up in many places as high as 38 percent. I think in 

California Blue Cross Blue Shield said everybody is getting a 38 

percent increase. So we have seen a dramatic improvement since 

that time. 

Mr. COHEN. That is right. 

Mr. YARMUTH. Yes. Thank you very much for your testimony. 

Mr. Chairman, thank you very much. I yield back. 

Mr. MURPHY. The gentleman yields back. 

60 

I now go to Dr. Gingrey for 5 minutes. 

Mr. GINGREY. Mr. Chairman, thank you. 

Mr. Cohen, I am going to read out to you some statistics which 

you may or may not agree with, but a number of years ago the 

United States Census Bureau came out with an estimate of 47 million people, 47 million people in this country without health insurance. They got this information basically by calling and saying, do 

you have health insurance? Yes or no? If they had just lost their 

job and then off of health insurance for 1 week, the answer was no. 

If the call had been received 2 weeks later, the answer very well 

may have been yes. 

So 47 million people without health insurance is one thing, but 

if it were for a full year without health insurance, that would be 

a horse of an entirely different color. 

In that 47 million, let’s just assume there really were 47 million 

people who went uninsured for a full year. Eighteen million of 

those people make more than $50,000 a year, 18 million of the 47 

million. Ten million, it’s estimated, of those 47 million are in this 

country illegally. Fourteen million are eligible for a safety net program, SCHIP, Medicaid, they just don’t bother to fill out the paperwork or maybe they don’t know, maybe they haven’t been informed. 

But when you get right down to it there are probably no more than 

eight to 10 million people in this country that do not have health 

insurance because they are nearly poor. They are not eligible for 

Medicare, they are not eligible for Medicaid. So the number was so 

grossly inflated, and so when I hear from the other side of the aisle 

that we Republicans who are totally opposed to this bill, well, yes. 

We were, and that is one of the main reasons we were. 

Now, another statistic, 1950, the average individual spent $500 

a year on healthcare. In 2006, the latest year that I have statistics 

for, the average individual probably spent $7,000 a year for 

healthcare. But look at the life expectancy. The life expectancy in 

1950, was the late 50s. The life expectancy in 2006, 2007, indeed, 

today, is 80 years old practically. 

So the value, yes, health costs in this country is too high, and 

we need to constantly fight to lower it, find ways, eliminate waste, 

fraud, and abuse, anything that we can do to bring it down, but 

what is the value of each additional year of a person’s life because 

of what we have done. Yes, because it is costly, but that is because 

of research and development, durable medical equipment, medical 

devices, well-trained physicians, super specialists, outstanding 

drugs, antibiotics six generation now because of the GAIN Act. So, 

of course, we were opposed to this bill. Now, look. 

Let me get directly to a question for you. In 2 weeks the rules 

say that the signup period on the exchanges commences. Will individuals be able to sign up for a health insurance plan on October 

the 1st, 2013? 

Mr. COHEN. Yes. Consumers will be able to sign up for a health 

plan on October, beginning on October 1. 

Mr. GINGREY. They will actually be able to pick a plan, whether 

it is Cigna, Aetna, Blue Cross Blue Shield, Platinum Gold, Silver, 

Bronze, whatever, they will be able to do that on October the 1st? 

61 

Mr. COHEN. That is my expectation based on the progress that 

we have made and what I am told will be in place on October 1. 

Yes. 

Mr. GINGREY. Thank you, and this will be my last question because I am running out of time. Most of ObamaCare is based on 

the premise that by forcing younger people into the market, they 

will help lower the costs for the older and the sicker individuals. 

But because the penalty is so weak, there is a real problem if all 

those young people don’t show up, and I am afraid they won’t. 

In my home State of Georgia the insurance commission announced that for the average 27 year old no longer on their parents’ policy, out of the basement, living on their own, premiums are 

set to rise anywhere from 85 to 198 percent. It seems that a $95 

penalty would do little to incent young people like that to purchase 

coverage when faced with huge, huge premium increases. 

Mr. Cohen, a lot of the premise of ObamaCare is based on getting these young people to enroll, to help broaden the pool, lower 

the costs for the older and sicker. Have you heard any concerns 

that because the penalty for ObamaCare is so weak young people 

may stay out of the program in the first year, and if they do opt 

out, what will this do to the cost for the others? 

Mr. COHEN. So yes, I have read things speculating that the penalty is low and will not be a reason for people to sign up, but I 

think our research shows that most people want healthcare, and 

the barrier has been the cost, and that with subsidies care will 

be—the coverage will be affordable, and it will be high-quality care, 

and we are looking forward to people, including young people, enrolling in coverage. 

Mr. MURPHY. Thank you. 

Mr. GINGREY. Thank you, and Mr. Chairman, thank you for your 

indulgence, and I yield back. 

Mr. MURPHY. Thank you, Doctor. Mr. Griffith is next, but he is 

going to yield his time, I mean, yield first to Mr. Shimkus to ask 

questions and then to Mr. Griffith. 

Mr. Shimkus, you are recognized. 

Mr. SHIMKUS. Thank you. I thank my colleague. I want to thank 

the Chairman for letting me sit in. I am not on this subcommittee, 

and I want to thank the Ranking Member. 

Mr. Cohen, welcome. You are trying to do the job presented to 

you, and this is a tough committee. So let me ask a couple questions because I have been trying to get my, just like regardless of 

how we feel on the law, if nothing changes, and it gets enacted, 

members of the Congress are going to have to address our constituents’ concerns and deal with that. 

So what I have tried to do is a couple things. I have tried to meet 

with my grantees. I have met with one, but some are now making 

themselves available to me, and I am just trying to do it to get information. So I don’t know what we can do from the Administration’s perspective to encourage the grantees to talk to the elected 

members of Congress and the regions that they are going to represent, but I would personally appreciate it because I am trying to 

develop a relationship because constituents are going to come to us. 

They do for Medicare, they come to us for Medicaid, they do for SoVerDate Nov 24 2008 14:17 Aug 06, 2014 Jkt 037690 PO 00000 Frm 00067 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-84 CHRIS
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cial Security, veterans affairs. That is part of our job, and I just 

need help. 

So I just say that as a member appealing to the Administration. 

Mr. COHEN. So I think we would like to work with you on a process for getting you the information that you want, and are entitled 

to that won’t be disruptive of the work that needs to be happening, 

particularly at this particularly critical moment when they are just 

getting ready to start their work. 

Mr. SHIMKUS. Yes, and I get it, I mean, because I did meet with 

one, and it was very helpful. 

The other request I have is we have asked if we can get, especially our staff member who deals, most of us have constituent 

service people in our Congressional districts. I have one that she 

is an expert now on Medicare and Medicaid. I have another one 

who is an expert on veterans’ affairs. We have put forth a request 

to say can’t I get this person trained? Can they sit through the 

training? 

Mr. COHEN. Yes. 

Mr. SHIMKUS. We were told no. So—— 

Mr. COHEN. You were told no by? 

Mr. SHIMKUS. I can get you the answers, but we were told we 

can’t, they wouldn’t allow us to be trained. So—— 

Mr. COHEN. That doesn’t sound right to me. 

Mr. SHIMKUS. That is fine. I want my staffer to know as much 

information as they can as they are going to have to deal with this. 

Hopefully not but—— 

Mr. COHEN. No. Absolutely. 

Mr. SHIMKUS [continuing]. My guess is they might have to deal 

with this. So when I talked to the one grantee, this is the point 

that they made. They have got 33 Navigators, they are dispersed 

throughout healthcare. We have kind of vetted that out in this 

hearing today. 

But they only have two slots for training. There is a 20-hour, I 

mean, there is an online training. I have learned that much, and 

then I am from Illinois, so there is a 2-day training, probably an 

overnight, and that is kind of where we were researching to get our 

staffer involved in both those trainings, but the real—— 

Mr. COHEN. At the state-required training or is that—— 

Mr. SHIMKUS. Yes. That is why I am trying to figure it out. So 

but my point is this one grantee will before the operational date 

of October 1, will only be able to get two of his individuals through 

the training. I am just—and I can tell you, I don’t want to air, but 

I would be glad to talk to you. 

Mr. COHEN. If our legislative folks could get in touch with your 

staff—— 

Mr. SHIMKUS. Thank you. 

Mr. COHEN [continuing]. I would really be very happy to look 

into that in particular. 

Mr. SHIMKUS. And then they also raised the issue that getting 

a clearance for these people is basically the State of Illinois providing clearance. They will not be ready to handle this information 

because of the clearance process. So I am just using this opportunity to show you some of the concerns that I have, and I am very 

concerned because I want to, I don’t like the law, I voted against 

63 

the law, but I know I am going to get calls about how we can help 

my constituents, and I want to be ready to do that. 

Mr. COHEN. So I appreciate that very much. I have to say that 

I am concerned that some states have put in requirements which 

they are entitled to do, you know, but that are making it a little 

bit more difficult for the Navigators to get ready in time for October 1. So maybe we can work with you and try to work through 

some of those issues. 

Mr. SHIMKUS. I would appreciate it. Let me just go the final 

question. It was kind of based upon listening to your testimony 

today about, you know, whether you are going to go door to door, 

and I don’t have a dog in that fight, but I am concerned that as 

we have people who are trained and qualified that we have a process that someone can go back to a government Web site and say, 

they are legit, they are not legit. Have you all considered putting 

a list of names of the Navigators on a .gov site or something? 

Mr. COHEN. So we are working through that. I think the latest 

discussion is that we will provide the list to the state insurance departments so that there will be a local place where people can go 

to make sure that folks are who they are supposed to be. 

Mr. SHIMKUS. And it is up to them if they put it online or not? 

Mr. COHEN. Right. 

Mr. SHIMKUS. OK. Again, Chairman, thank you very much. 

Ranking Member, thank you very much, and I yield back the time. 

Mr. MURPHY. I thank the gentleman from Illinois, and I know, 

I think many offices would love to know how our staff can also log 

on to get the training as well. Thank you. 

Finally, Mr. Griffith is recognized for 5 minutes. 

Mr. GRIFFITH. Thank you, Mr. Chairman. I appreciate that very 

much. 

Let me follow up on that. It might also be good to get some of 

these folks’ IDs. In this morning’s ‘‘Bluefield Daily Telegraph’’ there 

is an article about door-to-door scammers looking for prescription 

drug information. I know you can’t stop all the bad actors out 

there, but we have a group running around in Tazewell County, 

Virginia, pretending to be part of the Appalachian Agency for Senior Citizens, and even though you are telling folks they are not supposed to do door to door, the word out there is is that some people 

are going to do door to door. 

I would now draw your attention to Exhibit 2, and you will notice 

in that proposal in the second paragraph it says that they propose 

going door to door. So even some of the proposals and some of the 

people who are supposed to be doing this apparently have the misunderstanding they are supposed to go door to door. 

One of the other questions that I have for you and then I will 

come back to Exhibit 2 so you might want to leave that open is 

that the State Corporation Commission in Virginia, Bureau of Insurance approved or certified as acceptable plans at the end of 

July. It was their assumption that they would have some information by now. They as of this morning do not know whether or not 

their plans, because Virginia is not doing its own exchange, it is 

going through federal exchange, but the State Bureau of Insurance 

was sending plans that were approved. They haven’t heard anyVerDate Nov 24 2008 14:17 Aug 06, 2014 Jkt 037690 PO 00000 Frm 00069 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-84 CHRIS
64 

thing back as of this morning, so they don’t know whether these 

plans are actually going to be approved or not. 

And so I would ask you to check on that, please, and get us some 

help because we have got 7 business days left to go, and the State 

of Virginia doesn’t know what plans are going to be approved by 

the—— 

Mr. COHEN. I absolutely will. That surprises me because I know 

we have been in contact with the states on a regular basis, but I 

will absolutely follow through on that. 

Mr. GRIFFITH. And I will just tell you we checked with him this 

morning. I will tell you another concern is and this happens in a 

lot of rural areas I am sure, is that there is not going to be competition in ten of the jurisdictions I represent. There is either only 

one shop plan or only one individual plan, and five of those jurisdictions, the counties of Buchanan, Grayson, Lee, Scott, and the 

city of Bristol, there is only one shop plan and one individual plan. 

And so a lot of my constituents do not have a whole lot of choices 

to choose from, and obviously if there is a monopoly, that may have 

affect prices as well, wouldn’t you think? 

That being said I will point you back now to the Exhibit 2. Just 

so you will know that we are looking at this, you will see on the 

first page the project abstract for the Navigator, and it is going to 

cover two counties, one in Florida, one in Texas. On the next page 

you will see further that the application says they will have 50 exchange Navigators, and then you have to follow through, and we 

have done some of the math for you, and my time is running out, 

so I will lead you through some of this and then ask you to comment. 

On the next page you will see their enrollment goals, and they 

state in the second bullet point that they want enrollment goals 

about 75 percent of those they are trying to reach, and they indicate that through provision of literature, et cetera, a total of 

288,750 per targeted county by the end of the program year or a 

total of 577,700, and so what we have got is we have got a Navigator in their statement saying that somebody in your office approved that they are going to enroll 577,000 people plus by the end 

of the year, and that works out to 11,500 enrollees per Navigator 

when you take that 577,500 people and divide it by 50 Navigators. 

And, of course, remember these are the folks who were also not 

only going to be doing fairs and so forth but were going to be saying they were going to go door to door. 

Do you really believe that one Navigator can enroll 11,500 people, taking the time that they had originally when this was done 

until the end of the year? It looks like it is 31 people a day counting weekends and holidays. That is not really very realistic, is it? 

I have done door knocking before, and I have done a lot of voter 

outreach, and to reach that many people a day and actually get 

them to say yes is not an easy accomplishment. 

Mr. COHEN. So I would say again, I mean, this is clearly a proposal, an application. It was approved. This grantee was approved. 

They got a grant. There is a budget process that happens as part 

of that approval. I don’t, I can’t tell you. I will commit to you to 

find out more information about this grantee if you would like, but 

I can’t tell you whether this is how it ended up or whether there 

65 

*The information has been retained in committee files and is also available at http:// 

docs.house.gov/Committee/Calendar/ByEvent.aspx?EventID=101323 

were any changes, and I don’t feel comfortable commenting on it 

because I literally have, am just seeing it now. So—— 

Mr. GRIFFITH. I understand it if you could give me some comment later, I would appreciate that very much. These are concerning numbers, and obviously there are some people out there at 

least thinking they are supposed to go door to door, and that is of 

concern because then when people start going door to door it makes 

it much—— 

Mr. COHEN. Right. 

Mr. GRIFFITH [continuing]. Easier for particularly senior citizens 

to be victims of bad actors and not the real Navigators. They are 

not going to ascribe that to the real Navigators but folks going out 

there and they know people are supposed to be going door to door, 

people are coming by, and the next thing you know they are finding 

out whether or not they have prescription drugs, and then what 

they are doing apparently in that particular county or what the 

sheriff fears is that they will go back and rob the house, and they 

are more interested in getting the drugs than they are getting TVs, 

and they are just trying to figure out which are the prime targets. 

And so that is of concern. 

I will also tell you and I am not sure that this falls under your 

jurisdiction, but we are having a real problem with the doctor 

shortage in the Commonwealth of Virginia. There is an article 

today about some people in the eastern part of the state that are 

having a problem. I don’t represent that particular part of Virginia, 

and I will tell you that recently one of my hospitals closed. Their 

number one reason was ObamaCare, and the aspects, the cuts to 

Medicare, the double, I call it the scissor where the states under 

the original plan were supposed to but didn’t have to on the Supreme Court ruling, expand Medicaid and then the final straw for 

those particular folks besides the war on coal which lowered the 

economy in the area so you had less insured people, the final straw 

was the fact that they couldn’t get doctors to staff the hospital in 

an adequate fashion and so now I have got folks that are going to 

have to travel an hour to an hour and a half to get cardiac care. 

It is a very serious concern. I am very worried about the people 

who live in my district and whether or not they are going to be able 

to get adequate healthcare under this ObamaCare Program. 

And like the others who have spoken, I, too, hope that you will 

educate us on how to enroll people, because we will get calls. 

Mr. MURPHY. OK. The gentleman’s time has expired, and with 

that, Mr. Cohen, we appreciate you coming for this committee 

again today, and I ask unanimous consent that the written opening 

statements of other members be introduced into the record if they 

wish, and without objection those will be entered into the record. 

I also ask unanimous consent to enter the document binder into 

the record subject to appropriate redactions by staff. I also ask for 

unanimous consent to put an article into the record from the ‘‘Business Journal’’ dated September 12, 2013. 

So without objection that is so ordered. *

66 

Mr. MURPHY. Again, Mr. Cohen, thank you so much for coming. 

We appreciate your timely response also to members’ requests for 

assistance for their staff and others in providing information and 

for the testimony that you and other members have asked here and 

the devotion of members at this hearing today. 

The committee rules provide that members have 10 days to submit additional questions for the record of the witness. And with 

that this hearing is now adjourned. 

Mr. COHEN. Thank you. 

[Whereupon, at 12:26 p.m., the subcommittee was adjourned.] 

[Material submitted for inclusion in the record follows:] 

OPENING STATEMENT OF THE HON. FRED UPTON

We are now less than two weeks away from when the health law’s enrollment officially kicks off. It has been a rocky three and a half years to date. 

Unfortunately, the law’s implementation has been plagued by confusion, uncertainty, delays, and missed deadlines. The broken promises have reached near epidemic proportions. Hardly a day goes by without workers losing the coverage the 

president promised they could keep, or new figures detailing the looming rate shock 

in store for millions of Americans. The president’s hometown Chicago Tribune lamented about the part-timing of America, and many businesses have frozen hiring 

altogether to avoid the law’s costly mandates. 

Since health care reform was signed into law, two programs closed prematurely 

because they ran out of money: the Pre-Existing Condition Insurance Plan and the 

Early Retiree Reinsurance Program. The CLASS Act was repealed. Fundamental requirements of the law, like the employer mandate, were delayed with little fanfare, 

and hundreds of waivers were handed out to health plans that could not meet the 

requirements of the law. 

In the last few weeks, even more of the law’s consequences for American families 

have come to light. Some employers have announced that they will no longer cover 

spouses and children. Others have decided that they will need to jettison their retirees from company health care plans to the exchanges. 

The American people deserve better than this. They deserve better than a law 

that was crafted behind closed doors and rammed through despite wide opposition. 

Although there was no oversight of the law until Republicans regained control of 

the House in 2011, some have still questioned why this committee has investigated 

and conducted extensive hearings on the implementation of the Affordable Care Act. 

I believe it is our duty to ask questions and get the facts about how programs are 

going to work, and what they will mean for the American people, rather than sit 

back and wait until it is too late to ask questions after taxpayer dollars have been 

squandered. 

Mr. Gary Cohen, the Director of the Center for Consumer Information and Insurance Oversight, has appeared before this committee before and is here today to explain what we can expect when enrollment begins in less than two weeks. In April, 

Mr. Cohen testified that everything was ‘‘on track’’—but ‘‘on track’’ to what? Just 

weeks after his testimony, the administration delayed the employer mandate and 

rolled back the verification process, opening us up for potentially billions of dollars 

in fraud. With less than two weeks until launch, it is time for the administration 

to be frank with the American people. When will CCIIO finalize and announce the 

approved insurance plans and premium costs? Will states be ready? Will people who 

like their insurance plans be able to keep them? I hope Mr. Cohen will be able to 

offer specific answers to these questions today rather than vague assurances that 

everything is on track. 

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