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88–545 2015

2014: SEEKING PPACA ANSWERS 

HEARING 

BEFORE THE

SUBCOMMITTEE ON OVERSIGHT AND 

INVESTIGATIONS 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

JANUARY 16, 2014 

Serial No. 113–113 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 

(II) 

COMMITTEE ON ENERGY AND COMMERCE 

FRED UPTON, Michigan 

Chairman 

RALPH M. HALL, Texas 

JOE BARTON, Texas 

Chairman Emeritus 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOSEPH R. PITTS, Pennsylvania 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE ROGERS, Michigan 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

Vice Chairman 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

ROBERT E. LATTA, Ohio 

CATHY MCMORRIS RODGERS, Washington 

GREGG HARPER, Mississippi 

LEONARD LANCE, New Jersey 

BILL CASSIDY, Louisiana 

BRETT GUTHRIE, Kentucky 

PETE OLSON, Texas 

DAVID B. MCKINLEY, West Virginia 

CORY GARDNER, Colorado 

MIKE POMPEO, Kansas 

ADAM KINZINGER, Illinois 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

BILL JOHNSON, Missouri 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

HENRY A. WAXMAN, California 

Ranking Member 

JOHN D. DINGELL, Michigan 

Chairman Emeritus 

FRANK PALLONE, JR., New Jersey 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

MICHAEL F. DOYLE, Pennsylvania 

JANICE D. SCHAKOWSKY, Illinois 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

JOHN BARROW, Georgia 

DORIS O. MATSUI, California 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

JERRY MCNERNEY, California 

BRUCE L. BRALEY, Iowa 

PETER WELCH, Vermont 

BEN RAY LUJAN, New Mexico 

PAUL TONKO, New York 

JOHN A. YARMUTH, Kentucky 

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 

G.K. BUTTERFIELD, North Carolina 

KATHY CASTOR, Florida 

PETER WELCH, Vermont 

PAUL TONKO, New York 

JOHN A. YARMUTH, Kentucky 

GENE GREEN, Texas 

HENRY A. WAXMAN, California (ex officio) 

(III) 

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. Diana DeGette, a Representative in Congress from the state of Colorado, 

opening statement ................................................................................................ 4 

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

opening statement ................................................................................................ 6 

Prepared statement .......................................................................................... 7 

Hon. Kathy Castor, a Representative in Congress from the State of Florida, 

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

WITNESSES

Gary Cohen, Deputy Administrator and Director, Center for Consumer Information and Insurance Oversight, Centers for Medicare and Medicaid Services ......................................................................................................................... 10 

Prepared statement .......................................................................................... 13 

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

SUBMITTED MATERIAL

Minority memorandum dated January 16, 2014 .................................................. 58 

Minority memorandum dated January 9, 2014 .................................................... 62 

(1) 

2014: SEEKING PPACA ANSWERS 

THURSDAY, JANUARY 16, 2014 

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

The subcommittee met, pursuant to call, at 9:33 a.m., in room 

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

(chairman of the subcommittee) presiding. 

Present: Representatives Murphy, Burgess, Blackburn, Gingrey, 

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

(ex officio), DeGette, Braley, Schakowsky, Butterfield, Castor, 

Welch, Tonko, Yarmuth, and Green. 

Staff present: Carl Anderson, Counsel, Oversight; Gary Andres, 

Staff Director; Sean Bonyun, Communications Director; Karen 

Christian, Chief Counsel, Oversight; Noelle Clemente, Press Secretary; Brad Grantz, Policy Coordinator, Oversight and Investigations; Brittany Havens, Legislative Clerk; Sean Hayes, Counsel, 

Oversight and Investigations; Alan Slobodin, Deputy Chief Counsel, Oversight; Tom Wilbur, Digital Media Advisor; Brian Cohen, 

Democratic Staff Director, Oversight and Investigations, and Senior Policy Advisor; Hannah Green, Democratic Staff Assistant; Elizabeth Letter, Democratic Press Secretary; Stephen Salsbury, 

Democratic Special Assistant; and Matt 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 on the Subcommittee on Oversight and Investigations to review the implementation of the Patient Protection and Affordable Care Act. 

Our witness today is Mr. Gary Cohen, the Deputy Administrator 

and Director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services. 

Mr. Cohen, I would like to read you two quotes from your testimony before the committee last year. On April 24, 2013, when 

asked by the ranking member for benchmarks to measure CCIIO’s 

progress, you responded: and I quote, ‘‘I think the keys are that we 

are on schedule and on track with the IT build that were doing, 

which is clearly an important part of this.’’ And then you added, 

‘‘I think it is just important to take a look at each of the steps 

along the path and make sure that we are on track. But I am very 

2 

optimistic and confident of where we are at this point.’’ Again, this 

was on April 24, 2013. 

Here is a second quote. On September 19, less than 2 weeks before the start of open enrollment, when Dr. Burgess asked you if 

open enrollment would be ready on October 1st, you said: ‘‘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 1st.’’ When pressed further, you responded: ‘‘I have nothing further to add to my answer.’’ 

Now, those unqualified statements that the exchanges would be 

ready by October 1st are now contrasted against what we have 

learned through our investigation since the Healthcare.gov Web 

site failed on launch. 

Mr. Cohen, on April 4 and 5, 2013, just 3 weeks before you told 

this committee that you did not have any question about the exchanges being ready on October 1st, the McKinsey Company 

briefed you and a number of other members of the Administration 

teams on this on a number of risks facing the Web site and the federal marketplace. Those included late policy, delayed designs and 

building time, and a limited time to test the Web site. I would like 

to know why did you feel confident telling this subcommittee on 

April 24th that everything was on track? Similarly, CMS’s own 

emails from the summer of 2013 show that CMS officials were worried that Healthcare.gov would ‘‘crash on takeoff’’ and yet, you 

again told us in September that everyone would be able to go online, select a plan, learn their subsidy, and enroll starting October 

1st. 

Mr. Cohen, I thank you for being here today, and I know the 

number of times you have made yourself available to testify to this 

committee and I do appreciate that. But it seems like you are faced 

with two alternatives today: either you didn’t know about the problems with Healthcare.gov when you testified last year, or you did, 

and decided not to inform Congress. 

Now, this is part of a pattern for this Administration and the Affordable Care Act that is so disheartening to the American people: 

promises made and promises broken. We have spent over $600 million on the Healthcare.gov Web site and the Administration gave 

absolutely no warning that a disaster was approaching, and now 

we know those warnings were obviously there. 

The broken promises don’t end there. After years of saying if you 

like your plan you can keep it, the president finally apologized. And 

what about the $2,500 in premium savings the President promised? 

We don’t hear that promise anymore. And now recent news reports 

have discussed narrow provider networks as a consequence of 

Obamacare. Will Americans still be able to keep their doctors? And 

now we ask, will they be able to afford their deductibles? 

This hearing is not just about looking backward and determining 

who knew what about the Web site. But one important purpose of 

this hearing is accountability. So I would like us to try and start 

fresh in 2014, but our ability to do so depends on you explaining 

fully and honestly what you knew and what you understood about 

3 

the development of the exchanges and Web site as it was happening, and how that informed your testimony last year to this 

committee. Because, as we have often said, this is about more than 

a Web site. If people are to trust and rely on this system, and trust 

something so critically important to a family as their own health 

care, this Administration needs to have an honest and open dialogue with the public about the status of the implementation. 

Promises of all is well just don’t cut it anymore. 

With the start of coverage just a few weeks ago, there are many 

important issues to examine about how the exchanges are operating. If problems are looming, we need to get the facts on the table 

and do something about it before it is too late. Mr. Cohen, I hope 

you will give complete answers today to the following questions: 

Why didn’t you tell Congress last year about the problems with 

Healthcare.gov? How many people have actually paid their insurance premiums in the exchanges? Of those people who have paid 

their premiums, how many were uninsured and how many had 

their plans actually cancelled? How much will the taxpayers end 

up spending on the Healthcare.gov Web site, and where are you 

getting the money for it? News reports have stated that not enough 

young people are enrolling. When will we know about the risk corridors, and whether the federal and state exchanges are sustainable? 

[The prepared statement of Mr. Murphy follows:] 

PREPARED STATEMENT OF HON. TIM MURPHY

I convene this hearing on the Subcommittee on Oversight and Investigations to 

review the implementation of the Patient Protection and Affordable Care Act. 

Our witness this morning is Mr. Gary Cohen, the Deputy Administrator and Director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare & Medicaid Services. Mr. Cohen, I would like to read you two 

quotes from your testimony before the committee last year: 

• On April 24, 2013, when asked by the Ranking Member for benchmarks to measure CCIIO’s progress, you responded: ‘‘I think the keys are that we are on schedule 

and on track with the IT build that were doing, which is clearly an important part 

of this.’’ And then: ‘‘I think it is just important to take a look at each of the steps 

along the path and make sure that we are on track. But I am very optimistic and 

confident of where we are at this point.’’ Again, this was on April 24, 2013. 

• Here is a second quote. On September 19, less than two weeks before the start 

of open enrollment, when Dr. Burgess asked you if open enrollment would be ready 

on October 1, you said: ‘‘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.’’ When pressed further, you 

responded: ‘‘I have nothing further to add to my answer.’’ 

Those unqualified statements that the exchanges would be ready by October 1 are 

now contrasted against what we have learned through our investigation since the 

HealthCare.gov Web site failed on launch. 

Mr. Cohen, on April 4 and 5, 2013, just three weeks before you told this committee that you did not have ‘‘any question’’ about the exchanges being ready on October 1, the McKinsey Company briefed you on a number of risks facing the Web 

site and the federal marketplace. Those included late policy, delayed designs and 

building time, and a limited time to test the Web site. Why did you feel confident 

telling this subcommittee on April 24 that everything was on track? Similarly, CMS’ 

own emails from the summer of 2013 show that CMS officials were worried that 

HealthCare.gov would ‘‘crash on take off.’’ And yet, you again told us in September 

that everyone would be able to go online, select a plan, learn their subsidy, and enroll starting October 1. 

4 

Mr. Cohen, I thank you for being here today. I know the number of times you 

have made yourself available to testify to this committee and I do appreciate it. But 

it seems like you are faced with two alternatives today: either you didn’t know about 

the problems with HealthCare.gov when you testified last year, or you did, and decided not to inform Congress. 

This is part of a pattern for this administration and the Affordable Care Act that 

is so disheartening to the American people. Promises made, promises broken. We 

have spent over $600 million on the HealthCare.gov Web site and the administration gave absolutely no warnings that a disaster was approaching-and now we know 

those warnings were obviously there. The broken promises don’t end there. After 

years of saying that ‘‘if you like your plan you can keep it’’, the president finally 

apologized. What about the $2,500 in premium savings the president promised? We 

don’t hear that promise anymore. Now recent news reports have discussed narrow 

provider networks as a consequence of the Affordable Care Act. Will Americans still 

be able to keep their doctors? Will they be able to afford their deductibles? 

This hearing is not just about looking backward and determining who knew what 

about the Web site. But one important purpose of this hearing is accountability. Mr. 

Cohen, we would like to try and start fresh in 2014, but our ability to do so depends 

on you explaining fully and honestly what you knew and what you understood about 

the development of the exchanges and Web site as it was happening, and how that 

informed your testimony last year to this committee. Because, as we have often said, 

this is about more than a Web site. If people are to trust and rely on this system, 

this administration needs to have an honest and open dialogue with the public 

about the status of implementation. Promises of ‘‘all is well’’ just don’t cut it anymore. With the start of coverage just a few weeks ago, there are many important 

issues to examine about how the exchanges are operating. If problems are looming, 

we need to get the facts on the table and do something about it before it is too late. 

Mr. Cohen, I hope you will give complete answers today to the following questions: 

• Why didn’t you tell Congress last year about the problems with HealthCare.gov? 

• How many people have actually paid their insurance premiums in the exchanges? 

• Of those people who have paid their premiums—how many were uninsured and 

how many had their plans cancelled? 

• How much will the taxpayer end up spending on HealthCare.gov, and where are 

you getting the money for it? 

• News reports have stated that not enough young people are enrolling. When will 

we know about the risk corridors, and whether the federal and state exchanges are 

sustainable? 

# # # 

Mr. MURPHY. So I thank you for being here today, and I yield 

now to the ranking member, Ms. DeGette, for 5 minutes. 

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

Ms. DEGETTE. Well, thank you, Mr. Chairman, and welcome, Mr. 

Cohen, back to this committee. 

I think, Mr. Chairman, we could probably stipulate to the fact 

that Healthcare.gov had a rocky start. There is no doubt about 

that. But I am sitting here thinking, the longer the Republicans 

keep beating the dead horse about who knew what, when and all 

of that, the longer they keep raising these faux issues like the fact 

that they say the Web site is not secure, then I think the worst it 

is going to be for their constituents because after all, isn’t our desire to encourage people to sign up for health insurance, if they are 

eligible for Medicaid, to sign up for Medicaid, if they are eligible 

for subsidies, to get those subsidies to help pay for their insurance? 

As I hear my colleagues on the other side of the aisle talk about 

this, I can’t help but wonder if they really do want their constituVerDate Nov 24 2008 14:58 Sep 11, 2015 Jkt 037690 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-113 CHRIS
5 

ents to have insurance. Last week’s vote on the floor was a good 

example where we voted on this bill that said that we were going 

to have security in Healthcare.gov. Now, everybody thinks we need 

to have security in Healthcare.gov but the clear impression given 

during the floor debate and also the debate in this committee before that was that somehow Healthcare.gov is not secure when in 

fact there hasn’t been one breach of Healthcare.gov and, in the 

briefing we had, the federal IT people told us they haven’t had any 

more attempts to breach Healthcare.gov than any other Federal 

Government Web site, and of course, private Web sites, like, for example, Target, are not exempt from that either. 

And so I just can’t help but think that my colleagues on the other 

side of the aisle really don’t want to have us implement this 

Healthcare.gov or the entire Affordable Care Act in a reasonable 

way. They want to chill their constituents from signing up, and I 

think that is a darn shame. 

The good news is—and believe you me, I was one of the biggest 

critics on the implementation of Healthcare.gov on this side of the 

aisle. It was rocky. But the good news is, it does appear now that 

people are beginning to enroll in this in a robust way. 

Last week, Connect for Colorado, which is our state site, announced the figures for my state. We are about halfway through 

the open enrollment period and already 50,000 Coloradoans have 

signed up for private insurance on the exchange and about 90,000 

have enrolled in Medicaid. So this is 140,000 people who didn’t 

have health insurance before. 

Now, this represents real progress. This represents a family that 

doesn’t have to worry about how it will pay for treatment if a child 

gets sick or has an accident. It represents moms who can get preventive care from breast cancer screenings to vaccines. It represents small businessmen and -women who don’t have to worry 

about losing their livelihood if they have an accident. 

Now, I am proud of my governor, I am proud of my legislature, 

Democrats and Republicans, and I am proud of the leaders for Connect for Colorado for getting it up and going. I know we are not 

out of the woods yet. We are going to continue to have glitches and 

we need to address those. But sitting around and trying to figure 

out what happened last fall when everybody admits it was a disaster does not help us towards fixing this problem in the future. 

I want to say one last thing. The White House released enrollment figures for all 50 States earlier this week. The national numbers mirror what happened in my State. Over two million people 

have signed up on the exchanges and four million people have enrolled in Medicaid. That is six million people who didn’t have insurance before. 

Now, minority staff released a memo this morning that showed 

Affordable Care Act enrollment is ahead of where the Medicare 

Part D enrollment was at the time that program went into effect 

in 2006. Right now, the Affordable Care Act enrollment is at 31 

percent of projected enrollment with half the open enrollment period to go, and at this point during Part D, enrollment had hit only 

23 percent of projections, and Mr. Chairman, I would ask unanimous consent to put that memo into the record. 

Mr. MURPHY. Without objection. 

6 

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

Ms. DEGETTE. Thank you. 

So you know, I didn’t vote for Medicare Part D. Most Democrats 

didn’t. But we worked together to try to make it a success, and I 

think that is what we should do here. 

One of the things I continue to be concerned about with implementation of the Affordable Care Act and the exchanges is enrollment of young people. Now, I know everybody says they will all enroll at the end but I would be interested to know from the Administration what we are doing to make sure we hit those targets because the exchanges are not going to work without them enrolling. 

So in sum, let us work together to implement this, to get our constituents enrolled. Let us not sit around griping about what happened admittedly last year. 

Thank you, Mr. Chairman. 

Mr. MURPHY. The gentlelady yields back. I now recognize the 

chairman of the full committee, Mr. Upton, for 5 minutes. 

OPENING STATEMENT OF HON. FRED UPTON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MICHIGAN 

Mr. UPTON. Thank you, Mr. Chairman. 

Today we are going to continue our thoughtful oversight of the 

President’s implementation of the health care law and its effects on 

Americans in Michigan as well as across the country. 

So Mr. Cohen, we do welcome you back. You have testified before 

the committee a number of times and I appreciate you returning 

again today. In preparing for today’s hearing, we went back to review the transcripts, as you would imagine, of your testimony from 

last year, and when we asked what to expect at the start of open 

enrollment on October 1st, you assured us on two different times, 

once in April and again in September, less than 2 weeks before the 

launch, that yes, everything was on track. And during your more 

than 4 hours of testimony before the committee last year, there 

was no mention of the fact that you had been briefed twice by 

McKinsey in early April of last year and warned about the number 

of risks facing the marketplaces and the Web site nor was there 

any elaboration on the fact that CMS employees were well aware 

that the Web site build was riddled with problems, far behind 

schedule with the October 1 launch in jeopardy. 

So the purpose of today’s hearing is not to rehash every detail 

of the failed launch, but to move forward, we have got to understand what you knew about the status of the Web site and implementation of the President’s law at the time that you appeared before the committee, looked us in the eye, and said, of course, everything was on track. It is time to be candid and transparent with 

Congress and the American public. 

Lots of promises have been made, many have already been broken. What is next? The only way the public can trust the health 

care system and the Administration that is implementing this law 

is if Administration officials are open and transparent about the 

facts and what the American people should expect from this law 

and for their health care moving forward. Providing facts and specifics is an important first step toward restoring the credibility that 

we all want. The American people deserve the peace of mind that 

7 

there will be no more surprises, that the information available is 

the entire and true story, and I know that you will try to help us 

understand what happened and provide some answers, and I yield 

the balance of my time to the vice chair, Dr. Burgess. 

[The prepared statement of Mr. Upton follows:] 

PREPARED STATEMENT OF HON. FRED UPTON

Today we continue our thoughtful oversight of the Obama administration’s implementation of the health care law and its effects on Americans in Michigan and 

across the country. 

Mr. Cohen, welcome back. You have testified before the committee a number of 

times and I appreciate you returning again today. In preparing for today’s hearing, 

we went back to review the transcripts of your testimony from last year. When we 

asked you what to expect at the start of open enrollment on October 1, you assured 

us on two separate occasions, once in April and again in September less than two 

weeks before launch, that everything was on track. 

During your more than four hours of testimony before the committee last year, 

there was no mention of the fact that you had been briefed twice by McKinsey in 

early April 2013 and warned about the number of risks facing the marketplaces and 

the Web site. Nor was there any elaboration on the fact that CMS employees were 

well aware that the Web site build was riddled with problems, far behind schedule 

with the October 1 launch in jeopardy. 

The purpose of today’s hearing is not to rehash every detail of the failed launch 

of HealthCare.gov. But to move forward, we must understand what you knew about 

the status of the Web site and implementation of the president’s law at the time 

you appeared before this committee, looked us squarely in the eye, and proclaimed 

that everything was ‘‘on track.’’ It is time to be fully candid and transparent with 

Congress and the American people. 

Lots of promises have been made, many already broken. What’s next? The only 

way the public can trust this health care system and the administration that is implementing this law is if administration officials are open and transparent about the 

facts and what the American people should expect from this law and for their health 

care moving forward. Providing facts and specifics is an important first step toward 

restoring credibility. The American people deserve the peace of mind that there will 

be no more surprises, that the information available is the entire and true story. 

I hope you will help us understand what happened and provide some answers today. 

# # # 

Mr. BURGESS. I thank the chairman for yielding, and Mr. Cohen, 

I too want to welcome you back to the committee, and I appreciate 

the time that you devote to our oversight efforts. But here is the 

central question: How in the world can we expect people across this 

country to trust this Administration when they have been continually told that everything will be ready, and in fact it was not. 

It is pretty clear now that the Administration knew far more 

about the concerns prior to the launch of Healthcare.gov before October 1st and yet you came before us on September 19th, and each 

time you came to this committee in the past year, you promised 

that Healthcare.gov would be functional October 1st. If I recall 

your recitation correctly, there were no contingency plans because 

none were necessary. You insisted to subcommittee members less 

than 3 weeks before the launch of the federal exchange that everything was on track. I will stipulate that some parts of 

Healthcare.gov may be working now but they are only working now 

because a glitch czar had to be appointed after the launch of 

Healthcare.gov. I don’t know how you feel about that but it upsets 

me that you came before this committee and told us everything was 

OK. We spent hundreds of millions of dollars. You had well over 

8 

3 1⁄2 years to get it right, and then we have got to appoint a glitch 

czar to sort things out so that people can actually enroll on 

Healthcare.gov? The enrollment numbers, I think, are meager. Perhaps you have a different story and you will share that with us. 

But errors, canceled plans, and broken promises, those are just the 

start. 

Now we know that your agency, Health and Human Services, 

and the White House failed to heed internal warnings about the 

lack of readiness of the exchanges. It is my hope that you came to 

this subcommittee prepared to answer your questions. I hope you 

will set the talking points aside. You owe this to your superiors at 

HHS, you owe this so the Secretary, you owe this to the President, 

you owe it to the Congress and, most importantly, you owe it to the 

American people. 

This committee is about oversight. Yes, that requires that we 

look at the past. Yes, that requires that we look to the future. I 

think the problems of the past dictate to us that there are going 

to be significant problems during this first year of Healthcare.gov 

and you need to be prepared to work with this committee to mitigate the damage that is going to be visited on America’s health 

care system and the American people. 

Mr. Chairman, I yield back my time. 

Mr. MURPHY. The gentleman yields back. I now recognize Ms. 

Castor for 5 minutes. 

OPENING STATEMENT OF HON. KATHY CASTOR, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA 

Ms. CASTOR. Good morning, and thank you, Mr. Chairman, and 

good morning, everyone. 

Mr. Chairman, this is our first hearing of the year on the Affordable Care Act. Last year in this subcommittee and the Health Subcommittee and the full committee, the majority held 12 hearings on 

the Affordable Care Act. 

The hearings last year often were frustrating because they were 

not held necessarily to examine exactly what the law is doing or 

to work in a bipartisan fashion to improve the law. They were part 

of an effort to criticize the Affordable Care Act, spread misinformation and build support for repeal of the Affordable Care Act. The 

majority’s unrelenting focus on repealing the Affordable Care Act 

is one of the reasons I believe why this Congress has been one of 

the most least productive in the history of our country. 

But fortunately, we are at a different place today. As of today, 

approximately 10 million Americans have coverage because of the 

Affordable Care Act. Over two million have coverage through private plans sold through the marketplaces. More than four million 

have enrolled in Medicaid and now have access to a doctor or 

health services that they did not have before. More than three million young adults age 26 and under have coverage through their 

parents’ plans, and millions more have coverage purchased directly 

from an insurer. Now, as Ranking Member DeGette explained, the 

rollout of Healthcare.gov was anything but smooth, and I directly 

expressed my displeasure to President Obama and Secretary 

Sebelius. People were relying on us, and moving forward, and I 

know there will still be hurdles to overcome over the next few 

9 

months but the law is working. Members who want to repeal the 

Affordable Care Act will have to explain to these 10 million Americans why they should lose their coverage and their new rights and 

their protections, and coming from the State of Florida, they are 

going to have to explain to my older neighbors, our parents and 

grandparents, why they want to take away the improvements in 

Medicare: closing of the donut hole, the new preventive care and 

wellness visits that are available and the fact that we made Medicare stronger. 

The members will have to explain to the 129 million Americans 

with preexisting conditions why they do not deserve the same access to health coverage as everyone else. They will have to explain 

to American women why they want to go back to a world where 

they could be charged more for the same coverage as a man, and 

they will have to explain to people who work in blue-collar jobs 

why they should face higher premiums, and they will have to explain to the millions of Americans getting coverage for the first 

time why they would be better off uninsured. I do not think my Republican colleagues will be able to make this case. 

Mr. Chairman, Republican critics of the law were also incorrect 

about many things but they were right about one major fact, that 

once the Affordable Care Act went into effect, there would be no 

turning back. This law is in effect and it will continue to become 

a part of the fabric of this Nation. It will lift millions of American 

families, provide economic security. The Civil Rights Act, the Social 

Security Act, the original Medicare legislation, all landmark laws, 

were enormously contentious in their time. Republican opponents 

predicted they would put this Nation on the path to ruin. They said 

the Nation was not ready for the changes that were coming. They 

said the new rights and protections the laws guaranteed for our fellow Americans were not important. And now we cannot imagine 

our country without a basic safety net for our seniors or equal 

rights for all of our citizens. 

In the years ahead, all the hyperventilating about broken Web 

sites, enrollment trajectories and demographic mix will quickly be 

forgotten. Instead, we will look back and wonder how we ever had 

a health system that spent double what every other Nation spends 

per capita while leaving 50 million uninsured and allowing rampant discrimination against the people who needed the coverage 

most. 

I hope this hearing will be the start of a productive and cooperative session of Congress, and I hope we can start to work together 

on the ACA rather than spending another year in a never-ending 

campaign against a law that is doing enormous good for the American people. 

I yield back. Thank you. 

Mr. MURPHY. The gentlelady yields back, so I would now like to 

introduce the witness for today’s hearing. Gary Cohen is the Deputy Administrator and Director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and 

Medicaid Services. He has served as General Counsel for the California Health Benefit Exchange and has served as the Director of 

the Division of Insurance Oversight in CCIIO for 2 years prior to 

10 

becoming the Deputy Administrator and Director of CCIIO, and I 

will now swear in the witness. 

Mr. Cohen, you are aware that the committee is holding an investigative hearing, and when doing so, we have the practice of 

taking testimony under oath. Do you have any objection to testifying under oath? Thank you. 

The Chair then advises you that under the rules of the House, 

you are entitled to be advised by counsel. Do you desire to be advised by counsel? In that case, we will swear you in. 

[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 give a 5-minute summary of your written 

statement, Mr. Cohen. 

TESTIMONY OF GARY COHEN, DEPUTY ADMINISTRATOR AND 

DIRECTOR, CENTER FOR CONSUMER INFORMATION AND INSURANCE OVERSIGHT, CENTERS FOR MEDICARE AND MEDICAID SERVICES 

Mr. COHEN. Thank you. Good morning, Chairman Murphy, 

Ranking Member DeGette and members of the subcommittee. I appreciate the opportunity to update you on the Affordable Care Act 

and health insurance marketplaces and to talk about the millions 

of Americans who many for the first time are able to purchase 

high-quality affordable health coverage. 

When I appeared before this subcommittee shortly before the beginning of enrollment, I said that while we may encounter some 

bumps when open enrollment began, we would solve them. Clearly, 

the problems we encountered in October were far worse than I or 

any of us anticipated. Simply put, the system did not work nearly 

as well as it should have or that we expected that it would. 

This wasn’t a time to get discouraged. It wasn’t a time to give 

up. It was a time to roll up our sleeves and get to work and solve 

the problems, and that is what we did. 

Since that time, we have fixed Healthcare.gov piece by piece in 

a prioritized, metrics-driven manner. The tech team fixed the site’s 

software and enhanced the site’s hardware to improve its capacity, 

speed and stability. By the end of November, Healthcare.gov was 

able to support more than 800,000 consumer visits per day with a 

response time of less than 1 second and an error rate well below 

1 percent. 

Consumers have responded overwhelmingly to the improved site. 

Enrollments in the federal marketplace in December alone represent a sevenfold increase over October and November combined. 

By the end of December, nearly 2.2 million people had selected 

plans from the State and federal marketplaces. 

Sometimes we lose sight when we talk about numbers that are 

this big, that these enrollments are more than just numbers. They 

are individual people, many of whom have not been able to obtain 

needed care or had the peace of mind that comes from having 

health coverage for years. 

For example, Nathan Aldridge, a cancer survivor from Virginia, 

now has a plan without having to worry about paying more because of his preexisting condition. He had been playing for a plan 

11 

with a $483 monthly premium and a $5,000 deductible. Now he 

has a plan with a $111 monthly premium and a $1,750 deductible. 

Emily Wright, a university student in Tennessee, enrolled 

through the federal exchange, qualified for a federal subsidy and 

picked a top-tier plan that will cost her only $125 a month. She has 

been able to get an appointment with an obstetrics/gynecology 

practice, the first step before needed surgery. 

We hear stories like theirs every day. Because of the Affordable 

Care Act, Americans like Nathan and Emily can be confident that 

the plans offered in the marketplace are high quality and affordable. 

The Affordable Care Act standardizes certain essential benefits 

which insurers must offer. These include basics like doctor’s visits, 

hospitalizations, prescription drugs, and maternity and newborn 

care. Marketplace plans are designed so that consumers can compare plans with similar levels of coverage and make more informed 

decisions. 

Insurers are now prohibited from charging higher premiums to 

enrollees because of their health problems and from charging 

women more than men, making price more fair. At the same time, 

premium tax credits and cost-sharing reductions are helping consumers pay for their health care coverage. Of the nearly 2.2 million 

marketplace sign-ups so far, nearly 80 percent of those consumers 

are receiving financial assistance. 

Insurers can no longer refuse to accept consumers because of a 

preexisting health condition. With limited exceptions, plans are required to enroll individuals regardless of health status, age, gender 

or other factors. 

Finally, insurance coverage is there when people most need it because plans can no longer impose annual or lifetime dollar limits 

on essential health benefits. Americans no longer have to worry 

about hitting a prohibitive dollar amount which could force a consumer into bankruptcy or cause them to have to forego necessary 

care. 

The health insurance market in 2014 looks dramatically different 

than it did in the years before the Affordable Care Act. Now, as 

with any change this major, there is bound to be some disruption, 

so to ease the transition to the new market, CMS is working closely 

with insurers, consumers and other key stakeholders who are 

working together to ensure that consumers have coverage and receive needed medical care. 

In December, CMS announced a number of steps to help consumers including requiring insurers to accept payment through December 31, 2013, for coverage beginning January 1 and giving consumers additional days to sign up for marketplace coverage. Insurers have also stepped up with many agreeing to voluntarily extend 

the deadline for consumers to pay their first month’s premium, and 

many pharmacies announced plans to ensure a smooth transition 

by providing consumers with transitional supplies of prescriptions. 

I continue to believe what I said in September: the ultimate story 

of the Affordable Care Act will not be what happened in the early 

days that the Web site went live or even in the first days of January as people used their new coverage. The lasting legacy will be 

people like Nathan and Emily who will be able to get the health 

12 

care they need and have the security of knowing they will be able 

to pay for it because of the changes made by the law. 

Thank you, and I welcome your questions. 

[The prepared statement of Mr. Cohen follows:] 

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Mr. MURPHY. I thank the gentleman. The chairman now recognizes himself for 5 minutes. 

Mr. Cohen, you testified several times before this committee that 

HHS would be ready by October 1. Can you tell us why you were 

wrong on that? 

Mr. COHEN. When I testified, Mr. Chair, you referred to April 

and in September, and each time I gave you the best information 

that I had and gave you truthful testimony based on the information that I had available to me. It turned out that the problems 

that we faced when the Web site went live were, as I have said and 

as everyone knows, just dramatically different and bigger than I 

think what any of us expected. 

As to why we didn’t anticipate what was going to happen when 

we went live, I am not sure I know all the answers. I think some 

of the people who are responsible for designing and building the 

Web site might be able to give you better answers. I know initially 

we were overwhelmed by the volume of people who came in, but 

as time went by, that was clearly not the sole source of the problem. There were other problems as well. 

Mr. MURPHY. But you were there for the briefings, the McKinsey 

report, which we discussed in this subcommittee, the disaster that 

they talked about to a number of people within the Administration, 

so you had that information, but you also said you were told something otherwise. So who told you otherwise that things would be 

fine? 

Mr. COHEN. So may I speak for a moment to McKinsey? I absolutely attended briefings of the work that the McKinsey folks did, 

and there is no question that they identified a number of risks that 

they saw back in April, whether we would be successful come October. At no time did the McKinsey people say to us, you are not 

going to make it or you are not going to be successful. They identified a series of risks and they identified some steps that they recommended we take in order to mitigate those risks and increase 

the likelihood that we would be successful, and I think we did 

those things, and I think that a number of the concerns that 

McKinsey expressed, for example, whether the hub would be working or whether some of the larger States like New York and California would succeed did not prove to be a problem. The hub has 

worked very well, and New York and California have done very 

well. 

So I think we took very much to heart what the McKinsey people 

recommended that we do and we proceeded forward and tried to, 

you know, do the best we could to maximize the likelihood that we 

would be successful. 

Mr. MURPHY. But again, we have looked at the McKinsey report. 

It was not subtle. It was strongly worded in terms of there were 

serious problems, but in that same month you came before us and 

said things were fine, so who on your staff told you that things 

were going to be OK? Who informed you specifically? 

Mr. COHEN. I received regular briefings from the various parts 

of CMS that were responsible for—— 

Mr. MURPHY. Who was it? 

Mr. COHEN [continuing]. Overseeing the Web site build. The person that I heard from the most probably was Henry Chao. 

23 

Mr. MURPHY. And Henry Chao told you that despite the briefing 

from McKinsey that things would be OK? 

Mr. COHEN. Henry Chao gave—we had regular reports on the 

status of the build, and certainly when I came here in September, 

the testimony that I gave was based on briefings that I had from 

Mr. Chao and others as to what the capability of the site—— 

Mr. MURPHY. Did you share with Mr. Chao the McKinsey briefing? 

Mr. COHEN. I don’t know whether he saw the briefing itself. 

Mr. MURPHY. Did you discuss the contents of that with him? 

Mr. COHEN. I think we talked about the issues that were raised 

in the briefing, yes. 

Mr. MURPHY. See, I am puzzled, because when Mr. Chao was 

here speaking under oath, he said he didn’t know anything about 

it. 

Mr. COHEN. That is why I say I don’t know that we told him or 

whether he saw the report itself—but we talked about the 

issues—— 

Mr. MURPHY. So let me ask this. It was significant enough that 

the Secretary said that she hired McKinsey to give them a briefing 

and look at this analysis. Very important, significant problems 

were identified. They were not small. But now we are not sure 

whether or not the key person who was advising you of this was 

even told about this report to identify and what to do about the 

major problems. So there is something pretty inconsistent here. 

Mr. COHEN. Well, I think that we adopted a number of the recommendations that McKinsey had for us and put into place a number of things that McKinsey recommended that we do in order to 

increase the likelihood of our success, and that is what I mean. 

Those things happen. So Mr. Cao was aware of the things—— 

Mr. MURPHY. Well, I need to know what specifically, if you go to 

the doctor and the doctor says can you tell me what your specific 

symptoms and problems are, if you don’t tell the doctor what your 

problems are, they can’t properly diagnose and treat. So what specifically did you tell Mr. Chao and what specifically then did he do 

in response to that? 

Mr. COHEN. I am not going to be able to recall or tell you exactly 

what we told Mr. Chao. What I can tell you is that there were recommendations, for example, in the report with respect to how we 

should be organized and some changes that they recommended that 

we make in terms of how the process was managed that we implemented as a result of the report. 

Mr. MURPHY. Thank you. 

I recognize Ms. DeGette for 5 minutes. 

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

This hearing today, I just noticed this after my opening statement, is called ‘‘2014: Seeking PPACA Answers.’’ So I would really 

like to ask you, Mr. Cohen, some questions about where we go from 

here. 

As you acknowledged in your opening statement and your written statement, the problems with Healthcare.gov were far greater 

than ones you anticipated before October 1st, and we are now well 

aware of the Administration’s efforts to fix the problems. I am wondering if you can tell me as we sit here today, January 16th, what 

24 

problems do you still see with the federal Web site and what steps 

is the Administration taking to remedy them? 

Mr. COHEN. Thank you. We continue to address specific issues 

with respect to the way that the site is functioning, and that effort 

has not flagged at all. I mean, it is ongoing. So as we continue to 

identify any aspects in the way that the system isn’t performing as 

properly as it should, whether those be design and architecture or 

whether those be software, sort of coding types of problems that 

were not getting the right result, we continue to address a lot of 

those issues. The major one that we are dealing with right now I 

would say in terms of big picture has to do with the financial management making sure that the plans are getting paid. We are using 

a mitigating process right now because we don’t have full 

functionality for that particular process but we are working to put 

that in place. 

Ms. DEGETTE. As we heard in November and December, the Administration was focusing first on getting people enrolled and then 

they were worrying about the back end. So with that back end, 

what kind of problems are we still seeing and what are you doing 

to try to remedy that? 

Mr. COHEN. Well, right now, payments will be going out next 

week for the first time of advanced premium tax credits to issuers 

but we are using a process where they are providing us with the 

data from the issuers based on their records as opposed to being 

able to use the records that are generated by the FFM, and that 

more automated process will be going into place in the next 

months. 

Ms. DEGETTE. And are you working, is the Administration working with the insurers to make that happen? 

Mr. COHEN. Yes, absolutely, and we have actually had tremendous responsiveness from the insurers and they have told us that 

they are very pleased with the way that process is going. It is not 

ideal but it will work to get them paid. 

Ms. DEGETTE. Mr. Chairman, I think that would be a good follow-up hearing to bring the insurers in and see how that is working, just FYI. 

Let me ask you, Mr. Cohen, we have all heard about the number 

of people who have signed up both on the State exchanges in the 

States like mine that have State exchanges and also 

Healthcare.gov. What is your opinion about the number of people 

who have signed up and also the age mix? 

Mr. COHEN. So in terms of the number of people who have signed 

up, obviously there is no question that we got off to a slower start 

than we would have liked and than what we hoped but we had tremendous response in December and we are continuing to see very 

good numbers as we go into January. I think in terms of the total 

if we are able to maintain the pace that we are at now and if we 

see another, you know, sort of uptick towards the end of March as 

everyone expects because that is the deadline for the end of open 

enrollment, we still have almost 3 months to go so I think we are 

very encouraged by the enrollments that we are seeing now. There 

clearly is tremendous demand for this product. We saw that from 

the beginning. 

25 

Ms. DEGETTE. But there is also—I will say, though, because of 

the glitches with the Web site in the early days, enrollment has 

been lower than the Administration had projected, correct? 

Mr. COHEN. That is true. 

Ms. DEGETTE. And what about enrollment of younger people? 

Mr. COHEN. So, you know, we are actually quite encouraged by 

the response that we have gotten from younger people. The percentage of younger people that we reported this week is actually 

comparable to the percent of that age group in the general population so I think that is looking good. I think—— 

Ms. DEGETTE. If you could just—I am sorry. If you can just briefly tell me what the Administration is doing to bump those numbers 

back up between now and the end of March both for the general 

population and also for the younger enrollees. 

Mr. COHEN. Absolutely. So, I think you are going to see a 

stepped-up media campaign. Obviously we as well as the health insurance companies held back a little bit in the beginning because 

the site was working well, but now that it is, I think we will see 

a significant increase in that. It is going to be very much targeted 

at the younger audience so we have a Magic Johnson ad that is 

coming out now. We are going to be advertising during the Olympics. You know, we are trying to advertise in ways that will—and 

through social media as well, ways that are definitely targeted toward that younger group. 

Ms. DEGETTE. Thank you very much. 

Thank you, Mr. Chairman. 

Mr. MURPHY. You may want to talk to Jimmy Kimmel because 

he is not saying good things about this. 

Ms. DEGETTE. We can also have ads during the Super Bowl because I know that will appeal to the Colorado voters. 

Mr. MURPHY. That will be costly. There you go. 

I now recognize Dr. Burgess for 5 minutes. 

Mr. BURGESS. Thank you, Mr. Chairman, and Mr. Cohen, you 

know I am going to bring this up. I have got to do it. I need to have 

you address it. 

September 19, 2013, I asked you a yes or no question, will the 

enrollment process be ready October 1 of this year. I will remind 

you of your answer. You said, ‘‘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 1st.’’ 

Do you recall that exchange, sir? 

Mr. COHEN. I recall it very well. 

Mr. BURGESS. Knowing what you know now, would you like to 

revise that answer in any way? 

Mr. COHEN. Well, clearly, it was wrong, but it was also what I 

believed and what I understood—— 

Mr. BURGESS. I have got to—— 

Mr. COHEN [continuing]. Based on what I had been told. I would 

like to answer your question, if you would permit me. 

I knew that I was going to be asked that question obviously 

when I came here on September 19th and I knew that it was very 

26 

close to October 1st, and I was very careful to get a thorough briefing from the people who are responsible for overseeing the build of 

the Web site, and the answer that I gave you was exactly what 

they told me our functionality would be on October 1st, exactly. 

Mr. BURGESS. Who told you that exactly? 

Mr. COHEN. Mr. Chao was in the briefing, among others. 

Mr. BURGESS. Well, look, you know, I have just got to tell you 

this, and you have heard me say it before and I will continue to 

say it in the future. I simply do not understand why no one has 

been held accountable for an error that egregious. If I were you, I 

would fire someone under me, and it would have happened in October. If I were the Secretary, I would have fired you, and that would 

have happened in October, and if I were the President, I would be 

so mortified and embarrassed by what has been the disaster of my 

signature piece of legislation signed into law, I would fire the whole 

lot of you. 

Now, that was the tack not taken—— 

Mr. COHEN. But if that had happened—— 

Mr. BURGESS. I would like to understand why should we believe 

you now when nothing you said over the past year, year and a half 

has been accurate? 

Mr. COHEN. Because the site is working, Congressman. Because 

the site is working. That is why you should believe me now. 

Mr. BURGESS. I would submit—— 

Mr. COHEN. And if we had all been fired, it would not be working. 

Mr. BURGESS [continuing]. It is not working because it has not 

been built on the back end. Provider payments are not flowing. The 

subsidies that are supposed to go to the insurance companies, they 

tell me are coming as a result of a paper process that is having to 

be entered by hand. This thing is a disaster, and the providers are 

going to be the ones who take it on the chin because we are obligated to see those patients when they show up. No one can verify 

benefits at 3 o’clock in the morning. You take care of the problem 

after the fact. Who pays the bill? The Secretary said she would not 

be responsible for paying those bills, so I ask you, doctors and hospitals around this country are asking you, who is responsible for 

paying those bills? 

Mr. COHEN. The insurance company—— 

Mr. BURGESS. You haven’t built the back end of the Web site. 

Mr. COHEN. The insurance company that has enrolled a person 

is responsible for paying those bills, and the payments of the tax 

credits and cost-sharing reductions to those insurance companies 

will be flowing next week. They will begin next week. That is going 

to happen. 

Mr. BURGESS. And I would submit to you that part of the Web 

site has not yet been built and that is going by hand and is a painfully slow process. I have been told numbers as low as 5 to 10 percent of those payments are going through. I would appreciate if you 

have additional information that you will make it available to the 

committee. I hope we will have an opportunity to discuss that in 

the future. 

Mr. COHEN. Absolutely. 

27 

Mr. BURGESS. As it does concern me a lot. I think our providers 

are the ones who are truly at risk from your mismanagement of 

this problem. 

Now, there is something that is receiving a lot of attention right 

now. It is the concept of risk corridors and risk adjustment. Are 

you aware of that? 

Mr. COHEN. Yes. 

Mr. BURGESS. The risk corridor program does not contain specific 

appropriation in the law, so are you going to be seeking an appropriation for the risk corridor language in the law? 

Mr. COHEN. I am going to have to refer you to the Office of Management and Budget with respect to those issues. 

Mr. BURGESS. Would you be willing to share with us the ongoing 

discussions that are happening between you and OMB on that? Are 

there e-mails? Are there memos? Is there information you can 

make available to the committee? 

Mr. COHEN. I will certainly take that request back. 

Mr. BURGESS. It appears to a lot of us that you are going to be 

needing and sending taxpayer dollars in order to handle this problem of the risk corridors. Can you assure the committee today that 

that will not be happening, that this risk adjustment will be done 

from within the balances available in the Affordable Care Act and 

those amounts that you are collecting from insurance companies 

and not come from the taxpayer? 

Mr. COHEN. I don’t have an answer for you today. I understand 

it is an issue. We are working with OMB and I will certainly work 

with you and understand that it is an important issue that you are 

entitled to know about. 

Mr. BURGESS. If you have a legal memorandum that has been 

prepared for you or your department, will you share that with the 

committee? 

Mr. COHEN. That is not a decision I get to make but I will certainly take your request back. I haven’t seen such a memorandum 

myself, no. 

Mr. BURGESS. You have not? 

Mr. COHEN. At this point, no. 

Mr. BURGESS. Do you anticipate seeing one? 

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

Mr. BURGESS. This committee needs that memo, and I want you 

to take that request back with you. Again, we will have an opportunity to talk again, I believe. 

I yield back, Mr. Chairman. 

Mr. MURPHY. Thank you. 

Mr. Cohen, I want to give you an opportunity to answer one of 

Dr. Burgess’s questions. Has the part of the Web site dealing with 

payments been built or is it yet to be built? 

Mr. COHEN. The automated process for payments is still being 

built but we have a process in place that is working and payments 

will be going out next week. 

Mr. MURPHY. Do you have an anticipated date of when it is going 

to be built? 

Mr. COHEN. I don’t have an answer to that as I sit here, no. 

Mr. MURPHY. Thank you. 

28 

Ms. DEGETTE. Mr. Chairman, could we have him supplement 

that when he finds out when it will be built? 

Mr. MURPHY. Yes, we would like to know that. 

Ms. Castor, you are recognized for 5 minutes. 

Ms. CASTOR. Thank you, Mr. Chairman. Good morning, Mr. 

Cohen. 

You know, the headline back home in Florida this week was, 

Florida enrollment surges under Healthcare.gov during October 

and November. Due to the problems with the Web site, we only had 

18,000 Floridians sign up for coverage. But in December, we had 

140,000 Floridians sign up for coverage. Florida continues to lead 

the Nation in enrollment among the three dozen States that are 

using the federal marketplace. So this is good news. In fact, on 

Monday in Tampa, the mayor of Tampa, Bob Buckhorn, had a 

great announcement, and this is something that other Members of 

Congress can use and work on with their elected officials. Mayor 

Buckhorn announced that all of the parks and recreation centers 

in the city of Tampa would be available to host navigators and assisters sign up many of our neighbors for coverage. I think this is 

a very creative move. Secretary Sebelius gave him a pat on the 

back as well. 

We have got to make it easy for folks to sign up, and one of the 

things that is, I guess, a good problem to have is, we have such 

a competitive marketplace in the Tampa Bay area, we have over 

100 private insurance plans that people can examine and see what 

works best for them. But, you know, that can be a little daunting 

for folks as well if they just go on to—I guess there are people that 

can go on to Healthcare.gov and figure it out and analyze it and 

determine what works best for them but there are many, many 

people all across the country that need to sit down and work with 

a real person and sort through those options, understand what the 

tax credits do. In Florida, two-thirds of those who are eligible for 

coverage will be eligible for the tax credits. Already, over 80 percent of the people who have signed up have used those tax credits. 

What can we do to get more help out on the ground to help people understand the options? 

Mr. COHEN. So thank you, Congresswoman. I think it is very important, as you say, to get support from State and local officials 

from Congressional offices to help get the word out, to direct people 

to assisters who can help them. There is a Find Local Help section 

of Healthcare.gov where people can say, you know, what area they 

are in and get a list of the—— 

Ms. CASTOR. But many people, if they don’t have a computer, 

they don’t even know about that. 

Mr. COHEN. Right. 

Ms. CASTOR. So how are you going to reach them? 

Mr. COHEN. For the people who don’t have a computer, obviously 

the effort really has to be to bring them in to a location where, you 

know, a navigator is working or, you know, other assisters are 

available to help them through the process, and I think, you know, 

the more assistance that we can get from people in the community 

who know these folks rather than, you know, just coming from the 

Federal Government is a big help. 

29 

Ms. CASTOR. Our community health centers have been very active, churches. It is really a community-wide effort. But I appreciated that you said talking about the millions of folks who have 

signed up that these are not just numbers, these are real people, 

and really, one of the biggest obstacles right now for many of our 

neighbors to realize health care coverage is what Republican governors and State legislators have done in blocking the Medicaid expansion. For example, in the State of Florida, we have almost one 

million Floridians who are caught, are being blocked, access to the 

doctor’s office is being blocked just because they won’t accept the 

$50 billion available to the State of Florida over the next 10 years. 

That is our tax money. We want that tax money back to work for 

our neighbors to help our families get to the doctor’s office, create 

jobs, help our hospitals. 

Mr. Chairman, I think we need an oversight hearing on these 

States that have blocked Medicaid expansion and what that is 

going to do to the health care marketplace. 

Mr. Cohen, what is HHS’s plan to continue to work with the 

States on this issue? 

Mr. COHEN. We certainly encourage every state to take up the 

Medicaid expansion. It is a great deal for the state. It is a great 

deal for the people in the state. It is a great deal for providers in 

the state who will see a decrease in uncompensated care, a tax that 

falls on all of us, and we have been working as creatively as we 

can with different States to come up with different ways of doing 

this. Some States have some different approaches that they wanted 

to take that we have been working with them on, so we continue 

to work with all the States and hope that more will take up the 

expansion. 

Ms. CASTOR. Thank you very much. 

Mr. MURPHY. The gentlewoman yields back. Now the vice chair 

of the full committee, Ms. Blackburn, for 5 minutes. 

Mrs. BLACKBURN. Thank you, Mr. Chairman. 

Mr. Cohen, you just said that your testimony to Mr. Burgess on 

September 19th was incorrect and you had based it on staff reports. Am I correct in that? 

Mr. COHEN. I said it turned out to be wrong. 

Mrs. BLACKBURN. Turned out to be wrong. 

Mr. COHEN. It turned out to be wrong. 

Mrs. BLACKBURN. Let me ask you this then. If you are basing 

your testimony today on staff reports, how do we know that this 

is correct? 

Mr. COHEN. I think that there has been an intense focus since 

October on—— 

Mrs. BLACKBURN. Have you changed your process of due diligence? Are you vetting? Are you questioning? 

Mr. COHEN. I think we are receiving more and more thorough 

briefings at the leadership level. 

Mrs. BLACKBURN. How do you know that? If what you told us on 

September 19th was wrong, how do you know that what you are 

telling us right now is correct? 

Mr. COHEN. Well, ultimately, I have to rely on the people who 

work for me. I don’t—— 

30 

Mrs. BLACKBURN. You didn’t fire anybody then. Are you watching 

it more closely now? 

Mr. COHEN. I think we are having regular and very detailed 

briefings on—— 

Mrs. BLACKBURN. OK. 

Mr. COHEN. And we also brought in what we sort of call the general contractor, the QSSI company that was an existing contractor 

on the project. 

Mrs. BLACKBURN. Do you want to quantify those briefings for us 

as you submit things about the Web site and when it is going to 

be due? Why don’t you let us know what briefings you are having? 

Also, I want to ask you one thing real fast. You said the Web site 

is fixed. Can you define ‘‘fixed?’’′′ 

Mr. COHEN. I think the Web site is fixed in the sense that we 

are no longer having problems that we had creating accounts in the 

beginning. The responsiveness of the site—— 

Mrs. BLACKBURN. So it is not 100 percent operational, it is a 

qualified fix? 

Mr. COHEN. That is true. 

Mrs. BLACKBURN. OK. So it is fixed as an amoeba, and that is 

going to change as you come back to us. 

Let me move on. You had three promises in Obamacare. It was 

built on three promises. It was going to save families $2,500 a year, 

and the second two promises, one, if you like your plan, you can 

keep it, and if you like your doctor, you can keep it. So let me ask 

you this. Since the President promised that the average family 

would reap a premium decrease of $2,400 a year under the law, 

has that happened? 

Mr. COHEN. Well, I am not sure that is what the President said. 

Mrs. BLACKBURN. Yes or no. Oh, yes, he did say it. 

Mr. COHEN. I am not sure that is what the President said. 

Mrs. BLACKBURN. Yes, sir, he did say that. 

Mr. COHEN. Many Americans are able to obtain better coverage 

at lower costs than—— 

Mrs. BLACKBURN. Mr. Cohen, that is not what the President said, 

and I ask for a yes or no answer. 

Let me move on. The President said if you like your plan, you 

can keep it. Has he kept that promise? 

Mr. COHEN. The law permitted insurance companies to maintain 

grandfathered plans in effect. That was their decision whether to 

continue with those plans or to—— 

Mrs. BLACKBURN. No, sir, that was not the promise. The President even apologized for this, and he offered some enforcement relief so that these people could keep the plans they liked. Is that 

correct? 

Mr. COHEN. I was about to say that not all Americans were able 

to keep their plans because of the decisions that the industry had 

made, and so we announced a transitional policy that enabled more 

of the plans to stay in effect. 

Mrs. BLACKBURN. How long will that transitional process last? A 

year, 2 years, forever? 

Mr. COHEN. As of now, what we have announced so far is it is 

for a year. 

31 

Mrs. BLACKBURN. You know, a lot of those people couldn’t keep 

their plans, and you talked about an Emily from Tennessee. Let me 

tell you about another Emily from Tennessee. Emily lives in Pulaski. Emily had coverage because Emily has lupus, and guess 

what? Under Obamacare, her plan was canceled. Emily doesn’t 

have health insurance right now. She is having a tough time getting it under Obamacare. I am having her in as my guest for the 

State of the Union. Maybe you can help Emily work this out, Mr. 

Cohen, because your promises that were made by you and this Administration have not been kept, and then you want to give us a 

qualified definition of ‘‘fixed’’ and you are still depending on your 

staff, so you all are just running in circles, and you cannot give us 

definitive answers. 

So let me ask you this. Emily in Pulaski, she had a doctor she 

liked. Is she going to be able to keep that doctor even though she 

has no insurance and because of Obamacare her insurance was 

canceled and she is trying to be treated for lupus and work 40 

hours a week? 

Mr. COHEN. You know, if you will get us information about—if 

Emily is, you know, interested in talking to somebody from CMS 

who can help her understand what her options are—— 

Mrs. BLACKBURN. I appreciate that very much. 

Mr. COHEN. We would be happy to do that. We are doing—— 

Mrs. BLACKBURN. Because she is a classic victim of what has 

happened when the Federal Government stepped in and said all 

these plans that you have that work for you, that fit for you, we 

are not going to let you keep them because we the Federal Government think we know better how you, Emily, can handle your lupus. 

Now, that is what you have done to the American people, and when 

you come in here, you give us misinformation, and then when we 

ask you a question, you cannot be specific. 

Mr. Cohen, I agree with Dr. Burgess. You ought to be fired. 

Mr. MURPHY. The gentlelady’s time is expired. I recognize now 

the gentleman from Vermont, Mr. Welch, for 5 minutes. 

Mr. WELCH. Thank you, Mr. Chairman. 

Mr. Cohen, there are a lot of things in the Affordable Care Act 

but many of those provisions are about consumer protections to ensure that Americans do have a diverse choice of health care providers. But as with many new laws, there are some wrinkles in the 

implementation and some disagreement between—debate about 

Congressional intent, and I wanted to ask you about one of those 

with respect to the ACA. 

I have been hearing from some providers, and I know some of my 

colleagues have been hearing the same concerns about the interpretation of the provider non-discrimination provision in Section 2706 

of the Public Health Service Act, and specifically, what some of 

these providers are telling me is that your agency’s sub regulatory 

guidance, in their view and in the view of many legislators, is inconsistent with the statute and legislative intent, and the concern 

is this, that the guidance could lead in fact to discrimination 

against some providers by health insurers, which this provision 

was designed to prevent. Are you aware of these concerns? And my 

question is, what are your plans to address them and to ensure 

that the statute is implemented as intended? 

32 

Mr. COHEN. So thank you, Congressman, and yes, I am aware of 

those concerns. I have had meetings with a number of provider 

groups who have expressed the concern that you have raised. 

Frankly, it has been a while since we looked at that issue so what 

I would ask is that we could have folks talk to you and your staff 

and move forward to understanding what the concerns are and seeing whether there is something we can do to clarify the guidance 

so that we make sure that there isn’t discrimination, which clearly 

is what the law—— 

Mr. WELCH. Well, that would be helpful, and there may be some 

colleagues on the other side of the aisle as well who are hearing 

some of these concerns, so I would welcome the opportunity to follow up with your agency and try to work this out to make certain 

that we stay on that intent that there not be discrimination as to 

providers. 

Mr. COHEN. We would be happy to do that. 

Mr. WELCH. Thank you. And just a couple of things. You know, 

one of my concerns from the very beginning is, we have got to get 

health care costs down. I don’t care how we pay for it, whether it 

is employer based, taxpayer based, individual based. If the cost is 

going up a lot faster than wages, profit and growth, we are just not 

going to have a sustainable and affordable system, and what we 

are learning now is that Medicare spending is growing slower than 

the inflation rate. This is recently, and that is a welcome development, that the program spent only .7 percent more per beneficiary 

in 2012 than in 2011. Five years ago, that annual increase was 5.4 

percent. Overall, just an overall global health care spending, the 

rate of increase has slowed. It was 3.7 percent in 2012, less than 

half of the growth year a year ago. Two questions. One, do you attribute any of this to the law? And number two, what are the implications for the deficit over a 10- to 20-year period? 

Mr. COHEN. So I think that the law does contain a number of 

provisions that are attacking the question of health care costs. I 

think that that is an issue that we need to continue to work on, 

and I think that the law does give us some tools to continue to do 

that. I look forward to using our process of certifying qualified 

health plans going forward. We were quite liberal, I guess is the 

word I would use. We sort of took them all the first year to get the 

market up and running, but I think going forward we can at least 

look at what we can do to encourage health insurance companies 

to work to keep costs down, and certainly, you know, we know that 

health expense is a huge part that the American economy and the 

Federal Government spends so as we are able to attack that problem, it will have a great positive impact on spending and the deficit 

going forward. 

Mr. WELCH. Yield back. 

Mr. MURPHY. The gentleman yields back. I now recognize Dr. 

Gingrey for 5 minutes. 

Mr. GINGREY. Mr. Cohen, thank you for being with us once 

again. I asked you the last time you were here whether you had 

concerns that young people would not sign up for Obamacare and 

would cause an increase in cost to the rest of the risk pool in the 

following years. You responded that your research—this is a 

quote—‘‘research shows that most people want health care and the 

33 

barrier has been the cost,’’ and that you are looking forward to people, including young people, enroll in coverage. 

With the latest figures showing that young people are enrolling 

at a much lower rate than you had originally anticipated, are you 

now worried, are you still worried that premiums will increase next 

year, that it is not just the natural tendency for young people, indeed, for all of us to procrastinate that there are some other concerns such as maybe these overwhelming number of mandates 

which we knew 10 years ago were driving up the costs of 

healthcare insurance in the individual States, probably all 50 

States, including mine of Georgia. We knew these age banding 

rules that were put in Obamacare rather than, say, five to one 

maximum premium increase for older people compared to younger 

is now three to one. Community ratings, these things are there, 

and I am real concerned. Do you continue to be concerned about 

that? 

Mr. COHEN. Well, we certainly want to do everything we can to 

encourage all Americans and in particular young Americans to get 

health care. I think it is important to keep in mind that the risk 

pool is not just the risk pool in the marketplaces, the risk pool is 

in the entire market, and so when you have, say, three million 

young people who have been able to get health coverage on their 

parents’ plans, those are not necessarily in the marketplace but 

those are three million young Americans who didn’t have insurance 

before who do have insurance and are part of the risk pool. 

I also would just point to a recent study by the Kaiser Family 

Foundation, which actually said that a reduction in the percentage 

of people, young people who come into the risk pool really will have 

an impact on health care premiums that is pretty modest. 

Mr. GINGREY. Of course, some of that is anecdotal. I understand 

what you are saying. 

But let me move to my next question. You know, I am concerned, 

I have heard that navigators are actually going door to door, and 

this came up last time too, and you said that navigators would not 

be going door to door. They are. And if you recall during that same 

hearing, you told us, this subcommittee, that you would be ‘‘issuing 

instructions to navigators that they should not be going door to 

door.’’ Did you issue these instructions? 

Mr. COHEN. Yes, we have, and if you are aware of instances 

where navigators who are, our grantees are going door to door, we 

certainly want to hear about those. 

Mr. GINGREY. Well, I thank you, because I am aware, and I 

would like to ask staff to put up a brief clip of a video right now 

in regard to that since you asked me to show you some evidence. 

[Video shown.] 

Mr. GINGREY. OK. That is good. 

Mr. Cohen, what do you say to that? 

Mr. COHEN. I had not seen that before, and we will look into it. 

Thank you for calling it to our attention. 

Mr. GINGREY. Well, I hope you will look into it. I mean, some of 

my colleagues, we are very strong in saying that you should be 

fired. I don’t know. My dad told me one time when I was in college 

and my grades came in and they weren’t so good, and I said Dad, 

I am doing the best I can, and he said son, unfortunately, your best 

34 

just isn’t good enough. I am not calling for you to be fired but we 

are concerned. You have a big job. You have got a huge responsibility, and you know that and we know that, and back to the drawing board, you have got to do better, absolutely. 

With that, Mr. Chairman, I yield back. 

Mr. MURPHY. Mr. Yarmuth, you are recognized for 5 minutes. 

Mr. YARMUTH. Thank you, Mr. Chairman. 

Mr. Cohen, welcome back, and it is good to see you again. I 

would like to start off by getting something clarified for the record. 

This relates to Ms. Blackburn’s questioning. It is my recollection 

that what the President said was that after the Affordable Care 

Act was implemented, that insurance premiums, people would save 

$2,400 a year as opposed to what they would have been spending, 

compared to what they would have been spending if it weren’t for 

the passage of the Affordable Care Act. Is that your recollection of 

what he had said? 

Mr. COHEN. That is my understanding of what he said, yes. 

Mr. YARMUTH. Not that people’s insurance would cost $2,400 

less? 

Mr. COHEN. That is my understanding, correct. 

Mr. YARMUTH. And in fact, as has been alluded to earlier in the 

various questioning, health care costs are rising at a much lower 

rate than they have historically. So while the numbers may not be 

precise, there is evidence to suggest that the President was actually correct in that insurance would have cost more if it weren’t for 

the Affordable Care Act. 

Mr. COHEN. I think there is no question about that, and I think 

it is also true that many Americans are seeing actual reductions 

in what they are paying over what they were paying, not every 

American but many Americans are. 

Mr. YARMUTH. Right. Let us talk about the enrollment history 

because, first of all, it gives me an opportunity to boast about my 

State, Kentucky, which is widely recognized as having had one of 

the most successful rollouts of the Affordable Care Act. Currently, 

the numbers are, in a State of 4.4 million people, 778,000 visitors 

to Kynect, our Web site, 123,000 plus have enrolled in either Medicaid or private plans. Five hundred and fifty-nine thousand Kentuckians have been screened to determine whether they were eligible for either Medicaid or subsidies under private insurance, and 

many of those have not yet selected their plan, even though they 

have been told that they qualify for private insurance, and 1,283 

small businesses—this is as of January 2nd—have started the process to enroll their employees as well. So we are talking about already having insured about 20 percent or more of our entire uninsured population in just over half the—well, this would have been 

exactly half the enrollment period. 

And by the way, 40 percent of those are under 35, so in terms 

of Kentucky’s experience, I think there is reason to be, as you said, 

optimistic that going forward, we will have adequate numbers of 

young people in the risk pools and we shouldn’t be too concerned 

yet about that. 

But a couple weeks ago, in one of the major national media, 

there was a chart that actually broke down the enrollments according to three categories of States. They had the 14 States and the 

35 

District of Columbia, which had both expanded Medicaid and set 

up their own exchanges, States that have expanded Medicaid using 

the federal exchange, and then States that had not expanded Medicaid, and while I didn’t do the math, it was pretty clear that at 

least two-thirds and maybe even 75 percent of all the enrollments, 

the six million or so enrollments, were in those 14 States plus the 

District where there was concerted government support for the program. 

So I would like you to comment that and whether you are seeing 

that the degree of enrollment seems to be correlated to the degree 

of support at the State and local level for the program. 

Mr. COHEN. I think that is absolutely right, and it is true for 

many reasons. Kentucky is a great example where Governor 

Beshear has been just a stalwart advocate for health care reform 

and for the Kentucky marketplace and getting it going. I think that 

contributes to the success that those States have had in terms of 

developing their marketplace and their IT systems. If the administration in the State is solidly behind that, it helps. It certainly 

helps with the outreach. It helps with sending out positive messages to people and to the community of how important this is and 

what a great benefit this is for people, so I think there is no question. 

Mr. YARMUTH. Now, we saw video there of navigators going door 

to door. There is another side of that coin as well, and I know I 

have talked to some people, for instance, in Florida where they 

have actually been handing out flyers discouraging people from 

signing up. Have you seen much evidence that there is a concerted 

effort to actually discourage people from exploring their options 

under the exchanges? 

Mr. COHEN. You know, I have heard some of that. I wouldn’t be 

able to say how extensive it is. I think obviously it is very unfortunate that anybody would try to discourage people from taking advantage of an opportunity to get health care. 

Mr. YARMUTH. Just the last question: Is there any effort in your 

organization to try to find out or get evidence as to whether that 

is happening or not? Because that would, I think, be of interest to 

us. 

Mr. COHEN. I don’t know that we are investigating that within 

CCIIO, no. 

Mr. YARMUTH. Thank you. I yield back. 

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

Mr. OLSON. I thank the Chair, and welcome, Mr. Cohen. I hope 

you had an enjoyable holiday season like I did with my family. 

Mr. COHEN. Thank you. 

Mr. OLSON. My first question is about a thing called the Federally Facilitated Exchange User Fees. Are you familiar with that 

fee, sir? 

Mr. COHEN. Yes. 

Mr. OLSON. OK. So as you know, it is a fee that is imposed upon 

states that have chosen not to create their own health care plan, 

but to be in the federal health care plan, such as my home State 

of Texas. This fee is required under the Affordable Care Act? 

36 

Mr. COHEN. I think it is authorized by the law, and we set the 

fee on insurance companies based on the premium that they get in 

the market. 

Mr. OLSON. Would it surprise you that an HHS rule in November 

of 2012 created and authorized that fee? 

Mr. COHEN. Yes, we issued a rule that implemented that provision. 

Mr. OLSON. Is it 3.5 percent? 

Mr. COHEN. Yes. 

Mr. OLSON. Is the Administration fully using that fee? Or do the 

plans and States have to cover some slack? 

Mr. COHEN. I don’t believe that the amount of that fee will fully 

cover the cost of operating the Federally Facilitated Marketplace. 

I don’t think it is going to be enough to pay all of the costs of running the marketplace. 

Mr. OLSON. So you are tapping the resources of the private sector, the States to pay the shortfall from this fee that is not getting 

the job done, correct? 

Mr. COHEN. No, no. We are tapping resources from within our 

budget, but the fee is the fee. 

Mr. OLSON. OK. And the fee is authorized for one year. Do you 

expect to extend it next year? 

Mr. COHEN. Yes, I expect there will be a fee next year. 

Mr. OLSON. OK. My second line of questions are about the navigators, and as you know, that video from my colleague, Mr. 

Gingrey, was pretty damning. You may recall when you were here 

September 19th when I asked you about the navigators back home 

in Texas, that there was voter registration cards going door to door, 

and you said, and this is a quote, about the navigators: ‘‘We will 

be issuing instructions to navigators that they should not be going 

door to door.’’ 

My question is, and I’m serious. Have you issued those instructions? Yes or no. 

Mr. COHEN. Yes. 

Mr. OLSON. Can we get a copy of those instructions? 

Mr. COHEN. I am sorry? 

Mr. OLSON. May we get a copy of those instructions so we can 

see them? 

Mr. COHEN. Sure. I can go back and tell you how we communicated that. I know we have regular communications with the 

navigators and we put out that information to them, that that was 

something that they were not supposed to go door to door to enroll 

people. They could drop off information but they were not supposed 

to go door to door to enroll people. 

Mr. OLSON. We have heard stories from New York and Florida 

and the New York Times that people, about all the fraud that is 

coming out with these navigators. What has CCIIO done to address 

these fraud cases and make sure fraud doesn’t happen? Because it 

is a big window of opportunity for people who want to do harm. 

Mr. COHEN. Any situation that we have learned about that involves any misconduct by a navigator, we have responded to. We 

have—including requiring individuals that were involved to be dismissed and not to serve as navigators, and including issuing correcVerDate Nov 24 2008 14:58 Sep 11, 2015 Jkt 037690 PO 00000 Frm 00040 Fmt 6633 Sfmt 6633 F:\MY DOCS\HEARINGS 113\113-113 CHRIS
37 

tive action plans to any navigator organizations that if we feel that 

they are not supervising their employees adequately. 

Mr. OLSON. My final question is about the disastrous rollout of 

Obamacare and its continued problems. Delays and misinformation 

are happening today all over America. For example, I enrolled in 

the D.C. exchange shop, as did my staff. My wife called up last 

week trying to make sure we could keep this one doctor we like, 

a specialist. It took her 30 minutes to talk to somebody on the 

phone, and she was asked to read her new information. She got her 

new Care First card there, read it proudly, and they said, we have 

no record of that. So she had to get the old card and work through 

this agency to be confirmed that yes, we could keep that doctor on 

our plan. 

And so my question is, given this disastrous rollout and the continued problems, have you ever been part of a conversation, debate, 

or discussion about delaying the launch or putting a hold on it 

while dealing with all these problems? Any discussions? Have you 

ever been part of that? 

Mr. COHEN. No. 

Mr. OLSON. No. OK. I yield back the balance of my time. Thank 

you. 

Mr. MURPHY. Thank you. Mr. Green, you are recognized for 5 

minutes. 

Mr. GREEN. Thank you, Mr. Chairman, and again, welcome back, 

Mr. Cohen. I was shocked to see the news report in New Orleans, 

because in Houston, our navigators do not go out and go door to 

door. We do have nonprofits that are not federally funded who are 

going in, and I am encouraging them to come into our district to 

go out and let folks know they have this ability to do it, but the 

federal navigators we have, now, they will come out to someone’s 

house but it will be a request or because they need to somebody 

to help with the family or something. So I am glad you are going 

to investigate that happening because I want navigators actually 

helping people do the paperwork. 

As one who supported the Affordable Care Act and continues to, 

we need the law, and I would love our committee to be able to work 

on it and fix some of the flaws that we have in that we have discovered, but I am pleased with the enrollment increases in the last 

few weeks. HHS released them earlier this week, and we know 

that nearly 2.2 million have signed up for the private insurance 

plans through the federal and State marketplaces as of December 

28th. Four million more were signed up for Medicaid, and let us 

not forget that three million adults under 26 are still being able to 

get insurance through their parents. 

Do these enrollment estimates sound accurate to you that we received? 

Mr. COHEN. Oh yes, I am sure they are as accurate as we can 

make them. 

Mr. GREEN. They are not as much as we would like, and I know 

the Administration, but I have a memo from my Democratic staff 

on our committee that puts these numbers in context. Enrollment 

in the Affordable Care Act exchanges is ahead of the Part D enrollment at a similar time in 2006. Republicans then called Part D a 

success. Now they insist the Affordable Care Act is a failure. We 

38 

still have a lot more work to do in the months ahead but there is 

no doubt that a lot of people are finding access to quality, affordable health care. I hope my Republican colleagues will sit down 

and work on legislation that will fix some of the problems we have 

because nothing Congress ever passes is perfect, and we know that, 

and particularly with this. Instead of just throwing rotten apples, 

maybe they should look back on what happened in 2003 when we 

passed the prescription drug plan that I didn’t vote for but I was 

also helping my seniors sign up for it and encouraging people to do 

it, even though I thought the law was flawed in 2003. Some of it 

has been fixed by the Affordable Care Act but it has—we want to 

make sure those folks get it, and that is what amazes me. 

Mr. Cohen, based on Massachusetts’ experience with implementing health reform, what would you expect enrollment numbers 

to look like over the next few months? 

Mr. COHEN. I think we are very encouraged by what we saw in 

December. I think we are encouraged by the tremendous interest 

that there remains in the plan. Clearly, Americans are now very 

much aware of Healthcare.gov as a result of what has happened 

over the last few months, and I think everyone expects that as we 

move toward the—we still have 2 1⁄2 months left to the open enrollment period and I think everyone expects as we get towards the 

end of March when it is the real deadline, we will see another real 

uptick in the number of people enrolling, and if that happens, I 

think we will have some very good total enrollment numbers by the 

end of the period. 

Mr. GREEN. Well, we know that in the federal exchanges, seven 

times the amount of people signed up in December as did in October and November. Frankly, part of it is because of the Web site, 

and a lot of have concerns because that Web site was down. We did 

an event in Houston in the middle of November and we actually 

had about 800 paper applications, and we had plenty of applications—I know there was an issue—we had paper applications both 

in Spanish and English that were used. But that is not the way 

we can get to the numbers we need. The Web site has to work. 

Finally, can you talk about outreach plans the Administration 

has in place to ensure that as many people as possible learn about 

the signup for the new health coverage during the remainder of the 

enrollment period? 

Mr. COHEN. I think we will be seeing significantly more paid 

media. I know there is a plan, as I mentioned, to advertise during 

the Olympics and other events that are particularly geared toward 

younger people, sporting events and those kinds of things. I know 

the social media activities are very much picking up, and I think 

from what I am hearing, we are going to be seeing very significant 

investment by the private health plans in marketing and advertising as well. A number of them sort of held back because of the 

issues early on with the Web site, but now that they see the enrollments are coming through, I think we will see significant investment on outreach on their part as well. 

Mr. GREEN. Thank you, Mr. Chairman. 

Mr. MURPHY. The Chair now recognizes Mr. Griffith for 5 minutes. 

Mr. GRIFFITH. Thank you, Mr. Chairman. 

39 

Mr. Cohen, thank you for being here. In your responses to Ms. 

Blackburn, you indicated that many Americans have better plans 

at a lower cost. Do you recall indicating that to her? 

Mr. COHEN. Yes. 

Mr. GRIFFITH. Under oath and in your sworn—— 

Mr. COHEN. Yes. Many Americans have better coverage than 

what they had before and it is costing them less. I think I mentioned at least one of them in my oral testimony. 

Mr. GRIFFITH. Yes, you did, and you actually mentioned a couple, 

one of them from my district, and I understand that. 

Also, you would have to acknowledge under oath that many 

Americans have lesser coverage at a greater cost. Isn’t that true? 

Mr. COHEN. No, that is not what I said. What I said was—— 

Mr. GRIFFITH. It isn’t what you said. I am asking—— 

Mr. COHEN. For some—— 

Mr. GRIFFITH. Yes or no. I am asking you a question under oath. 

Mr. COHEN. I don’t believe—— 

Mr. GRIFFITH. Do you know that many Americans have lesser 

coverage under the Affordable Care Act at a greater cost than they 

had before? Isn’t that true? 

Mr. COHEN. No, I don’t know that. 

Mr. GRIFFITH. You don’t know that? Well, let me tell you, I received an email today from a constituent of mine who I know very 

well. His premiums in March are going to triple, and his deductible 

is doubling. That is lesser coverage at a greater cost. So there is 

one. 

I will tell you that I have received numerous communications 

from members of my district, people who live in my district, along 

those lines and yes, there are some winners but there are also 

many losers, and it shocks me that you cannot acknowledge that 

here today when you are testifying under oath in front of this committee. There are losers under Obamacare, aren’t there? 

Mr. COHEN. Can I answer? 

Mr. GRIFFITH. Well, it is a yes or no. You know that there are 

losers under Obamacare, do you not? 

Mr. COHEN. If I am not allowed to answer, then—— 

Mr. GRIFFITH. The answer is either, yes, you know that there are 

losers, or no, you don’t know that there are losers. It is a yes or 

no, sir. 

Mr. BUTTERFIELD. Will the gentleman yield? 

Mr. GRIFFITH. I will not yield. The witness is not being responsive. 

Mr. BUTTERFIELD. I think you need to define ‘‘losers.’’ 

Mr. GRIFFITH. A loser is one who has to pay more for coverage 

that is lesser, and I just gave him an example but he won’t acknowledge that he knows of anybody in the—do you know of anybody in the United States in that circumstance, sir? Yes or no. 

Mr. COHEN. I am sure there is somebody in the United States in 

that circumstance, yes. 

Mr. GRIFFITH. And do you acknowledge that you have read the 

reports on other people who have had some successes who are winners under this, you have also read reports in the media of people 

who are losers under Obamacare, have you not? 

40 

Mr. COHEN. The problem that I have, Congressman, is that I 

don’t know what all the options are that might be available to that 

person. So it is difficult for me to answer without knowing the full 

situation of what might be available to that person. I understand 

that there are people who had coverage and received a notification 

from their insurance company that they were being put into a different plan that costs more. Absolutely that has happened. 

Mr. GRIFFITH. And you have reason to believe that those people 

are paying more and receiving lesser coverage? 

Mr. COHEN. Well, I don’t know the details of what the plan is 

that they were in, what the details of the plan is that they were 

being offered, and I don’t know the details of what other plans 

might be available to them that might enable them to avoid that 

situation. So I think it is a little more complex than you are presenting it to me and that is all. 

Mr. GRIFFITH. Well, and I would submit that it is more complex 

on all of these situations because we have a 2,000-some-page bill 

that is very hard for people to get their arms around and it is very 

hard for this Administration apparently to operate and to run. 

That being said, let us talk about the SHOP exchanges for small 

businesses. That is another part of the plan that has been delayed 

for a year. Is that correct? 

Mr. COHEN. The online capability for SHOP is delayed for a year, 

yes. 

Mr. GRIFFITH. And many of the other delays were for a few 

weeks or months. Why was this program delayed for a year? 

Mr. COHEN. Given everything that we needed to do to get the 

system working well for people in the individual market, we made 

a decision that in terms of allocation of resources, we couldn’t get 

the SHOP online functionality built in time for this year and so we 

are relying on the traditional agents and brokers who historically 

have always been the way that—— 

Mr. GRIFFITH. It was a complicated situation that you had a hard 

time getting your arms around, and maybe if you sat down and 

learned all the aspects of it you could advise—— 

Mr. COHEN. No, we had to make a choice. We had to decide what 

to devote our resources to. 

Mr. GRIFFITH. I was being sarcastic. I apologize. 

Mr. COHEN. I know you were. 

Mr. GRIFFITH. Here is my problem, and this happens so often 

with this. The delay was announced the day before Thanksgiving, 

wasn’t it? 

Mr. COHEN. I believe you. I don’t remember but I believe you. 

Mr. GRIFFITH. OK. Do you know if there were conversations before that day before Thanksgiving announcement? How long in advance was the decision made to delay the SHOP plan? 

Mr. COHEN. I am sure that there were conversations before it 

was announced. I wouldn’t be able to tell you exactly when but I 

know that into November there were conversations, and then a decision was made and then it was announced. 

Mr. GRIFFITH. There is a great concern for a lot of us that a lot 

of these announcements come—we have even made comments in 

other hearings that these announcements come at holidays so that 

people will be doing other things and won’t pay attention to the 

41 

fact that there has yet been another delay, another failure in the 

rollout of this program. 

Do you agree that that is not an appropriate way to run the operation and it really ought to be coming out when people can know 

what is going on instead of during the holiday time when nobody 

is paying attention? 

Mr. COHEN. Well, I would agree with you that it is very important that we put out accurate information so that people could understand what is happening with the program, yes. 

Mr. MURPHY. The gentleman’s time is expired. I now recognize 

Mr. Tonko for 5 minutes. 

Mr. TONKO. Thank you, Mr. Chair, and thank you, Director 

Cohen, for your testimony once again before the subcommittee. I 

believe we should have civil discourse with you, and so I will try 

to conduct myself accordingly. 

Before I get to my questions, I just wanted to share with the 

committee an Obamacare success story that I recently received 

from a constituent. Brian from the city of Schenectady wrote to me 

that he had been paying almost $360 per month for a plan with 

no dental or vision coverage. Through New York State’s online exchange, he was able to get a comparable medical plan and also purchase dental coverage for $290 per month. As he described it to me, 

this is more coverage for less money. Brian was able to complete 

the process in less than 2 hours, and because he makes only $11 

per hour, the difference in premiums is having a huge impact on 

his budget. Brian is not alone. As of January 1, more than 241,522 

New Yorkers were now enrolled in quality, low-cost health insurance coverage through my home State’s exchange. 

In addition, more than 6,500 young adults in my district now 

have health insurance through their parents’ plan, and more than 

12,100 seniors in the district receive prescription drug discounts 

worth $16 million. One hundred and twenty-four thousand seniors 

in the district are now eligible for Medicare preventive services 

without paying any copays, coinsurance or deductibles. I could go 

on and on but the point is that the Affordable Care Act is here to 

stay and it is providing an enormous benefit already to the people 

of the 20th Congressional District of New York, which I have the 

good fortune of representing. 

It never ceases to amaze me how hard my Republican colleagues 

work to avoid acknowledging the benefits of ACA. I have never 

heard them admit that this law helps the millions of Americans 

with preexisting conditions who can no longer be discriminated 

against. 

Mr. Cohen, can you summarize for us some of the important new 

protections that are now in place under the Affordable Care Act? 

Mr. COHEN. Well, certainly. Thank you, Congressman. Absolutely, the issue of preexisting is a huge one. Previously, people 

could be denied insurance altogether, not even because they are 

sick at the time they are applying but because they had some condition in the past that caused the medical underwriters to say that 

they weren’t a good risk, and then if they were offered insurance, 

notwithstanding whatever that preexisting condition might be, they 

could be charged significantly more as a result of that, and one of 

the impacts of that, of course, was the fact that women were being 

42 

charged, you know, substantially more than men—being a woman 

was deemed to be a preexisting condition. So all of that is gone. 

And then the last one I would mention, and I think it is very important, is that in the past, people could find that if they did become seriously ill, their insurance would run out because they had 

either an annual limit of how much it would pay or a lifetime limit 

of how much it would pay, and they might be in the middle of a 

course of treatment that was necessary to save their lives and find 

that all of a sudden the insurance companies stopped paying and 

that they were responsible for those costs on their own, and that 

can’t happen anymore. 

Mr. TONKO. Thank you. The stories of people signing up for coverage would drive home how important these new provisions are, 

and I know some stories have recently been posted. I read a story 

about Nick from Miami. He is 29 and was denied coverage last 

year because of a preexisting condition. He was forced to enroll in 

a short-term catastrophic plan that cost him $280 a month and had 

a termination date. Because of the ACA, he now has better coverage with lower out-of-pocket costs and a guarantee that he won’t 

be kicked off his coverage or denied because of a preexisting condition. Now he is covered and he does not have to worry. There are 

more of these stories each and every day. 

Albert from Texas got covered for the first time in his life because of the ACA. He got a plan for only $23 per month. He said 

it is the right thing to do. You never know what could happen to 

you. 

Mr. Cohen, have you heard other stories like these? 

Mr. COHEN. Yes, we are hearing stories like that all the time, 

and we are seeing them through social media. We are seeing people 

are sending us their stories. On Healthcare.gov there is a place 

where you can provide your story, and I must say they are extremely heartening. 

Mr. TONKO. And what do they say to you about the importance 

of the Affordable Care Act? 

Mr. COHEN. The Affordable Care Act is literally going to be lifesaving for many, many, many Americans who without it would not 

have had the ability to get the health care that they need and it 

is going to be a financial lifesaver for many Americans who otherwise would have faced bankruptcy as a result of medical costs, 

which was the leading cause of bankruptcy in the country prior to 

the ACA and I think we are going to see that change dramatically. 

Mr. TONKO. I just wish our colleagues would just admit for even 

the briefest moment that this law is helping millions of people. 

Maybe then we could move forward and have a national conversation about the Affordable Care Act and any additional improvements that might be required. So with that, I thank you, Director 

Cohen, and thank you for appearing before our committee. 

Mr. MURPHY. The gentleman yields back. I now go to Mr. Long 

of Missouri for 5 minutes. 

Mr. LONG. Thank you, Mr. Chairman. 

One person that does not think this is a lifesaving endeavor is 

Brenda from my district, and Brenda has been fighting a very rare 

form of cancer for the last 7 years, and she leaves Springfield, Missouri, to go down to Little Rock, Arkansas, to seek treatment. She 

43 

is in a high-risk pool. She was in a high-risk pool. When she found 

insurance, she found out that she could no longer go to Little Rock, 

Arkansas, to seek treatment from this very specialized doctor that 

has literally kept her alive for the last 7 years. They gave her 3 

months to live when first diagnosed. She got active. She is mid-50s, 

late 50s, and back then she was early 50s, I guess, 50 years old, 

and she decided it wasn’t time to die so she wanted to fight and 

get active and find a treatment for this, so she did down in Little 

Rock, Arkansas, and she called me from her chemo chair or texted 

me, emailed me from her chemo chair telling me that she had lost 

her insurance, and when she found new insurance, because the 

high-risk pool is going away, when she found new insurance, she 

was told that she could no longer seek treatment down in Little 

Rock, Arkansas, from this doctor, who is one of the few in the country that does it. So I know you say it is lifesaving. I know that my 

friend from New York says that he wants people on this side of the 

aisle to admit there are good cases. Sure, there is people that are 

picking up insurance, there are good cases, but there is also people 

that this could very easily cost them their life. So I am concerned 

for people like Brenda. 

Mr. COHEN. Well, we certainly would like to hear from you about 

Brenda’s situation, if there is anything we can do to work with the 

insurance companies. 

Mr. LONG. And I appreciate that. 

Mr. COHEN. We would be very happy to do that. 

Mr. LONG. I gave a floor speech on the subject a month or so ago, 

whenever she first emailed me, and she was literally in the chemo 

chair in Little Rock taking the treatment, and she said all the 

nurses stood up and cheered for my floor speech in the room, but 

there are serious concerns for people like Brenda. 

Sticking with the high-risk pools for just a minute, I know that 

this new national high-risk pool as opposed to the State-run ones 

that ran out at the end of December or whatever have been extended to the end of what period? 

Mr. COHEN. End of March. 

Mr. LONG. End of March. How are those being paid for? I mean, 

where are you getting the money to pay for those? Who is paying 

for that? We cannot get any answers, at least my staff has been 

able to, on how this is being funded. 

Mr. COHEN. Oh, that is very clear. I mean, there is a $5 billion 

appropriation in the Affordable Care Act, and that is the entire 

amount of money, that $5 billion appropriation that was in the Affordable Care Act that has paid for the PCIP program, and we 

had—— 

Mr. LONG. I hate to interrupt you, that is not my style, but the 

$5 billion, wasn’t that for a set amount of time? But we keep getting these extensions that don’t seem to be paid for. 

Mr. COHEN. So the statute says that we can use that money to 

ease the transition of PCIP enrollees into the new market and so 

what we found was, we had enough funding based on the number 

of enrollees we had and the costs that we are incurring to allow 

those benefits to continue through March, and at the end of 

March—by the end of March, everyone who is in that program 

needs to get private coverage, and that program—— 

44 

Mr. LONG. Or they won’t be able to seek care in Little Rock. That 

is the rub there, I think. 

The ranking member said earlier, and my friend from Florida 

made reference to the fact that there is all these people that have 

enrolled in the Affordable Care Act that didn’t have coverage before. How can we drill down and figure out what the number is? 

Just because 146,000 in Florida in Ms. Castor’s district signed up 

in December, how do we know that those people did not have insurance before? How do we know they are not like Brenda that was 

forced off her plan and hopefully can find another plan? Is there 

a way to ascertain if these are true numbers, if these are really 

people that are covered for the first time ever, they now have 

health care insurance that never had it before? 

Mr. COHEN. So that is a really good question, and we are working on being able to provide data as to the number who were previously uninsured versus the number who may have been insured 

before and are switching to new coverage, and we understand that 

is an important issue. We don’t have that data today. 

Mr. LONG. If you can work on that, because one side tells one 

side of the story, one side tells the other, and usually, as you know, 

the truth lies in the middle. So when I hear how many people that 

never had cover before, I question if they didn’t have it, lost it and 

bought new. 

So thank you for your time here today. 

Mr. COHEN. Thank you. 

Mr. MURPHY. The gentleman yields back. Now Mr. Butterfield for 

5 minutes. 

Mr. BUTTERFIELD. Thank you, Mr. Chairman, and thank you, 

Mr. Cohen, for your testimony today. I want to assure you, Mr. 

Cohen, that when the history of this debate is written many years 

from now, I promise that you will be regarded as one of many people in this Administration and across this country who were on the 

right side and helped millions of Americans get insurance. You are 

doing the right thing, and I want to thank you for what you do. 

Mr. COHEN. Thank you. 

Mr. BUTTERFIELD. But Mr. Chairman, this is getting ridiculous. 

My friends just won’t let go. I think Mr. Tonko made reference to 

it a few minutes ago. 

Let me try to put this in somewhat of context. Yesterday’s New 

York Times wrote that North Carolina Senator Kay Hagan has 

faced more than 3,500 negative ads about the Affordable Care Act 

since June 1st. That amount of negative ads is more than three 

times as much as any other Member of Congress. Five million dollars has already been spent on negative ads related to Obamacare 

in my State of North Carolina. 

The fact is, Mr. Chairman, the Affordable Care Act is the law of 

the land. It is working in my State. A vendor in my district is 

named Carlton Stevens, Jr. I drove up to an Exxon station a few 

days ago, and Little Carlton, we call him, jumped out his car and 

told me how excited he was that he had signed up with the Affordable Care Act, told me that he was paying $700 for he and his wife 

and two children, that the premium was going up to $800, that he 

enrolled in the Affordable Care Act and is now paying $240 per 

month. 

45 

The fact is, and the reason Mr. Cohen had difficulty in trying to 

describe winners and losers is that each case is unique. You have 

to compare the coverage. You have to compare the cost. You have 

to compare the circumstances. And so the vendor in my district is 

Carlton Stevens and he is getting insurance now for $240 per 

month. 

Of all states participating in the federal exchange, my state, Ms. 

Ellmers’ state as well, had more than 107,000 enrollees from October to December, which constitutes the most enrollees in the federal marketplace per capita. Eighty-nine percent of those enrollees 

are low or middle income and qualify for a tax credit for their 

plans. North Carolinians are having tremendous success with the 

federal marketplace and Healthcare.gov. In fact, North Carolina 

leads all other States in Health and Human Services Region 4 with 

more than 61 percent of individuals who complete an application 

selecting a marketplace plan. 

Nationwide, the trend is very similar. By the end of December, 

nearly 2.2 million had enrolled and several hundred thousand more 

have enrolled since then. Tuesday’s Washington Post cover story 

stated, ‘‘The data show a sevenfold upswing in enrollment in the 

federal exchange from the first 2 months as the Web site’s performance improved.’’ 

And so Mr. Cohen, I want to ask you, can you describe for me 

the trend in the number of adults 18–34 who have selected these 

marketplace plans? 

Mr. COHEN. I think we reported the 18–34 was about 24 percent 

of the enrollments and that that was very close to the percentage 

of that age group in the general population, so we were quite 

pleased by that, and we expect to see that number increasing as 

we move through the rest of the open enrollment period. 

Mr. BUTTERFIELD. Well, talk to me about some of the national 

campaigns which will help to begin to get youth enrollment up 

higher than even 24 percent, perhaps to 40 percent. 

Mr. COHEN. So I know that we are going to be doing a lot more 

paid media, specifically around the Olympics, which will be starting in a couple of weeks, and around other sporting events and 

other activities that we would expect young people to be particularly interested in. I know we have been doing and are doing an 

increased amount of outreach through the social media, Facebook, 

Twitter, all that sort of thing, and I know that all of our advertising is very targeted to try to reach the populations that we most 

want to get—obviously we want everyone to enroll but we want to 

particularly focus obviously on the young people, as we have talked 

about. 

Mr. BUTTERFIELD. Thank you. And lastly, I made reference to my 

home State of North Carolina in my introductory statement, and 

I am very proud of the enrollment rates there. I have 700,000 people in my congressional district, and I tell you that 100,000 of those 

700,000 are uninsured, and this is making a difference. What factors do you believe contribute to North Carolinians choosing marketplace plans at such a high rate as compared to the national 

norm? 

Mr. COHEN. Well, I mean, I have to believe that in places where 

the need is the most, is where we are seeing the biggest response. 

46 

So in places where the rate of uninsured was high, I think that is 

where we are seeing the biggest response. 

Mr. BUTTERFIELD. Thank you. 

Mr. MURPHY. In response to his question, do you know how you 

are spending on the Olympics advertising? 

Mr. COHEN. I actually don’t but I am sure we can get that for 

you. 

Mr. MURPHY. Please let us know. Thank you. 

I now recognize the gentlelady from North Carolina, Ms. Ellmers. 

Mrs. ELLMERS. Thank you, Mr. Chairman, and to my colleague 

from North Carolina, Mr. Butterfield, I am going to extend some 

of the questions to you, Mr. Cohen, where Mr. Butterfield left off. 

Mr. BUTTERFIELD. And adjoining districts, we might add. 

Mrs. ELLMERS. Yes. 

Mr. BUTTERFIELD. Adjoining districts. 

Mrs. ELLMERS. My colleague pointed out that about 107,000 have 

enrolled in North Carolina. Those are the figures that we are seeing. However, 437,000 received cancellation notices for health care 

policies they already had. So even though 107,000 may sound impressive, we are way behind on those who have had their policies 

cancelled. So there is a lot of making up to do. 

I do want to get back to some of those numbers. Now, correct me 

if I am wrong, but how many people in America do you believe 

have signed up for coverage now? 

Mr. COHEN. Well, the most recent figures that we put out were 

2.2 million, and that is just in the marketplace. Obviously there are 

people who are buying coverage—— 

Mrs. ELLMERS. So the six million figure that I keep hearing 

about today, where is the six million figure coming from? 

Mr. COHEN. That is taking the 2.2 and adding 3.9 million who 

enrolled in Medicaid. 

Mrs. ELLMERS. OK. So basically what we are doing is, we are culminating. Are you aware that the Washington Post gave three 

Pinocchios to this number? Are you going to keep this figure? 

Mr. COHEN. I didn’t see the Pinocchios. I would have to take a 

look at what they called into question. 

Mrs. ELLMERS. So you agree with the six million figure? You believe that there have been six million? 

Mr. COHEN. I believe that as we reported, 2.2 million have enrolled in marketplace plans and about 3.9 million had enrolled in 

Medicaid, and I think the Medicaid number was actually only 

through November. 

Mrs. ELLMERS. OK. Now, of those who signed up for Medicaid, 

how many of them could have previously signed up for Medicaid 

but did not before Obamacare was instituted? 

Mr. COHEN. I don’t have that number for you. 

Mrs. ELLMERS. You don’t have the number? Can you get the 

number? 

Mr. COHEN. I can certainly ask my colleagues in Medicaid if they 

have that number. 

Mrs. ELLMERS. OK. Because that—— 

Mr. COHEN. I don’t run Medicaid so—— 

Mrs. ELLMERS. That doesn’t fall under you? 

Mr. COHEN. No. 

47 

Mrs. ELLMERS. OK. So now we have a situation where we have 

a number of Medicaid that are signed up. Wonderful. We want to 

make sure that people have coverage that is applicable to them, 

but isn’t this going to play into the cost factor, especially for those 

States, we don’t really know where the numbers fall as far as those 

who could have signed up before, but did not for whatever reason 

and now have? 

Mr. COHEN. Well, the States that expand, the newly eligible will 

be paid 100 percent by—— 

Mrs. ELLMERS. Right, the newly eligible, but those who could 

have received coverage before, the States are going to be responsible for a percentage of that, correct? 

Mr. COHEN. That is right, under the usual match, yes. 

Mrs. ELLMERS. Now, you said you don’t have the number, you 

don’t have the figure, when we had Secretary Kathleen Sebelius, 

she said that she did not have that number, and I believe she actually said that they could not get that number, so I would appreciate 

if you could get that to us in the committee, because I think the 

thing of it is—and I will just quote the Washington post fact checker. Basically what he said is this number tells you almost nothing 

about how the health care law is affecting Medicaid enrollment. Reporters need to stop using it because basically—and that is a 

quote—it is very misleading. It is very misleading. 

Now, I have got a little bit more time here. We are all sharing 

stories about our constituents, and some of the stories that we have 

heard have been positive. I want to hit on the issue of the change 

for women because I keep hearing about bringing down costs for 

women. However, I have a woman who was formerly in my district, 

is not in my district now, from Rocky Mountain, North Carolina, 

who basically reached out to my office and through a personal situation, lost her health care coverage and now the plan—she was 

paying $254 a month. Now she is going to have pay $610 a month. 

She simply cannot afford it. She is probably going to have to choose 

to not take coverage. How can we continue to claim that health 

care has improved for women (with mammograms) when we call 

these things free, how did we go from $254 a month to $610 a 

month and we can still claim that she is getting free services? 

Mr. COHEN. So again, I really can’t address an individual’s situations without more of the specifics. We would be happy to, you 

know, have folks talk to her if she is interested. 

Mrs. ELLMERS. Well, I would appreciate that. I will have my staff 

get that information to you and your office so that we can work, 

because if we are really going to take care of women in this country, health care issues for women, let us be straight on it. Let us 

make sure that we are getting the points across because women’s 

health is very, very important, and this is very misleading. 

So with that, I yield the remainder of my time. 

Mr. MURPHY. The gentlelady yields back. I now recognize Ms. 

Schakowsky for 5 minutes. 

Ms. SCHAKOWSKY. Thank you, Mr. Chairman. 

I want to talk a little bit about constituent services when it 

comes to health care because long before the Affordable Care Act, 

my office spent a lot of time dealing with insurance problems, people who suddenly weren’t able to get the medication that they had 

48 

been getting before, I mean, really tricky issues that sometimes we 

could solve and sometimes we couldn’t solve. So the private insurance market as it was before was very difficult to navigate. I think 

that is really important to remember. 

But I have to tell you, Mr. Cohen, we have done constituent service with your office on many occasions now since the Affordable 

Care Act is in place, and I am happy that you were able to tell my 

friend, Congressman Long, that you would look at the Brenda situation and work to get her the health care that she needs, and I 

would suggest that my experience has been that we have been able 

to resolve through your office many of the problems. Yes, this is a 

confusing time, but I guarantee you that before Obamacare, it was 

very confusing every year, and by the way, still is with Medicare 

Part D, and we really encourage all of our constituents on that program to look every single year to make sure that their medications 

are still on the formulary. 

Mr. COHEN. And if I can just say, Congresswoman, we have gotten tremendous response from the insurance industry, from the 

pharmaceutical industry as we have tried to resolve these problems 

this January, and I have talked with the issuers, I have talked 

with the pharmacies, I have talked with the hospital association, 

and what I am hearing from them is that the nature of the problems that we are seeing as we moved into January and people 

using their coverage are no different from what has happened 

every year as people get new coverage, change coverage. There are 

always issues in terms of people being able to verify their enrollment, being able to see their doctor, all those kinds of issues, and 

we stand ready to help. We have caseworkers in every single region 

of the country, and we stand ready to help anybody if we possibly 

can. 

Ms. SCHAKOWSKY. And I know that in my state, Democrats and 

Republicans are working very hard to help their constituents and 

so I am hoping that everyone on the other side of the aisle on this 

committee is taking advantage of the constituent service that is 

available from you and then also through the insurance companies 

and the pharmaceutical companies. 

I wanted to again go over a little bit on the issue of these letters 

of termination. Insurance companies that we have talked to said 

they expected almost all of their current customers to stay covered. 

Have you seen evidence of that? 

Mr. COHEN. Oh, absolutely. So it really is not accurate to think 

that because a plan is no longer being offered that that means the 

person is not getting coverage. Again—— 

Ms. SCHAKOWSKY. And let us be clear. It is not offered because 

it doesn’t meet the criteria of the—— 

Mr. COHEN. That is right. So in every instance that I am aware 

of, the carrier offered the person a new plan that in some cases 

automatically enrolled them in a new plan so that there would be 

no gap in coverage. So and then in addition to that, of course, 

through our transitional policy, we have made it possible for people 

to keep their existing plan if that is what the insurance company 

wants to offer to them. 

49 

Ms. SCHAKOWSKY. My understanding of this issue of the grandfather option enables about half of those who receive cancellation 

notices to renew their plan. Has this been happening? 

Mr. COHEN. That is right. 

Ms. SCHAKOWSKY. And roughly half the remaining group that got 

cancellation letters, my understanding is, are able to get actually 

a better deal through the federal and state marketplaces because 

they are eligible for tax credits or Medicaid, so they get better coverage for a lower and often much lower cost. 

Mr. COHEN. So for people who are eligible for the subsidy, absolutely, we would expect that they would pay less and they would 

in many cases get better benefits than what they had had. 

Ms. SCHAKOWSKY. And finally, in December, the President announced that individuals who had canceled policies would be eligible for a hardship exemption so they could purchase low-cost catastrophic plans. How will this change the options available to those 

that got cancellation notices? 

Mr. COHEN. So what that basically means is, anyone who got a 

cancellation and feels that the plans that are available to them are 

not affordable can claim the hardship exemption and can enroll in 

a catastrophic plan, which is a high-deductible plan but will cover 

them in the case of any serious illness, and those plans are generally very affordable. 

Ms. SCHAKOWSKY. Thank you. I yield back. 

Mr. MURPHY. The Chair recognizes Mr. Johnson for 5 minutes. 

Mr. JOHNSON. Thank you, Mr. Chairman. 

Mr. Cohen, I too would like to thank you for being here today. 

You know, we have had a long and arduous journey since this all 

started and the American people came under the Affordable Care 

Act back last October, the Web site going up, and you mentioned 

in your testimony that the problems that we had, that it wasn’t 

time to give up, it was time to roll up our sleeves and get to work. 

Well, I respect that, but I will submit to you that we have got a 

little bit of a different idea about what roll up your sleeves means. 

You see, the American people, businesses, individuals, hardworking 

taxpayers across this country who are increasingly burdened by the 

big-spending over-regulating policies of this Administration, not 

very many of those folks get a second chance. Only in Washington, 

D.C., and with this Administration do we see a constant pattern of 

redo at somebody else’s expense. In this case, it is the American 

people’s expense. 

So I submit to you that what we should have done, what the Administration should have done is roll up its sleeves and do this the 

right way in the first place. Let doctors and patients manage their 

health care. We have got a private sector health care system that 

has provided the best health care in the world. It did not have to 

be done this way. 

Let me get to a few specific questions. Since the launch of 

Healthcare.gov, Mr. Cohen, has the site been subject to any security breaches? 

Mr. COHEN. No. 

Mr. JOHNSON. No security breaches? 

Mr. COHEN. There have been no breaches in the sense of anybody 

attacking the site and being able to—— 

50 

Mr. JOHNSON. There have been no incidences of people attacking—— 

Mr. COHEN. No, where they were successful. 

Mr. JOHNSON. That is what you just said. 

Mr. COHEN. Well, because you interrupted me, Congressman. I 

didn’t get a chance to finish what I am trying to say. No, there 

have been no successful attempts where anyone has been able to 

attack the system and penetrate it. 

Mr. JOHNSON. Wow, that is contrary to what we have heard in 

other testimony and what is widely known in the media. 

Ms. DEGETTE. Mr. Chairman, I respectfully disagree with that. 

Mr. JOHNSON. Claiming my time. Claiming my time. What is the 

difference, in your opinion, between a security incident and a security breach? 

Mr. COHEN. You could have a security incident where because of 

an error or a mistake or somebody sent something to the wrong 

place, you know, that was an isolated, specific incident where information was transmitted in a way that was incorrect. When I hear 

breach—— 

Mr. JOHNSON. How do you relate that back to the testimony that 

we have heard before the Energy and Commerce Committee that 

security was never even factored in and tested prior to standing up 

the Web site? So can you promise the American people today right 

now that their personal information is secure on Healthcare.gov? 

Mr. COHEN. Yes. I can’t promise that there won’t ever be an incident but I can promise that their information is secure, and I can 

promise that—— 

Mr. JOHNSON. That sounds like an oxymoron to me. You can’t assure that there is not going to be a breach but their information 

is secure? 

Mr. COHEN. That is not what I said. 

Mr. JOHNSON. Let me ask you a follow-on question. Can you 

promise to this Congress that if Healthcare.gov is subject to a 

breach or a hack or any security failure that you will alert the Congress as soon as you find out about it? 

Mr. COHEN. We follow normal procedures and protocols for when 

those incidents happen. 

Mr. JOHNSON. But the American people need to know and this 

Congress needs to know, so can we get your agreement that you 

will notify Congress if that occurs? 

Mr. COHEN. We will certainly work with you to make sure you 

get that information. 

Mr. JOHNSON. Whose job is it to inform Congress and the American people when a security breach occurs? Whose job is that? 

Mr. COHEN. CMS has an Office of Security, information security, 

that is responsible for that, and is today in the case of the Medicare system where we have 50 million enrollees whose data—— 

Mr. JOHNSON. I got it. CMS is responsible. Who is responsible for 

the overall cyber security of the Healthcare.gov site? 

Mr. COHEN. I think that is the same. 

Mr. JOHNSON. Do you know how many people in CMS are dedicated to protecting the security of Healthcare.gov? 

51 

Mr. COHEN. I couldn’t tell you a number of people. I know we 

have a dedicated security team. I know we do continuous monitoring. We actually have people watching the site 24 hours a day. 

Mr. JOHNSON. Do you know how many contractors are involved? 

Mr. COHEN. I don’t. 

Mr. JOHNSON. Do you know how much money is being spent to 

provide security? 

Mr. COHEN. On security? I would have to get that number for 

you. 

Mr. JOHNSON. Does anyone report to you regarding the security 

of the site? 

Mr. COHEN. My office is not responsible for the security of the 

site but I am given reports—— 

Mr. JOHNSON. Can you give us examples of those reports so we 

can see what those reports include? 

Mr. COHEN. I can certainly take that request back and see what 

we have. 

Mr. JOHNSON. OK. Well, I mean, they come to you so you ought 

to be able to release them, right? 

Mr. COHEN. I can certainly take your request back and see what 

we have. 

Mr. JOHNSON. Mr. Chairman, I yield back. 

Ms. DEGETTE. Mr. Chairman, I ask—oh, go ahead. 

Mr. MURPHY. I was just going to say that a number of the reports on attempts to hack into the system are classified, and we 

can make that available to all members to know that there have 

been multiple attempts. There has not been a breach yet but I am 

sure the attempts will continue on, but much of that is classified. 

Ms. DEGETTE. Mr. Chairman, in that vein, last week Democratic 

staff of the subcommittee and full committee prepared a memo of 

information that was provided in the classified briefings, which is 

not classified. A lot of the—I was at the classified briefings. A lot 

of that information was not of a classified nature, and what that 

information said is, there are no successful hacks of 

Healthcare.gov, and it further said that surprisingly there have 

been no additional attempts than other government Web sites. And 

so I would ask unanimous consent to put that memorandum, which 

is dated January 9, 2014, into the record. 

Mr. MURPHY. And we will take that into the record. 

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

Mr. MURPHY. We will also remain vigilant, because we suspect 

there will continue to be attempts. 

Now, there is some time left on the floor for votes. We can adjourn to go vote and come back and complete this—— 

Ms. DEGETTE. I think we have time. 

Mr. MURPHY. Would you like to continue? Who is next? 

Mr. Harper, you are recognized for 5 minutes. 

Mr. HARPER. Thank you, Mr. Cohen. Good to see you again. We 

are almost done. I would like to ask a few questions if I could. 

You touched on earlier in response to some questions about risk 

corridors. 

Mr. COHEN. OK. 

52 

Mr. HARPER. And it is a program to offset huge cost increases 

being the temporary risk corridor program. Where within the Administration is this program housed? Is it HHS, CMS or where? 

Mr. COHEN. Risk corridors is under my program. 

Mr. HARPER. And the individual in charge of that program would 

be who? 

Mr. COHEN. The person who works for me who is responsible for 

that program’s name is Sharon Arnold. 

Mr. HARPER. So it is just that one person then that would be the 

one in charge? 

Mr. COHEN. Well, she runs the program. She reports to me, so 

I am responsible but she works for me, and that is her program 

that she is managing with other people, with her staff. 

Mr. HARPER. And there are other staff then, multiple people 

would help her to run that program? 

Mr. COHEN. That is true. 

Mr. HARPER. And would you be able to provide us a complete list 

of the staffers who do perform any service connected to the risk 

corridor program? 

Mr. COHEN. Yes. 

Mr. HARPER. Thank you. Under this program, if insurers are hit 

with costs greater than 103 percent of their premiums, the government will give them money. Am I correct? 

Mr. COHEN. That is right. 

Mr. HARPER. How will—— 

Mr. COHEN. And there are certain—it is a little more complicated 

than that but yes. 

Mr. HARPER. And I have got a couple of follow-up questions that 

may allow you to answer that. How will the determination be made 

of what these costs are? I mean, is there a form or—— 

Mr. COHEN. The insurance companies will have to present data 

to us on their health care expenditures, and then it won’t be until 

2015 that we actually make any payments under the program. 

Mr. HARPER. So can you tell us exactly how the insurers will report this? I know it has to be—they are going to report it, but how 

are they going to report it? 

Mr. COHEN. There will be forms or templates or whatever that 

they will have to provide to us, the accounting information that 

will tell us what their health care spending has been. 

Mr. HARPER. And I have got follow-up too on some enrollment 

questions if I can shift over to that. 

Mr. COHEN. Sure. 

Mr. HARPER. The most important number, as has been reported 

by many news outlets, is whether individuals have paid. Does the 

Administration collect this information? I am just asking, do you 

collect this information? 

Mr. COHEN. Right now we are not but we will be. 

Mr. HARPER. When? 

Mr. COHEN. As soon as that functionality is built. I think I answered some questions about that earlier, that not all of that 

functionality is built yet. 

Mr. HARPER. Will that mean then that we have to go back all 

those that are enrolled, find out whether or not they paid so they 

53 

will have to go back to those that are already in? We are not collecting it as it occurs? 

Mr. COHEN. We ultimately will reconcile to make sure that advanced premium tax credits, for example, are not paid with respect 

to anyone who didn’t pay their premium because that is a requirement, that you pay your premium in order to get the tax credit. 

Mr. HARPER. What department would have this data? 

Mr. COHEN. It is going to come to my office. 

Mr. HARPER. Who would be the individual that would be in 

charge of that operation? 

Mr. COHEN. That is also Sharon Arnold. 

Mr. HARPER. So we don’t know at this point how many people 

have actually paid for coverage? 

Mr. COHEN. That is right. 

Mr. HARPER. So are you telling me that you don’t have any data, 

you haven’t received any information as to who has paid or you just 

haven’t compiled it yet? 

Mr. COHEN. We have gotten enrollment data from the issuers 

with respect to the APTC payments that we are going to be making 

next week but it is not on an individual basis. So they have told 

us who—the number of people who are enrolled and who have paid 

but we don’t have it on an individual basis. 

Mr. HARPER. Am I—— 

Mr. COHEN. Ultimately we will. 

Mr. HARPER. And I didn’t mean to cut you off, Mr. Cohen. Are 

you telling me you are going to be paying insurers without knowing 

whether or not the insureds have been paid? 

Mr. COHEN. No, we are going to be relying on data from them 

as to who has paid but we don’t yet have an automated system—— 

Mr. HARPER. So if you are relying on that—— 

Mr. COHEN. And we will reconcile that as soon as—make sure 

that those numbers are reconciled and are correct once we do have 

the capability of receiving the additional data. 

Mr. HARPER. All right. Well, do you know the total amount of 

paid from each insurer at this point since you are relying on that 

data? 

Mr. COHEN. Yes, we have information on what we are going to 

be paying to each insurer in this first group of payments that is 

going out next week. We do have that. 

Mr. HARPER. Can we go ahead and get the data that you do have, 

whether it is compiled or not? 

Mr. COHEN. I am sure you can. 

Mr. HARPER. All right. I believe my time is almost expired. I will 

yield back. 

Mr. MURPHY. The gentleman yields back. I now recognize the 

gentleman from Colorado, Mr. Gardner, for 5 minutes. 

Mr. GARDNER. Thank you, Mr. Chairman, and thank you, Mr. 

Cohen, for your time today. 

I too received my insurance cancellation. Have you ever met anybody who had their insurance canceled? 

Mr. COHEN. You may be the first. 

Mr. GARDNER. That is pretty shocking, because 335,000 people in 

Colorado alone had their insurance canceled. The letter that I got 

that told me that it would be cancelled included this option: your 

54 

option includes purchasing another individual health plan from us, 

purchasing a health plan from another carrier or purchasing a new 

plan through Connect for Health Colorado. Was the President’s 

promise that I could keep my health care plan upheld? The President’s promise to me, was that upheld? 

Mr. COHEN. Well, we have talked about this a lot. The law provided that insurance companies could keep the existing plans as 

long as they didn’t make significant changes to benefits and cost 

sharing. Insurance companies made different choices. There are 

still a lot of grandfathered plans out there, and those maintain, but 

then there were other plans that did not continue into 2014. In 

some cases, those plans were canceled. 

Mr. GARDNER. So was the President’s promise upheld to me? I 

mean, I don’t remember the President saying there are qualifications if you like your health care plan. There is no asterisk. 

Mr. COHEN. The law made it possible for everyone who is in an 

existing plan as of the time it was passed for that plan to be maintained but it didn’t require insurance companies to continue offering them. 

Mr. GARDNER. So the President—— 

Mr. COHEN. What we did—so what we did in November was, we 

offered another opportunity to say to insurance companies, you can 

keep those plans in place even if they didn’t meet the requirements 

of the grandfathering provisions. 

Mr. GARDNER. So these changes to allow that, these are big changes that you have to—or would a $5 change require them to 

discontinue the plan? 

Mr. COHEN. It was a percentage change that was in the regulation as to how much—and it wasn’t a change in premium, it was 

a change in benefits or cost sharing. 

Mr. GARDNER. So a copay of $5, that would require you to lose 

your insurance then? 

Mr. COHEN. I think that was one of the requirements. 

Mr. GARDNER. And so is that a significant change to an insurance policy, in your opinion? 

Mr. COHEN. Well, if a copay was $20 and it goes up $5, that is 

pretty significant, yes. 

Mr. GARDNER. So the President’s promise, he said—so really, in 

your mind, he shouldn’t have even had to apologize because he 

didn’t do anything wrong. 

Mr. COHEN. I think the President said that he recognized that 

what he had said did not prove to be true for many Americans, and 

as a result of that, we offered another transitional policy to make 

it be more possible for more Americans to get plans. 

Mr. GARDNER. And do you have legal opinions that give the 

President the authority to make these extensions and changes? 

Could you provide me with a legal memorandum that—— 

Mr. COHEN. I would have to—I honestly don’t recall whether we 

had a legal opinion on that issue. 

Mr. GARDNER. You testified in September, as we talked about, 

before the committee talking about everything going fine, and it 

would be fine. When did you first know that it wasn’t going fine? 

Was it September 27th, 28th, October 1st? 

Mr. COHEN. October 1st. 

55 

Mr. GARDNER. So you had no indication prior to October 1st that 

things weren’t going well? 

Mr. COHEN. I had no indication prior to October 1st that we are 

going to have the major, major problems with the Web site that we 

ended up having. 

Mr. GARDNER. When did you first know that people would have 

their insurance canceled? 

Mr. COHEN. I think we have always known that not all of the 

grandfathered plans were going to continue. I don’t think we had 

necessarily a sense of how many would and how many wouldn’t. 

Mr. GARDNER. When do you expect small business plans to start 

canceling insurance? 

Mr. COHEN. That will likely happen throughout the course of the 

year. Small business plans don’t tend to all come up for renewal 

in January. Many of them were renewed early in 2013 so that they 

will continue—— 

Mr. GARDNER. And how many do you anticipate being canceled? 

Mr. COHEN. I don’t have a number on that. We can look to see 

if we can come up with a number. 

Mr. GARDNER. If you could provide an estimation of how many 

additional insured you think will be canceled, that will be great. 

And so do we have an idea of how many signed up through the 

federal exchange so far? I know some of this we have talked about 

before but how many people have signed up through the federal exchange? 

Mr. COHEN. Well, we reported that through December 28th, it 

was 2.2 million in the federal and the state, and of those, it was 

something over 1.1 million that were in the federal. 

Mr. GARDNER. OK. So about 1.1 million in federal, 1.1 million in 

States? 

Mr. COHEN. Roughly, yes. 

Mr. GARDNER. OK. How many of those who signed up in exchanges were not previously insured? 

Mr. COHEN. I don’t have that number. 

Mr. GARDNER. How many were previously insured but had their 

insurance canceled and now signed up in the federal exchange? 

Mr. COHEN. I don’t have that number either. 

Mr. GARDNER. How many saw their insurance rates go up? 

Mr. COHEN. I don’t have that number. 

Mr. GARDNER. But you said that you know of a significant number of people who saw their rates go down? 

Mr. COHEN. As we have been hearing—— 

Mr. GARDNER. So you don’t know for sure if their rates went 

down. You are hearing anecdotal evidence. 

Mr. COHEN. We are hearing anecdotally, and I think—— 

Mr. GARDNER. So you don’t have any concrete numbers on 

whether rates went up or down? 

Mr. COHEN. I think that we know that for people who are eligible 

for a subsidy that, for those people, it is almost certain that their 

costs would have gone down. 

Mr. GARDNER. So you have some numbers but you don’t know 

how many went up. OK. 

So of the supposed 45 million without insurance, how many people now have insurance? 

56 

Mr. COHEN. I don’t think we have that number yet but certainly 

we are going to try to come up with as good data as we can as we 

go forward, you know, to the end of open enrollment. 

Mr. GARDNER. How do we know the law is working? 

Mr. COHEN. Well, we know the law is working for many people 

and we know that—— 

Mr. GARDNER. But you don’t know how many of the uninsured 

are now insured. You don’t know how many people saw their rates 

go up versus rates go down. Insurance companies aren’t being paid 

yet. 

Let us talk about the risk corridor provisions. What is the probability of the risk corridor provision being utilized or activated? 

Mr. COHEN. Utilized? 

Mr. COHEN. What is the probability of the risk corridor language 

being utilized? 

Mr. COHEN. Oh, I mean, I think there will be a risk corridor program. 

Mr. GARDNER. No, but I mean, when is the provision of that language being activated and payments being made from the government to insurance companies? What is the probability of that? 

Mr. COHEN. Oh, that will happen. 

Mr. GARDNER. So you are saying that the government will be 

paying private insurance companies—— 

Mr. COHEN. Oh, how likely is it that there will be claims on the 

program? 

Mr. GARDNER. Yes. 

Mr. COHEN. I think we anticipate that there will be claims on the 

program but there also may be some whose costs are lower than 

what they anticipated and there will be payments into the program, and I think the estimate was that it was budget neutral. 

Mr. MURPHY. The gentleman’s time is expired. Dr. Burgess, do 

you have a follow-up question on something? I am just going to 

give you 30 seconds. 

Mr. BURGESS. I know we will have to do this for the record, Mr. 

Cohen. We are interested in any legal memoranda that you have 

been advised of or briefed on that define the authority under the 

Affordable Care Act to delay implementation or the authority to exercise enforcement discretion over enforcement provisions. We all 

know this law that was signed in March of 2010 bears no resemblance to what is actually going on today because of the variety of 

enforcement discretions and delays that have been implemented by 

the Administration. We would like to know under what legal authority you are operating or what you have seen that gives you the 

legal authority to do so. Thank you, Mr. Chairman. 

Mr. MURPHY. And you will provide that for the record, Mr. 

Cohen? 

Mr. COHEN. We will certainly take that request back and work 

with you. 

Mr. MURPHY. I would also like you to follow up with the other 

questions that members on both sides of the aisle asked as followup questions. I would really like to know Mr. Gardner’s answers 

to his questions he asked about, just how many people of the 45 

million that were originally supposed to be helped are signed up 

and if it is more or less expensive for them. 

57 

And I ask unanimous consent that the written opening statements of other members who wish will be introduced into the 

record. 

And in conclusion, I would like to thank the witness and the 

members that participated in today’s hearing and remind members 

they have 10 business days to submit questions for the record, and 

I ask, Mr. Cohen, if you would please agree to respond promptly 

to the questions, and with that, this committee hearing is adjourned. 

[Whereupon, at 11:42 a.m., the subcommittee was adjourned.] 

[Material submitted for inclusion in the record follows:] 

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