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82–107 PDF 2013

EXAMINING THE CONCERNS ABOUT OBAMACARE 

OUTREACH CAMPAIGN 

JOINT HEARING 

BEFORE THE

SUBCOMMITTEE ON ENERGY POLICY, 

HEALTH CARE AND ENTITLEMENTS 

AND THE

SUBCOMMITTEE ON ECONOMIC GROWTH, 

JOB CREATION AND REGULATORY AFFAIRS 

OF THE

COMMITTEE ON OVERSIGHT 

AND GOVERNMENT REFORM 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

FIRST SESSION 

MAY 21, 2013 

Serial No. 113–39 

Printed for the use of the Committee on Oversight and Government Reform 

( 

Available via the World Wide Web: http://www.fdsys.gov 

http://www.house.gov/reform 

(II) 

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM 

DARRELL E. ISSA, California, Chairman 

JOHN L. MICA, Florida 

MICHAEL R. TURNER, Ohio 

JOHN J. DUNCAN, JR., Tennessee 

PATRICK T. MCHENRY, North Carolina 

JIM JORDAN, Ohio 

JASON CHAFFETZ, Utah 

TIM WALBERG, Michigan 

JAMES LANKFORD, Oklahoma 

JUSTIN AMASH, Michigan 

PAUL A. GOSAR, Arizona 

PATRICK MEEHAN, Pennsylvania 

SCOTT DESJARLAIS, Tennessee 

TREY GOWDY, South Carolina 

BLAKE FARENTHOLD, Texas 

DOC HASTINGS, Washington 

CYNTHIA M. LUMMIS, Wyoming 

ROB WOODALL, Georgia 

THOMAS MASSIE, Kentucky 

DOUG COLLINS, Georgia 

MARK MEADOWS, North Carolina 

KERRY L. BENTIVOLIO, Michigan 

RON DESANTIS, Florida 

ELIJAH E. CUMMINGS, Maryland, Ranking 

Minority Member 

CAROLYN B. MALONEY, New York 

ELEANOR HOLMES NORTON, District of 

Columbia 

JOHN F. TIERNEY, Massachusetts 

WM. LACY CLAY, Missouri 

STEPHEN F. LYNCH, Massachusetts 

JIM COOPER, Tennessee 

GERALD E. CONNOLLY, Virginia 

JACKIE SPEIER, California 

MATTHEW A. CARTWRIGHT, Pennsylvania 

MARK POCAN, Wisconsin 

TAMMY DUCKWORTH, Illinois 

ROBIN L. KELLY, Illinois 

DANNY K. DAVIS, Illinois 

PETER WELCH, Vermont 

TONY CARDENAS, California 

STEVEN A. HORSFORD, Nevada 

MICHELLE LUJAN GRISHAM, New Mexico 

LAWRENCE J. BRADY, Staff Director 

JOHN D. CUADERES, Deputy Staff Director 

STEPHEN CASTOR, General Counsel 

LINDA A. GOOD, Chief Clerk 

DAVID RAPALLO, Minority Staff Director 

(III) 

SUBCOMMITTEE ON ENERGY POLICY, HEALTH CARE AND ENTITLEMENTS

JAMES LANKFORD, Oklahoma, Chairman 

PATRICK T. MCHENRY, North Carolina 

PAUL GOSAR, Arizona 

JIM JORDAN, Ohio 

JASON CHAFFETZ, Utah 

TIM WALBERG, Michigan 

PATRICK MEEHAN, Pennsylvania 

SCOTT DESJARLAIS, Tennessee 

BLAKE FARENTHOLD, Texas 

DOC HASTINGS, Washington 

ROB WOODALL, Georgia 

THOMAS MASSIE, Kentucky 

JACKIE SPEIER, California, Ranking 

Minority Member 

ELEANOR HOLMES NORTON, District of 

Columbia 

JIM COOPER, Tennessee 

MATTHEW CARTWRIGHT, Pennsylvania 

TAMMY DUCKWORTH, Illinois 

DANNY K. DAVIS, Illinois 

TONY CARDENAS, California 

STEVEN A. HORSFORD, Nevada 

MICHELLE LUJAN GRISHAM, New Mexico 

SUBCOMMITTEE ON ECONOMIC GROWTH, JOB CREATION AND REGULATORY AFFAIRS

JIM JORDAN, Ohio, Chairman 

JOHN DUNCAN, Tennessee 

PATRICK T. MCHENRY, North Carolina 

PAUL GOSAR, Arizona 

PATRICK MEEHAN, Pennsylvania 

SCOTT DESJARLAIS, Tennessee 

DOC HASTINGS, Washington 

CYNTHIA LUMMIS, Wyoming 

DOUG COLLINS, Georgia 

MARK MEADOWS, North Carolina 

KERRY BENTIVOLIO, Michigan 

RON DESANTIS Florida 

MATTHEW A. CARTWRIGHT, Pennsylvania, 

Ranking Minority Member 

TAMMY DUCKWORTH, Illinois 

GERALD E. CONNOLLY, Virginia 

MARK POCAN, Wisconsin 

DANNY K. DAVIS, Illinois 

STEVEN A. HORSFORD, Nevada 

(V) 

C O N T E N T S 

Page 

Hearing held on May 21, 2013 ............................................................................... 1 

WITNESS 

Mr. Gary Cohen, Deputy Administrator and Director, Center for Consumer 

Information and Insurance Oversight, Centers for Medicare and Medicaid 

Services 

Oral Statement ................................................................................................. 7 

Written Statement ............................................................................................ 9 

APPENDIX 

Questions for Mr. Gary Cohen from Chairmen James Lankford and Jim 

Jordan ................................................................................................................... 58 

(1) 

EXAMINING THE CONCERNS ABOUT 

OBAMACARE OUTREACH CAMPAIGN 

Tuesday, May 21, 2013, 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON ENERGY POLICY, HEALTH CARE & 

ENTITLEMENTS, JOINT WITH THE SUBCOMMITTEE ON

ECONOMIC GROWTH, JOB CREATION AND REGULATORY

AFFAIRS

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM, 

Washington, D.C. 

The subcommittees met, pursuant to call, at 10:09 a.m., in Room 

2154, Rayburn House Office Building, Hon. Jim Jordan [chairman 

of the Subcommittee on Economic Growth, Job Creation and Regulatory Affairs] presiding. 

Present from Subcommittee on Energy Policy, Health Care & Entitlements: Representatives Lankford, Gosar, McHenry, Jordan, 

Walberg, DesJarlais, Woodall, Speier, Norton, Cartwright, 

Duckworth, Cardenas, Lujan Grisham, and Horsford. 

Present from Subcommittee on Economic Growth, Job Creation 

and Regulatory Affairs: Representatives Jordan, DeSantis, Duncan, 

McHenry, Gosar, DesJarlais, Collins, Meadows, Bentivolio, Cartwright, Duckworth, Connolly, Pocan, Kelly, and Horsford. 

Also Present: Representative Cummings. 

Staff Present: Ali Ahmad, Majority Communications Advisor; 

Alexia Ardolina, Majority Assistant Clerk; Brian Blase, Majority 

Senior Professional Staff Member; Molly Boyl, Majority Parliamentarian; Caitlin Carroll, Majority Deputy Press Secretary; Katelyn 

E. Christ, Majority Professional Staff Member; Drew Colliatie, Majority Professional Staff Member; Gwen D’Luzansky, Majority Professional Staff Member; Adam P. Fromm, Majority Director of 

Member Services and Committee Operations; Linda Good, Majority 

Chief Clerk; Meinan Goto, Majority Professional Staff Member; 

Tyler Grimm, Majority Professional Staff Member; Mark D. Marin, 

Majority Director of Oversight; Emily Martin, Majority Professional 

Staff Member; Tegan Millspaw, Majority Professional Staff Member; Scott Schmidt, Majority Deputy Director of Digital Strategy; 

Sharon Meredith Utz, Majority Professional Staff Member; Jaron 

Bourke, Minority Director of Administration; Yvette Cravens, Minority Counsel; Devon Hill, Minority Research Assistant; Jennifer 

Hoffman, Minority Press Secretary; Nicholas Kamau, Minority 

Counsel; Una Lee, Minority Counsel; Jason Powell, Minority Senior 

Counsel; Brian Quinn, Minority Counsel; and Rory Sheehan, Minority New Media Press Secretary. 

2 

Mr. JORDAN. The committee will come to order. We want to welcome folks today. 

Mr. Cohen, we will get to you in just a second, but you know how 

it works: you have to listen to us first, then we get to you. So we 

will do our opening statements. 

And Mr. Lankford is on his way and Mr. Cartwright is on his 

way, but, in the interest of time, we will get started. 

There is a lot we don’t know about Obamacare, but the more we 

learn, the worse the law seems. We know that Obamacare remains 

unpopular. We know that it has sparked considerable confusion 

and certainly uncertainty. Frankly, I spoke to business people yesterday in our district and this was one of the main topics we talked 

about. We know that many businesses are refusing to hire and expand because of the law. 

Now the Administration wants to spend billions of dollars promoting the law, money that would be much better spent on patient 

care or something else. If it is so good, why does the Administration have to spend so much money in advertising? Because of 

Obamacare’s complicated mix of regulation, taxes, subsidies, and 

mandates, premiums for relatively young and healthy people are 

projected to spike next year. For millions of these individuals, premiums will increase by 50 percent or more, and, of course, lots of 

these young people are currently paying lower rates, the very 

groups of individuals that the Administration, through navigators 

and assisters, most wants to enroll in the exchanges. 

The increased premiums will make millions of Americans worse 

off. Other individuals will only be applying for insurance and exchanges because of Obamacare’s expensive subsidies, which will 

greatly exacerbate Federal deficits beginning next year. 

CBO estimates that the law will cost $1.8 trillion over the next 

10 years, a price tag that seems to rise each year. 

We know that there is a major problem in California. The California State legislature decided to conceal spending on all of its exchange contracts, including funding for the State’s Assisters Program. This means Federal taxpayers won’t have knowledge of how 

California is spending hundreds of millions of their dollars. 

In addition to all the funding, training, and oversight concerns 

about navigators and assisters, the overreach of the Administration 

in its overall implementation efforts is also stunning. For example, 

Congress has denied Health and Human Services Secretary Kathleen Sebelius several additional requests for pouring more taxpayer 

money into the law, so the Secretary has taken money, in many 

cases, without clear legal authority from different sources to fund 

Obamacare. 

HHS officials admitted to this committee that the Secretary lacks 

legal authority for this Assisters Program, a program created solely 

to get around Obamacare’s explicit prohibition on using State-established grants to fund navigators in exchanges established by 

those States. 

The Secretary has failed to respond to an April 19th, 2013, letter 

from the committee relating to the Secretary’s transferring of funds 

for Obamacare implementation. More recently, however, is the Secretary’s brazen fundraising push, despite Federal ethics regulations 

3 

forbidding any department official from fundraising in a professional capacity. 

Recent reports indicate that the Secretary has placed multiple 

phone calls to help insurance, pharmaceutical, and hospital executives over the past three months, asking them to contribute money 

to nonprofits leading Obamacare outreach efforts. One such organization, Enroll America, a spinoff of Families USA, which lobbied 

strongly for the passage of the law, HHS actions to elicit donations 

on behalf of organizations connected to the Administration are even 

more troubling. 

Finally, in light of the revelation of IRS’s targeting of conservative groups applying for tax-exempt status, it is crucial for the 

American people to understand that Obamacare tasks the IRS with 

enforcing nearly 20 new tax laws. It is amazing to me. The very 

organization who is charged with enforcing Obamacare was systematically targeting conservative groups who came into existence 

because they opposed Obamacare, and it was targeting them for 

over a two year time period. 

It is also important to remember that the IRS is building the 

largest personal information data hub the Federal Government has 

ever attempted. The IRS has a central role in Obamacare’s very 

complicated subsidy scheme. According to Treasury’s own analysts, 

many taxpayers who do everything right will still face significant 

harm from the scheme. According to the Taxpayer Advocate, taxpayers who did not update their household information during the 

year, such as income, marital status, change in family size, or receipt of employer-sponsored insurance, may find that they owe a 

significant amount of money at the end of the year, money they 

likely do not have. 

In fact, the IRSs role in enforcing Obamacare is tied with the 

Navigator and Assister Program. If navigators and assisters incorrectly fill out people’s health insurance applications and individuals 

receive subsidies to which they were not entitled, then the IRS will 

go after the individuals for the overpayment. The insurance companies who receive the overpayment and the navigators or assisters 

who provided the bad advice won’t face any harm. 

With less than four months to go before the launch of the health 

care insurance exchanges, we must focus on what can be done to 

save our health care system from the huge train wreck that 

Obamacare implementation has become. 

I hope, Mr. Cohen, that you can tell us that the Health and 

Human Services has given much greater thought to the navigator 

and assister rule, and will issue a final rule that is consistent with 

statutory authority which protects consumers and which increases 

standards for navigators. 

With that, I would yield to the gentlelady from the District of Columbia, Ms. Norton. 

Ms. NORTON. Thank you very much, Mr. Chairman. I must take 

exception to your attempt to link the Affordable Health Care Act 

with the present investigation of IRS. To say that is a stretch is 

to give you too much credit. 

I thank the members and our witnesses, Mr. Cohen, who is before us now. 

4 

Until recently, I had thought that one of the major differences 

between the Banana Republics and other pseudo-democracies was 

that in this Country, once a law was passed or once the Supreme 

Court has spoken, the law was the law and the law was carried 

out. This has been always, until now, a Country where respect for 

law and the rule of law was unquestioned, even when our side lost 

a particular bout or a particular round and a law came forward 

with which we disagreed. The nature of democracy is you implement the law that has been passed by the majority. 

Now, last summer, the Supreme Court ruled, and on this question the Supreme Court is the law of the land, and they ruled that 

the Affordable Health Care Act was constitutional, and there was 

no question that this was the law of the land. Of course, that is 

very good news for millions of Americans who don’t have health insurance and every day are getting access to health insurance. 

But the Republican majority is still fighting the Affordable 

Health Care Act as if it were not the law of the land and if they 

had not taken an oath to uphold the law of the land, whatever that 

law was. Just last week, I am not sure whether it is because they 

have no agenda whatsoever for the 113th Congress and they needed something to fill the time, but they passed, once again, the 37th 

repeal of the Affordable Health Care Act, to giggles and scorns 

throughout the United States. 

You keep that up, and more and more no one takes you seriously 

as a legislature. 

Like that vote, today’s hearing is merely an attempt to obstruct 

the law and the rights of American citizens to health insurance. It 

is time to assure that the law of the land is carried out effectively 

and efficiently, instead of trying to undermine the law of the land 

as if this were not a democracy. 

Congress intended that consumers receive assistance and information in the process of enrolling in the new health care options. 

After all, this is a new law, an unprecedented law. Accordingly, the 

Navigator Program was created by Congress to serve as a tool to 

help educate and enroll citizens. The reason for the Navigator Program is simple: reducing health care costs, which I had assumed 

everyone wanted to do, requires that everyone be covered; that everyone be in the insurance pool. Navigators are helping people to 

get health care coverage, some for the first time in their lives, and 

in the process lower health care costs for everyone in the Nation. 

The more people in the pool, the less health care costs everybody 

in the United States. 

Furthermore, the model for the enrollment efforts of the Affordable Care Act is very well established. Much the same model was 

used more than two decades ago to implement the State Children’s 

Health Insurance Program. In some States an enrollment assister, 

as she is called, helped consumers enroll, just like Congress intended for the health exchanges created through the Affordable 

Health Care Act. 

As of today, not a single grant application for the Navigator Program has been reviewed and no grants have been awarded as of 

yet. It is, therefore, premature to say much of anything about what 

the program is doing. I hope that we can avoid speculating about 

the worst case scenarios that haven’t happened and will sincerely 

5 

work toward the efficient and effective implementation of health 

care that lowers health care costs for us all. 

That is within our reach if we will fulfill what Congress intended 

in passing the Affordable Health Care Act and, I might add, what 

the law now demands for everyone who took the oath to uphold the 

law as a member of the United States Congress, and I yield back. 

Mr. JORDAN. I thank the gentlelady. 

We now turn to the chairman of the committee, and let me just 

say I am sure, on behalf of the whole committee, we are certainly 

thinking about the folks in Oklahoma, in your district and surrounding areas, and praying for all that they have to deal with and 

what you are dealing with as a member. 

So we now recognize the chairman, Mr. Lankford. 

Mr. LANKFORD. Thanks, Jim. 

And thank you, so many people that have prayed for us for what 

is going on in Oklahoma right now. These are incredibly difficult 

days for a lot of families there. 

Last month, my subcommittee held a hearing on key problems in 

America’s health care system. We heard testimony about the lack 

of transparency in competition in health care markets, about widespread medical errors, and about rising health care costs. Four 

years ago, Congress created the Affordable Care Act to attempt to 

resolve these issues. I strongly believe that the Affordable Care Act 

actually creates more problems than it solves, and I want to do everything that I can to protect the people in my district from the 

harmful effects of this law. 

But it is the law of the land and the implementation is beginning. Congress has an important oversight role to ensure the Administration follows the law during its implementation efforts and 

that implementation harms as few people as possible. 

Obamacare requires that exchanges make grants to at least two 

organizations in each State with a Federal exchange to serve as a 

so-called navigator, an entity responsible for finding people without 

insurance and encouraging them to sign up. However, Obamacare 

explicitly prohibited State-based exchanges from using Federal 

grants for navigators. 

Now we understand that a twin program, called In-Person Assisters, has been created by HHS funded with Federal grants. In 

fact, during a briefing last month, HHS officials confessed to Republican and Democratic staff that there is no statutory authority 

for the Assisters Program. 

On April 19th and May the 6th, Chairman Issa, Chairman Jordan, and myself sent letters to Secretary Sebelius outlining many 

of our significant concerns with the agency’s plans for these outreach programs. We still have many unanswered questions. Our 

letter still has not been responded to. 

Has HHS mandated a criteria for individuals who can be navigators or assisters? For instance, could felons, individuals convicted 

of identity theft, high school dropouts be navigators and handle 

sensitive and personal information? 

Is there an expectation that a navigator or an assister applicant 

will have any prior knowledge about the functioning of health insurance markets? Currently, the training for navigators and assisters will only be 20 to 30 hours of online training and will contain 

6 

tests after each module that can be taken an unlimited number of 

times. 

Has HHS developed an oversight plan? For instance, are there 

plans to check with individual navigators or assisters to evaluate 

their job performance? What if there are reports of misconduct and 

wrongdoing of individual navigators or assisters? 

There are conflicting reports if the State requirements for licensing will apply to navigators. It is also uncertain if they will have 

to carry errors and omissions insurance. It is even uncertain if 

navigators will face any consequences if they give wrong tax or insurance advice, since they will be dealing with specific tax references that will apply to their next year’s tax. 

There are also media reports that the director of HHS has made 

calls to solicit health insurance executives, pharmaceutical executives, and hospitals to donate large sums to nonprofits responsible 

for the Obamacare outreach efforts. According to The New York 

Times, several executives said they were uncomfortable with the 

discussions because the Federal Government has the power to approve or reject the health plans they want to sell in insurance markets that will be run by the Federal officials in more than 30 

States. These actions unduly pressure private companies to financially support implementation and promotion efforts, fearing retribution from the Department of Health and Human Services if 

they do not contribute to organizations like Enroll America. 

With the October 1 enrollment period looming, these problems 

must be addressed now. The Administration must assure us that 

individuals facing financial security will be protected and that taxpayer dollars will not be abused during the implementation of this 

law, and the Secretary must stop using unethical, if maybe not illegal, we don’t know yet, methods to fund the law’s implementation. 

I look forward to hearing from our witnesses and further discussing our concerns. 

Thank you, Chairman Jordan. 

Mr. JORDAN. I thank the chairman. 

All right, Mr. Cohen, you are up. Mr. Cohen is Deputy Administrator and Director for the Center of Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services. Just like government to have that long title there, Mr. Cohen. 

We appreciate you being here. We swear folks in at this committee, 

so if you will stand up, raise your right hand. 

Do you solemnly swear or affirm that the testimony you are 

about to give will be the truth, the whole truth, and nothing but 

the truth, so help you, God? 

[Witness responds in the affirmative.] 

Mr. JORDAN. Let the record show the gentleman answered in the 

affirmative. 

You are now recognized for five minutes. You know how this 

works. You have the lighting system in front of you. Make sure you 

pull the mic close and fire away. 

7 

WITNESS STATEMENT 

STATEMENT OF GARY COHEN 

Mr. COHEN. Thank you, Chairman Jordan, Chairman Lankford. 

On behalf of everyone at CMS, Mr. Lankford, we certainly send our 

thoughts to the people in Oklahoma at this difficult time and certainly will do anything that we can to help out in that difficult situation. 

Thank you for the opportunity to discuss the CMS Navigator 

Program today. Before I begin, I want to note that we have received the letter from the chairs of the subcommittees and are 

working to provide you and your staff with the information you 

have requested as quickly as possible. 

Over 40 million of our fellow citizens and neighbors live daily 

with the insecurity of not knowing how they will pay for the medical care which they and their families need. The uninsured are one 

diagnosis away from medical bankruptcy. They often do not receive 

the preventive care and early diagnosis and treatment that are associated with better outcomes and lower costs. When the uninsured 

do seek treatment, it is all too often at the emergency room, and 

every American business and taxpayer helps pay for the uncompensated care that is provided there. 

The new health insurance marketplaces will fundamentally 

change that reality for these Americans. The marketplaces are precisely what the name describes: a place where consumers and businesses can find health coverage options. Consumers will be able to 

compare costs, benefits, and cost-sharing in order to choose a plan 

that is right for them, their families, and their employees. If eligible, consumers and businesses will be able to receive help in paying 

the premiums through premium tax credits that lower the cost of 

premiums right away, cost-sharing reductions, or a small business 

health care tax credit. 

Ensuring that consumers and businesses participate in the marketplaces requires, of course, that they learn about the benefits 

that these marketplaces have to offer and that they get the help 

they need in order to take advantage of those benefits. This is a 

significant undertaking. 

We know quite a bit about the uninsured Americans we need to 

reach. Many currently do not have health insurance, so the transaction of selecting, applying, and enrolling in health coverage may 

be unfamiliar to them. 

Twenty percent of the uninsured have not completed high school 

and nearly 10 percent live in a household that does not have an 

English-speaking adult. To inform these people about their new 

health insurance options, information must be provided by people 

connected to the community in a way that they can understand. 

The existing insurance market clearly has not served these millions of Americans well. So while we know that more traditional 

ways of reaching them, such as the marketing efforts that insurance companies and agents and brokers will be doing will be important, we also know that we need members of the community to 

speak neighbor to neighbor to get the word out. 

For that reason, the Affordable Care Act authorizes, and CMS is 

implementing, a variety of ways to provide outreach, education, 

8 

and enrollment assistance to the uninsured. The Navigator and InPerson Assistance Programs will help Americans enroll in affordable, high-quality coverage beginning on October 1. These programs provide funding for trained helpers who must maintain expertise in eligibility enrollment and program specifics; raise public 

awareness about the marketplace; provide consumer-focused information and services in an easy to understand, fair, accurate, and 

impartial manner; and help people enroll in a qualified health plan 

through the marketplace. 

On October 9, CMS published a funding opportunity announcement that uses cooperative agreements to fund navigators in federally-facilitated or State partnership marketplaces. Applications are 

due on June 7. I am pleased to report that we have received over 

830 optional letters of intent from a variety of organizations. We 

expect to receive a similarly robust number of applications for the 

Navigator cooperative agreements by the June due date. This high 

level of interest and the competitive application process will ensure 

that only the most qualified individuals and organizations will be 

selected to participate as navigators. 

The application process to become a navigator is rigorous and extensive. Applicants must provide detailed information about how 

they plan to perform the navigator duties, their estimated budget, 

their track record and accomplishments, and the expertise of their 

personnel. Applications will be scored by an expert objective review 

panel and screened by our grant managers to ensure that applicants have the business management capability to successfully perform these duties, and that their proposed budget is allowable and 

reasonable. 

Once the successful applicants are chosen, navigators must complete a 20-to 30-hour long training program and must pass an 

exam prior to beginning to help consumers. Grantees will be monitored by CMS based on their quarterly financial and progress reports to make sure they are meeting the program’s goals, as well 

as its terms and conditions. CMS may terminate any award for violation of the terms and conditions of the award, including failure 

to perform award activities in a satisfactory manner; improper 

management or use of award funds; or fraud, waste, abuse, management or criminal activity. 

HHS awards grants for more than 300 programs, including consumer outreach and education programs, such as the State Health 

Insurance Assistance Program for Medicare beneficiaries, the nationwide Senior Medicare Patrols Program, and the Connecting 

Kids to Coverage Program. The Navigator Program follows this tradition of responsible grant-making for consumer education for 

newly developed marketplaces. We are confident that the Navigator and State-based In-Person Assistance Programs will provide 

consumers with the high quality help they need as they consider 

their health coverage options. 

I appreciate the subcommittees’ interest in this program and 

would be happy to answer your questions. 

[Prepared statement of Mr. Cohen follows:] 

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Mr. JORDAN. Thank you, Mr. Cohen. Forty seconds to spare. We 

appreciate that. 

The gentleman from Oklahoma is recognized for five minutes. 

Mr. LANKFORD. Mr. Cohen, thank you for being here, and this is 

a brand new program, so we will have additional questions as you 

are pulling this together, and the CMS team and HHS, and for us, 

as well, as we are trying to oversee it and understand it a little 

bit more. 

What is the difference between a navigator and an assister? 

Mr. COHEN. The functions are essentially the same. The difference is that we really responded to requests from a number of 

States, recognizing that they have to have a Navigator Program 

that cannot be funded from Federal grant funds. 

Mr. LANKFORD. Right. 

Mr. COHEN. But in the first year of the program they also have 

an obligation, that is in the statute, to provide outreach and assistance to help people get enrolled, and in the first year of the program they don’t have a funding source, which will come into place 

through user fees and so forth once the program is operational. 

Mr. LANKFORD. So is there a statutory authority, then, to create 

this State-based Navigator Program? 

Mr. COHEN. The statutory authority is the requirement in the Affordable Care Act that State-based exchanges and all exchanges 

provide outreach and education and enrollment assistance to people. 

Mr. LANKFORD. So you make an assumption that because the law 

says you need to have this, even though the law specifically states 

that only navigators go to Federal exchanges, you just assume they 

wrote the bill wrong and they meant you should also have this 

other program? Because I am trying to figure out the statutory authority to it. And I hear the assumption that you assume they are 

going to do it, and States like California, Colorado, this past week 

came up and said, hey, we don’t have near enough money to be 

able to do this, asked for another $14 million just for their Assister 

and Navigator Programs; say we were promised enough, this is not 

enough. I get their frustration in trying to implement the law, I am 

just trying to figure out the statutory authority of creating a program that the law specifically says you just do this. 

Mr. COHEN. Well, the In-Person Assister Program is a program 

that is separate from the Navigator Program, it is a transitional 

program. 

Mr. LANKFORD. But it is pretty much the same. 

Mr. COHEN. The function that the people will be performing is 

very much the same. 

Mr. LANKFORD. So is there a reason you wouldn’t call it State 

navigators and Federal navigators, just use the same term; these 

are State-funded navigators or these are Federal-funded navigators? 

Mr. COHEN. Well, State-based marketplaces are required to have 

a Navigator Program that they fund. But as a transitional program 

during the establishment of the exchanges, only in the first year 

and before they are financially sustainable, States came to us and 

said—— 

Mr. LANKFORD. We don’t have enough money. 

21 

Mr. COHEN. That is right. 

Mr. LANKFORD. Okay. We will have some follow-up on that. 

You mentioned in your opening statement about only the most 

qualified will be the individuals in there. I assume that you are requiring some basic background checks, that you are requiring some 

of the things to be able to prove these are only the most qualified. 

These will be folks that will have some familiarity with health care 

in the background or insurance in the background; they have gone 

through a background check; they have gone through a 

fingerprinting, you know that? Is that my assumption as well? 

Mr. COHEN. So I think if you look at the funding opportunity announcement you will see that the successful applicants will demonstrate both a past history of knowledge and expertise in this area 

and a track record of working in the community successfully in this 

area, as well as—— 

Mr. LANKFORD. So a background in health care or a background 

in insurance, as well as a connection with the community? 

Mr. COHEN. One of the requirements that will be scored in the 

grant selection process is showing expertise in the private health 

insurance market—— 

Mr. LANKFORD. I am sorry, Mr. Cohen, I don’t mean to interrupt. 

That is for the organization. What about for the individuals that 

are actually going to be the navigators on the ground? Will there 

be a background check; will there be a requirement of competence 

beyond the 20 or 30 hours of online training? 

Mr. COHEN. We have left the States’ flexibility to determine what 

specific checks need to be made on the individuals who will be performing this function. 

Mr. LANKFORD. So can the State, then, require to have a licensing as well? 

Mr. COHEN. What we have said is that State licensing is permitted. The only thing that is not permitted is requiring an agent 

broker license. 

Mr. LANKFORD. Would they be required like many States, my 

State included, that they have errors and omissions insurance if 

you are handling insurance information? So if they give someone 

bad advice, for instance, if they are going to advise them, say, here 

is how much your subsidy is, but if they punched it in wrong, next 

year that individual is going to get a huge tax bill. So this person 

is giving tax advice at their door, basically, as well as health care 

advice. Will there be some errors and omissions insurance required; 

will that be allowed by States as well? 

Mr. COHEN. So I actually don’t think that navigators are going 

to be giving tax advice, Congressman. I think that is really kind 

of a misconception of their role. 

Mr. LANKFORD. Will they help determine are you eligible for the 

subsidy? 

Mr. COHEN. No, they will not. That will be determined through 

the application process that each person will have to go through, 

where they enter certain information about their financial situation, and the navigator will help them to do that, but the navigator 

is not going to be giving them tax advice. 

Mr. LANKFORD. Can I ask just a quick question, as well, on the 

background? Would you assume that the individuals that are naviVerDate Aug 31 2005 09:58 Jul 30, 2013 Jkt 000000 PO 00000 Frm 00027 Fmt 6633 Sfmt 6633 C:\DOCS\82107.TXT APRIL
22 

gators that have access to Social Security numbers, private health 

care information as far as their insurance companies and such, 

they would have the same standards as census workers, for instance, that are doing a headcount in the house? They are going 

to walk away with an awful lot of private information when they 

walk away from this door, so would they have the same standards 

as a census worker? 

Mr. COHEN. So I would make two points. First of all, they won’t 

walk away with any private information. The private information 

will be entered through the application process, but the navigators 

are specifically going to be trained and directed not to retain any 

private information. 

Mr. LANKFORD. So is there any way to verify that? I get that is 

the desire, but there has to be a verification that they are not 

walking away with a pretty big database of that community. 

Mr. COHEN. Sure. And we will be doing an oversight process and it is punishable by a fine of up to $25,000 if you steal somebody’s 

personal information, so it is a pretty significant thing. But the 

other thing I would say, Congressman, is I think that these folks 

are going to be comparable to what we have seen for many, many 

years in the State Medicare programs, where they have had people 

who have assisted in getting folks enrolled. It has been extremely 

successful in the CHIP program, where they have had people who 

have helped getting people enrolled, and I am not aware of any 

problems that have occurred in those programs in terms of the 

kind of thing that you are mentioning, so I don’t expect we will see 

them here. 

Mr. LANKFORD. Well, I am going to yield back, but I can say in 

my State there is already some questions about licensing and brokers, errors and omissions insurance, and all those things that we 

assume are going to be a part of this that are in our State law that 

now we feel like we are getting some push-back on to say, no, you 

will have your group and we will have our group, and though they 

are handling insurance they really are not handling insurance. So 

there will be some questions and we have to figure out the process 

on that. The letter that we sent to you a while back, some of those 

details will actually help us to be able to get some of the information as well. 

I yield back. 

Mr. JORDAN. I thank the gentleman. 

The gentlelady from the District of Columbia is recognized. 

Ms. NORTON. Thank you, Mr. Chairman. 

I would like, Mr. Cohen, to see if we can put what you are doing 

in some context. One would think this is an unprecedented program, but you just mentioned some of the programs that required 

outreach in the past. Many of us are familiar, of course, with the 

Children’s Health Insurance Program, Medicare Part C and Part D. 

Were these in any way models for Navigator? Is there something 

different between the outreach that was used for Medicare C and 

D or S–CHIP and what you are doing now? 

Mr. COHEN. I think we definitely tried to learn lessons from 

those previous programs and, as you know, since TRIPA was enacted, for example, CMS has given out grants to over 100 grantees, 

including schools, community organizations, provider groups, faithVerDate Aug 31 2005 09:58 Jul 30, 2013 Jkt 000000 PO 00000 Frm 00028 Fmt 6633 Sfmt 6633 C:\DOCS\82107.TXT APRIL
23 

based organizations, tribal entities, and so forth, to help kids get 

enrolled in that program. The same thing is true of the State programs to help people get enrolled in Medicare. And we looked at 

all those different programs. I actually think that what we are 

doing with the Navigator is at least as rigorous, or more, of an application process and a review process has been true in those programs. 

Ms. NORTON. Well, out of those programs, since these programs 

go back some years, have there been a set of best practices that 

have informed how you have created the Navigator Program? 

Mr. COHEN. Exactly. That is right. And we know that community-based application assistance itself is a best practice when it 

comes to helping people to get enrolled in programs such as Medicaid and in CHIP and in Medicare. Person-to-person assistance delivered by trusted individuals is really the best way. So this is not 

a bunch of people from Washington flying in to tell people this is 

what you ought to do; this is people in the community who have 

a history in the community, are trusted in the community, who are 

going to be providing this assistance. 

Ms. NORTON. But apparently there are two entities who are navigators in each marketplace, one is consumer-based off a nonprofit. 

Would you tell us about this two-layered approach? What is the difference between the navigators? 

Mr. COHEN. I think that what the statute contemplates is that 

at least one of the two navigators that is required to be in each 

State be a nonprofit consumer group and then the other can be 

something else. 

Ms. NORTON. For example? 

Mr. COHEN. It could be a hospital; it could be a labor union; it 

could be a Native American tribe. There are a variety of different 

types of organizations that serve the community that would qualify. 

Ms. NORTON. So the two-layered approach is necessary for what 

reason? 

Mr. COHEN. I think it is just to ensure that we have a variety 

of different types of organizations. Of course, anyone serving as a 

navigator may not have any sort of conflict of interest or financial 

benefit from the insurance industry, so that applies across the 

board. But I think the idea was to make sure that there would be 

at least one group that had a history of serving consumers in that 

community. 

Ms. NORTON. Well, that, I applaud you for. Instead of using only, 

pardon the pejorative, bureaucrats, you are also using people from 

the community, training them and sending them into the community with the right kind of best practices background. 

Thank you very much, and I yield back. 

Mr. JORDAN. I thank the gentlelady. 

Now recognize the gentleman from Florida, Mr. DeSantis. 

Mr. DESANTIS. Thank you, Mr. Chairman. 

Thank you, Mr. Cohen. Just to go back to the gentleman from 

Oklahoma, when he asked you about statutory authority for the assisters, was your answer that, yes, there is statutory authority or 

no, there is not explicit statutory authority? 

24 

Mr. COHEN. There is statutory authority because the statute requires that exchanges provide outreach education and enrollment 

assistance to consumers. That is the statutory authority. That is 

the function that has to be performed by the exchanges. 

Mr. DESANTIS. So when the HHS folks briefed the committee 

staff and they said there was not statutory authority, they were incorrect? 

Mr. COHEN. Well, I wasn’t there, so I can’t speak to what they 

said or didn’t say, or what folks heard or didn’t hear. But I’m telling you— Mr. DESANTIS. Well, if they said that, I am asking you if they 

said that, they would have just been mistaken and not understood 

the law, correct? 

Mr. COHEN. We have statutory authority for the In-Person Assister Program, yes. 

Mr. DESANTIS. Okay, now, in terms of the goal, as I read the 

statute, that these navigators are supposed to provide fair, impartial, and accurate information about this program, correct? 

Mr. COHEN. Yes. 

Mr. DESANTIS. And so, for example, California, they are now trying to develop a system where they are paying these navigators per 

enrollment, and they say the reason for that is they want to 

incentivize enrollment. But if there is a conflict between 

incentivizing enrollment and providing fair and accurate information, the navigator would have to provide fair information, even if 

it may lead somebody to not enroll, correct? 

Mr. COHEN. They have to provide fair and accurate and impartial 

information, yes, regardless of what the decision is. 

Mr. DESANTIS. Right. So, for example, the way the law is structured, you have this tax or mandate that applies to folks who do 

not get insurance, but then you also have a must-issue provision 

so that if people do develop a condition, they still will get insurance 

issued to them. And I think the cost for an individual is about $95 

in 2014 for those who choose not to get insurance. 

So my question for you is will navigators be required to inform 

applicants that their failure to purchase insurance will lead, in 

some instances, to a penalty that is actually cheaper than the cost 

out of pocket to them to maintain insurance? 

Mr. COHEN. Navigators would be required to provide accurate, 

fair, impartial, and truthful information with respect to all aspects 

of this, including the potential penalties. 

Mr. DESANTIS. So they would have a duty to affirmatively provide this information. 

Mr. COHEN. Well, ordinarily, people that navigators will be dealing with are going to be people who want health insurance coverage; that is why they are going to find their way to a navigator. 

So I don’t know that they are going to say to every person who 

comes in the door, well, if you don’t get health insurance, you 

might have to pay a penalty of $95. But if they are asked a question, they will give a truthful, accurate answer to the question. 

Mr. DESANTIS. Well, in California they are doing this to try to 

incentivize it, so they must feel that there will be some folks that 

they are trying to reach who are not going to be actively seeking 

it. So will navigators be required to tell individuals that they can 

25 

wait until they develop a condition or get sick to purchase insurance without facing a financial penalty? 

Mr. COHEN. Well, that would be inaccurate because the people 

will only be able to sign up for insurance during an open enrollment period, just as is true of the market today. 

Mr. DESANTIS. Well, how does that work? So if I have a job and 

I have insurance, and I have a preexisting condition and I lose my 

insurance or I find myself developing a condition through no fault 

of my own, I would actually have to wait? I thought this law provided for coverage for preexisting conditions? That was one of the 

main things that I heard. So there may be people, through no fault 

of their own, who are having to wait until an enrollment period, 

which could be six, eight, ten months. 

Mr. COHEN. Well, I think you have confused a couple different 

things. There are circumstances in which what is called a special 

enrollment period. This is the same as in the market today, nothing different. If you lose your job, for example, and you lose your 

coverage through your employer, then you would have an opportunity to get enrolled and coverage on an individual basis. 

But normally, without some event happening that allows you to 

have a special enrollment period, the open enrollment period for 

the first year will run from October through March, and then there 

will be an open enrollment period in subsequent years, just as 

there is today. And you are right that when you go to enroll in coverage, the law says that insurers may not decline to give you coverage because you have a preexisting condition, but that doesn’t 

mean that you can wait until you get sick and then sign up. You 

are taking a risk if you don’t sign up during an open enrollment 

period that you may get sick and may not be able to sign up until 

the next open enrollment period. 

Mr. DESANTIS. Or if you don’t qualify for one of the special enrollment, even if you are not trying to game the system. 

Mr. COHEN. That is true. 

Mr. DESANTIS. You would be in a tough situation there. Okay, 

well, thank you, Mr. Cohen. 

I yield back the balance of my time. 

Mr. JORDAN. I thank the gentleman. 

I now recognize the ranking member, Mr. Cartwright. 

Mr. CARTWRIGHT. Thank you, Mr. Chairman. 

And thank you, Mr. Cohen, for coming here today and sharing 

your thoughts with us. I think by now everybody understands the 

way insurance works. The more people who are in the pool, the 

more diversified the pool, the lower the costs are for everybody. 

And the same basic principle applies to health insurance; the more 

people who are enrolled in health exchanges, the lower the cost is 

going to be for health care for everybody. Is that a fair statement, 

Mr. Cohen? 

Mr. COHEN. It is a fair statement. And I would add one more 

thing. Because, if people show up at an emergency room without 

health coverage, they may get treated anyway, and so there is a 

lot of uncompensated care. So we have an additional problem in addition to the one that you have identified. We have an additional 

problem that we are paying for a lot of this uncompensated care 

today that isn’t covered by insurance. 

26 

Mr. CARTWRIGHT. So the more successful the Navigator Program 

is, the more people are going to be enrolled and the lower the cost 

of health care is going to be for everybody in the Nation. Isn’t it 

true that the navigators are going to help assist people who might 

otherwise not know about how to enroll in the health exchanges? 

Mr. COHEN. Exactly right. 

Mr. CARTWRIGHT. Now, isn’t it also true that more people are 

going to enroll in the health exchanges due to the work of the navigators than would otherwise enroll if Congress had not created the 

navigator function, Mr. Cohen? 

Mr. COHEN. That is true. And we know that particularly from 

our experience with Medicare and Medicaid and CHIP that that is 

true. 

Mr. CARTWRIGHT. That is they don’t know about the program, 

they are just not going to enroll in it. 

Mr. COHEN. Right. 

Mr. CARTWRIGHT. And we are talking about people, a majority of 

whom were previously uninsured, is that correct? 

Mr. COHEN. Yes. 

Mr. CARTWRIGHT. So these are people that kind of could use some 

guidance on how to sign up for health insurance, right? 

Mr. COHEN. That is right. 

Mr. CARTWRIGHT. Now, Mr. Chairman, I think it is pretty obvious that what is happening here at this hearing is by going after 

this Navigator Program, the majority is really attacking both the 

new access to health insurance coverage for millions of previously 

uninsured Americans thanks to the Affordable Care Act and lower 

health insurance costs that everybody is going to enjoy in this Nation once the health exchanges extend coverage to everybody eligible under the law. 

Now, Mr. Cohen, I want to ask you a study by the Kaiser Family 

Foundation estimated that 65 percent of the people enrolling 

through an exchange will have been previously uninsured. Is that 

correct? 

Mr. COHEN. Yes, I am familiar with that. 

Mr. CARTWRIGHT. Have you seen that figure? 

Mr. COHEN. I have. 

Mr. CARTWRIGHT. And many individuals who are now eligible for 

health insurance are unaware of what a health exchange is and 

how it can benefit them. For these individuals, how important is 

it that we do outreach and education activities? 

Mr. COHEN. I think it is extremely important, and I think it is 

important that we do it in a variety of different ways that reflect 

the great diversity of this Country and the different kinds of people 

who live in it, and that we make sure we target as carefully as possible so that we reach as many as possible. 

Mr. CARTWRIGHT. Now, is it safe to say that many of these previously uninsured individuals who will now have access to health 

care coverage are unfamiliar with the terms and options that they 

will need to get through when seeking coverage? 

Mr. COHEN. I think that is true. 

Mr. CARTWRIGHT. And some of these consumers may have other 

individual limitations which make it particularly difficult for them 

27 

to make informed health plan choices. Would that be correct as 

well? 

Mr. COHEN. Yes. 

Mr. CARTWRIGHT. Given these prior barriers to coverage, how 

critical will navigators be in helping Americans gain access to the 

health care benefits available to them? 

Mr. COHEN. Navigators are very critical in particular, as you 

mention, in helping people who do have barriers such as disabilities, limited English language proficiency, and other obstacles. 

Mr. CARTWRIGHT. Now, Mr. Cohen, in your testimony you stated 

that ensuring that consumers and businesses participate in the 

marketplaces requires that they learn about the benefits that these 

marketplaces have to offer and that they get the help they need in 

order to take advantage of the benefits. How are the navigators 

going to assist small businesses participating in health insurance 

exchanges and what kind of help is available to small businesses 

participating in the health insurance exchanges? 

Mr. COHEN. Small businesses are eligible if they have 25 or 

fewer employees and they are otherwise eligible for a small business tax credit, and navigators will be able to help small business 

owners understand their eligibility for the tax credit and also help 

them in selecting a plan that is good for their employees and for 

their business. 

Mr. CARTWRIGHT. Well, thank you, Mr. Cohen, for helping explain how the navigators assist making our new health care law 

work, and I yield back, Mr. Chairman. 

Mr. JORDAN. I thank the gentleman. 

I now recognize the vice chair, Mr. Gosar. 

Mr. GOSAR. Thank you, Mr. Cohen. 

Thank you, Mr. Chairman. 

I am confused. I am very confused from what I have been hearing from my colleague from Florida and the gentleman just before 

me. I want you to describe this navigator, so I am going to ask you 

a number of questions. Yes or no would be a great answer. 

So you would require a high school diploma, yes or no? 

Mr. COHEN. It is really not a question I can answer yes or no. 

Mr. GOSAR. That makes my point. This is getting complicated. So 

let me ask you, they have to have insurance knowledge, yes or no? 

Mr. COHEN. The grantee recipient has to demonstrate, as part of 

the process for applying, insurance knowledge and also it has to 

maintain that knowledge through the course of informing. 

Mr. GOSAR. I am glad you did that. So what is the checks and 

balances in that educational process? Is somebody coming and visiting with that navigator or is it done online? 

Mr. COHEN. In terms of the course that they are taking? 

Mr. GOSAR. Absolutely. 

Mr. COHEN. The course that they are taking is going to be an online course, just as it is for agents and brokers in many States 

today. 

Mr. GOSAR. And there is no other checks and balance? 

Mr. COHEN. No. So there is a very rigorous grant oversight process that we follow that is the same type of process that we follow 

in all of the grants that CMS administers and HHS administers. 

28 

There will be quarterly and annually reports, there will be financial review, and there can be site visits as well. 

Mr. GOSAR. I understand. I have a limited amount of time. 

The gentleman that you had a conversation with that there are 

special needs so that you are going to have to be very aware of special needs. That does not describe to me somebody that has a very 

simple objective or a basic education, does it not? Oh, by the way, 

I have been doing this for 25 years; I am a dentist. So I have dealt 

with insurance. It is not an easy issue and it is not what 20 and 

30 hours can actually oversee. 

When you are talking about special needs people, it takes an 

awful lot of compassion and actually have walked in their moccasins, as we say in Arizona, a long time to understand how that 

application means. So when you look at 20 to 30 hours, that is inadequate, absolutely inadequate. 

Let me ask you the next question. How can you guarantee for me 

that a convicted felon wouldn’t utilize this information and be actually able to participate as a navigator? 

Mr. COHEN. I don’t see that, really. If you look at the process of 

what organizations and people are going to have to go through to 

get these grants, and you look at the history that we have had of 

doing similar types of programs in Medicare and Medicaid and 

CHIP, where I am not aware of any of those kinds of problems, so 

we can speculate—— 

Mr. GOSAR. No, no, no, no, no. I am glad you brought that up. 

So there is no fraud and deceit within some of these programs like 

Medicaid? In fact, I want you to go back to what we have seen here 

over the last year with deceitful actions in regards to applications 

of processes in Medicaid and Medicare. So let’s not go there. 

Mr. COHEN. But that is not what I said. What I said is I am not 

aware, and would be happy to hear, about problems with application assisters helping people and committing some kind of fraud. 

Mr. GOSAR. Well, I guess what I am getting at, this isn’t a simple 

process, and what you are belaboring here is that this is a simple 

process and that this person can be pretty much anybody looking 

at both health care, as well as insurance. And then the second part 

is we are only going to be dealing with, for the most part, people 

like my colleague from Florida said, actually looking for health 

care. Wouldn’t it be behooving people to sign up because we want 

a bigger pool, like the gentleman that just spoke prior to me in regards said, the bigger the pool, the better insurance rates? So you 

are going to be engaging people who you are engaging on door-todoor knocking, could it be not? 

Mr. COHEN. Outreach and letting people know about the benefits 

of getting health insurance coverage can provide for them is part 

of the function of a navigator, yes. 

Mr. GOSAR. So we are going to come back to this. So we do have 

some minimum requirements for this navigator or assister, do we 

not? 

Mr. COHEN. Yes. 

Mr. GOSAR. And what are those? 

Mr. COHEN. Well, in order to get a grant, they have to demonstrate a track record of work in the community, expertise of the 

29 

personnel who are going to be doing the work, and a plan for how 

they are going to perform the work and a budget. 

Mr. GOSAR. And I want to go back to that working in the community. You said that there is no worry about this information. Well, 

when you give somebody your Social Security number and give tax 

records, which they will be able to access, right? 

Mr. COHEN. The navigator will not be receiving people’s information; the information will be submitted through an application that 

the navigator can assist with, but the navigator is not collecting 

this information. And again I would point out application assisters 

in Medicaid and Medicare and CHIP do the same thing, and Social 

Security numbers are required in those programs as well. 

Mr. GOSAR. Thank you. I am out of time. 

Mr. JORDAN. I thank the gentleman. 

Now recognize the gentlelady from New Mexico, Ms. Lujan Grisham. 

Ms. LUJAN GRISHAM. Thank you, Mr. Chairman. 

And thank you for being here today, Mr. Cohen. I want to do 

maybe a couple of things in reaffirming there are many public programs where we have not only required, but, because we didn’t require it up front, had limited enrollment and misinformation about 

a variety of health care programs from veterans’ benefits to Medicare to senior citizens programs and Medicaid. So I will get back 

to that in a second. 

And I appreciate that, that we want navigators or assisters to be 

accountable and effective so that people get the best information, 

but I am stymied that so far in this hearing we are more concerned 

about background checks and those qualifications for people who 

would be navigators and outreach specialists, than we are for people who would, today, buy a firearm. And I want to point out that 

we have incredible success with outreach and health care benefits 

programs. For example, when we did Medicare Part D, in spite of 

the fact that we had a national hotline and a variety of nationallybased information programs, most States had to provide additional 

supportive information because it was too hard to make the decisions about the independent prescription drug insurance benefits 

that were available. 

For at least 20 years, that I am aware of, States have operated 

in their aging programs health insurance and benefits assistance 

corps. Most States don’t require fingerprinting or background 

checks, they don’t require that folks have to have a high school 

education, maybe a GED; but that they work on is have those folks 

gone through a rigorous training program, do they understand the 

benefits and the complexities between the health care delivery system, private insurance, and the social programs or social insurance 

programs like veterans’ Medicare and Medicaid, so that you can 

help someone navigate those complexities. 

And I would also submit that the high back program was one of 

the most effective programs at identifying fraud and waste, which 

created then the Operation Restore Trust Program. I am going to 

highlight also, and I am going to ask if you are familiar with those, 

that this program was a very successful program for both veterans, 

Medicaid recipients, and Medicare Part D enrollees. 

30 

So we will start there. Are you familiar with the high-back program and related programs by States? 

Mr. COHEN. I am actually not. I am familiar with State health 

insurance and assistance programs and a number of States that 

have provided in-person assistance for people to help them get enrolled in Medicare and Part D. 

Ms. LUJAN GRISHAM. Are you aware that in many States, including New Mexico, we have looked at, for the high-risk pools, because, again, it is also, even though it is a very finite eligibility 

context for those programs, both State high-risk pools and Federal 

high-risk pools, the States have incentivized agents and brokers to 

understand the difference between the Federal pool, the State pool, 

Medicaid, Medicare, Medigap. Because what you want, people who 

have Medicaid have far better coverage than people in a traditional 

insurance plan through the pools. 

Mr. COHEN. Yes. 

Ms. LUJAN GRISHAM. And are you aware of the significant fraud 

or privacy protection problems for any of those States, including 

New Mexico, my home State, who are engaged in those operations? 

Mr. COHEN. I am not. 

Ms. LUJAN GRISHAM. My last context here for questioning, and 

I agree with the statements that have been made before, that if 

you don’t do this outreach, people don’t know. People on Medicare 

cannot describe to you their benefits. People on private insurance 

cannot adequately describe their co-pays, their benefits, their authorizations, their referrals. They have difficulty navigating for 

their own taxes today what was their health care costs or tax 

deductibles that are out-of-pocket versus those that are not. It is 

complicated. We all understand that. 

Are you engaging in specific efforts for a State like New Mexico— 

and I realize I am leaving you very little time—to use navigators 

in places like the Navajo Nation, with 21, if you don’t count the 

Navajo Nation, independent, with independent languages, tribes, a 

large Asian-American and Hispanic community? What are we doing 

to make navigators successful in that context? 

Mr. COHEN. Thank you. As you know, we have an obligation 

under the Affordable Care Act to do tribal consultation, which we 

do on a regular basis, and we are working very closely with the 

tribes to make sure that Native Americans are aware of the benefits of the Affordable Care Act and some benefits of the Affordable 

Care Act that are particular to Indians that are even better than 

are true for the rest of the population. We very much encourage 

tribes to apply to be navigators because we think that would be one 

very effective way that they can reach their community. So that is 

an area that we definitely have put some very particular focus on. 

Ms. LUJAN GRISHAM. I have a few seconds left, Mr. Chairman, 

before I yield back. I would point out that—maybe I am doing the 

opposite clock now, I just saw that. But if I might just finish that, 

Mr. Chairman. 

Mr. JORDAN. You are fine. 

Ms. LUJAN GRISHAM. I might argue with you that the benefits 

under the Affordable Care Act are not more robust for a Native 

American community, but notwithstanding the fact that they are 

sorely under-insured in an Indian health service, and notwithVerDate Aug 31 2005 09:58 Jul 30, 2013 Jkt 000000 PO 00000 Frm 00036 Fmt 6633 Sfmt 6633 C:\DOCS\82107.TXT APRIL
31 

standing frontier and rural access, it is a huge problem; and for my 

State, where we have a more than 21 percent under-insured, with 

one of the poorest and sickest populations in the Country, we are 

going to need navigators and assisters and outreach and education 

efforts to facilitate, which is required under the Act, to facilitate 

enrollment to the highest degree. 

Thank you. No further questions. I yield back. 

Mr. COHEN. And I was just referring, really, to the provisions on 

cost-sharing, which are a little bit different for Indians. 

Ms. LUJAN GRISHAM. Fair enough. 

Mr. JORDAN. I thank the gentlelady. 

Mr. Cohen, Senator Baucus has said implementation of the Affordable Care Act is a huge train wreck. Is he right? And let me 

just say this. He wrote the bill; he has a distinguished career in 

the Senate. He was intricately involved in writing the bill over 

there. He is a guy who comes with some expertise, a number of 

years serving in Congress. So when he says something, it means 

something. Is he accurate? 

Mr. COHEN. I don’t agree with Senator Baucus’ statement. I 

think we are very much on schedule; we are moving forward. We 

are going to be ready October 1st for open enrollment to begin. 

Mr. JORDAN. So Senator Baucus is wrong? 

Mr. COHEN. Well, I am not sure exactly what he is referring to 

or what he meant. 

Mr. JORDAN. He said implementation of the Affordable Care Act 

is a huge train wreck. He didn’t say it is complicated; he didn’t say 

what you said in your opening statement. You said this is a significant undertaking. He could have used that kind of language. He 

didn’t choose to use that language, he said it is a huge train wreck. 

So I am asking is he accurate in his assessment of what is coming 

to the American people. 

Mr. COHEN. I disagree with Senator Baucus’ statement. 

Mr. JORDAN. So the guy who helped write the bill in the Senate 

is wrong. You are saying maybe he is 71 years old, he is losing it, 

he doesn’t have it anymore? What are you saying? 

Mr. COHEN. I disagree with Senator Baucus’ statement. We are 

doing very well; we are moving forward. We just recently completed 

receiving submissions—— 

Mr. JORDAN. Do you think you can do it? Do you think you can 

get ready? 

Mr. COHEN. Yes. We will be ready. 

Mr. JORDAN. Here is my understanding. You don’t start training 

these navigators. They get these navigators, assisters, and the confusion that exists around this. What I do know is the money goes 

out like August 15th, is that right, this year? 

Mr. COHEN. Yes. 

Mr. JORDAN. And then, a few weeks later, they are supposed to 

be out there signing people up. I mean, normally, when you have 

a new product, you don’t need people out there telling folks they 

have to do it; people find out, well, if it is a good product, I will 

sign up on my own. So August 15th this all starts, and then the 

enrollment runs through what, October 1st through March, is that 

right? 

Mr. COHEN. Correct. 

32 

Mr. JORDAN. And you think you can get it all up and running in 

that time, even though the guy who helped write the bill, who was 

intricately involved, has a distinguished career in the Senate, calls 

it a huge train wreck? 

Mr. COHEN. It will be up and running, and it will be ready. And 

I would like to point out navigators are not the only way that people are going to learn about this law and are going to get help. 

Mr. JORDAN. They are learning now. I talk to business guys. 

They are learning now, trust me. We know what is coming. Go 

ahead, I am sorry. I just talked to a bunch of business guys yesterday. 

Mr. COHEN. Agents and brokers are going to be out there helping 

people get enrolled; the insurance industry itself, obviously, has a 

tremendous interest in getting people enrolled. 

Mr. JORDAN. Let me ask another question, another thing that is 

on people’s minds. The American people have heard what Senator 

Baucus called the implementation of this bill. I think they understand what train wreck means versus a significant undertaking. 

But let me ask you this, because in my opening statement I referenced the situation with the Internal Revenue Service, and Ms. 

Norton said that that was a stretch to tie that in, but I just want 

to know, isn’t it true that the Internal Revenue Service is intricately involved with implementing and enforcing the Affordable 

Care Act? 

Mr. COHEN. The Internal Revenue Service has a significant role 

in overseeing tax provisions insofar as they are implicated in the 

Affordable Care Act, not everything about the Affordable Care Act. 

Mr. JORDAN. You just answered Mr. Cartwright’s question that 

one of the things these navigators are going to be out doing is, 

when they talk with small businesses, they are going to be giving 

them tax advice. So there is that component as well. So the IRS 

is involved, significantly, you said, correct? 

Mr. COHEN. The IRS is involved, yes. 

Mr. JORDAN. And I just want to know since they are involved and 

since you are intricately involved in all this, does it trouble you 

what is going on with the Internal Revenue Service, this scandal 

that has been uncovered? Does that trouble you as an American, 

that someone who is involved in putting together the implementation of the Affordable Care Act? 

Mr. COHEN. You know, it is not my job to oversee what the IRS 

does. I don’t see a connection between what I have read in the 

newspaper and what we are doing. 

Mr. JORDAN. Has HHS transferred any Federal tax dollars to the 

Internal Revenue Service for the significant portion that they are 

involved with in enforcing Obamacare? And, if so, how much 

money? 

Mr. COHEN. I don’t believe HHS has transferred money to the 

IRS. I don’t know the answer, frankly. 

Mr. JORDAN. My understanding is it is hundreds of millions of 

dollars that have moved to the Internal Revenue Service for the enforcement of this. 

Mr. COHEN. Well, the Internal Revenue Service certainly has gotten funding for its part of implementing its role in connection with 

33 

the Affordable Care Act. Whether that money came from Health 

and Human Services, I don’t know the answer to that. 

Mr. JORDAN. And as someone who is so involved in this issue, do 

you find it troubling at all that the agency who has a significant 

role in enforcing the Affordable Care Act was systematically targeting groups who came into existence because they initially opposed the Affordable Care Act? And the date that the targeting 

started, according to the inspector general’s report, the date that 

the targeting started was the very month that the Affordable Care 

Act passed, March of 2010. Do you find that at all troubling, as an 

American citizen? First Amendment rights were obviously violated 

in this thing. Do you find that as cause for concern? 

Mr. COHEN. Congressman, I would be happy to have a beer with 

you and talk about what I think as an American citizen, but, sitting here right now, I don’t have a position on what I have read 

in the newspapers about the IRS. I don’t see a connection between 

what I have read in the newspapers and what we are doing. 

Mr. JORDAN. You don’t see a connection at all? 

Mr. COHEN. I don’t. 

Mr. JORDAN. And you don’t think we need to delay the implementation of this, even though the guy in the Senate who was so involved in putting it together, has said it is a huge train wreck? You 

don’t think we need to delay, a suspension, a hold? 

Mr. COHEN. Absolutely not. 

Mr. JORDAN. Okay. 

Mr. CARTWRIGHT. Mr. Chairman, would you yield for a point of 

information? 

Mr. JORDAN. I would be happy to yield to the ranking member. 

Mr. CARTWRIGHT. I would just like to point out that what Senator Baucus said was if the Obamacare is not implemented properly, it will be a train wreck. 

Mr. Cohen, when the chairman asked you that question, did he 

put the question in that context? 

Mr. COHEN. It was a little different. 

Mr. CARTWRIGHT. And, overall, would you agree, if we don’t have 

things like the Navigator Program, that would lead to improper implementation of Obamacare? 

Mr. COHEN. You know, I am sure that many people recall that 

when Medicare Part D went into effect, there were problems in the 

beginning, there were some significant problems in the beginning; 

and I think that was a previous administration to this one. And 

today millions of Americans rely on the benefits that they get from 

that program. 

So I think we ought to look at this like any other big undertaking. Will it be perfect on day one? It may not be perfect on day 

one. We are working day and night to make it as good as it can 

be. We are going to be successful. We are going to be ready on October 1st and millions of Americans will benefit from the work that 

we are doing. 

Mr. CARTWRIGHT. Thank you, Mr. Chairman. I yield back. 

Mr. JORDAN. I appreciate that. I just want to, again, for the 

record, though, the senator used the term train wreck, he didn’t 

use that this was a big concern, this was going to have some probVerDate Aug 31 2005 09:58 Jul 30, 2013 Jkt 000000 PO 00000 Frm 00039 Fmt 6633 Sfmt 6633 C:\DOCS\82107.TXT APRIL
34 

lems, this was going to take some time. He said train wreck. And 

that was why I had the line of questioning I did. 

With that, would yield to the gentlelady from Illinois, Ms. 

Duckworth. 

Ms. DUCKWORTH. Thank you, Mr. Chairman. 

Mr. Cohen, how are you this morning? 

Mr. COHEN. Good. Thank you. 

Ms. DUCKWORTH. Great. Health insurance availability and costs 

are a huge concern for small businesses, and in my district I have 

a large percentage of small businesses. One of the things that 

small businesses face is that they have less bargaining power than 

large companies and they generally pay higher prices for insurance, 

if they can afford it at all. 

I was very disappointed when, earlier this year, CMS decided to 

delay the requirements to make more poor health plans available 

for small business workers in the Small Business Health Option 

Program, the SHOP Program. I have heard a lot of anxiety from 

small businesses in my district about how the health care law will 

affect them. This provision has real promise, when it gets implemented, to improving the status quo for small businesses, since 

most of them are only currently able to offer their employees access 

to a single health plan that the employer themselves select. 

Could you comment on the reason for this delay and how do you 

expect the delay to effect the attractiveness of the exchanges? 

Mr. COHEN. Thank you. We are committed to providing employee 

choice through the SHOP. We are mindful of the significant undertaking we have ahead of us, and this really was a strictly operational decision that we had to make in terms of what we are able 

to accomplish for year one, and we reached the conclusion that it 

was the more prudent thing just to delay it for a year. We are committed to it, we believe it is important, and we will put it into effect, but it was really just a matter of the difficulty we had of getting it into place in time for this October. 

Ms. DUCKWORTH. Thank you. We have been discussing the importance of the Navigator Program and how we need to certainly 

make sure it is implemented in the best way possible for optimum 

results. With regard to the Navigator Program and other outreach 

efforts, can you elaborate on the Administration’s plans to ensure 

that the information is accessible and usable by people with disabilities? 

Mr. COHEN. Yes. That is one of the factors that will be scored in 

applying for grants under the Navigator Funding Opportunity Announcement, is both a track record and a plan to reach more difficult-to-reach, more vulnerable communities, in particular the disabled. And then through the application review process and the 

grant decisions we will definitely be looking to provide grants to organizations that can fill that need. 

Ms. DUCKWORTH. Thank you. You know, one of my highest priorities is to ensure that my constituents have access to affordable, 

quality health care. It is what my constituents have told me over 

and over again that they want. I am concerned, however, by reports that say that the majority of Americans who are eligible for 

assistance to help them afford health care are still unaware of how 

they can benefit from the law. It seems to me that with the October 

35 

1st enrollment date quickly approaching, you have a big communications problem on your hand, and you alluded to that. 

Could you speak a little bit on the Administration’s readiness to 

reach out to this huge number of people so that they can enroll in 

time? Basically, you say that you are going to be ready to go on 

October 1st, and you need to be. If not, what do you need in order 

to get ready and have a successful rollout of these provisions? 

Mr. COHEN. So we have a plan in place that basically is timed 

so that people are getting the information close to the time in 

which there is something that they can do with it. So right now we 

are in what we call the education phase, which began in January 

and proceeds through June, where we are just putting out information. We are in the process of re-purposing the HealthCare.gov site 

to be really a consumer information site. Our call center will be 

going live in June, where people will be able to call and get information that way. And then starting in the summer we will begin 

what we call the anticipation, or get ready phase. And I am not an 

expert in these things, but what I understand is that if you start 

too early and then people say, well, what do I do, and then there 

is nothing that they can do because it is too soon, then you may 

end up having people who get a little bit kind of frustrated or disappointed. 

So we really are gearing towards making sure the people get the 

information they need in time for October, when they actually can 

take action and begin to get enrollment coverage. 

Ms. DUCKWORTH. Thank you, Mr. Cohen. 

I yield back my time, Mr. Chairman. 

Mr. GOSAR. [Presiding.] I thank the gentlelady. 

I will yield to the gentleman from Tennessee, Mr. Duncan. 

Mr. DUNCAN. Thank you, Mr. Chairman. 

Medicare ended up costing 12 times more than what was predicted after its first 25 years of operation. The cost of Medicaid exploded even more than that, as Chairman Jordan mentioned in his 

opening statement. The estimated cost for Obamacare, now the unAffordable Care Act, are now double or triple what was originally 

estimated. All other Federal medical programs have gone far beyond what was originally predicted with the low-ball front end estimates. And, of course, Speaker Pelosi was famously quoted as saying we would have to pass Obamacare before we could find out 

what was in it. But the more we find out, the more complicated, 

confusing, and convoluted it becomes. And we are told we have to 

hire 16,500 more agents for the Internal Revenue Service to enforce 

the law, and possibly thousands of navigators and assisters. 

But I want to go in a little different direction, and that is the 

solicitation of the contributions by the Secretary. The Washington 

Post story on this says, but the industry official who had knowledge of the cause, but did not participate directly in them, said 

there was a clear insinuation by the Administration that the insurers should give financially to the nonprofits. Meredith McGehee, 

policy director for the nonpartisan Campaign Legal Center, which 

researches government ethics issues, said she was troubled by 

Sebelius’ activities because the Secretary seemed to be ‘‘using the 

power of government to compel giving or insinuate that giving is 

going to be looked at favorably by the government.’’ 

36 

The New York Times story said, but several executives said they 

were uncomfortable with the discussions because the Federal Government has the power to approve or reject the health plans they 

want to sell in insurance markets that will be run by Federal officials in more than 30 States. Health care executives said they were 

reluctant to make big contributions for several reasons, including 

the fact that insurers are required to pay more than $100 billion 

in new taxes over the next 10 years to help defray the cost of expanded coverage. Direct companies must pay new fees totaling $34 

billion over the same period. 

As you can see, my main concern, Mr. Cohen, are the costs. But 

do you know did the Secretary request a legal opinion about the 

propriety of soliciting donations? 

Mr. COHEN. I can’t speak to the specifics of what the Secretary, 

any conversations she had or what she did because I don’t know. 

It sounds like the person quoted in the story doesn’t know either, 

because they say they weren’t on the phone, but they just heard 

about it from somebody else. 

What I can tell you, though, is that during Medicare Part D, 

which was put into place by a previous administration, the Department worked with a wide array of groups, including AARP, 

PhRMA, the National Alliance for Hispanic Health, the National 

Association of Area Agencies on Aging to do outreach and to help 

people get enrolled in coverage in Medicare Part D. That is what 

they did with Medicare Part D. It is called a public-private partnership, and it can be a very effective way of reaching out into the 

community and helping people learn about a program and what it 

can benefit for them. That particular partnership, which was called 

La Promesa, operated to do one-on-one outreach in 17 different 

States. So that is what they did with Medicare Part D. 

Mr. DUNCAN. All right. Let me ask you something else that 

Chairman Jordan mentioned. He mentioned the loss of jobs and the 

fact that many companies are cutting people’s hours back so they 

don’t go over the 30 hour limit, and once again The Washington 

Post had this, said because of this Cook Medical-Boston Scientific 

extractor corporation, Medtronic, Covidien, and Zimmer Companies 

have all cited the medical device tax is the reason for building 

plants in China, Mexico, Ireland, and Costa Rica, and for laying off 

hundreds of U.S. workers, 1,000 in the case of Stryker. Several of 

these companies, possibly all, have already planned charges 

against earnings ranging from $50 million to $175 million. 

Have you looked into this part of the law? 

Mr. COHEN. I am not familiar with what those companies have 

done or the decisions that they have made, no. 

Mr. DUNCAN. All right, before my time runs out, how many different companies and unions and businesses and governments have 

requested waivers from the law and how many have been granted? 

Mr. COHEN. I would have to get you that information; I don’t 

know it off the top of my head. The only waiver program that we 

had was a waiver from the annual limits provision to allow companies that offered coverage to their employees, to keep that coverage 

until January 1 of 2014. But I couldn’t give you the number. But 

it is on our website, I know that. 

Mr. DUNCAN. Okay, thank you very much. My time is up. 

37 

Mr. JORDAN. [Presiding.] I thank the gentleman from Tennessee 

and now recognize the gentleman from Nevada, Mr. Horsford. 

Mr. HORSFORD. Thank you, Mr. Chairman. 

Thank you for being here, Mr. Cohen. I am from Nevada and we 

actually have a governor, who happens to be a Republican, who is 

working to implement this bill, so I am going to focus on what we 

can do and what we can’t in my questioning. 

As you know, Nevada has been working hard to set up our exchange and to develop training and certification requirements for 

the Navigator Program. We are already in the process of training 

navigators; however, it is my understanding that States are still 

waiting for CMS to finalize its proposed rule on standards for navigators and the non-navigator assistance personnel. 

Can you give us an idea of when we can expect a final rule on 

that so that the States who are working to implement this bill can 

continue to do so on time and on track? 

Mr. COHEN. I know that we are working through the comments 

that we received to the proposed rule, and while I can’t give you 

a specific date, I expect that the final rule will come out very soon. 

Mr. HORSFORD. Also, my particular district in Nevada is sparse, 

it represents both rural and urban interests, and it takes over six 

hours to drive from one corner of my district to the other, so one 

of my concerns is the implementation in ensuring that all constituents are able to access information, even the struggle that we have 

around online. I have communities that literally have very little 

broadband connectivity. So what is being done to ensure that ACA 

implementation information is being disseminated to rural communities in particular? 

Mr. COHEN. I think it is a really good question, and obviously 

there are parts of the Country where broadband access is an issue 

and where it is not going to be practical for someone to come doorto-door, given the distances involved and the population density. I 

think for those people it is probably going to have to end up being 

a paper application, and they will probably have to get the help 

that they need through the call center, which will be operational 

beginning in June, 24 hours a day, 7 days a week, and will be there 

to provide people with assistance over the phone who don’t have access to online help. 

Mr. HORSFORD. And is that an 800 number? 

Mr. COHEN. You know, I actually don’t know what their phone 

number is. It is being launched in June and the information will 

be out. 

Mr. HORSFORD. And what type of personnel will be trained to 

deal with different languages? 

Mr. COHEN. There will be access to translation services, and 

don’t hold me to the exact number, but it is going to be a large 

number of languages through a translation service that will be 

available. 

Mr. HORSFORD. I want to follow up on something my colleague, 

the gentlelady from New Mexico, talked about, the fact that health 

insurance is complicated to begin with, it doesn’t matter what type 

of program, if you are a private payer or not. But one of the areas 

that the navigators are supposed to respond to is specifically the 

uninsured individuals who may have never been in an insurance 

38 

program and are unfamiliar with coverage options. How will navigators respond to this population of uninsured specifically? 

Mr. COHEN. So that is a great question, and part of the training 

and then what the navigators will be doing is to provide very basic 

information on how health insurance works; what benefits are, 

what is covered, what is not covered; what deductibles are; what 

cost-sharing is, co-insurance, co-pays. And then, as you know, once 

you get to the point where you are choosing what plan to buy, the 

Affordable Care Act requires a couple things that do make it a little bit easier: one, all plans have to have essential health benefits 

so that there is a continuity across plans as far as what is covered; 

and then, secondly, we have these medal levels, so you have the 

bronze, silver, gold, platinum, and the navigator can help walk 

through with the person what are your medical costs typically in 

a year? If you have high medical costs, you might want to pay a 

little bit more in premium, but get less of a deductible. If you have 

not a lot of medical costs in a typical year for your family, you 

might want to go with the bronze plan, which will be less expensive, but the deductible will be higher before coverage actually 

kicks in. 

And that is the kind of information the navigators will be trained 

in to be able to help their neighbors in understanding this transaction. 

Mr. HORSFORD. I am out of time. I do have some additional questions I would submit for additional responsible. I just hope that we 

will work in this Oversight Committee to figure out ways to implement this bill and to help States like Nevada, who actually want 

to do it right. Thank you. 

Mr. GOSAR. [Presiding.] I thank the gentleman from Nevada. 

I now yield the floor to the gentleman from Tennessee, Dr. 

DesJarlais. 

Mr. DESJARLAIS. Thank you, Dr. Gosar. 

Thank you, Mr. Cohen, for being here today. I was listening to 

your conversation a bit earlier with Mr. Cartwright about how the 

more people you get into a health care pool, the cheaper it makes 

it for everyone. Is that your understanding or your belief? 

Mr. COHEN. Well, it is the mix as well as the number, right? So 

generally we expect that folks who have a lot of health care costs 

will find their way to us and will get enrolled in coverage. 

Mr. DESJARLAIS. Okay, that is a good point. 

Mr. COHEN. We really want to reach out to the young and the 

healthy folks who may not appreciate the need for health insurance, and yet if, unfortunately, something were to happen to them 

and they were to get sick or be in an accident, they would need it. 

Mr. DESJARLAIS. Okay, so people who have preexisting conditions 

or health problems, they have a hard time getting insurance now 

why? 

Mr. COHEN. Because, if they are covered by their employer, they 

are okay; but if they are not covered by their employer and they 

are out in the individual market—— 

Mr. DESJARLAIS. It is very expensive, right? 

Mr. COHEN.—a health insurer may decline to write them at all 

or it will be very expensive. 

39 

Mr. DESJARLAIS. So the insurance companies cherry-pick in order 

to be profitable; they keep these people out. And what is frightening to me is who decides what a preexisting condition is. It is 

really the people who are trying to make the money, the insurance 

companies. We think of preexisting conditions as cancer, maybe 

previous heart disease, but it actually can be defined as anything 

from acne to hemorrhoids. And anyone in here either has or is 

going to have a preexisting condition, so it is going to get more expensive. And the whole problem with our health care system is 

that it is too expensive right now and it is unaffordable for too 

many people. So to have this discussion that bringing a bunch of 

people in, especially the most expensive people, is going to somehow make it cheaper for everyone is just simply false. I have been 

in health care for over 20 years and I can tell you that is not going 

to be the case. 

But there are a couple things I want to talk about. Do you think 

that the statutory authority that you described here to create the 

navigator/assisters is ambiguous or is it pretty clear, the statutory 

authority? 

Mr. COHEN. You know, I am not the lawyer, but we are confident 

and believe that we have the statutory authority to do the program 

that we propose. 

Mr. DESJARLAIS. Okay, the Health and Human Services created 

the Assisters Program solely through the rule-making process, and 

HHS officials admitted to the committee staff that there is no statutory authority for the Assisters Program. Are you discounting 

what HHS said to the committee? 

Mr. COHEN. Well, I wasn’t there, so I can’t tell you what they 

said or they didn’t say. What I am telling you in my testimony is 

that we have authority for that. 

Mr. DESJARLAIS. So you don’t know whether they misled the 

committee or not. 

Mr. COHEN. Well, I am sure that they didn’t mean to mislead the 

committee. 

Mr. DESJARLAIS. Well, they said they didn’t have statutory authority and you are saying you do, and I am asking you if it is clear 

or ambiguous. Can you answer whether it is clear or ambiguous? 

Mr. COHEN. No. I just don’t feel comfortable characterizing it one 

way or the other. 

Mr. DESJARLAIS. So basically, every time we run into a hitch, 

rather than go through Congress, we just circumvent Congress and 

we just make the rules to make it fit, we try to put a round peg 

in a square hole. And that is what has been going on with this bill 

because it was poorly written. We heard the other side testify that 

this is the law of the land. Well, sometimes bad laws are written, 

and this is a case of a bad law. And to think that it is going to 

be ready to implement by October is just ridiculous, considering the 

involvement of the IRS, and the fact that we are having to create 

assisters to be funded in a different fashion than what navigators 

are shows that there is a real flaw here, too, as well. 

I wanted to get to one more point. The proposed rule requires 

navigators to recruit, support, and promote a staff that is representative of the demographic characteristics of communities in 

40 

their service area. However, HHS has yet to reveal how they plan 

to enforce this provision. 

Okay, so my question is the proposed rule requires navigators 

and assisters staff to be representative of the demographic characteristic of communities in their service area. What are the specific demographic characteristics that HHS is referring to? 

Mr. COHEN. I don’t know what we have defined then any more 

specifically than that, but I think the goal is—navigators are going 

to help whoever comes to them, regardless of what their demographic characteristics are. But we want the navigators to reflect 

the community in which they will be working. That is the purpose. 

Mr. DESJARLAIS. Okay. 

I have no further questions. 

Mr. GOSAR. I thank the gentleman from Tennessee. 

The gentlelady from Illinois is recognized. 

Ms. KELLY. Thank you, Mr. Speaker. 

Thank you, Mr. Cohen, for being here. The majority has suggested that the Navigator Program is somehow unprecedented and 

has suggested a parade of horribles that will result from community organizations and nonprofits providing consumers with information so they can get enrolled in affordable, high-quality health 

insurance plans. I wanted to ask you what types of organizations 

can apply for Navigator grants under the Funding Opportunity Announcement that CMS has released? 

Mr. COHEN. A broad variety of different types of organizations 

can apply: faith-based organizations, Native American tribes, 

chambers of commerce, community nonprofits. 

Ms. KELLY. So really the whole gamut? 

Mr. COHEN. Really, the whole gamut that reflects the great diversity and public activity of America. 

Ms. KELLY. Does the Navigator Funding Opportunity Announcement look at the organization’s ties to the community and history 

in the community in which it operates as important factors in the 

review criteria? 

Mr. COHEN. It absolutely does, yes. 

Ms. KELLY. And doesn’t CMS have prior experience with exactly 

this type of program? 

Mr. COHEN. We do. We have been involved with similar programs for Medicare for Part D, for Medicaid, and for CHIP. 

Ms. KELLY. Okay. Because I was going to say isn’t it true that 

the community-based application assisters under the State Children Health Insurance Program back in the late 1990s. 

Mr. COHEN. Exactly so. 

Ms. KELLY. How successful would you say these organizations 

are in getting children enrolled in the State Children Health Insurance Program? 

Mr. COHEN. I think they have been very successful. 

Ms. KELLY. Thank you. It seems like CMS is on sound footing 

and relying on its experience in establishing this grant program. 

We need to do everything we can to ensure that consumers are 

made aware of all their health insurance options and that they 

choose a plan that is right for their family. The Navigator Program 

is an important component, in my opinion, of this process. Thank 

you. 

41 

Mr. COHEN. Thank you. 

Mr. CONNOLLY. Would the gentlelady yield? 

Mr. GOSAR. Yes. She yields. 

Mr. CONNOLLY. I thank my colleague. 

Mr. Cohen, is there a confirmed head of CMS? You are the deputy administrator and director. 

Mr. COHEN. I believe Ms. Tavenner was confirmed last week to 

be the administrator of CMS, yes. 

Mr. CONNOLLY. And have you been showered with appropriations 

to implement the Affordable Care Act? 

Mr. COHEN. We have not. 

Mr. CONNOLLY. In fact, is it not true that the majority has refused to provide your department with any funds for implementation? 

Mr. COHEN. Yes. I mean, we have the funds that were provided 

under the bill when it was enacted. 

Mr. CONNOLLY. Originally. 

Mr. COHEN. Originally. But that has been the extent. 

Mr. CONNOLLY. We have a new majority in this Congress. 

Mr. COHEN. Yes. 

Mr. CONNOLLY. And is it not also true that the majority here in 

the House has voted, just last week, for the 37th time, to try to repeal, in whole or in part, the Affordable Care Act? 

Mr. COHEN. That is my understanding, yes. 

Mr. CONNOLLY. Well, so you have $54 million left over in grants 

for the Navigator Program to try to implement the exchanges, is 

that correct? 

Mr. COHEN. That is what we have put out in this grant application, yes. 

Mr. CONNOLLY. Do you know what the Yiddish word chutzpah 

means, Mr. Cohen? 

Mr. COHEN. I do. 

Mr. CONNOLLY. Might one just observing not want to apply that 

word to the alleged concern being expressed here today by some 

who have made it their lifelong effort to repeal Obamacare and to 

make sure that you don’t have a dime to implement it, to suddenly 

show great concern as to whether it will be implemented well? 

Might that fit the Yiddish definition of chutzpah, Mr. Cohen? 

Mr. COHEN. I think I will leave that to you, congressman. 

Mr. CONNOLLY. Well, growing up, I was known as the Little 

Rabbi; I worked in a restaurant called The Pumpernickel, so I take 

credit for understanding what chutzpah means. And if it means 

anything, it certainly has application to this hearing. It is a bit 

much to have people lecture you about how well or poorly it is 

going to be implemented who have spent every waking hour trying 

to make sure you can’t implement a law that they could not defeat 

fair and square on the floor of the House in 2009. 

Mr. COHEN. I will say we can use all the help we can get from 

anyone who is interested in seeing us do the job well. 

Mr. CONNOLLY. Thank you. 

And I thank my colleague for yielding. 

Mr. GOSAR. The gentlelady yields back. 

Just to make a comment here, we are comparing apples and oranges. When we are talking about CMS and S-CHIP, it is the same 

42 

plan that you are providing across the board. This is not the same 

plan. These will have different deductibles. It is much more authoritative and interpretive in regards to those benefits. So it isn’t the 

same program. 

I yield to the gentleman from North Carolina, Mr. McHenry. 

Mr. MCHENRY. Well, thank you. And I certainly would point out 

to my colleague that we did succeed in passing a repeal of 

Obamacare out of the House. The gentleman says in 2009 we lost 

the vote, but we have won multiple—he referenced 37, so we have 

won those 37 votes. It would be great if we had some folks on the 

other side of the Senate comply with that and actually do what is 

reasonable and right, and address these concerns. 

The reason why we are trying to address concerns with you, sir, 

is that we have deep concerns about this program and what is happening. My colleague, Mr. Duncan, referenced a press report about 

Secretary Sebelius making multiple phone calls to solicit fund-raising from—and you can flip to your notes on this, and I would certainly appreciate your answer on it—but soliciting funds from 

health insurance folks, pharmaceutical executives, hospitals, to donate large sums to Enroll America to fund the implementation of 

Obamacare, the outreach effort. Are you aware of this? 

Mr. COHEN. No, I don’t know what the Secretary did or didn’t do, 

so I can’t comment on it. 

Mr. MCHENRY. Are you aware that the Secretary made these 

calls? 

Mr. COHEN. No. 

Mr. MCHENRY. Is this the first time you have heard this being 

brought up? 

Mr. COHEN. I have seen it in the media. 

Mr. MCHENRY. Oh. Let me give you an opportunity to restate 

this. Have you heard or read about Secretary Sebelius making 

fund-raising calls for Enroll America? 

Mr. COHEN. I have read some stories about Secretary Sebelius 

and Enroll America, yes. 

Mr. MCHENRY. Okay. 

Mr. COHEN. But I don’t know what she did or didn’t know because I am not privy to what she did or didn’t do, so I can’t comment on it. 

Mr. MCHENRY. Okay. I just wanted to make sure we had it correct on the record, and you can correct the record that you have 

heard about it, because we certainly have and my constituents 

have. I have gotten a lot of questions about it. 

But are you aware if the Secretary or any HHS staff has official 

legal opinion on the propriety of this, soliciting donations? 

Mr. COHEN. I don’t know. 

Mr. MCHENRY. You don’t know? Okay. 

So are you going to take specific steps to ensure that there is not 

one favoring of a business that gave to this effort or this organization, Enroll America, that that group isn’t favored over one that 

said no to the Secretary? 

Mr. COHEN. Well, I am not aware that anyone was asked, gave, 

said yes, said no. I don’t know any of those things, so I am not in 

a position to favor anybody or not favor anybody because I am not 

aware that any of that happened. What I can tell you, as I menVerDate Aug 31 2005 09:58 Jul 30, 2013 Jkt 000000 PO 00000 Frm 00048 Fmt 6633 Sfmt 6633 C:\DOCS\82107.TXT APRIL
43 

tioned before, is that public-private partnerships to help promote a 

new program, such as was done in Medicare Part D, where AARP 

and PhRMA were involved with CMS in efforts to help get information out about a prescription drug program that presumably the 

members of PhRMA stood to gain by, that is something that has 

been done in the past. I think public-private partnerships can be 

a very effective way. 

Mr. MCHENRY. Have you done any of that? 

Mr. COHEN. I have not. 

Mr. MCHENRY. You have not undertaken that. Okay. So there is 

legal authority to do that? 

Mr. COHEN. I haven’t asked for any legal authority. I haven’t 

done it, so I don’t know the answer to your question. 

Mr. MCHENRY. Okay. And you are not aware of any persons or 

individuals who are participating in this effort? 

Mr. COHEN. I am not. 

Mr. MCHENRY. You are not. Okay. So you don’t know how closely 

HHS is working with Enroll America on this advertising effort? 

Mr. COHEN. I don’t. 

Mr. MCHENRY. Okay. So you had no input on this Enroll America process? 

Mr. COHEN. I have no input with respect to Enroll America at 

all. 

Mr. MCHENRY. Okay. Okay. Now, this is interesting. In The New 

York Times it said a number of executives felt a bit uncomfortable 

with these calls. And the reason why we ask, Mr. Cohen, is because 

many of us did not ask questions of the IRS, and we found disclosures now about what happened in that whole process with IRS 

undertaking targeting of certain political groups. So we just want 

to confirm that that is in fact the case, and that is why I ask these 

series of questions. 

Mr. COHEN. Understood. 

Mr. MCHENRY. And if you want to correct the record for anything, I have 20 additional seconds, if I have not given you ample 

time. 

Mr. COHEN. Nope. 

Mr. MCHENRY. Okay. Well, I certainly appreciate that, and I just 

call the folks attention. The press reports say the Secretary was 

making these fund-raising calls. We hope that, at the end of the 

day, the groups that said no will not be targeted for retribution by 

either Secretary Sebelius or the Health and Human Services Department or the folks that are implementing Obamacare. This is a 

deep concern Americans have about their privacy and what their 

government can do to them if they say no or try to act counter to 

the wishes of those in powerful positions. 

With that, I yield back. 

Mr. GOSAR. I thank the gentleman for yielding and I acknowledge the gentlewoman from California, Ms. Speier. 

Ms. SPEIER. Thank you, Mr. Chairman. 

Mr. Cohen, it is great to see you. 

Mr. COHEN. It is great to see you too. 

Ms. SPEIER. Unlike most of the members here on the panel, I 

have worked with you before. I know what a great talent you are, 

44 

how you served California very well in the Department of Insurance, so we are very lucky that you are with us. Thank you. 

Mr. COHEN. Thank you. 

Ms. SPEIER. Is it true that the Affordable Care Act passed the 

Congress? 

Mr. COHEN. Yes. 

Ms. SPEIER. Is it also true that President Obama was re-elected? 

Mr. COHEN. He was. 

Ms. SPEIER. So isn’t it our obligation to then implement that law? 

Mr. COHEN. It is, and we are doing that every single day. 

Ms. SPEIER. All right. So what keeps you up at night in terms 

of your ability to implement that law? 

Mr. COHEN. We would like to have more funding. That would be 

helpful. And we would like to have less distraction. 

Ms. SPEIER. All right, let’s talk about one of the concerns that my 

Republican colleagues have about the grantees that serve as navigators or non-navigator assisters. My understanding is, and based 

on your written testimony, that qualified, unbiased, expert contractors will review all applications using an evaluation rubric developed by HHS which will be scored and statistically ranked. Will 

you explain that process and some of the factors that have gone 

into that consideration? 

Mr. COHEN. I would be happy to. So this is a process that we undertake in connection with our Office of Acquisitions and Grant 

Management at CMS; it is a longstanding process, it is not new to 

this particular grant. And they work with us to make sure that we 

put out a Funding Opportunity Announcing that is clear and complies with the law, and that people can submit applications for. 

Then they help us, through a contractor, select review panels that 

are people who know about the area that we are involved with, 

who don’t work for HHS or CMS, and then they score the applications based on very specific criteria that are set forth in the announcement that include what type of organization it is, its ties to 

the community, its previous accomplishments, the expertise of its 

personnel, just how good an application and budget they have submitted, all those things; and they score it on a 1 to 100 scale so 

we get this objective view of the strength of each applicant. And 

then they do a summary for us that basically says here are the 

strengths, here are the weaknesses, as we move forward to make 

the selections. 

Ms. SPEIER. So this is very similar to the selection process used 

for other grantees in HHS. 

Mr. COHEN. Exactly. 

Ms. SPEIER. All right. So nothing different, nothing that is going 

to show bias; very objective, correct? 

Mr. COHEN. Correct. 

Ms. SPEIER. All right, let’s go on and talk about training. As I 

understand it, there are some training standards that will require 

up to 30 hours of training in 15 different categories of health care 

topics. Furthermore, as you explained in your written statements, 

navigator grant awardees would have to pass an exam prior to beginning to help consumers. 

Based on all of this, I get the impression that the training requirements in this actually exceed the training requirements that 

45 

States require for licensing of health insurance agents and brokers, 

is that true? 

Mr. COHEN. I think they are at least as much as what most 

States require. They are more than some States require. In some 

States there isn’t any pre-licensing education that is required; you 

have to pass a test, but you don’t actually have to take a course. 

So, yes, I think that this training compares very favorably to what 

States require for agents licensing. 

Ms. SPEIER. And the funding to provide this training you have? 

Mr. COHEN. Yes. 

Ms. SPEIER. All right. Would you tell us a little bit more about 

the program that has been developed in HHS that will ensure that 

we will have skilled individuals who will be assisting consumers? 

Give us some idea of what the training components will include. 

Mr. COHEN. So the training components will range from just sort 

of very basic health insurance knowledge and knowledge of the 

health insurance market; to benefits and what is covered by health 

insurance policies, and specifically the essential health benefits 

that are required to be covered by the Affordable Care Act; to costsharing, deductible, co-insurance, co-pay, and how that relates to 

the premiums that people will have to pay and the different medal 

tiers that plans have under the Affordable Care Act. It is also going 

to require training in public programs, because some of the people 

who come to navigators will be eligible for Medicaid or CHIP, and 

they will have to have an understanding of how that works as well 

based on adjusted gross income. And then it will also include training in the entire process of helping someone through an application 

through to the shopping experience and choosing a plan. 

But it is very important to note that they will not be making recommendations, they will not be telling people this is the plan I 

think is best for you; it is purely objective information that they 

will be providing. 

Ms. SPEIER. Thank you. 

Mr. GOSAR. I thank the gentlelady for yielding back. 

Mr. Cohen, can you make those training modules accessible to 

the committee? 

Mr. COHEN. You know, we are working on them right now. 

Mr. GOSAR. So they don’t exist. So this is theory right now. 

Mr. COHEN. We are working on them right now, and we would 

be happy to get them to you. 

Mr. GOSAR. And do you have a date in mind? You know, we talk 

about that we are going to be on time here. Can you tell me when 

you expect to have them done and when we can actually have them 

in possession by the committee? 

Mr. COHEN. Well, as was noted earlier, the grants go out in August, and that is when the training will begin. So the training will 

be complete and ready prior to that. I can’t give you a specific date, 

but we are happy to work with you to get you whatever information. 

Mr. GOSAR. We would like to have a constant dialogue, so we 

would like to have those modules. 

Mr. COHEN. Absolutely. 

I would like to recognize the gentleman from Michigan, Mr. 

Bentivolio. 

46 

Mr. BENTIVOLIO. Thank you, Mr. Chairman. 

Boy, have I got a lot of questions. Thank you, Mr. Cohen, for 

coming in today and testifying. 

Mr. COHEN. Sure. 

Mr. BENTIVOLIO. You had talked earlier, and I am a bit confused. 

Maybe you can straighten me out here. You said that the assisters 

don’t obtain confidential privacy information from those who are 

applying, correct? 

Mr. COHEN. They don’t retain any. The information is put by the 

person who is filling out the application, either on paper or online, 

but the person who is helping them doesn’t keep that information, 

because it just goes directly from the person who is applying 

through the system and the navigators will be instructed they are 

not to retain any personal information belonging to the people they 

are helping. 

Mr. BENTIVOLIO. With that said, even though California has a 

law that says that assisters have to have a background check? 

Mr. COHEN. Yes. 

Mr. BENTIVOLIO. And you also said that if somebody does misuse 

that privacy information, there is a $25,000 fine? 

Mr. COHEN. Correct. 

Mr. BENTIVOLIO. And who investigates and enforces the assisters, the IRS? 

Mr. COHEN. No. It is our grant, so CMS will be doing the oversight with respect to the federally-facilitated marketplaces, and 

then the States will be doing it with respect to the State marketplaces. 

Mr. BENTIVOLIO. So even though it goes on a computer or on 

paper, the assisters aren’t supposed to retain it. 

Mr. COHEN. That is right. 

Mr. BENTIVOLIO. But I am a little concerned when you—maybe 

I misunderstood, and you could clarify to me the qualifications to 

be an assister. When he asked you have to have a high school education, you didn’t really answer that question. I mean, what are the 

requirements for being an assister; social worker, prior experience 

selling insurance? 

Mr. COHEN. Well, in the navigator grant process, you have to 

demonstrate both a track record and expertise of the people who 

are going to be performing this function. So whether someone could 

qualify who wasn’t a high school graduate, I can’t say. I don’t believe that that is going to be the norm, no. 

Mr. BENTIVOLIO. Okay. And you said how many hours of training 

in modules? 

Mr. COHEN. Twenty to 30 hours. 

Mr. BENTIVOLIO. Twenty to 30 hours. I think that is the amount 

of time you need to study HIPPA, if I remember what my wife told 

me. She has been a nurse for 33 years. 

Mr. COHEN. Okay. 

Mr. BENTIVOLIO. So 20 to 30 hours? 

Mr. COHEN. Yes. 

Mr. BENTIVOLIO. How tall are you? 

Mr. COHEN. How tall am I? I am about 5’6. 

47 

Mr. BENTIVOLIO. Five foot six. Okay. I am 5’11, just short of 6’. 

Do you know how many pages are in the new regulations for the 

un-Affordable Health Care Act? 

Mr. COHEN. I don’t. 

Mr. BENTIVOLIO. Okay. It is 20,000. Can we get that up? 

Mr. COHEN. There it is. 

Mr. BENTIVOLIO. There it is. Seven foot tall. And you expect an 

assister who is going to assist people on this un-Affordable Health 

Care Act to understand 20,000 pages of new regulations? 

Mr. COHEN. No, I don’t. They are not going to have to read all 

those regulations, and neither does an insurance agent have to 

read every—— 

Mr. BENTIVOLIO. Somebody does. And they have to digest that information to put it in these modules. Twenty thousand pages. 

Mr. COHEN. They will have the information that they need to 

help people understand the benefits of the law and get enrolled in 

coverage. That is what they need to do. They don’t need to understand every aspect of what it takes to implement the Affordable 

Care Act. They will have the information that they need. 

Mr. BENTIVOLIO. In reference to Congressman Connolly’s definition of chutzpah, if I remember right, I wasn’t a member of Congress at the time, but I remember my definition of chutzpah is saying something like you have to pass the bill before you can read 

it. In fact, truth in labeling, we would have said you have to pass 

it before you even write it, or something along those lines. Now, 

that takes a lot of chutzpah. And calling it a constitutional right, 

when in fact the Supreme Court said it was a tax, right? Didn’t the 

Supreme Court the un-Affordable Health Care Act is a tax? 

Mr. COHEN. I believe the Supreme Court upheld the individual 

responsibility penalty as a tax. 

Mr. BENTIVOLIO. Yes. It kind of reminds me of walking into a department store, not buying anything, and meeting the IRS agent 

outside and he says, hey, you have to pay a tax for not buying anything. You are taxed on failing to engage in commerce or buying 

any type of insurance under this program, correct? 

Mr. COHEN. People who are required to have health insurance 

under the law may be penalized if they don’t have insurance under 

the law. 

Mr. BENTIVOLIO. So they are going to be taxed for failing to engage in commerce, correct? Yes or no? I am running out of time. 

Mr. COHEN. I can’t argue with you what Chief Justice Roberts 

decided in the case; he decided what he did. 

Mr. BENTIVOLIO. It takes a lot of chutzpah to do that to the 

American people. 

I could use more time, but I yield back. 

Mr. GOSAR. I thank the gentleman. 

I would like to recognize the gentleman from Georgia, Mr. 

Woodall. 

Mr. WOODALL. Thank you, Mr. Chairman. 

Thank you, Mr. Cohen, for being here today. I am relatively new 

in Congress and I was not here when we voted on the bill and I 

did not read it. Your testimony titled Navigators and Assisters Programs, the copy that I have talks a lot about the Navigators Program but does not talk a lot about the Assisters Program. We have 

48 

talked about the requirements for participating in the Navigator 

Program, how those grants go out the door. Where will I look to 

find the answers to what those regulations and requirements are 

for participating in the Assisters Program? 

Mr. COHEN. So we will be coming out with a final rule. Right 

now the Assisters Program is in a proposed rule, and we are reviewing comments and will be coming out with a final rule soon. 

Mr. WOODALL. I may have asked the wrong question, Mr. Cohen, 

and, again, forgive me if I have. I was looking at the stack that Mr. 

Bentivolio put up there on the wall. I know there is a lot of reg 

that has to come out and, after I vote yes or no, I sometimes lose 

control over that and it goes down to the agency. I am actually 

thinking about the bill itself. Even the legislative language of the 

bill is explicit about how to participate. It is in this whole consumer 

choice section, it is all about protection, all about making sure we 

get the best people involved and making sure consumers have the 

best information they can. I see the Navigator side. 

Mr. COHEN. Right. 

Mr. WOODALL. I just don’t see the Assister side. 

Mr. COHEN. Well, what we propose in the rule that we put out 

was that States have come to us that are running their own exchanges, and what they have said is that—— 

Mr. WOODALL. Again, I might not be asking the right question. 

I am not interested in what you all are doing in your regulatory 

work. 

Mr. COHEN. Okay. 

Mr. WOODALL. Because I think all of your regulatory work is 

simply responding to what we passed in the Affordable Care Act. 

Mr. COHEN. Right. 

Mr. WOODALL. So in the Affordable Care Act I see all about how 

to participate in the Navigators Program; it defines it, tells me 

about it, tries to make it very robust. 

Mr. COHEN. Right. 

Mr. WOODALL. I don’t see anything about the Assisters Program. 

Mr. COHEN. It says that exchanges have to provide outreach, 

education, and consumer assistance, and that is what the Assisters 

Program is going to implement, that provision. 

Mr. WOODALL. It says that States have to provide that? 

Mr. COHEN. If they are operating their own marketplace, yes. 

Mr. WOODALL. And that the Feds will fund the provision of those 

services? 

Mr. COHEN. That funds are available under Section 1311 while 

States are establishing their exchanges, yes. 

Mr. WOODALL. So what do you make of the funds under 1311? 

Because, again, language is very explicit here: navigators will do 

this, navigators will do that, States will provide these services. And 

it says very clearly grants under this subsection shall be made 

from the operational funds of the exchange, and not Federal funds 

received by the State to establish the exchange. I read that as an 

explicit we don’t want Federal funds used for this purpose. If you 

choose to participate in an exchange, you will be responsible for 

these costs. But you are going through an entire rule-making process, great machinations in order to make sure folks do receive Federal funds for this. Do you read this provision differently than I do? 

49 

Mr. COHEN. I agree with you that the statute says that Federal 

funds under 1311 are not available to States to do their Navigator 

Programs, and what we said is but States still have this obligation 

to provide consumer assistance, and during the first year, before 

they are financially self-sustaining, they may use 1311 money to 

perform that function. 

Mr. WOODALL. Let me make sure I—— 

Mr. COHEN. But not to run their Navigator Program. They still 

have to have a Navigator Program, but they may use that funding 

to perform their statutory obligation under the law to do consumer 

assistance, to do consumer outreach as part of establishing the exchange before it is financially self-sustaining. 

Mr. WOODALL. That doesn’t pass the smell test for me. You 

know, when is a cut not a cut? Only in Washington, right? You increase it by $2 and we call that a cut. Folks don’t understand the 

Washington math. I don’t think they understand the Washington 

rhetoric. I wish we were all in this together to try to make provisions better. 

Can I ask how many times have you gone to the committee of 

jurisdiction to say, you know what, you explicitly say we can’t do 

this, but we think we need to do this, and can you change the law 

to give us that authority? 

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

Mr. WOODALL. Do you believe that it has happened, though? 

Mr. COHEN. I don’t know. 

Mr. WOODALL. You don’t have any idea? 

Mr. COHEN. I don’t. 

Mr. WOODALL. Mr. Chairman, that is the crisis of confidence I 

think we perpetuate on the American people. Here is something 

that explicitly says thou shalt not. I wasn’t here to vote on it, but 

my colleagues did, the Senate did; the President signed it. For 

whatever reason, we said thou shalt not. And when you decided 

you didn’t like it, you just decided you would go a different way to 

do the exact same thing, the exact same way, but call it something 

different, and get another pot of money. Not even knowing if you 

ever came to Congress to say we think this could be done better, 

will you give us that authority. Folks say that the Administration 

and Congress can’t work together; hard to work together when we 

don’t even get the invitation and the first thing we see is the rulemaking that seems to be directly contradictory to statutory authority, and I deeply regret that both for us and for the American people. 

I yield back, Mr. Chairman. 

Mr. GOSAR. I thank the gentleman of Georgia. 

The gentleman from Georgia, Mr. Collins, is now recognized. 

Mr. COLLINS. Thank you, Mr. Chairman. We will just continue 

the Georgia pattern here for just a moment. I want to have a dialogue and I have a lot of questions here that I think can be answered sort of yes, no, or just say you will provide. I am leaving 

it open at this point. 

One of the questions that always comes up here, especially in 

these oversight hearings, is the issue of oversight, and it is one of 

those things that, after something happens, well, if we had had 

50 

better oversight, we would have caught it. I understand explicitly 

the States are supposed to provide for their own oversight in dealing with their program; however, States such as our own, Congressman Woodall and myself, have chosen not to participate in 

this. So the Federal program will have to do. Do you have a program set up for oversight and management that would oversee this 

if it falls back on you to instruct this? 

Mr. COHEN. And you are speaking about the Navigator Program? 

Mr. COLLINS. Yes. 

Mr. COHEN. Yes, we absolutely do. It is consistent with the way 

we manage grants. 

Mr. COLLINS. I apologize, sir. Do you have these written down? 

Are these policies written down? Is this oversight plan written 

down? 

Mr. COHEN. I am hesitating because I am not certain whether 

there is a specific oversight plan for this program written down. 

There are rules that we follow in terms of how we do oversight 

when we do grants administration that are not unique to this program. 

Mr. COLLINS. But as far as this program, especially in light of 

what this program is going to entail, it seems to me that there 

should be, because you are requiring the States to have a written 

oversight program for this, and an oversight plan. 

Mr. COHEN. I will have to look. 

Mr. COLLINS. Okay, so at this point we don’t have one. 

Mr. COHEN. I will have to look; I am not certain. 

Mr. COLLINS. If you do, will you provide it to this committee? 

Mr. COHEN. I will look and we will certainly work with you, yes. 

Mr. COLLINS. Also, you said on awarding—and I am going simply 

by your statement that you provided for this committee. It said you 

were using an evaluation rubric developed by HHS for the qualified 

unbiased expert contractors who will review all the applications. 

Do you have that rubric? 

Mr. COHEN. I am sure we do. 

Mr. COLLINS. Okay, I am trying to be calm here. You are sure 

we do? 

Mr. COHEN. I am sure we do, yes. Yes. 

Mr. COLLINS. And can you provide it? 

Mr. COHEN. We will work with you to get that for you, sure. 

Mr. COLLINS. Okay. 

Mr. COHEN. And let me, as long as you are on that subject, if I 

might, because I made a statement earlier that I am informed is 

not correct, so I want to make sure I correct it. I was talking about 

the grant review panels and I said that people from HHS and CMS 

won’t be on them, and that is not right; there could be people from 

HHS and CMS who could be on them. There won’t be anyone on 

them who is involved in the program that is running the Navigator 

Program. 

Mr. COLLINS. Okay. All right. 

Mr. COHEN. So I just wanted to correct that. 

Mr. COLLINS. Same page you discuss that these folks will all 

comply with different standards. In your statement you said comply with privacy and security standards, among other activities. Do 

51 

you have written down what these privacy and security standards 

are? Are they written down anywhere? 

Mr. COHEN. The privacy and security standards are in our proposed rule, I think, yes. 

Mr. COLLINS. Okay. Can you provide those for the committee? 

Mr. COHEN. Yes. 

Mr. COLLINS. Thank you. Can you ensure us that the navigators 

and assisters who will have access to extremely personal and sensitive information will be held to the same hiring standards of U.S. 

Census employees? 

Mr. COHEN. I hesitate there because I am not responsible for the 

census, so I don’t know what they are required to do. I know that 

they will be subject to the standards that CMS employs with respect to all the grants that it does, there is nothing different here. 

Mr. COLLINS. Thank you. Will you commit to requiring background checks equivalent to those that the U.S. Census uses before 

the rule is finalized? 

Mr. COHEN. In the proposed rule we have not required background checks, and I can’t say what is going to happen in the final 

rule, but we have given flexibility to States, and some States have 

decided that they are going to require them, yes. 

Mr. COLLINS. And not to be argumentative here, I am not trying 

to be. This is so important for people right now because this is absolutely changing what we do, and I believe in a very bad way. But 

in a security situation here I would encourage you, if that is not 

being given a lot of thought, as far as security background checks, 

you are dealing with people’s lives here, and I would believe that 

that would be an important aspect. 

Moving on. Are you aware of the secrecy law passed by the State 

of California to conceal spending on government contractors setting 

up the California exchanges? 

Mr. COHEN. I am not, actually. 

Mr. COLLINS. From April 2012 to July 2012, did you serve as 

chief counsel to the California Health Exchange Board? 

Mr. COHEN. I did. 

Mr. COLLINS. Okay. Two weeks ago it was revealed that the 

State of California passed a law allowing State exchanges to conceal spending on the contractors that will perform most of its functions, potentially shielding the public from seeing how hundreds of 

millions of dollars are spent. These contracts will be funded largely 

by taxpayer dollars. Do you believe taxpayers have the right to 

know how Federal taxpayer dollars are being spent to implement 

State-based exchanges? 

Mr. COHEN. Well, I know that we review the budgets and the expenditures of all the State-based exchanges, including California’s, 

so whatever law California passes is not going to affect our ability 

to do oversight over their activities. 

Mr. COLLINS. Okay, but at this point I think the question here 

is should taxpayers have the right to know which companies receive these contracts and how much, and how are you going to balance that if you have set the State exchange up to do it their own 

way, then you are going to say now that you are going to override 

California law? 

52 

Mr. COHEN. No. Under the terms of the grant, we have the right 

to look at what they are spending, and we are looking at—— 

Mr. COLLINS. Which will be public record? 

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

Mr. COLLINS. Okay. So the concern comes here is it secret. And 

my time has expired, but these are the kinds of questions, just providing transparency if we are heading down this road. But that is 

a concern, because if we are going into this and we don’t have those 

answers, that was just the reason for these questions. I appreciate 

your time. 

Mr. Chairman, I yield back. 

Mr. GOSAR. I thank the gentleman. 

What we are going to do, Mr. Cohen, is I am going to acknowledge the gentlelady from California, then myself to close off the 

meeting. Thank you. 

The gentlelady from California, Ms. Speier. 

Ms. SPEIER. Thank you, Mr. Cohen. 

And, Mr. Chairman, thank you. 

Do you feel like you are being sabotaged? 

Mr. COHEN. Well, I prefer not to use that word. 

Ms. SPEIER. I think you are being sabotaged. And I think it is 

un-American at this point in time, when this law has passed, we 

are in the process of implementing it, that you don’t have the resources to do the job. You are going to be doomed if you don’t get 

the resources you need. 

We just spent over $1 billion in the Air Force on a computer system that didn’t work and we had to trash. A billion dollars. And 

you have $54 million to do your outreach? How much do you need 

to do your outreach? 

Mr. COHEN. I don’t have a number in my head, but we certainly 

could use additional funding to be able to do additional outreach 

and to perform all of the things that we need to do under the law, 

definitely. 

Ms. SPEIER. All right, so I think what the committee should benefit from is having an estimate from you of what you really need 

in order to do the job and do it well. I mean, there is a lot of stirring up the pot today about how this is going to fail. Well, we can 

guarantee that it will fail if we don’t give you the resources to actually roll it out properly. So tell us what you need. If we can spend 

$1 billion on a failed system for the Air Force computers, we can 

certainly spend enough money so that every American has the information they need to access the health care and the health insurance that they are now qualified to receive. 

Mr. COHEN. I do know that in the President’s budget he has requested about $1.5 billion for implementation of the exchanges. 

Ms. SPEIER. And that includes the outreach? 

Mr. COHEN. Yes. 

Ms. SPEIER. $1.5 billion. 

Mr. COHEN. That is in the 2014 budget. 

Ms. SPEIER. So maybe that money we spent on that failed computer system could have been better spent here. 

I yield back. 

Mr. GOSAR. I thank the gentlelady. 

53 

Mr. Cohen, how closely is HHS working with IRS on Obamacare 

implementation? 

Mr. COHEN. We are working closely with IRS on those aspects of 

implementation where we have to work together, so, for example, 

as you know, in determining whether a person is eligible for Medicaid or CHIP on the one hand, or tax credits in the marketplaces 

on the other, income is a test, and we are working with IRS on 

verifying people’s income when they apply. 

Mr. GOSAR. So the IRS is going to be gathering and sending this 

enormous amount of taxpayer information to all the 50 exchanges. 

All 50 exchanges are to be ready by October 1st, right? 

Mr. COHEN. Yes. 

Mr. GOSAR. So will there be any problems with this massive 

amount of data sharing? 

Mr. COHEN. No. And data sharing may not be exactly the right 

way to look at it. Basically what will happen is people will put information about their income in an application; that information 

will be verified by data that comes from the IRS, but there is no 

exchange of information from the IRS to the exchange; the information goes out, it is verified, and it comes back. 

Mr. GOSAR. But it is still from the exchange going to the IRS, 

and that is where I am going. 

Mr. COHEN. It is going to the data hub. Information is coming 

from the IRS to the data hub and from the exchange to the data 

hub, and there is a comparison and then there is an answer back. 

But the tax information isn’t actually going to the exchange. 

Mr. GOSAR. Gotcha. Okay, so what will the navigators and assisters tell individuals about the subsidy reconciliation process? 

Mr. COHEN. They will give them accurate information and they 

will encourage them, certainly, to make sure that if their income 

situation changes over the course of the year, that they should update their account to make sure that that is reflected. 

Mr. GOSAR. Okay, so will navigators and assisters tell individuals that a change in income, marital status, household size, or 

workplace insurance may make them ineligible for tax credits and, 

if not, almost certainly will impact the size of their tax credit? 

Mr. COHEN. They will certainly let them know that if they have 

a change in circumstance, they need to provide that information, 

yes. It is important that they do so. 

Mr. GOSAR. Okay. So will navigators and assisters tell individuals that the Government will be sending the tax credit to the insurance companies, but if an overpayment occurs, the IRS will 

come after the individual, not the insured, to collect that overpayment? 

Mr. COHEN. They will certainly let them know that if their situation changes, they need to put that information in there so that 

they can avoid getting a tax credit to which it turns out they are 

not entitled to at the end of the year. 

Mr. GOSAR. So will navigators and assisters tell individuals that 

the failure to report a change in income, marital status, household 

size, workplace insurance, and some other criteria may cause them 

to owe hundreds of thousands of dollars to the IRS when they file 

their taxes? 

54 

Mr. COHEN. Hundreds of thousands of dollars? I am not aware 

of that number. 

Mr. GOSAR. Hundreds or thousands. 

Mr. COHEN. Oh, hundreds or thousands. I see. You scared me 

there for a second. 

Mr. GOSAR. The IRS and hundreds of thousands always scares a 

taxpayer. 

Mr. COHEN. I think that it will be very important for people to 

understand that they need to update their information if their situation changes, and that information will certainly be provided by 

navigators, yes. 

Mr. GOSAR. Okay. So what will a navigator or assister do if an 

individual applying for health insurance doesn’t have a W–2 or an 

income tax return? 

Mr. COHEN. I don’t think it is a requirement that a person have 

a W–2 or an income tax return. If I understand the way the application works correctly, you can enter in the amount of income that 

you had, and if you have filed taxes, that is the data that will be 

accessible through the data hub from the IRS, what your tax return was last year, and that is what we will be checking against. 

Mr. GOSAR. Okay, so what will the navigator or assister do if an 

individual reports that they are paid under the table? 

Mr. COHEN. That is a good question. I will have to think about 

that and talk to folks. 

Mr. GOSAR. We will expect an answer. 

Couple last questions. Will you commit to the committee to getting us a list of all phone calls placed to whom they were made and 

the other solicitations that the Secretary made to fund Enroll 

America and for all other purposes? 

Mr. COHEN. I think you are asking the wrong guy for that. 

Mr. GOSAR. Well, you can carry the message back. I mean, you 

are the messenger from HHS, so you can be the messenger back. 

Mr. COHEN. I am happy to be a messenger back. 

Mr. GOSAR. Will you also commit to getting the committee a list 

of all the amounts that were promised or received? 

Mr. COHEN. Same answer. I will take the message back. I can’t 

commit anything to you because that is not my job. 

Mr. GOSAR. Well, one thing I want to end with here is I have 

done working with patients with insurances, with privacy compliance for 25 years being a dentist. It is not a simple task at all. 

And, to me, when we see that we are still developing modules and 

that we don’t have them in place, and we are coming up on June, 

and then we say that we already have some type of oversight 

made, I find it interesting that it is either the chicken or the egg. 

I think you have to have the modules first, before you outline a 

protocol of oversight. Wouldn’t you agree? 

Mr. COHEN. I think we are developing all those things and we 

will have them all in place in time for open enrollment in October. 

Mr. GOSAR. Well, I think some of your comments I applaud, that 

you are looking at building these modules, but I also think that 

how you develop those modules develops your oversight plan, so 

something off the shelf isn’t going to be applicable 100 percent of 

the time. So it seems to me you are going to build these modules 

and then behind it is going to be coming oversight. So we would 

55 

also like not only the modules, but the oversight plan to the committee as well. 

Mr. COHEN. That is a fair point and we will work with you to 

get you that. 

Mr. GOSAR. I thank you very, very much. 

Seeing there are no other questions, I adjourn this meeting. 

Thank you. 

[Whereupon, at 12:13 p.m., the subcommittee was adjourned.] 

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