Patient Protection and Affordable Care Act: Preliminary Results of Undercover Testing of the Federal Marketplace and Selected State Marketplaces for Coverage Year 2015
Published: 2015-10-23T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: PPACA provides for the establishment of health-insurance marketplaces where consumers can, among other things, select private health-insurance plans or apply for Medicaid. The Congressional Budget Office estimates the cost of subsidies and related spending under PPACA at $60 billion for fiscal year 2016. PPACA requires verification of applicant information to determine enrollment or subsidy eligibility. In addition, PPACA provided for the expansion of the Medicaid program. GAO was asked to examine application and enrollment controls for the marketplaces and Medicaid.
This testimony provides preliminary results of undercover testing of the federal and selected state marketplaces during the 2015 open-enrollment period, for both private health-care plans and Medicaid. GAO submitted, or attempted to submit, 18 fictitious applications by telephone and online, 10 of which tested controls related to obtaining subsidized health-plan coverage available through the federal Marketplace in New Jersey and North Dakota, and through state marketplaces in California and Kentucky. GAO chose these four states based partly on a range of population sizes and whether the state had expanded Medicaid eligibility under terms of the act. The other 8 applications, among the 18 GAO made, tested marketplace and state controls under the marketplace system for determining Medicaid eligibility in these four states. The undercover results, while illustrative, cannot be generalized to the full population of enrollees. GAO discussed the results of its testing with CMS and state officials to obtain their perspectives.
section_title: What GAO Found
paragraphs: Under the Patient Protection and Affordable Care Act (PPACA), health-insurance marketplaces are required to verify application information to determine eligibility for enrollment and, if applicable, determine eligibility for income-based subsidies or Medicaid. These verification steps include reviewing and validating information about an applicant's Social Security number, if one is provided; citizenship, status as a national or lawful presence; and household income and family size.
For 10 fictitious applicants, GAO tested application and enrollment controls for obtaining subsidized health plans available through the federal Health Insurance Marketplace (Marketplace) (for New Jersey and North Dakota) and two selected state marketplaces (California and Kentucky). Although 8 of these 10 fictitious applications failed the initial identity-checking process, all 10 were subsequently approved by the federal Marketplace or the selected state marketplaces. Four applications used Social Security numbers that, according to the Social Security Administration (SSA), have never been issued, such as numbers starting with “000.” Other applicants had duplicate enrollment or claimed their employer did not provide insurance that meets minimum essential coverage.
For 8 additional fictitious applicants, GAO tested enrollment into Medicaid through the same federal Marketplace and the two selected state marketplaces, and was able to obtain either Medicaid or alternative subsidized coverage for 7 of the 8 applicants. Specifically:
Three were approved for Medicaid, which was the health-care program for which GAO originally sought approval. In each case, GAO provided identity information that would not have matched SSA records. For two applications, the marketplace directed the fictitious applicants to submit supporting documents, which GAO did (such as a fake immigration card), and the applications were approved. For the third, the marketplace did not seek supporting documentation, and the application was approved by phone.
For four, GAO did not obtain approval for Medicaid; however, GAO was subsequently able to gain approval of subsidized health plans based on the inability to obtain Medicaid coverage. In 1 case, GAO falsely claimed that it was denied Medicaid in order to obtain the subsidized health plan when in fact no Medicaid determination had been made by the state at that time.
For one, GAO was unable to enroll into Medicaid, in California, because GAO declined to provide a Social Security number. According to California officials, the state marketplace requires a Social Security number or taxpayer-identification number to process applications.
According to officials from the Centers for Medicaid & Medicare Services (CMS), California, Kentucky, and North Dakota, the marketplaces and Medicaid offices only inspect for supporting documentation that has obviously been altered. Thus, if the documentation submitted does not show such signs, it would not be questioned for authenticity. GAO's work is continuing, and GAO plans to issue a final report at a later date.

section_title: Letter
paragraphs: I am pleased to be here today to discuss enrollment for health-care  coverage obtained through the health-insurance exchanges, or  marketplaces, established under the Patient Protection and Affordable  Care Act (PPACA) and, in particular, to discuss the preliminary results of  our undercover testing of eligibility and enrollment controls for the federal  Health Insurance Marketplace (Marketplace) and selected state  marketplaces for the 2015 coverage year. PPACA provides subsidies to  those eligible to purchase private health-insurance plans who meet  certain income and other requirements. With those subsidies and other  costs, the act represents a significant, long-term fiscal commitment for the  federal government. According to the Congressional Budget Office, the  estimated cost of subsidies and related spending under the act is $60  billion for fiscal year 2016, rising to $105 billion for fiscal year 2025, and  totaling $880 billion for fiscal years 2016–2025.
While subsidies under the act are not paid directly to enrollees,  participants nevertheless benefit financially through reduced monthly  premiums or lower costs due at time of service, such as copayments.  Because subsidy costs are contingent on who obtains coverage,  enrollment controls that help ensure only qualified applicants are  approved for subsidized coverage are a key factor in determining federal  expenditures under the act. In addition, PPACA provided for the  expansion of the Medicaid program. Under the expansion, states may  choose to provide Medicaid coverage to nonelderly adults who meet  income limits and other criteria. Under PPACA, the federal government is  to fully reimburse states through fiscal year 2016 for the Medicaid  expenditures of “newly eligible” individuals who gained Medicaid eligibility  through the expansion. According to the Office of the Actuary of the  Centers for Medicare & Medicaid Services (CMS), federal expenditures  for the Medicaid expansion are estimated at $430 billion from 2014  through 2023.
PPACA provides for the establishment of health-insurance marketplaces  to assist consumers in comparing and selecting among insurance plans  offered by participating private issuers of health-care coverage. Under  PPACA, states may elect to operate their own health-care marketplaces,  or they may rely on the federal Marketplace, known to the public as  HealthCare.gov. These marketplaces were intended to provide a single  point of access for individuals to enroll in private health plans, apply for  income-based subsidies to offset the cost of these plans—which, as  noted, are paid directly to health-insurance issuers—and, as applicable,  obtain an eligibility determination or assessment of eligibility for other  health-coverage programs, such as Medicaid or the Children’s Health  Insurance Program. CMS, a unit of the Department of Health and Human  Services (HHS), is responsible for overseeing the establishment of these  online marketplaces, and the agency maintains the federal Marketplace.
To be eligible to enroll in a “qualified health plan” offered through a  marketplace—that is, one providing essential health benefits and meeting  other requirements under PPACA—an individual must be a U.S. citizen or  national, or otherwise lawfully present in the United States; reside in the  marketplace service area; and not be incarcerated (unless incarcerated  while awaiting disposition of charges). To be eligible for Medicaid,  individuals must meet federal requirements regarding residency, U.S.  citizenship or immigration status, and income limits, as well as any  additional state-specific criteria that may apply.
Marketplaces are required by PPACA to verify application information to  determine eligibility for enrollment and, if applicable, determine eligibility  for the income-based subsidies or Medicaid. These verification steps  include validating an applicant’s Social Security number, if one is  provided; verifying citizenship, status as a national, or lawful presence  by comparison with Social Security Administration or Department of  Homeland Security records; and verifying household income and family  size by comparison with tax-return data from the Internal Revenue  Service, as well as data on Social Security benefits from the Social  Security Administration.
In light of the government’s substantial fiscal commitment under the act,  congressional requesters originally asked us to examine enrollment and  verification controls of the federal Marketplace. In July 2014, we  presented testimony on the results of our initial work, which focused on  application for, and approval of, coverage for fictitious applicants for the  2014 coverage year—the first under the act—through the federal  Marketplace. In July 2015, we testified on the final results of that work,  including the maintenance of the fictitious applicant identities and  extension of coverage through 2014 and into 2015, payment of federally  subsidized premiums on policies we obtained, and the Marketplace’s  verification process for applicant documentation. We plan to issue a  final report on the results of our undercover eligibility and enrollment  controls testing for the 2014 coverage year shortly.
Following the original request, you and other congressional requesters  asked us to continue to examine enrollment and verification controls of  the federal Marketplace and state marketplaces as well, for the 2015  coverage year—the second under the act. My statement today is based  on the preliminary results and analysis from this ongoing work.  Specifically, today’s statement describes the preliminary results of our  undercover testing of the federal Marketplace and selected state  marketplaces, for application, enrollment, and eligibility-verification  controls, for both qualified health-care plans and Medicaid, during the  act’s second open-enrollment period ending February 2015. We plan to  issue a final report at a later date.
To perform our undercover testing of the federal and selected state  eligibility and enrollment processes for the 2015 coverage year, we  created 18 fictitious identities for the purpose of making applications for  health-care coverage by telephone and online. The undercover results,  while illustrative, cannot be generalized to the full population of enrollees.  For all 18 applications, we used publicly available information to construct  our scenarios. We also used publicly available hardware, software, and  materials to produce counterfeit or fictitious documents, which we  submitted, as appropriate for our testing, when instructed to do so. We  then observed the outcomes of the document submissions, such as any  approvals received or requests to provide additional supporting  documentation.
Because the federal government, at the time of our review, operated a  marketplace on behalf of the state in about two-thirds of the states, we  focused part of our work on two states using the federal Marketplace— New Jersey and North Dakota. We chose these two states because they  had expanded Medicaid eligibility and also delegated their Medicaid  eligibility determinations to the federal Marketplace at the time of our  testing. In addition, we chose two state marketplaces, California and  Kentucky, for our undercover testing. We chose these two states, in part,  based on the states having expanded Medicaid eligibility and differences  in population.
For 10 applicant scenarios, we tested controls for verifications related to  qualified health-plan coverage. Specifically, we created application  scenarios with fictitious applicants claiming to have impossible Social  Security numbers; claiming to be working for an employer that offers  health insurance, but not coverage that meets “minimum essential”  standards; or already having existing qualified health-plan coverage. We  made 4 of these 10 applications online and the other 6 applications by  phone. In these tests, we also stated income at a level eligible to obtain  both types of income-based subsidies available under PPACA—a  premium tax credit, to be paid in advance, and cost-sharing reduction.
For 8 additional applicant scenarios, we tested controls for verifications  related to Medicaid coverage. Specifically, our fictitious applicants  provided invalid Social Security identities, where their information did not  match Social Security Administration records, or claimed they were  noncitizens lawfully present in the United States and declined to provide  Social Security numbers. In situations where we were asked to provide  immigration document numbers, we provided impossible immigration  document numbers. We made half of these applications online and half  by phone. In these tests, we also stated income at a level eligible to  qualify for coverage under the Medicaid expansion, where the federal  government is responsible for reimbursing the states for 100 percent of  the Medicaid costs in 2015. In cases where we did not obtain approval for  Medicaid, we instead attempted, as appropriate, to obtain coverage for  subsidized qualified health plans in the same manner as described  earlier.
After concluding our undercover testing, we briefed officials from CMS;  officials from the state marketplaces; and Medicaid officials from  California, Kentucky, and North Dakota on our results. We asked to brief  Medicaid officials from New Jersey but they declined our request. To  protect our undercover identities, we did not provide the marketplaces  with specific applicant identity information. CMS and selected state  officials generally told us that without such information, they could not  fully research handling of our applicants. We also reviewed laws,  regulations, and other policy and related information.
We are conducting the work upon which this statement is based in  accordance with generally accepted government auditing standards.  Those standards require that we plan and perform the audit to obtain  sufficient, appropriate evidence to provide a reasonable basis for our  findings and conclusions based on our audit objectives. We believe that  the evidence obtained provides a reasonable basis for our findings and  conclusions based on our audit objectives. We are conducting our related  investigative work in accordance with investigative standards prescribed  by the Council of the Inspectors General on Integrity and Efficiency.
subsections: section_title: Preliminary Results of Undercover Attempts to Obtain Qualified Health-Plan Coverage from the Federal Marketplace and Selected State Marketplaces
paragraphs: Our undercover testing for the 2015 coverage year found that the health- care marketplace eligibility determination and enrollment process remains  vulnerable to fraud. As shown in figure 1, the federal Marketplace or  selected state marketplaces approved each of our 10 fictitious  applications for subsidized qualified health plans. We subsequently paid  premiums to put these policies into force.
As the figure shows, for these 10 applications, we were approved for  subsidized coverage—the premium tax credit, paid in advance, and cost- sharing reduction subsidies—for all cases. The monthly amount of the  advance premium tax credit for these 10 applicants totaled approximately  $2,300 per month, or about $28,000 annually, equal to about 70 percent  of total premiums. For 4 of these applications, we used Social Security  numbers that could not have been issued by the Social Security  Administration. For 4 other applications, we said our fictitious applicants  worked at a company—which we also created—that offered health  insurance, but the coverage did not provide required minimum essential  coverage under PPACA. For the final 2 applications, we used an identity  from our prior undercover testing of the federal Marketplace to apply for  coverage concurrently at two state marketplaces. Thus, this fictitious  applicant received subsidized qualified health-plan coverage from the  federal Marketplace and the two selected state marketplaces at the same  time.
For 8 applications among this group of 10, we failed to clear an identity- checking step during the “front end” of the application process, and thus  could not complete the process. In these cases, we were directed to  contact a contractor that handles identity checking. The contractor was  unable to resolve the identity issues and directed us to call the  appropriate marketplace. We proceeded to phone the marketplaces and  our applications were subsequently approved. The other two applicants  were accepted by phone.
For each of the 10 undercover applications where we obtained qualified  health-plan coverage, the respective marketplace directed that our  applicants submit supplementary documentation. The marketplaces are  required to seek postapproval documentation in the case of certain  application “inconsistencies”—instances in which information an applicant  has provided does not match information contained in data sources that  the marketplace uses for eligibility verification at the time of application, or  such information is not available. If there is an application inconsistency,  the marketplace is to determine eligibility using the applicant’s  attestations and ensure that subsidies are provided on behalf of the  applicant, if qualified to receive them, while the inconsistency is being  resolved using “back-end” controls. Under these controls, applicants will  be asked to provide additional information or documentation for the  marketplaces to review in order to resolve the inconsistency.
As part of our testing, and to respond to the marketplace directives, we  provided counterfeit follow-up documentation, such as fictitious Social  Security cards with impossible Social Security numbers, for all 10  undercover applications.
For all 10 of these undercover applications, we maintained subsidized  coverage beyond the period during which applicants may file supporting  documentation to resolve inconsistencies. In one case, the Kentucky  marketplace questioned the validity of the Social Security number our  applicant provided, which was an impossible Social Security number. In  fact, the marketplace told us the Social Security Administration reported  that the number was not valid. Despite this, however, the Kentucky  marketplace notified our fictitious applicant that the applicant was found  eligible for coverage. For the four fictitious applicants who claimed their  employer did not provide minimum essential coverage, the marketplace  did not contact our fictitious employer to confirm the applicant’s account  that the company offers only substandard coverage.
In August 2015, we briefed CMS and California and Kentucky state  officials on the results of our undercover testing, to obtain their views.  According to these officials, the marketplaces only inspect for documents  that have obviously been altered. Thus, if the documentation submitted  does not appear to have any obvious alterations, it would not be  questioned for authenticity. In addition, according to Kentucky officials, in  the case of the impossible Social Security number, the identity-proofing  process functioned correctly, but a marketplace worker bypassed identity- proofing steps that would have required a manual verification of the  fictitious Social Security card we submitted. The officials told us they plan  to provide training on how to conduct manual verifications to prevent this  in the future.
As for our employer-sponsored coverage testing, CMS and California  officials told us that during the 2015 enrollment period, the marketplaces  accepted applicants’ attestation on lack of minimum essential coverage.  As a result, the marketplaces were not required to communicate with the  applicant’s employer to confirm whether the attestation is valid. Kentucky  officials told us that applicant-provided information is entered into its  system to determine whether the applicant’s claimed plan meets  minimum essential coverage standards. If an applicant receives a  qualified health-plan subsidy because the applicant’s employer- sponsored plan does not meet the guidelines, the Kentucky marketplace  sends a notice to the employer asking it to verify the applicant  information. The officials told us the employer letter details, among other  things, the applicant-provided information and minimum essential  coverage standards. However, our fictitious company did not receive such  notification.
CMS, California, and Kentucky officials also told us there is no current  process to identify individuals with multiple enrollments through different  marketplaces. CMS officials told us it was unlikely an individual would  seek to obtain subsidized qualified health-plan coverage in multiple  states. We conducted this portion of our testing, however, to evaluate  whether such a situation, such as a stolen identity, would be possible.  CMS officials told us the agency would need to look at the risk associated  with multiple coverage.
Kentucky officials told us that in response to our findings, call center staff  have been retrained on identity-proofing processes, and that they are  improving training for other staff as well. They also said they plan  changes before the next open-enrollment period so that call center  representatives cannot bypass identity-proofing steps, as occurred with  our applications. Further, they said they plan to improve the process for  handling of applications where employer-sponsored coverage is at issue.  Also in response to our findings, California officials said they are  developing process improvements and system modifications to address  the issues we raised, and would share details later.
Finally, in the case of the federal Marketplace in particular, for which, as  noted, we conducted undercover testing previously, we asked CMS  officials for their views on our second-year results compared to the first  year. They told us the eligibility and enrollment system is generally  performing as designed. According to the officials, a key feature of the  system, when applicant information cannot immediately be verified, is  whether proper inconsistencies are generated, in order that they can be  addressed later, after eligibility is granted at time of application. Earlier,  CMS officials told us the overall approach is that CMS must balance  consumers’ ability to effectively and efficiently select Marketplace  coverage with program-integrity concerns.
section_title: Preliminary Results of Undercover Attempts to Obtain Medicaid Coverage through the Federal Marketplace and Selected State Marketplaces
paragraphs: In addition to our applications for subsidized private health plans, we also  made eight additional fictitious applications for Medicaid coverage in  order to test the ability to apply for that program through the  marketplaces. As shown in figure 2, in these tests, we were approved for  subsidized health-care coverage for seven of the eight applications. For  three of the eight applications, we were approved for Medicaid, as  originally sought. For four of the eight applications, we did not obtain  Medicaid approval, but instead were subsequently approved for  subsidized qualified health-plan coverage. The monthly amount of the  advance premium tax credit for these four applicants totaled  approximately $1,100 per month, or about $13,000 annually. For one of  the eight applications, we could not obtain Medicaid coverage because  we declined to provide a Social Security number.
As with our applications for qualified health plans described earlier, we  also failed to clear an identity-checking step for six of eight Medicaid  applications. In these cases, we were likewise directed to contact a  contractor that handles identity checking. The contractor was unable to  resolve the identity issues and directed us to call the appropriate  marketplace. We proceeded to phone the marketplaces. However, as  shown in figure 2, the California marketplace did not continue to process  one of our Medicaid applications. In this case, our fictitious phone  applicant declined to provide what was a valid Social Security number,  citing privacy concerns. A marketplace representative told us that, to  apply, the applicant must provide a Social Security number. The  representative suggested that as an alternative, we could apply for  Medicaid in person with the local county office or a certified enrollment  counselor.
After we discussed the results of our undercover testing with California  officials, they told us their system requires applicants to provide either a  Social Security number or an individual taxpayer-identification number to  process an application. As a result, because our fictitious applicant  declined to provide a Social Security number, our application could not be  processed.
subsections: section_title: Details of Medicaid Applications through the Federal Marketplace
paragraphs: For the four Medicaid applications submitted to the federal Marketplace,  we were told that we may be eligible for Medicaid but that the respective  Medicaid state offices might require more information. For three of the  four applications, federal Marketplace representatives told us we would  be contacted by the Medicaid state offices within 30 days. However, the  Medicaid offices did not notify us within 30 days for any of the  applications. As a result, we subsequently contacted the state Medicaid  offices and the federal Marketplace to follow up on the status of our  applications.
For the two New Jersey Medicaid applications, we periodically called the  state Medicaid offices over approximately 4 months, attempting to  determine the status of our applications. In these calls, New Jersey  representatives generally told us they had not yet received Medicaid  information from the federal Marketplace and, on several occasions, said  they expected to receive it shortly. After our calls to New Jersey Medicaid  offices, we phoned the federal Marketplace to determine the status of our  Medicaid applications.
In one case, the federal Marketplace representative told us New  Jersey determined that our applicant did not qualify for Medicaid. As  a result, the phone representative stated that we were then eligible for  qualified health-plan coverage. We subsequently applied for coverage  and were approved for an advance premium tax credit plus the cost- sharing reduction subsidy.
In the other case, the federal Marketplace representative told us the  Marketplace system did not indicate whether New Jersey received the  application or processed it. The representative advised we phone the  New Jersey Medicaid agency. Later on that same day, we phoned the  federal Marketplace again and falsely claimed that the New Jersey  Medicaid office denied our Medicaid application. Based on this claim,  the representative said we were eligible for qualified health-plan  coverage. We subsequently applied for coverage and were approved  for an advance premium tax credit plus the cost-sharing reduction  subsidy. The federal Marketplace did not ask us to submit  documentation substantiating our Medicaid denial from New Jersey.
We asked to meet with New Jersey Medicaid officials to discuss the  results of our testing, but they declined our request. CMS officials told us  that New Jersey had system issues that may have accounted for  problems in our Medicaid application information being sent to the state.  CMS officials told us that this system issue is now resolved. In addition,  CMS officials told us they do not require proof of a Medicaid denial when  processing qualified health-plan applications; nor does the federal  Marketplace verify the Medicaid denial with the state. CMS officials said  that instead, they accept the applicant’s attestation that the applicant was  denied Medicaid coverage.
For our North Dakota Medicaid application in which we did not provide a  Social Security number but did provide an impossible immigration  document number, we called the North Dakota Medicaid agency to  determine the status of our application. An agency representative told us  the federal Marketplace denied our Medicaid application and therefore did  not forward the Medicaid application file to North Dakota for a Medicaid  eligibility determination. We did not receive notification of denial from  the federal Marketplace. Subsequently, we called the federal Marketplace  and applied for subsidized qualified health-plan coverage. The federal  Marketplace approved the application, granting an advance premium tax  credit plus the cost-sharing reduction subsidy. Because we did not  disclose the specific identities of our fictitious applicants, CMS officials  could not explain why the federal Marketplace originally said our  application may be eligible for Medicaid but subsequently notified North  Dakota that it was denied.
For the North Dakota Medicaid application for which we did not provide a  valid Social Security identity, we received a letter from the state Medicaid  agency about a month after we applied through the federal Marketplace.  The letter requested that we provide documentation to prove citizenship,  such as a birth certificate. In addition, it requested a Social Security card  and income documentation. We submitted the requested documentation,  such as a fictitious birth certificate and Social Security card. The North  Dakota Medicaid agency subsequently approved our Medicaid application  and enrolled us in a Medicaid plan.
After our undercover testing, we briefed North Dakota Medicaid officials  and obtained their views. They told us the agency likely approved the  Medicaid application because our fake Social Security card would have  cleared the Social Security number inconsistency. The officials told us  they accept documentation that appears authentic. They also said the  agency is planning to implement a new system to help identify when  applicant-reported information does not match Social Security  Administration records.
section_title: Details of Medicaid Applications through State Marketplaces
paragraphs: As with our applications for coverage under qualified health plans,  described earlier, the state marketplace for Kentucky directed two of our  Medicaid applicants to submit supplementary documentation. As part of  our testing and in response to such requests, we provided counterfeit  follow-up documentation, such as a fake immigration card with an  impossible numbering scheme for these applicants. The results of the  documentation submission are as follows:
For the application where the fictitious identity did not match Social  Security records, the Kentucky agency approved our application for  Medicaid coverage. In our discussions with Kentucky officials, they  told us they accept documentation submitted—for example copies of  Social Security cards—unless there are obvious alterations.
For the Medicaid application without a Social Security number and  with an impossible immigration number, the Kentucky state agency  denied our Medicaid application. A Kentucky representative told us  the reason for the denial was that our fictitious applicant had not been  a resident for 5 years, according to our fictitious immigration card. The  representative told us we were eligible for qualified health-plan  coverage. We applied for such coverage and were approved for an  advance premium tax credit and the cost-sharing reduction subsidy. In  later discussions with Kentucky officials, they told us the  representative made use of an override capability, likely based on  what the officials described as a history of inaccurate applicant  immigration status information for a refugee population. Kentucky  officials also said their staff accept documentation submitted unless  there are obvious alterations, and thus are not trained to identify  impossible immigration numbers. Finally, Kentucky officials said they  would like to have a contact at the Department of Homeland Security  with whom they can work to resolve immigration-related  inconsistencies, similar to a contact that they have at the Social  Security Administration to resolve Social Security-related  inconsistencies.
By contrast, during the Medicaid application process for one applicant,  California did not direct that we submit any documentation. In this case,  our fictitious applicant was approved over the phone even though the  fictitious identity did not match Social Security records. We shared this  result with California officials, who said they could not comment on the  specifics of our case without knowing details of our undercover  application.
As noted earlier, the findings discussed in this statement are preliminary,  and we plan to issue a final report later, upon completion of our work.
Chairman Pitts, Ranking Member Green, and Members of the  subcommittee, this concludes my statement. I look forward to the  subcommittee’s questions.
section_title: GAO Contact and Staff Acknowledgments
paragraphs: For questions about this statement, please contact Seto Bagdoyan at  (202) 512-6722 or BagdoyanS@gao.gov. Contact points for our Offices of  Congressional Relations and Public Affairs may be found on the last page  of this statement.
Individuals making key contributions to this statement include Matthew  Valenta and Gary Bianchi, Assistant Directors; Maurice Belding, Jr.;  Mariana Calderón; Ranya Elias; Suellen Foth; Maria McMullen; James  Murphy; George Ogilvie; Ramon Rodriguez; Christopher H. Schmitt; Julie  Spetz; and Elizabeth Wood.
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