The clerk the speakers room, washington, d. C. , february 3, 2014. I hereby appoint the honorable thomas e. Petri to act as speaker pro tempore on this day. Signed, john a. Boehner, speaker of the house of representatives. The speaker pro tempore pursuant to the order of the house of january 7, 2014, the chair will now recognize members from lists submitted by the majority and minority leaders for morning hour ebate. Pursuant to clause 12a of rule 1, the chair declares the house in recess until 2 00 p. M. Today. Will have more state of the state speeches for you to for you. Today, Oklahoma Republican governor mary fallin will be delivering her speech. That will be live at 1 30 p. M. Eastern on our companion network, cspan3. A specialtoday, Election Debate for the 13th Congressional District seat in florida. Filled,the seat to be held by the late representative bill young. He passed away in october of last or after serving 40 years in congress. Last year after serving 40 years in congress. Heres a look at tonights first ladys program. I was in a car wreck that i wrote about extensively in my book. The whole time i was in the hospital not injured, really. I had a cut on my leg and a broken ankle. I was praying that the other person in the car would be ok. And the other person in the car ,as one of my best friends which i didnt know. I didnt recognize that at the side of the crash. And i think because i prayed over and over and over for him to be ok and he wasnt, you know, i thought god was not listening. My prayer was not answered. I went through a very long time , and notlieving believing that prayers could be answered. Time and a lotng of growing up to come back to faith. First Lady Laura Bush, tonight at 9 00 eastern, live on cspan and cspan three. Also on cspan radio and cspan. Org. Interview at the george w. Bush president ial center in dallas at 10 30 a. M. 10 30 p. M. Consumers will win in the end, in that allows isp to continue to innovate, to continue to wring billions of networks and new services and new pricing and Business Models to consumers. Consumers are the main beneficiary. The big corporations one out in this decision. They are the ones with the tremendous amount of market power. Tremendous amount of influence in washington, d. C. To try to shape policy in their direction. Consumers will be the losers in this deal and that is why so many of them are speaking up and asking the fcc to move forward on a clear path to protect them. The impact of the court Net Neutrality ruling, tonight on the communicators at 8 00 eastern on cspan2. Officials running state Health Insurance exchanges met recently and talked about the processes and the challenges of setting up the exchanges and the successes they had. Youll hear from Audrey Haynes exchangeky and the director christine ferguson. This was hosted by the Robert Wood Johnson foundation. Its about an hour and 15 minutes. Good morning and welcome to our Robert Wood Johnson sponsored roundtable. Where are we now with state and roman . I am the policy adviser to the foundation. I also want to briefly introduce some of my foundation colleagues here today. Kathy hempstead in the front row who hosts the coverage with the foundation. Her colleague, brad thompson, who runs can indication for the team. Both of them will be available at the end of the briefing to answer any questions. Today marks the end of the fourth month for the held extremists Health Insurance exchange. It was a rocky start. On the other hand, other state for state marketplaces fared much better. In the aggregate, the big picture is that it now appears that millions of people have successfully signed up, either for private Health Insurance coverage, medicaid, or the still the childrens Health Insurance program through the exchanges. Today we have gathered five people who have worked closely with some of the most successful state exchanges to report on their experience. None of these were without glitches, but on the other hand, many things worked and we will hear about both the challenges and the successes. We have asked all of our speakers to teach to bring us up to date on the enrollment in the exchanges. What Outreach Strategies worked and which did not work so well, and what they perceived the between now and the end of the enrollment time frame between now and march 31, as well as what plans they are making for open enrollment next year, which believe it or not, is only nine short months away. Let me introduce our speakers. First of all, Heather Howard is with us. Shes the Program Director of the state Health Reform programce network, the funded by the Robert Wood Johnson foundation. It is dedicated to providing Technical Assistance to states to maximize coverage expansion under the Affordable Care act. She is also a Public Affairs lecture at the Woodrow Wilson school at Princeton University and a faculty affiliate for the center for health and wellbeing. Heather previously served as the commissioner of the new Jersey Department of health and Senior Services and worked before that in the u. S. Senate, house of representatives, the Domestic Policy Council at the white house, and the Health Care Task force at the antitrust division at the u. S. To justice department. Delighted to have with us Audrey Haynes, the secretary of the kentucky cabinet for health and Family Services. She previously served as the Senior Vice President and chief Government Affairs officer for the ymca in you in washington, d. C. Her office oversees the kentucky exchange. She served during the Clinton Administration for womens initiatives and outreach. Also with us, we are happy to say is christine ferguson. She is the director of the Rhode Island Health benefits exchange. Close toy, she spent eight years as a Research Professor at the George WashingtonUniversity School of Public Health and services. She has also served as commissioner of the Massachusetts Department of Public Health, the director of the Rhode Island Department of human services, and formerly as counsel and deputy chief of staff to the late u. S. Senator john chafee of rhode island. We are very happy to have her with us as well. Kaufman, the executive director of the d. C. Health benefit Exchange Authority has also joined us. She is a nationally recognized expert on private Health Insurance markets, and served as the superintendent of insurance of the state of maine from true thousand 811. She has served in key leadership positions from 200811. She has served in key leadership positions and was project director at the university of Georgetown Health policy institute. On the phone from california, peter lee, the executive director of covered california, a sacramentobased statence exchange and the Insurance Exchange for individuals and Small Businesses. He formerly served as the Deputy Director of the center for medicare and medicaid intervention at cms where he helped shape implement shaped initiatives to implement Higher Quality care and lower costs. Of the was the ceo Pacific Business group on health and the executive director for the center for health care rights. Welcome to all of you. We will start with an overview from Heather Howard, setting the stage for what we have seen to date in the statebased Health Insurance exchanges. Heather, welcome. Thank you for bringing us together. I have a few slides for the key takeaways. Thank you for bringing us together. I have a few slides were the key takeaways. What are we seeing . Despite the rocky start, we have seen that enrollment in statebased marketplaces is generally outpacing the enrollment in the federally facilitated marketplace. That is because most of the system glitches have been worked out relatively quickly in those statebased market places. It is also because we are seeing far more robust consumer assistance and Marketing Efforts in the statebased market places. An important also a seamless eligibility between the marketplaces and medicaid. It is worth noting, too, that there is a Success Story in five states, and this is just early on that have been doing what expeditedsttrack enrollment for food stamp beneficiaries into medicaid. Oregon, for example, despite their ongoing Exchange Implementation challenges, have been able to enroll 121,000 people into medicaid into that fasttrack enrollment. And we are also seeing that plan choice varies by state level across the statebased exchanges. We will hear from our friends about what it looks like in their states. But overall, we are seeing that 80 are choosing silver or higher levels. The aid distribution also varies across the state, but overall, 24 of the enrollees are in the 1834 age range, that covered age range. Consumerioned, assistance varies. One important distinction between the statebased exchanges in the federally facilitated marketplace is active, robust consumer assistance. This chart demonstrates how much more funding is going into marketing and outreach. This we know how important that is, given the general confusion about options. People are learning more and more the statebased market places have more resources to get the word out. This chart includes statebased market places, but also the consumer Assistance Partnership states, which are also receiving funding from the federal government for outreach. Have seen these early successes, but there are challenges. We will hear about those as well today. First up are the systems failures. We have seen in some states that some vendors have not been able to deliver. Withtates have struggled the i. T. Implementation and several of those states have been doing audits to go back and look at what went wrong and what the path forward is. Those are prompting decisions about whether and how to salvage what they have built thus far and whether to start over. It demonstrates a commitment from the state to system repair and enhancement. That suggests that ultimately, those statebased exchanges will be successful over time. There have been significant investments in i. T. And if they can salvage or repair, they will be successful. Not only have there been system failures, but states have figured out workarounds, as they tend to be good at doing. First, there has been paper processing. In several states, states have been pursuing policy options to allow people to keep their previous coverage option during this transitional time frame. While we have had some rocky start in some states, states have been looking at transitional paths to allow people to keep their coverage. It is very important to make sure we are a sexual it in the enrollment and the coverage. The enrollment and the coverage. There were some good reports out about how many people have been paying their premiums. But something that has been a real focus for statebased marketplaces is a effectuating that coverage and making sure that they are able to transfer that data back to the carriers without enrollment and to the payment to make sure that is effectuated. Overall, very promising news from these statebased marketplaces as we look forward to promising enrollment data, which we know we will be hearing more about today. Think you. Im thank you. I will turn it over to audrey. Im very pleased to be here. We have heard a lot about kentucky, which were very pleased about. And as you know, our governor is really pleased about it. This is a short version of our story. In kentucky, there were 640,000 uninsured in a state that is just over 4 million. We have about the exact ber is 3008000 that we 3008000 that we expect to qualify for medicaid under the new eligibility rules when we expanded medicaid. That wet 290,000 decided to qualify for premium assistance through the exchange. Kentuckyt happened in is the governor signed an executive order, which created the exchange. It is organized in my cabinet, the cabinet for health and Family Services. I want to mention this just a little bit. We found that this has been part of what we call the secret sauce i suppose. They cabinet, you have department for medicaid services. You have the department for communitybased services, which has been doing all of the eligibility for medicaid. Andalso provides food stamp the snap Program Benefits and tanf childcare. Those programs. The in our department is department for Public Health, and the department for behavioral health, the office of health policy, just to mention a few of the major departments. We think this is rather significant because we have not had as many of the structural barriers that you would think everyone works for one big administration and it should be a it should not be a problem, but we all know that organizations sometimes become barriers. Also, because medicaid is in the cabinet and they work so closely and did work so closely with the exchange we also have a very experienced i. T. Department. Anyone knows that medicaid has i. T. Ve a pretty Super Department that supports it, but so do the other departments within our cabinet. We had a lot of experience in bringing a vendors and we also had a great partner in the deloitte company. We established an Advisory Board at was made up of all the stakeholders, as im sure it happened in the other states as well. One of the stakeholders, i just there havent out been varying degrees of success around the country. But the Insurance Agents have been really involved in kentucky. We have over 2000 agents that have become certified on the exchange and are helping both Small Business as well as individuals get signed up. Theylearly, even though still receive an insurance commission, when they help people fun of for medicaid they do not get a help people sign up for medicaid they do not get anything for that. A lot of agents are in lower income neighborhoods and communities where a lot of people that are uninsured would versus one medicaid of our qualified health plans. They have been really terrific in helping them as well. And of course, we have what we navigators tos or help all around the state. Our exchange is known as kentuckys healthcare connection. Why did we decide to do it . It is not something we are proud of, but we are about the 44th sickest state in the country. If that is not reason enough, then im not sure what is. We all know that both education and health are such important for a statecks economic development, opportunities that are afforded to them. For Health Outcomes that are 50th and smoking, 40th in obesity, 43rd and sedentary lifestyles, 41st in diabetes, 48 in Mental Health days, 49th in Poor Physical Health is, 50th in cancer death, 49th in cardiac heart disease, 40 third and high cholesterol, 48 and heart attacks, 44th in annual dental visits. Something that any of us in our state would be proud of, and certainly not something if you were serving as governor or decorative area of the cabinet for health and Family Services you would be proud of. You can see kynect and the Affordable Care act provided us and extraordinary opportunity to take it vantage of the law and turn our health around. Our health statistics, we believe, could get worse before they get better. At least the reporting of them. The reason we say that is because there will be such high demand for screening and so may people that have gone without insurance for so long that we actually think there will possibly be a lot of chronic diseases that are righthave gone undiagnosed and unreported. That have gone on diagnosed and unreported. We know those numbers could go up, but ultimately we will be heading in the right direction. These enrollment statistics are as of monday morning. When i given to you, it will give you an idea of how daily enrollment has picked up. For example, as of this morning, 195,502195,000 enrolled in Health Care Coverage through kynect. Have 148 thousand 830 seven that have qualified for medicaid. Approximately 148,000 that have qualified for medicaid. That is about 6 36 of enrollment. It started out about 30 enrollment has and medicaid. Then