To get medical care. They didnt need it. They were healthy, and others chose bronze and ended up paying more out of pocket than they should have had they made a better decision. Our products are very diverse. Everything from High Deductible Health plans, as you say, compatible to zero deductible, nationwide networks as well as Regional Networks from all major carriers. Our successes, in large part due to our partners, we have strong relationships with the broker community, with assisters, navigators, other Government Agencies, elected officials, the Faithbased Community has been significant in our efforts, and we find that when we have sunday enrollment events, our numbers always go up in terms of number of applications, completed applications and plan selection. We have strong partnerships with all of the largest chambers in the district of columbia, and the National Association of Health Underwriters does our training for brokers, and that has helped significantly with our broker community. I think im out of time. Do you need to make, do you need another moment . If i can borrow some of your extra time you didnt use. Absolutely. Thank you. [laughter] and i did try to talk fast. So we learned many lessons from the first two open enrollments. Last year what was successful for us was having storefronts with regular hours. So a person anywhere in the city could just go to a storefront and know that someone will be there, either a broker or navigator or an assister. So were going to continue doing that. We have onetouch enrollment events where we bring together other Government Agencies like medicaid brokers, navigators and assisters to help people enroll. One touch means you dont let the person leave until theyre fully taken care of. If they need identity proofing, were right there to do that. If they need health plan selection, brokers are right there to do that. So its just one touch, you get everything done in one place. We also did many Creative Things like 24hour enrollment events where for 24 hours we were somewhere in the city, mostly in clubs and bars and diners, bens chili bowl, doing enrollment events, and that helped us with some of the younger population we were trying to reach. On super bowl sunday if you ordered pizza from some of the restaurants we partnered with, you got a flier, and that actually generated a bunch of enrollments. We saw an influx in our data when we looked to see if that worked. We targeted specific populations who we know have a higher rate of uninsurance. So we did special events at selma opening, we had boys two men barbershop days. On valentines day, if you love someone, make sure they have Health Insurance cards. They said Better Things than that, but you get the gist of it. [laughter] and, of course, during all of the college bowls and other events we were out there doing enrollment and education. For this open enrollment, we have even a bigger challenge. We think we got most of the uninsured, and were looking for folks who are just hiding from are us. We havent found you. So our effort is going to focus on each one link one, so because you care, be the link are. Reach family, reach a friend, reach a neighbor. So its going to be very much localized, more localized. Were also expanding our social Networking Community through social media and Digital Campaign efforts. Weve learned a whole lot, that certain populations use are certain types of communication. So, for instance, the Greater WashingtonHispanic Chamber is going to be doing a bunch of texting for us. Texting is a major r major way that the Latino Community communicates. So were going to be utilizing and expanding our social and Digital Campaign. And just one add, a local business may customize make customized dress shirts for men only. Maybe theyll expand to women, but theyre in our ad, and they say were saving money and providing great coverage through d. C. Health link. We have many local businesses, cupcakes and several breweries, so if youre a beer drinker, youre probably getting it from one of our customers. And also the other major population weve served are people who had job lock in the past, were afraid to leave their job without access to affordable, stable coverage, and now they have it. So many people in our ads are folks who are entrepreneurs who couldnt leave their jobs before and now have that freedom to pursue their dreams because they have stable coverage through us. And with that, ill conclude. Thank you so much for the extra time. Great. Thank you, mila. So we will now open up for, to take your questions, and again, we have two microphones, here and here. You can submit a question on a green card, and you may tweet a question to hashtagging oe3. And we already have a question here an the microphone. If you could, please, introduce yourself. [inaudible] cori and jon, do you have any idea to what degree [inaudible] may have an impact [inaudible] do you have any idea [inaudible] well, im sorry, i dont have any data on that. I know in the trade literature theres been a number of articles about the increased use of Mental Health services, but i cant give you any numbers, and i cant cite any studies that i can recall that gave us numbers. Oh. Anybody else . He had asked, i guess, two questions. Yeah. So we dont have any numbers, but i will tell you that we have a Behavior Health subcommittee under our Advisory Board that meets, and we have had conversations regarding Mental Health parity. And to our knowledge and weve also engaged the department of insurance in those discussions were not really having any issues with Mental Health parity in kentucky. But we do have a meeting scheduled on november 9th, and were bringing together all of the issuers and either their medical directors or their staff that are familiar with Behavior Health as well as the Medicaid Managed Care organizations to have a fuller discussion on Mental Health parity. Thank you for your question. So in january of 2013 one of our working groups was looking at Mental Health and Substance Abuse issues, and early on we decided that we werent going to allow day limits. So that is from the first day that was part of the requirement in the district. We, like kentucky, are monitoring everything, and one of our high Priority Areas are folks who have Mental Health, Substance Abuse needs. Often times, and this is back to our state insurance regulator days, i can tell you that that particular segment of the population doesnt always call you when they need help. So it is extra important if the local societies are hearing of issues even though its anecdotal, it will help us tremendously to monitor if there is a problem. So i encourage you to get in touch with us. Okay. Lets go to this microphone, and then well swing to this side. Thank you. John graham, National Center for policy analysis. Im just wondering about how enrollment evolves over the year. First year there was a dropoff, and then you lose a lot of people. Looks like the same things happening in 2015. Is that persistent, and what explains that . Ill just take a stab at it and then maybe carrie and mila want to jump in. People, people do sort of move in and out of the marketplaces. People have always moved in and out of the individual Insurance Market. So people who may sign up in march or april or in this case in january may actually find another source of coverage, you know, halfway through the year and leave. What we dont know is the number of people who are leaving because of the plan itself. So i think thats a question. But theres, this market has really been characterized by a lot of fluctuation historically. You know, weve had some movement. We had a slight decrease based on some recent numbers issued by cms, but thats pretty typical, and, you know, we try to track that as best we can. Yeah. For us as well. And actually in d. C. After open enrollment we have high volume of people coming in through special enrollment periods. So after open enrollments are are done, every month we have between 5001,000 people coming in which is significant for us. I can tell you anecdotally people who end up losing their coverage not because they have a job or move away, but because they missed paying their premium , they lost their source of income or their circumstance changed, thats im seeing about 1015 people a month. And the reason i see them all is because i review all of the sep denials before the person is denied access to coverage. And so that is a growing concern for me even though its 10 or 15 people a month. It tells me that affordability is still an issue, and we may have to look at policy interventions to catch people when they have a bad period. We shouldnt force them to to wait six or eight months to get back in through open enrollment. Rebecca adams with cq roll call. This is a question i hope a few of you can address. We recently learned that cms has a 2. 5 billion shortfall in risk corridor payment, and im wondering if you can look ahead and talk about how this might affect premiums Going Forward. So i dont think that it directly so the risk, the request for risk corridor payments going out exceeds dramatically the money coming in from the Risk Corridor Program which suggests that premiums were understated. But the fact now that cms has said theyre only going to be paying a portion of that, those requests shouldnt itself have an effect on 2016 premiums. Because the information that insurers had to set their 2016 premiums was kind of the same that they had when submitting their risk corridor requests. So that shouldnt have an effect on premiums. Where i think you will see more of an effect and a concern is on the solvency side, especially for those small and newer plans who expected to be getting some risk corridor payments and now theyre receiving only a portion of those. That may be more of a concern that we need to look at more. The cms statement, that onepage statement that they put out just had really the topline information about how much was requested, how much they expect to receive. But im hoping in the future theyll provide a little bit more information that we can understand a little better whats driving some of these numbers. Is the transition policy that i talked about, is that driving some of this . So being able to examine those numbers by whether the plan was in a state that had the transition policy, i think, would be very helpful in better understanding these numbers. Because, remember, in 2014 that transition policy occurred after 2014 premiums were already finalized. So i would expect in some states for that to be a significant driver of some of these risk corridor requests. Can cori, could you take half a step back and explain what a risk corridor is and what the issue is . I know you got into some of that, but just take a half step back very briefly. So the aca has three risksharing provisions in it. Theres risk adjustment which shifts money between plans based on the relative risk profile of the plan. So mans that enrolled high plans that enrolled highcost people were going to be getting money from those plans that enrolled more healthy people. Theres the Reinsurance Program which i spoke about which provides some subsidies to plans for their highcost enrollees. Then theres risk corridors. And the risk corridor provision was to, in a sense, acknowledging that in 2014 and this is a temporary program like the Reinsurance Program just is scheduled to run from 20142016. In the early years of this new program, there was a lot of uncertainty, as i said, regarding who was going to enroll in coverage and what their Health Spending would be. So the government was going to, in a sense, mitigate some of that pricing risk by sharing some of the costs and some of the gains if insurers premiums were either too high or too low. So if premiums came out in the end to be too low relative to the claims that the plan experienced, the government would pay that plan to share in those losses, to offset some of those losses. If, on the other hand, the plans premiums were high relative to what was actually experienced, the plan then would pay the government a share of those gapes. I just wanted, also, just to jump in and put the claims in context with the other, with the other claims in the Reinsurance Program and the risk adjustment program. So the claims are about 2. 9 billion for the Risk Corridor Program this year, and they actually can be continued to be paid out in out years, so 2016 and 2017, as the payments come into that program. But on the reinsurance side, nearly 8 billion were paid out this year in claims for people that, for companies that needed them. There were fewer claims that came in than were expected, so actually the dollars that came out were larger than they were originally going to be. And then also the risk adjustment transfers amounted to about 4. 6 billion. So the Risk Corridor Programs are really important for some smaller insurers, its actually a smaller part of that, of those risk adjustment programs. You want to we have a question on insurance consolidations and what, in fact, we might expect those to have or those proposed consolidations on premiums. Well, my research on both shops and the individual exchanges indicates that as the number of insurers in the state increases, you see a decline in premiums. Modest, maybe 2 per carrier. But still if theres lots of carriers, that can be pretty significant. So i think its good news that were going to see on the individual marketplaces more carriers participating. But overall, the individual Insurance Market has always been heavily concentrated market. When i say always, i say since about 2000. Last time i looked at it, in a typical state the largest carrier had 55 of the market. So this is preaca. So i would say i dont think, i dont look at consolidation based on my research. I dont look at it as something that will lower premiums. I think its much more likely to raise premiums. Mila or yeah. So just stepping back, recall that the largest component of premiums is claims. So that nick that helps lower anything that helps lower claims can help put downward pressure on premiums. But theres still some uncertainty about the impact of mergers, and that will depend in part on the particular market. Regarding both the level of insurer competition that exists in that market right now and also the relative balance of negotiating power between the insurers and providers and whether insurers can get increased power when theyre negotiating their provider payment rates and also the enhanced ability to implement some alternative payment and Delivery System reforms. So i think theres some potential there, but i think it really is going to vary by market. I would just quickly add in some states before the aca the largest carrier was, essentially, a monopoly with 90 or more of the market. And since the aca, certainly, in many places weve seen market share shrink which is good if you believe that smaller market share increases opportunities for other carriers to come in and compete effectively, and that has happened since the aca. I agree it really depends on where you are. In some cases where you still have a market thats 90 monopoly, it is really hard to enter that market because of the investment it takes by the insurers. So in some cases it could be very helpful to get new players in through consolidation in other states its not going to be helpful. Just offer this, want to remind people of carries really striking slide of whats happened in kentucky in just a small number of plans. Right. I mean, prior to the aca we basically had two insurers. But the dominant insurer had 80 of the individual market. So postaca we have new carriers coming into the market, prices are more competitive, you know . So its been a tremendous benefit to kentucky. Okay. Lets take a question at the microphone. So finally, its right on that note and if you could identify yourself, please. So Kyle Redfield from the congressional budget office. So this is primarily for carrie, but yeah. As you noted, theres a pretty rapid expansion of the number of insurers available, so i was just wondering if you have any sense of what was driving that interest and then if there were any, was any impact on premiums as a result. And then sorry, before you jump in. Separately for, but related for mila, so im not an actuary, but is the pool size in d. C. Any issue for insurers . Does that drive their interest at all . So i think the reason that we have more carriers entering the kentucky market is the success of connect. So, you know, were extremely excited about that. And, you know, those coming in, some of them are offering very, very competitive prices as well. So, you know were not actuaries either. Yeah, we are not. Right. [laughter] but we do have one here. I have one more thing to add too. One thing to note, too, that i guess some of the carriers that have come into the market have offered Medicaid Managed Care plans. So is, you know, they see this as positioning themselves for those people maybe who are terminated from medicaid due to increased income that a, you know, theyll stay with anthem, or theyll stay with humana, or theyll stay with aetna. So i think probably the Medicaid Managed Care organizations just trying to position them