Is a collection of stories on the history of Popular Culture. When you say Popular Culture, it is quite more than that. I believe that what i have been trying to do is go into more detail as to how Popular Culture impacts the politics and sports and other arenas. It is not just about pop culture. It is about what we have for stories about popular music. Sports biographies. We have had some history of media. So i purposely castanet to see what we had. Were with the founder and publisher jack boyle sunday at 8 00 p. M. On cspan q a. The forum on the Health Insurance exchanges. The former head of medicare and medicaid and Michael Burgess of texas on the subcommittee. Politico pro posted this one hour at events. Good evening, i want to thank you for joining us at the Politico Health care breakfast. Thank you for joining us. We are Live Streaming as well. We have a good panel and we are going to talk about state involvement and some of the other aspects that are happening on the ground. I would like to thank cbs for their partnership on this series of the proHealth Care Breakfast briefings. Here to say a few words from cbs and caremark. Good morning, everyone. We are thrilled to be sponsoring this event and to have such an esteemed group of people and participants on the panel. The Affordable Care act has been described as one of the most complex implementations. That is the way that it could be that october 1 is the implementation of these dates. It is somewhat like building a bridge that is really an excellent description. We are trying to figure out how to make this work with the government sector and nonprofit corporations. So one of the ways to make that connection is to fill the knowledge gap that exists. Cbs and caremark released research that shows that 36 of people that we have surveyed were likely to enroll in the Health Care Exchanges and we need more help and information as we think about all this. Even more striking, half of those people who are eligible for subsidies do not know that they are eligible for subsidies. We also found the overall awareness is up 74 . In other words, more people know that this is coming and they are prepared to do something. At cvs and caremark, we help you help the consumer navigate their benefits. We are helping customers enroll in these new plans. 68 of the people that were surveyed actually just expect pharmacies to be able to provide to them with exchange related information. We hope to make this program work for all the americans we can serve. Thank you very much. Im not. We want to thank everyone for watching us. You can tweak your questions in the hash tag today is the Health Care Breakfast briefing and i will be tracking this from the tablet. Yall know that i got it right last time. We would like to welcome our panelists. We have representative Michael Burgess who is the chairman of the House Energy Subcommittee on health. Good morning to you. Good morning. We also have the director for the National Academy for state Health Care Policy and the director of Health Programs and the California Health foundation and the president and ceo. We are going to have a great discussion and we will be taking questions from the audience as well. Okay, lets get started. We wanted to get some state specific knowledge and a national overview. We are going to break down the mechanics of what is going well, what youre worried about, also it has become a red hot political issue. I think we have all seen it the last few weeks, it has risen back to the intensity that we have seen before. I wanted to get from the three of you, first of all, i wanted to question a little bit about what we know here what the elements are like in washington. How intends has it been . I think this is probably an easy question from texas, but lets start there. Sure come, the short answer to the question is yes, i want to give people a moment to check their programs. I thought this was a health care briefing. [laughter] youre also a physician and ob gyn. Yes, who canceled on me at the last minute. [laughter] with everything i have told you so far, i said that no bill would come to the house floor get through the senate and the Supreme Court will take care of this and that will take care of it. One of our editors was just speaking about this. We are taking that financial responsibility and it is not something that the governor has said that we are going to do. Even though the state legislature is in special session, we see them working on other things and not theirs. Everything is right on track him everything is right on schedule. When you look around, things are kind of following. Because we have this little trail of debris that is left behind for the Affordable Care act. The bumps down the road. Obviously july 2, the revelations and it was very startling were just a few weeks before, can he do this, will you have to delay it, you have to know the scope. And then a few short weeks later we have to face the headlines. One of the most troubling things to me is the concept that since we are not collecting and what could go wrong with that. But it is of concern to me. We are part of the subsidy we capture. Because i dont know people are actually aware if this will be a subsidy available to them, they are going to be asked how much money youre going to earn this year. It would be difficult to know how much im going to earn into your head because there are a lot of unknowns. The subsidy, of course, will be paid primarily to the insurance company. So there is still a lot of anxiety and question marks about october 1. Stay tuned. Is there a trail of debris in california . No, i would not say that. We have established a statebased exchange we are talking about the Medicaid Expansion under the Affordable Care act. Many important milestones have been had. The political environment is not particularly divisive in part because we have a democrat controlled legislature as well as a democratic government. But again, i think the stay tuned, and is not out of place in california either. It is a very complicated law with many moving parts. Ito coming we have many conservatives, governor brownback, insurance commissioner who has wanted to go ahead with the implementation and a governor who doesnt want to go near it. And the governor prevailed. As you keep track, what is the intensity their. The politics is interesting. I have lived in texas for 50 years. I still have trouble understanding it. Its like you have kansas, that has transformed itself and quickly disproved when Kathleen Sebelius was elected and is dropped off over the last two years of her term. Will with me leaving with governor brownback elected and the legislature has been extremely conservative. Yet there are elements of moderate politics. We have this very interesting dynamic for the last couple of years where the republican governor very strongly against the Medicaid Expansion in the aca in general, one more moderate republican who actually supported the legislation wanted very badly from exchange to be set up in four to be implemented. It has been very interesting to watch. Is very interesting. You have lived through the implementation, which was hard and complicated. It was not as technically as complicated. We are two months now. I mean, how in the spectrum, it will be bumpy, but it will work as well. It will all fall apart. What do you worry about when you are alone . So i guess that is a pretty wide margin and i think it is going to vary from state to state in some states like california we have a lot of outreach and education activities we are not expanding medicaid and the republican side has not had as much exposure to the lot. This is different from the Medicare Part b implementation, one is to make a distinction between the philosophical and political differences about where our countrys Health Care System should head. And when patent means probably for the public. It is just an issue where we do have very different views in congress throughout the country. That is going to continue for a wild. It is what does this mean for me, and i think that this will mean some questions, republicans, democrats, we have resources that will be available. We did a whole round of outreach this is the pose that medicare modernization made it not a philosophical issue, but we want to make sure people come to you with questions or when you have questions, where to go to get answers and work with them with these kinds of tools. We are taking more of a different approach of a campaign style. 7 million switchover of their coverage on one day. We are working through these month or two and the vast majority of medicare has talked about the Enrollment Period that ended. That is not likely to happen in this case. Everyones projections, theyre going to be a lot of people that remain uninsured after this first open enrollment. Matt, by their own choice and because there is not a Medicaid Expansion as of yet in the state. So this is going to be a several year implementation process debating whether this is the right way to go and modifications to the program along the way. A similar assessment, probably all of the states are many of the graves there is a difference about what is actually happening on the ground. Has that gap widened . Or it may vary. There are states that are doing federal exchanges that are still working on this. Let me start with the ageold policy adage, which is you have seen one state, you have seen one state. But that is something that having been said, i think that i can talk about groups of states and groupings. They are the states that have embraced reform, statebased exchanges, they are working hard and they are going to be ready for opening in october. The directors and we work closely with them, i spent a day recently with five of the ceos of the exchanges and these are people who are not in it for a job. They are mission driven. Their mission is to get the doors open, if you will. But it is not going to be the 2. 0 version that we will see over time. It is going to be offering options for coverage with a lot of creativity and in terms of the way that they are connecting with consumers. Then you have the states that are the partners of the federal government and even there, while you dont have a lot of activity necessarily a political level, you have political employees that are Civil Servants and have a job to do. In all the states their job is to protect the consumers and to make sure that the coverage that they have this quality coverage and that there are no ill kind of things that are going on. They take that job very seriously. Some of them have taken this a step further. They understand when this exchange opens and they are prepared to answer and field those questions and some of them are looking within the state of kansas to what they could possibly do to make it easier for consumers to understand their choices. The medicaid department, whether expanding or not, in order to make it smoother for implementation and they were looking for a better customer experience. At the implementation stage, and this is the law of the land, they are working hard to implement the. You guys are cms, you are working in the Bush Administration, you are an administrator, an academic, all of these things. You dont agree with everything in this administration, but just from a technical perspective, and when you watch what they are doing, save your watching evening news and something comes on, what makes you say, dont do that. I dont know how much advice you give them, but what do you say . Not that again . I dont have that reaction to news very often. But i think that it will be three times coming up or we might have some reaction. One is in september and it will be, when you see the results of the policy decisions that have been made. That is what plans have been available, that has also been across the states that have had a lot of insurance regulation having this as an adjustment, some in the state exchanges that are way out in front, maybe having a more comprehensive set of plans and we will see one that was released in september. We would point out that there are a number of people who already have individual or Small Group Insurance coverage and are not operating under all of the rules of the federal exchanges were the rest of the long now. Some of which will be significant premium increases. We will see this on october 1. We have a lot of funding for that in the administration seems to be trying very hard to put all of this together, the ones that they have deferred some of the doctor ardea mentioned, there is a difference with how Technology Works in theory and how this is incomplete or otherwise incompatible data and its going to include a lot of issues around that. We will see how big that is. Then there is education outreach and there are a lot of questions about how well people are going to do when they find out about this, especially for younger and healthier people. Those are things i certainly have opinions on. Those are the things that i would be watching, making sure that the metrics that i can follow, that this functions best with timely and uptodate information. Whats good october 1 on the first day we are expecting to have over a Million People signing up. There will be a snapshot quality to it. On october 1, and again in the first week of january. It may dribble out a little bit more because not everybody will be getting care the first day. There are more seniors to try to get something. If you have a serious chronic disease in the mr. Medication that. Of the larger subset of people. Texas is one of the states that is the most approached. He is sort of symbolic of the resistance and opposition. What happens in texas on october 1. Do people sign up, do they say that this is the worst thing that we have ever heard of, i mean, what you see in texas . You get a lot of that reaction. But the Medicare Part d this is not just political. You hear about them and he read about them and about a third of those people have to be in the invincible category in order for the economics of this thing to work. So i would imagine that they are focused very much on getting to that number as quickly as they can. But it is at a point where no one is going to necessarily qualify for the subsidy. So at the end of the year, i think that there will be some difficulties there. But if the only metric is the number, there is a lot of activity in states like mine the advantage is not only to get someone signed up for insurance, and this is some point in the future that may be used to it. But you dont see a lot of it happening on the articles of the paper they are talking about the nsa and the irs and all the other things youre talking about. So basically youre saying is there evidence that they are just looking at us this and we are looking by mr. . So simply because we have identified what successor is in this includes 7 Million People, and we need to get there pretty quickly. In order to say, well, look, this thing is working just as we planned. The whole suttons lossing because that is where the money is. You have a very differently and you are doing much more outrage. You are doing messaging. It is a totally different political environment, if you also have hardtoreach populations and have nonenglishspeaking, you have the farm areas, plenty of young invincibleis, so that the obstacles are similar in a different political context. What are you seeing and what is happening when october comes . Circuit is hard to say until october. It seems like we will be investing a huge amount in outreach and enrollment Grateful Campaign has not launched yet. So there are very Big Investments that are going to be made by california. Californias statebased exchange there is also a very Large Campaign funded by another statewide Health Care Foundation targeting primarily those already ordered. Those need to be well targeted and focused. The question will be how effective it is at. A lot of thought is being put into targeting these populations for example, State University systems, they have sort of a natural affinity to younger people and people with families. So a lot of thought has gone into that. But approval would really be when people when they receive that message, what do they do. Do they activate . Do they go to other sources to learn more. And when they get there, do they find an attractive set of options at prices that are affordable with conditions that are understandable . The question of how the subsidies and tax credits were, that is a huge question about how people really navigate with that and engage with those choices. To the extent that you see what is going on in kansas. Let me answer and say that i realize we need to add 7 million folks that we can add right now. We believe that this will impact folks and the thing that i look at the most if the cost go up dramatically for currently covered persons come in the political dynamics are such that it will be very difficult for the law to remain in the longterm. The medicare extensions will incur and eventually they will get around to that on the other hand, people wont care if we beat the 7 million of them. Okay, 7 million if you look at people who have individual coverage now plus people who have coverage to Small Businesses now, its a much larger number than 7 million. Those individuals and those Small Businesses are going to be significantly affected by the law. The choices t