Good morning, everyone. Welcome to the newly refurbished, excuse me, well, i want to call it the oversight Investigation Committee room which is sometimes used by energy and commerce, and what a but beautiful room. It is more conducive to the good hearing. This is the the first one of the 115th congress and welcome here, and welcome in the Witnesses Today. This is the and welcome back to my friend and colleague Ranking Member from colorado. This is our Medicaid Oversight Committee on existing problems and ways to strengthen the program. We are convened to examine a critical component of the Affordable Care act, medicaid and medicare expansion. It covers over 70 million americans and accounts for more than 15 of the Health Care Spending in the United States. In 2015 alone, the federal taxpayers spent over 350 billion on medicaid and the costs continue to rise each year according to the congressional budget office, and the shares are expected to rise significantly in the coming the decade from 371 billion in 2016, and to 624 billion in 2026, ten years. At a time when the medicaid costs are skyrocketing, and asking the question, is medicaid serving ad quay will the most vulnerable populations . It was originally designed to be a safety net to provide care for the vulnerable populations children, women, and mn and women with disability, and for many who have not received medicaid, people with d disabilities would have struggled. And so these restrictions surrounding medicaid do not allow the doctors and the nurses to have the flexibility to arrive at the best outcomes. Many of them do not use the physicianfocused alternative payment models to reduce costs. And many say that medicaid costs do not result in better outcomes. One cited study in oregon said that it improves selfreported health and Mental Health with no effect on mortality or physical health. Similarly, the National Bureau of Economic Statistics found that there is only 30 cents to 40 cents of each dollar that the federal government spends. And reports of nonpartisan watchdogs, two of which are here today show that the Medicaid Program is a target for waste, fraud and abuse. Because of the size and the scale of the program, the imp p improper payments and including payments for people not eligible for medicaid or services not provided are extremely high. The Government Accountability office i says that medicaid paid out over 17 billion in fiscal year in 2015 alone. To these reasons, it is dedicated as a High Risk Program by the jao in 24 years since 2003 and despite the longstanding problems in the Medicaid Program, the Health Care Affordable act is to be expanded to a whole new population, and medicaid benefits have been opened up to adults for age 65 to make less than 33 of the poverty level. And since the enrollment began roughly 11 million americans have signed up under the new eligibility parameters which means that the majority of th r obamacare. And the enrollee care has been far more expensive than the Obama Administration predicted. The average cost of the expansion of the enrollees was 50 higher. The average cost is 6,366 in fiscal year 2015 which is 49 higher than aca predicted the year higher. That means that not only are the expansion enrollees are, pensive to ensure, but the costs are unpredictable, and the higher rate, the tax payers are on the hook for the vast majority of the expenses associated with the new enrollees and the reports show that both states and federal government cannot effectively oversee the medical expansion and the gao found errors in determinations that could lead to the misspending of funds. And likewise, the Inspector General found the troubling evident that they failed to implement the requirements of the patient implementation of the Affordable Care act, and to improve integrity and root out waste, fraud and abuse. And while we acknowledge the deficiencies in how the program relates, it is the responsibility of the federal government the provide a safety net for the most vulnerable among us to make sure that the taxpayers dollars are best serving the medicaid population. We want it to work. Not to hinder the services. I want to bipartisan way support the strengths, and find the problems and find solutions. Tomorrow, the Health Sub Committee is going to find solutions to strengthen medicaid, but as we move forward, we have to make sure that we dont repeat some problems that exist in the program. As we will hear from the Witnesses Today, we have a lot of work to do and i would like to the thank the witnesses to appearing today, and look forward to the discussion, and turn to the Ranking Member for five minutes. Thank you, mr. Chairman, and it is good to be back for another session of congress. We have two new members on our side of the aisle in the subcommittee this year, and i am happy pi to welcome them. Dr. Ruiz is an actual emergency room doctor who will be able to bring us so much great perspective on the hearing and other hearings and then scott pe peters who is not here at this moment, im pleased that he is here. He and i comprised 2 3 of the nyu law graduate delegation to congre congress. So i am here that we are loading up the committee with nyu law grads. So i think that i would be deceiving myself if i thought that todays hearing was intended actually strengthening the Medicaid Program, although i hope it is not so. I fear that this discussion about medicaid is intended to lay the groundwork for drastic cuts to the program, and eventually to appeal the Affordable Care act historic Medicaid Expansion. Id like the talk a few minutes about the importance of the program, and what Medicaid Expansion has accomplished for the American People. Today, more than 70 million low income americans including senior, children, adults and people with disabilities have k access to Quality Health care thanks to medicaid. C contrary, frankly to, what my colleagues on the other side of the aisle believe, medicare delivers care efficiently and the costs are actually substantially lower than for private insurance and growing more slowly per beneficiary. Numerous studies have shown that medicaid has helped to the make millions of americans healthier by improving the access to preventative and primary care, and to management and identity fi serious disease. So it saves lives. Research in the new england journal of medicine reported that previous expansions for low income adults in arizona, new york, and maine reduced deaths by 6. 1 . The acas historic Medicaid Expansion have let the states build on this record of success, and provide assurance to millions of americans who otherwise would not have had access to health care. And last year and we need to think about this, more than 12 million low income adults had Health Care Coverage because of the Medicaid Expansion. This is astonishing and combined with other important provisions of the aca this has helped to drive the uninsured rate to the lowest level in the countrys history, and it is important to know that it is not people who have shifted from private insurance to the Medicaid Expansion. This is people who had no insurance, and they were using the Emergency Rooms as their primary care facilities. In colorado the rate of the uninsured was cut in half since the enactment of the aca and the expansion of medicaid. Has actually resulted in tremendous savings for the states. Hospitals nationwide have seen their uncompensated drop by 10. 4 billion since the aca became law. Their up compensated care claims fell by 30 since passage of the aca, this is real savings, also we know that medicaid is helping people get Health Care Services. I had a session in denver last week about the aca, i had 200 show up at the listening session and most of the people who told their heart rendering stories were employed but couldnt afford insurance, they had services for catastrophic accidents they had had and on and on. It got to the point where i literally had to take a packet of kleenex out of my purse and put it on the podium because everybody including my staff and myself were in tears listening to these stories. This is what the majority wants to take away and this is what were talking about. We can all talk about eliminating fraud, waste and abuse in the program and were all for that and would support that 100 but taking away Vital Health Care for so many millions of americans is wrong and i yield back. We dont have anybody else on our side of the aisle who wants to give a statement. Perhaps mr. Pallone do you want to be recognized for five minute s. Thank you mr. Chairman, its great to be back in our room here today. It looks really nice. For seven years now Congressional Republicans have railed against the Affordable Care act with a steady drum beat of repeal and replace and sabotaged implementation of the law and leading the public with falsehoods of the mis failingfa the subcommittee should be known about the impact it would have on the americans and the system. But they highlight the laws of the Medicaid Expansion despite it is made available and afr affordable for the first time nationwide. Tomorrow is what is considered to be the first pieces of the g. O. P. Replacement plan. It will not prevent them from losing their Health Care Coverage successfully repeal the Affordable Care act. They are creating on certainty and instability in the individual market. This instaability the republican made chaos in the Health Care System has already gun and of course were seeing the same thing with the president S Immigration executive orders. I just hope that at some point our g. O. P. Colleagues join us against what i consider reckless and rash actions and oppose president trumps actions. C Congressional Republicans continue to ask the American People to trust them and they have a planned somehow everything will be okay and repeatedly assured the public they will not lose their insurance, but recently released audio at a closed door meeting from the republican retreat meeting last week confirms they simply have no plan, they admitted it could avis rarate f those covered under the medicare expansion. One warned and i quote we better be prepared we are willing to live with the market that this will reveal. The american plan republicans are so scared to own the chaos theyre causing that theyre trying to pretend that the law is imploding on its own which could not be further from the truth. Americans today have Better Health coverage thanks to the Affordable Care act. It has improved the quality and accessibility for millions of americans and my colleagues would be wise to consider the impact their actions would have for the current millions benefitting from the Affordable Care act. It would realize the Affordable Care act should not be repealed. I say this because i dont care about the ideology, the fact is real people are going to be harmed if the Affordable Care act is repealed. And hope at some point my republican colleagues will admit that and we can Work Together to improve the Health Care System. We move forward with our witnesses. I want to ask unanimous consent that the Opening Statements be entered into the record and documents introduced into the record. First up we have miss carolyn yocum, at the u. S. Government accountability office. And anne maxwell, inspections of Department Department of health and Human Services office of Inspector General. And paul howard director of Health Policy at the Manhattan Institute as well as mr. Josh arsham arshambo. Timothy m. Westmoreland professor on the georgetown university. Thank you for coming, looking forward to hearing from you on this important issue. Doing so has the practice of taking testimony under oath. Do any of you have objection to testify you should oath. See in objections. Under the House Rules Committee and to be advised by counsel . Do you prefer to be advised by counsel . I see no objection. Swear you in. Do you swear that the testimony you are about the o gio give is truth, the whole truth and nothing but the truth. All affirmed. Section 1001 of the United States state code. Is there some lights that will go on for them when they are well see. Is there something in front of you, green means keep talking, yellow means youre time is about up. Chairman murphy, ranking, members and members of the subcommittee, its a pleasure to be here today to discuss actions needed to prevent improper payments in medicaid. Medicaid finances health care for a diverse population including children, adults people who are elderly or those with disabilities. Also offers a set of acute and Long Term Health care services. Medicaid is one of the largest programs in the federal budget an one of the largest components of state budgets as well. In fiscal year 2016 medicaid covered about 70 Million People and federal expenditures were projected to total about 363 billion. Unfortunately over 10 of these over 36 billion are estimated to be improper, for services not covered by the program, were not medically necessary or never provided. The program, size and diversity make it vulnerable to improper payments. It states our first line of defense against improper payments. They have responsibility for screening providers, detecting an recoverying overpayments and referring suspected cases of fraud and abuse. At the level they over see integrity efforts. In 2010 the Affordable Care act gave states an provider and integrity oversight tools and provided low income americans new options for obtaining Health Care Coverage. Through possible expansions of medicaid or through exchange a marketplace where individuals may compare and Purchase Health insurance. My Statement Today focuses on four key Medicaid Program integrity issues that we have identified. Steps cms has taken and the related challenge of the agencies and states continue to face. First, with regard to ensuring only eligible individuals are enrolled in medicate cms has taken a variety of steps to make the process more data driven yet gaps exist, including enrollment for those eligible as a result of the expansion. As one example, we found that federal and selected state based marketplace has approved federal Health Insurance coverage and subsidies for nine of 12 fictitious applications made during the 2016 special enrollment period. Second efforts to improve oversight. Cms provided states with methods of identifying improper payments made to providers and in active response to recommendations requirements for states to audit managed Care Organizations an providing states with additional audit support, but further actions are need. In particular, in counter data which allows them to track those in managed care are not always timely or reliable. Third cms has taken the steps of screening providers, there are new risk based initiatives for over seeing provider checks and these are important steps, but there are in place to share providers who are ineligible for coverage. Lastly cms has implemented policies to prevent duplicate coverage, since our report cms has started doing checks on duplicate coverage to at least two times a years, this could save federal and beneficiary dollars but cma needs to develop this broadly and make sure of the efficiency of these checks. In closing, it is important for healthcare of tens of americans its long term sustainability is critical and requires effective federal and state oversight. Thank you members of the members of the committee. This concludes my prepared statement. I would am prepared for questio. Thank you for the opportunity to appear before you today to protect tax payers, and patients. From medicare abuse. It can be very complex and on one instance we indicted 30 Nursing Homes that billed for services that patients didnt need. In another example reconvicted a doctor for writing fake prescriptions, expensive drugs then sold on the black market