Transcripts For CSPAN3 Politics Public Policy Today 2014092

CSPAN3 Politics Public Policy Today September 29, 2014

Knowing that the upcoming november Enrollment Period is coming for millions of americans, who will be shopping on the exchanges, how prepared are you to take these 28 recommendations and others to assure protection . Yes, maam. Let me start with the 22 technical recommendations. 19 of those have been resolved or mitigated or will be further reviewed prior to open enrollment. So those will be handled. Of the six other recommendations, were in the process of either completing have completed those, or will complete those prior to open enrollment. And based on the 19 that youve identified, miss tavenner, and the remaining measures to implement, you are confident that not only are they implemented, but theyre tested, and will have to the greatest degree i might disagree with some of my colleagues that we can do everything in our power, and those hostile, those negative, those who intend us harm and intend to access that information for their own gain will find ways to do that. I want to make sure that were doing everything that we know that mitigates and prevents and gives us the opportunity to also detect when theres been a problem. Youre confident that these will be tested and in place by the open Enrollment Period . I am confident. But we will never quit continuing to try to improve the process. Our work with the department of homeland security, our work with gao, org, will always be looking for improvements. I appreciate that. And given that were working on another issue in my state, i appreciate your attention to that. And your coming. Mr. Chairman, were working on a Behavioral Health issue. For me, it all ties to making sure that consumers have confidence, that theyre protected in a way that cms is responsible to protect those citizens, that they are clear, that your responsibility and oversight is paramount to the work that you do. And that the access to health care is only as good as making sure that the information and the protections that are required by law are in fact in place, and that they can go to cms when theres a problem and have that resolved objectively and appropriately. I really appreciate your attention to all those matters. Thank you. I yield. Miss tavenner, i just want to make sure that i understood what you just said. And i agree with every word that my colleague just said. But youre saying that there are six recommendations left, is that right . Sorry. There were six major correct me if this is wrong there were six major recommendations. And were in the process of completing those. And some of them are done. And the answer to those is, all of them will be done prior to open enrollment. And that starts when . November 15th. Would you let us know officially when they are done . Yes, sir. Because the chairman and myself id really appreciate that. If the gentlelady would yield. You didnt agree to all six, but three out of the six. You will now agree and complete all six . I think in some of them, we partially concurred. Were getting the work done. Whether we totally agreed or not, i think there were some things, for instance, there was a different description of how we did security testing versus what gao wanted. That wasnt an action we would change, but we understand where theyre coming from. We just have a different way of getting the security testing done. The rest of these things, such as the privacy impact statement, we will have that done. That was a documentation issue. The computer matching agreements with peace corps and opm, well get that done before open enrollment. With equifax, well complete that. The 22 technical recommendations, 19, weve already done the others were reviewing. Ill be happy to do something in writing back to the chairman, and to the i think we both would proesht it. Gentleman from north carolina. I wanted to follow up on one thing, miss tavenner. It really, as we start to focus on some of these other issues, it takes our eyes off of the core issue, and thats what the Ranking Member is talking about, is providing health care, really, to the american public. And thats your primary responsibility. I can tell that you take that seriously. It is a distraction, to say the least, when we have a billion dollars spent on a website that doesnt work, Security Issues that are there. But along that same time, there was a rule that came out with regards to Medicare Part d in january. That a rule that really would limit some of the options of our seniors. A rule that you came much to your credit and said, were not going to do. And i want to say thank you for doing that on behalf of millions of Senior Citizens who would have seen choices limited. Do i have your assurances here today that we are not going to put forth a rule that is similar in nature to that rule that was brought back . I very rarely have an opportunity to have you in a public forum under oath, so on behalf of millions of americans, do i have your assurances that were not going to do it . I think you made a good decision. My mom whos a Senior Citizen thinks that you made a good decision. So do i have your assurances that we will not see a similar rule . Im not interested in bringing back the pieces that we pulled. Thats a good almost answer. So do i have your assurances, yes or no . Yes, my assurances i wont bring back the things i just pulled, how about that. Or something similar. Let me tell you the reason why. And it gets back to cbo indicates that much of the reason that it is working so well is the competitive nature that we have. I mean, thats what the study says. And yet were going to limit competition. Were going to limit options for our seniors. Some cancer, some antidepressants, some antiepileptic. These are serious things. And so you and i can banter back and forth, but really, what i need is on behalf of the American People, your assurances here today that thats not going to happen . Now youre bringing in specifics. Im not interested in bringing back the drug categories if thats the question. I am interested in promoting competition, promoting private market. And i think weve tried to do that with the marketplace rules as well. We would continue to work with that. Were not going to limit competition and were not going to narrow what people can get . That would be my preference, yes, sir. Thats your assurance . Thats my assurance. All right. Thank you. I yield back. Could you yield to me . Be glad to. Briefly, item 4 from the gao says perform a comprehensive security assessment of the ffm, including the infrastructure platform and software elements. Initially that was one you said no to. Are you saying you will perform that full systemwide test and have it done by november 15th . Because thats sort of the one that gao couldnt we cant know what we dont know until you do that, right . The mic, please. We get into a discussion of style here. It is our intention, and we will complete a full endtoend security assessment prior to open enrollment, yes, sir. Thats scheduled for later this month, or october. I think where we got into a different kind of construction, it had to do with infrastructure and platform and our definitions. But i think our intentions are the same. Why dont we let, greg, give us the rest of it. As long as the tests that they perform includes how the applications enter the phase of what the operating platforms and infrastructure, to look at it in totality is going to be critical. Because certain vulnerabilities on certain layers of the security could affect the security of the other components of it. Because there are a number of components involved with this website and supporting systems, and a number of different entities involved with their operation. And so for the layperson out there, would it be fair to say that, for example, when software opens a portal on a particular piece of equipment, that that can create a vulnerability, and one type of hardware, that it wouldnt in another. That thats the type of thing that they actually have to look at the type of hardware theyre using, what it interfaces with and so on, is that right . To include looking at the fire walls and routers and switches that support it, as well as the operating systems and how theyre being configured, yes, sir. And i assume any Remote Access to devices, vpns, all of that would be part of it. As i understand it, one pc that has a vpn connection that isnt in the software, that once you put it in, it can create a separate vulnerability, right . So if i saw the heads nod, and i like that, the two of you one of you is going to come back to the Ranking Member and myself if this agreement that youre going to do this by november 15th doesnt happen, is that right . Maybe both of you . I would be willing to work with your staff to do followup. I think thats all that mr. Cummings and i would like to know. Since youre shaking your heads and now, if that stops between now and november 15th, one of you will tell us. Yes, sir. Mr. Cummings . Im going to encourage you to do that. Just do it, please. We will do that. And im not trying to be smart. Miss tavenner, i know and all of you, i know youre trying to do whats in the best interests of the American People. I understand that. But it seems as if what we want is the highest level of best practice. Am i right, mr. Chairman . Absolutely. And miss tavenner, i couldnt help but when i was thanking you on behalf of my constituents, i could see a tear come up in your eye. You know, soh k÷ often i think federal employees a lot of people dont realize that a lot of our employees, most of them are not in government for the money. Theyre in it and i have people coming to work for our committee all the time who are willing to take reduction of salaries from the private sector, because theres something about this that feeds their souls. Something about lifting up the public, and making their lives better. So to all of you, and to all of the federal employees who may be listening out, and the ones behind you, miss tavenner, and all of those in the audience and up here, i just want to thank you very much. Thank you. Thank you. I understand the gentlelady from new mexico, did you have any followup questions . Mr. Chairman, i dont. I was thanking you. I thank both the leadership that we get feedback, and they represented very effectively all of my concerns and points. So thank you very much for your leadership. Thank you. Ive got a couple very quick wrapups that came out of these. Big smile, because were nearing the end. There was a question about more people being insured. And i just have to ask, is medicaid insurance . In my opinion, medicaid is insurance, for sure. But that was not but the actual level of insurance under medicaid, that was talked about, its medicaid insurance, thats whats lowering the number of uninsured is medicaid . Plus the marketplace, lowering that number. Which has been subsidies primarily . The actual number of people who are receiving unsubsidized health care has gone down, is that right . You know, i dont have all the reports in front of me, but actually, the number of people insured off the Exchange Without subsidy is also rising. I dont have the latest private Insurance Private insurance had a negative trim going on for the last ten years. That seems to kind of stabilized out. If you add medicaid, and you add the Marketplace Exchange with or without subsidy, i think thats what youre seeing this falling the reason this question led to this sort of feeling that everything was better, but isnt it true that the medicare trustee, charles blahouse, he projected that by 2021, the impact of the Affordable Care act will be a 346 to 427 billion increase in the deficit. Essentially, because the governments going to pay that 100 , and then 90 for medicaid, the government is in fact the taxpayer, so the deficit will rise based on the money that buys that insurance, is that true . Im not familiar with that report. Okay. But the government is general tax revenues are in fact paying for these subsidies and medicaid, it doesnt come out of a trust fund. Medicaid is ordinary income tax. Is that correct . Im sure that you know that, mr. Chairman. I dont. For the record, medicaid is paid out of income tax, and much of medicare is paid out of income tax, that the trust fund, when we talk about it, only pays for a small part of what our seniors reflect. Now, really, the final question, and its one that deeply concerns me, and it wasnt the main topic today, but its right in your lane. On may 15th, you projected 8 million as an enrollment number. August its now 7. 3. What happened to that 700,000 to 800,000 people . Why was there such a precipitous drop . The 8 million individuals, and i think that number was after the end of open enrollment, had signed up. And i think during the course of the next several months, individuals may have either gotten employer sponsors insurance, they may have found other eligible for medicaid instead of the marketplace, and some individuals may have decided not to go forward and pay. I think there was always thats a great question. And the reason i ask that question is, people were asserting that signing up meant nothing, and paying meant everything. How much of that 700,000plus drop were people who did not pay . Or do you know . I dont know that information. Wouldnt it be all of those people did not pay . I dont think well know that until the end of the year. Let me ask the question a different way. Im an old businessman. People signed up, they were there for insurance, is that correct . They enrolled, they were insured. These were people who signed up for a plan. In order to get insured, you had to make a payment, right. No, they were insured right away, and then if they didnt make the payment, they went off. 90 days, right. They basically got a free ride, 700,000 people had a free ride. They had coverage. And if something catastrophic happened, they could make a payment. And if something catastrophic didnt happen, they could just let it drop. I dont think we know that information. No, but this is a structural question that i know you must know, or the technical people behind you must know. If 8 Million People sign up, lets just say 8 Million People sign up and not the 700,000 who dropped, lets just say 50 people out of 8 million had a health event, and they werent going to pay, they just signed up on a lark because its a free ride to sign up. But then they had a health event, did they get to go to the doctor during that 90 days, because they had signed up and hadnt yet paid . Yes. So the system as it is today is an incredibly easily gamed system, if i understand correctly . 316 million americans could all sign up, and get 90 days worth of free insurance, and if nothing happened, theres no down side, that theyre just letting it lapse by not making a payment, is that right . You dont dunn them, you dont go after them, you dont sue them foreign the coverage they had, but never paid for, do you . Which i think is why its important to know that as of august, 7. 3 million were still making their payments and were still continuing the insurance. 7. 3 Million People may have made small payments because they were highly subsidized or larger payments because they werent. Are you prepared to release those figures anytime soon so we understand the 7. 3 million, how many of them, if any, it would be some, were completely unsubsidized, how many were substantially subsidized . As soon as we have that information, well release it. Estimate when . I dont have an estimate, but im happy to get that for you. ÷ okay. Being an old businessman, i must admit that giving people 90 days free, and no retrospective look to find out whether in fact they were maybe dual insuring, just signing up for a lark, to me means people should be cynics and say, we dont know how many people have signed up, but next year, starting november 15th, im presuming that if gao is going to estimate the signups, theyre going to be able to only use, that if you get 8 million again, they can assume 7. 3 is the net number, right . 7. 3 is a very strong number. I would remind you the people who sign up and get tax credits have a reconciliation process next april. Yeah, were looking forward to that part. This Committee Held a hearing, and on the issue of over 15 billion owed to the American People by the state of new york, for excess payments in violation of the law, in violation of cmx maximums, that falls under your watch. Have you done anything to reclaim that 15 billion . Yes, sir, we have. Have you gotten any of it back . We recently initiated that. I dont think weve gotten any of this back yet. But we sent basically the request for recovery. Youve made a request for recovery. We follow our normal process. Do you have the authority to simply withhold as you would to a private entity . If im a doctor, and i overbill 15 billion, or maybe some minor amount less than that, if im less hard working, the first thing you would do is cut off payments for services, right . You simply wouldnt send them a penny. Youre sending millions or billions of dollars to new york every month, arent you . I can brief you or your team on this in some detail. Whether its a doctor or entity or whatever, we ask them how they would like to repay us. And we i wish that were true. I think too Many Health Care entities who make it very clear, your people come in, you make a determination, the moment you make a determination, they basically have to quit their practices and go into an appeal process. And in the meantime, theyre not receiving a penny, and you claw back. You want to state that in a way that the private sector people dont call me up and say, how did you let her say that you give people lots of time and ask them how theyd like to repay it. I think you know i was on the private sector side for quite a period of time. If theres ever a question of overpayment, yes, cms will make you aware of an overpayment situation. And claw back real fast. Dmls you want to pay them up front. If youre able to write a 15 billion check, they wont deduct from the revenue. Right. Is new york prepared to give you a 15 billion check . I cant speak for new york. But right now, new york, and perhaps others, owe the American People money from excess payments. And theyre not being treated the way private sector is being treated. Theyre being treated a little bit with kid gloves. 15 billion is a lot of money. Actually, we went through the first year and we made a request, or demand for the money. And im happy to brief your staff on that. Will the gentleman yield . O

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