and we're the only in the united states. >> and we'll learn about the history of martin theodore kerney, who established the california raisin grower's association. >> he was interested especially in the growing of raisins, and he wanted to get together a co-op of raisin growers to control quality and structure the pricing of racens. >> that's saturday at noon eastern on c-span2 book tv and sunday afternoon at 2:00 p.m. on c-span3, working with our cable affiliates and visiting cities across the country. now a hearing on challenges to the implementation of the affordable care act, and issues of waste, fraud, and abuse in the program. this hearing is 90 minutes.

>> the hearing will come to order. my understanding is that the democrat caucus has not designated who all the members are. we need to do unanimous consent that all members be allowed to fully participate in today's hearing without objection, so ordered.

welcome to the new congress. if you would like a -- we have mr. mitchell and i know a number of other new members will be joining us from the democrats side, as well. so i want to welcome mr. mitchell to the committee this afternoon. let's start with opening statements and get right to our witnesses. and we appreciate our witnesses being here today, talking about an important -- this important subject. health insurance premiums are soaring. president obama and the administration promised multiple times that affordable care act would lower health insurance premiums by $2500. american families are still waiting to see those reductions. instead, the health insurance premiums have skyrocketed under the affordable care act. there's about 25% average increase in premiums just this year.

some americans have experienced even higher premium increases and had to drop coverage because it became too darn expensive. under the affordable care act, they are not just rising premiums. many have seen massive increases in the cost of their deductible. health care cost are one of the top care costs for families and people with insurance often times can't afford to use it, especially individuals enrolled in high deductible health plans under the aca. there are promises from the administration about increased competition. in fact though, in most parts of the country there are only one or two insurers participating in the health insurance exchange in 2017. insurers are seeing unprecedented losses on the exchange and reaching into the billions of dollars. several large insurers are pulling out of the exchange.

there were 12 participating in north carolina. today only two are participating in the exchanges in that state. in many areas, there is only one carrying coverage on the exchange. the american affordable care act was sold as one -- on one of the biggest political misleading statements of all time. if you like your plan, you can keep it. if you like your doctor, you can keep your doctor. even the president today apologize for that one. as we examine health care proposals, it is important to keep this in mind. while many received coverage under the affordable care act, many more are harmed by the skyrocketing health care costs. today i want to hear from health and human services inspector general and gao of the health care act and their work in this area. both of these agencies have done excellent work reviewing affordable care act reforms and

i want to hear recommendations on how we can use lessons learned from implementation of some of these programs to improve future programs. the work of hhsoig is critical to ensuring health and human services programs and i'm constantly impressed with the great work that comes out of their office. i look forward to hearing about the oig's work relating to the affordable care act. thank you, mrs. robinson, for testifying on behalf of oig's office today. the general accountability office has done great work examining early impact of affordable care act on private health insurance markets and i look forward to learning more about their findings. thank you for testifying on behalf of gao today. we are pleased to have mr. jonathan segal to hear about his experiences under the aoc. thank you for being here to testify. i look forward to your discussion today. congress needs to find way it make sure americans have access to affordable health insurance and can choose among a variety

of plans. with that i would now yield to our ranking member for his opening statement, then right to our witnesses in our hearing. gentlemen, from illinois is recognized. >> thank you, mr. chairman. thank you to our witnesses for joining us today. millions of people now have high quality affordable health care as a result of the affordable care act. one of my constituents wrote this to me and i quote, we are so grateful for the changes brought about by the aca in our situation. they have truly been life-changing for us. for the first time our family has access to dental coverage. this means we actually good to the dentist. before this, was a rare thing and only when in pain. for the first time our preventative care is covered. this means my children are up-to-date on their vaccines and physicals because it is not costing me hundreds of dollars out of pocket. for the first time, we have hope that we may be able to dig out of the mountain of medical debt

we have accumulated through a 10,000 a year deductible plan that we were locked into because of preexisting conditions because we now can get reasonable coverage through the marketplace. mr. chairman, there are millions of people with similar stories all across the country and all of our offices are flooded by correspondents relating the same. in addition, as a former small businessman, i know that the aca has allowed entrepreneurs to flourish because they don't have to worry that starting a new business means they can't afford health care. when people have high quality affordable health care they can afford to follow their dreams, their talent, become entrepreneurs like myself, start businesses, create jobs and grow the economy. when they are fearful about losing their health insurance or are buried under medical debt, none of those things are possible. the affordable care act empowered millions of people.

one of them is a witness today, mr. jonathan seagull and thank you, sir, for joining us. he will testify that guarantee of affordable coverage under the aca enabled him to start a new business. there is fear those gains will be taken away by house republicans if and when they repeal the affordable care act. in fact, today, house republicans have not offered an alternative to replace the aca that offers the same coverage at a similar or lower cost. let me repeat that. today house republicans have not offered alternative to replace the aca that offers the same coverage at a similar or lower cost. the consequences will be seriously harmful to americans. first, a recent cbo and joint committee on taxation analysis estimate that 18 million americans would lose their health insurance in just the first year following repeal without replacement.

second the cbo and joint committee estimate that premiums would increase by 20 to 25% more than currently projected in the first planned year following repeal. these consequences are not limited to those who bought their health care on exchanges. aca protections apply to all health plans including those that many americans get through their employer. employer provide insurance plans would no longer be required to offer the same level of care that they do today. employees with preexisting conditions would have restrictions placed on their care. the lifetime cap on out of pocket expenses would disappear. and we would return to the days when parent could no longer have young adult children under 26 on their plans. removing these protections will hurt businesses, workers and families in my district and across the country. third, and finally, the economic consequences of repeal without

replace would be catastrophic. my home state of illinois stands to lose over 100,000 jobs and $13 billion in gross state output. my district alone would lose 4,000 jobs. ohio, your state, your home state, sir, could lose up to 126,000 jobs. repealing without replacing is full hardy and reckless. what house republicans have proposed so far inspires little trust their plans will actually help americans. we will not sit idly by while the aca is torn down with no replacement. we need a replacement that offered coverage at similar or lower cost. i yield the balance of my time. >> thank you, gentlemen. we have three goals for today hearing. one, the impact of aca on health insurance market including affordability, quality and access, too.

we want to see how tax dollars were spent. if there is any waste, fraud in those areas. we have a big debate in congress and we want as much information as we can get. so those are our three goals. well hold the record open for five legislative days for any members who would like to submit a written statement and i want to recognize mr. grothman for being here. first time he has been part of the subcommittee and recognize if he would like a short opening statement. our new vice chair, mr. walker, from north carolina. >> jim, thank you for your work as chairman. and hope we are able to really fulfill our promises to the american people in getting to the bottom of some of the issues and concerns we have with the aca as a whole. i have been privileged to work with you the last few years. we look forward to seeing what we can get done. thanks. privileged to be part of it.

>> ms. vicki robinson is with us today as well as mr. john dicken, director of health care at government accountability office. and jonathan seagull, welcome. all witnesses will be sworn in before testimony. please rise and raise your right hands if you would please. do you solemnly swear or affirm the testimony you are about to give will be the truth, whole truth and nothing but the truth so help you god? let the record show that each of the witnesses answered in the affirmative. you are way ahead of me. let's start with our first witness, ms. robinson. you get to go first. you get five minutes and we'll go to the next person. >> good afternoon. thank you for the opportunity to

discuss our work overseeing the federal and state health insurance marketplaces established under the affordable care act. we are committed to combatting fraud, waste and abuse and promoting integrity, efficiency and effectiveness in the programs run by the department of health and human services. our work looks retrospectively to determine whether programs have worked as they should and prospectively to identify weaknesses to avoid and best practices to replicate in the future. to oversee the marketplaces we examined core program integrity questions. our taxpayer funds being expended correctly for their intended uses. are the right people getting the right benefits. is the department managing and administering the programs effectively and efficiently? we identified three types of vulnerabilities.

one, the need for tighter payment controls to prevent wasteful spending. two, the need for more reliable processes to insure accurate ability terminations for applicants. and three, the need for improved management. our findings and recommendations are detailed in my written testimony and in our reports. let me offer some examples starting with cms. cms was hampered in its administration of the advanced premium tax credit that provides subsidies to help consumers afford insurance. at the start, cms used a manual financial process that did not collect data on enrollee by enrollee policy level payments. rather cms collected only aggregated payment data from insurers. as a result we found that cms

was not able to verify the accuracy of payments to insurers nor than enrollees benefitting from the payments had paid their portion of the premium as required. we also found efficiencies in the administration of the establishment grant wall that provided federal funding the states. most states we examined failed to allocate cost properly between their establishment grant funding and funding for other programs that shared systems with the marketplaces such as medicaid. this resulted in states overclaiming federal establishment grant funding. further, we found vulnerabilities and eligibility verification processes about the federal and state marketplaces. for example we found the marketplaces did not always properly verify social security numbers, citizenship, and household income. finally, we identified weaknesses in management of the federal marketplace including poor oversight of the many contractors engaged to build it. for example, cms waited far too

long no hire a systems integrated to coordinate the work of the contractors. we examined cms's management of the federal marketplace across the five-year period. we identified many missteps that contributed to the poor launch of the healthcare.gov website. we also identified better management practices that contributed to subsequent improvement. these included for example a signing clear project leadership and fully integrating technical and policy staff. our work offers important lessons to inform management of complex policy and technology projects now and in the future. to close, protecting taxpayer investments and consumers requires vigilance and sustained focus.

program integrity should remain a priority for the design and operation of current and future programs. preventing, detecting, and remediating problems is our collective mission. thank you again for inviting me to appear today and i look forward to answering your questions. >> thank you, ms. robinson. mr. dicken, you're recognized for five minutes. >> thank you. i'm pleased to be here today as subcommittee discusses the patient protection and affordable care act. ms. robinson highlighted some of the inspector general findings related to program integrity. my comments focus on the affordable care act in relation to health insurance markets highlighting findings from recent gao reports on insurer availability variation in premiums and enrollee satisfaction.

the affordable care act contains provisions of how they market their plans. many of these provisions took effect in 2014. for example the act prohibits issuers from denying coverage or varying pleem premiums based on health status or gender. there are tiers, gold, silver and platinum. s where require also health insurance exchanges in each state from which participants select from a plan. about 11 million participants purchased in 2016. given the act's reliance on the participation of private health plans -- the law required gao to report on competition and concentration in health insurance markets. in a 2016 report, we found that health insurance markets were concentrated among a small number of issuers in most states

from 2010 through 2014. where the three largest issuers had at least 80% of enrollment. during the first year, it was generally more concentrated among a few issuers and true for overall markets. gao is also reported on consumers access to health plans offered through the exchanges. in 38 states for which gao had sufficiently reliable data, most had six or more bronze, sim -- silver and gold tier plans available. for example, 94% of counties had at least six silver tier plans available in 2015. since gao issued the report, hhs reported the decline in the number of issuers participating in the federally facilitated exchanges in 2017. according to hhs all consumers continue to have multiple plan

options but for about 21% of them the options were limited to plans offered by a single issuer. gao also reported on the considerable variation on premiums available to consumers in 2014 and 2015. for example, in arizona in 2015, the lowest cost silver plan for a 30-year-old consumer was $147 per month. but in may, the lowest cost silver plan for 30-year-old was $237 per month. the range of premiums also varied considerably by state. while the lowest cost silver plan for a 30-year-old arizona, was $147 per month, the highest cost silver plan in 2015 was $545 per month. a difference of 270%. in contrast, in rhode island

2015 premiums for silver plans available to 30-year-old range from $217 to $285 per month. a difference of just 32%. more recent analysis by hhs found premiums for exchange plans increased more in 2017 than in earlier years. average of 25% from 2016 to 2017 for the second lowest cost silver plans in states that use federal facility of exchange. in comparison average premiums for these plans increased 2% from 2014 to 2015 and 7% from 2015 to 2016. finally, let me close with key findings from a 2016 gao report on enrollee experiences and health plans offered through the exchanges. most exchange enrollees report being satisfied overall with their plans in 2014 through 2016. according to three national surveys. this report satisfaction was either somewhat lower than or similar to that of enrollees and

employer sponsor plans. while most enrollees express overall satisfaction, concerns in enrollees experiences with exchange plans were revealed in other information gao collected from literature. often consistent with long standing consumer concerns about private health care insurance generally such as affordability of out of pocket expenses and difficulties understanding coverage terminology. mr. chairman, this concludes my statement. i'm here for questions anyone may have. >> thank you, mr. seagull, mr. dicken, you're recognized. >> thank you, mr. chairman. ranking member. members of the committee. a pleasure to be here today. i come as a husband, father and independent businessman but most of all as a citizen of our beloved country. here is my story. in 2012, i was laid off with one child in high school and the other graduated.

i was lucky. i was given a severance and cobra insurance to cover in 2012 through 2013. the effective launch of aca was only year away. because of aca i would start this business knowing my family would get affordable insurance no matter how the business did. without aca i wouldn't have had the courage to launch my own business but would have sought traditional employment. we purchased our insurance without subsidy, the gold plan. our premium is about $1360 a month plus $60 for dental insurance. $600 a month less than the cobra plan. because new york took the med cad expansion, i knew my family would get affordable health care. affordability is a big issue. my spouse of 30 years has ms. she is the bravest person i know.

taking her shots for over 20 years. the cost of her medications is over $30,000 a year. yes, we do participate in a manufacturing program that gives some people access to their meds without charge. but we don't know when it will end. even though, there's the cost of doctor visits and other tests. my children are working at jobs that do not provide health insurance. we make sure they have it today. it is a great comfort to an aging parent to know that the aca assures that they can have affordable coverage when they turn 26, no matter their situation. in all of these ways, the aca enhances security, reduces anxiety and furthers freedom. not just for me but all americans who at my time may find their employer based insurance doesn't work or isn't available to them.

possible replacement of aca with insurance options that are unwise, inadequate and discriminatory threatens us. we aren't making much more than the point of subsidies. about 20 to 25% of our income goes for health care today. i don't know what that percentage will be when purchase becomes voluntary and insurance can peddle anything they want, skimming away those lucky enough to be healthy. what happened if without the aca the cost goes up to $3,000 or more a month. how can anyone afford that. for years on end, my spouse is after all only 57 years old. what happens if no one will insure her at any price. some people say that high risk is a solution. we don't know what illness will strike us or when. these pools are really pools of us citizens. that is a real complaint some have about my spouse. once it is clear that the cost

not the risk that is a problem it is obviously why so many of us fear high risk pools to work for the patient you have to have clear rules, food gets put in them. you have to insure they don't pay for more insurance than others would way and ensure they get the care they need. you i have yet to see a proposal that provides these protections. instead vague promises of federal and state support. high risk pools are not health care, they are just vicious cruelty to ordinary americans who have played by the rules but had wad luck. a better name for high risk pools is death pools. my view it is to shun off one side the folks that cost too much. let them die out of sight and out of mind. my spouse is not someone to cast away. she is a human being who has as much right to quality health insurance and care at a price affordable to any of us.

the object of these proposals seems to reduce eligibility. the real goal is punishing low income people for being low income. there's a good chance that will include my children. my children and all people with low income do not deserve this. they are children of god just like the rest of us. in closing the story of the aca is not just my story or the story of millions of other people, it is first and foremost a story about democracy. democracy is about ensuring equal dignity for all citizens. the argument over health care insurance is the latest battle in the never ending struggle that lincoln described many years ago, struggle that to me defines the united states and high purposes of citizenship, the government of the people by the people and for the people shall not perish from the earth. thank you. >> thank you, mr. siegel.

real quickly, i just want for clarification, you are not receiving a subsidy from the government? >> that's correct, no subsidy. >> you're paying for your insurance on your own? >> entirely, since day one. >> just wanted to make that clear. >> i now recognize the gentleman from north carolina. >> thank you, mr. chairman. mr. siegel, thank you for the courage you expressed today in sharing your story. i'm impressed as to how much you love your wife. you can tell she means a lot to you. mine does, as well. she's a nurse practitioner, 24 years. i spent much of my life as a pastor and minister. worked in refugee camps of europe. seen destitute, health, funerals, you name it, been across the board. i'm also concerned about the millions of people who have been damaged by even unintentional, by the affordable care act. if you want to get down to raw

numbers, we have 11% of the people of north carolina that still don't have insurance of any kind. i don't want to get into all of the bits and pieces but according to the most neutral polling 25% of population have been damaged by higher premiums, lost insurance or something along when it comes to dealing with obamacare, affordable care act. even moving from the individual aspect and getting it to the business it was president clinton and minnesota governor who recently talked about the damage that aca cost for small businesses. according to a gallup poll not too long ago, 77% believe it should be altered, overhauled or completely repealed. my questions today after giving a preface there is specifically i would like to talk to mr. dicken about questions that we have on broken promises when it comes to the treasury. under obamacare insurance

program, section 1341, directed that hhs to collect $5 billion. and send it directly to united states treasury to pay for obamacare's cost. as of 2015, hhs denied the treasury and taxpayers up to $3.5 billion that they were owed. so i don't have a lot of questions but one major one here is, would be this, if i would answer. in september of last year, gao issued a ruling concerning hhs's actions. what did gao determine with this report? >> thank you, congressman, walker. you're correct, last year gao did issue a legal opinion looking at the payments under

the program. as you indicated affordable care act indicated payments collected were to be provided some to the general treasury and some in reinsurance payments to the payers. in fact the collections were less than the amount what hhs had fully intended to include in the reinsurance and paid all of that insurers instead. legal opinion indicated that in fact those payments should have been to the general treasury. >> obviously this is a pattern for the last three years. can you share what reasoning was as far as disregarding the treasury which as we know is basically taxpayers money. why was it disregarded? can you brief us on that? >> yeah. i would defer to hhs attorneys, they can speak to the legal reasoning there. but in general because collections were less than the amount they are authorized, that

was the priority that hhs made in giving reinsurance to the assurors first without payments to treasury. >> do you still -- let me ask this. do you have any idea how much is owed to the u.s. treasury that the previous administration refused tore denied to pay? >> i don't have that at my fingertips but certainly can follow up. >> do you have any kind of ballpark? billions of dollars? >> i think you indicated the requirement was for several billion treasury. those could still be made because the collections were 2016 would be made in 2017. some of that is still being reconciled. >> thank you. mr. chairman, i yield back. >> thank you. now to the ranking member from illinois for his five minutes. >> thank you. i would like to yield to the ranking member of the general committee to make a few comments, please. >> thank you very much.

i want to thank you, mr. chairman. i would like to take the opportunity to officially welcome congressman murphy to his first oversight committee hearing. we're very fortunate to have him on our committee. he brings valuable perspective as a small businessman and entrepreneur and is a lawyer and public servant. we are also fortunate that he has accepted the responsibility of serving as the ranking member on this very, very important health subcommittee. this subcommittee takes up some of the most important issues that come before our committee, not the least of which is the affordable care act. recent polls show, that number one issue, even beyond this, is another that he has at some point that is the cost of

prescription drugs. that the number one issue with independent, democrats and republicans. so in recent hearings we've had testimony about how mr. chairman and ranking member about how the cost of prescription drugs, these folks who are improperly and because of greed in raise is prices of these drugs that too is going into the cost of health care and very significant. we are truly at a crossroads of the aca. moving forward to repeal the law without having a replacement, as a matter of fact they didn't maid make the deadline. it would be disastrous for tens of millions of americans who have gained coverage thanks to

the aca. it would also be disastrous of americans with employer-provide insurance who have benefitted from the aca's many consumer protections. people with employer provided insurance no longer have caps, the annual and lifetime coverage benefits. they now have free preventative care like cholesterol screenings and mammograms. and there is no price that you can pay or put on prevention. no price that you can put on ss. they cannot be treated any differently by their insurance company because of a preexisting condition. repealing aca would also have disastrous effects on our economy. repeal would completely destabilize the insurance market. drive premiums up and cost millions of jobs across our entire country.

this is not what american people want and certainly not what they need. all types of statistics have been cited with regard to people who want to repeal. but you need to dig into those numbers and discover that there are a whole group of people that want to expand the affordable care act. and so we've got a situation here where we have to keep in mind that health care should not be a privilege. it must be a right. when you have an unhealthy society you have a society that cannot be all that god meant for it to be. so i am excited about our new ranking member. i know that he will bring much to this discussion. he is here for a reason and that is to make a difference. i would only say this. mr. ranking member, you weren't

here when we voted for the affordable care act. but i've told my constituents many times that in my 14 years as a member of the legislature and my 21 years as a member of this legislature, there is nothing that i have done that has been more important than pulling that lever for the affordable care act. i have absolutely unequivocally no doubt that we have saved lives and will continue to save lives. we can repair things that need to be done but we must make sure that the american people are healthy. and with that, i would thank the chairman for -- ranking member for yielding. and i yield back. >> i thank the gentlemen. the ranking member is recognized. >> thank you mr. ranking member. i agree with your comments that it appears to me we should mend the aca, not end it. mend, don't end it.

i have a couple questions. thank you so much to the witnesses for coming today. i was heartened to learn from mr. dicken that people on the aca were about as satisfied as far as their satisfaction levels as compared to those in employment plans. is that generally correct? >> yes. the surveys we saw, they were generally satisfaction levels in 07% to 80%. overall satisfaction, similar to or somewhat lower than employer sponsored plans. >> i would surmise their levels would go down if they had no health coverage. if there is repeal without replacement, correct? >> this is satisfaction with health plans. so i can't speak to what satisfaction would be without health plans. >> right. ms. robinson, thank you for your testimony in investigating issues related to the aca. i presume you didn't look waste fraud and abuse before the aca was instituted, right?

[ inaudible ] >> thank you. sorry. thank you for that question. we have done a lot of work in looking at fraud, waste, and abuse in medicare and other hhs programs before the affordable care act. our jurisdiction is to look at programs of the department so if you are asking whether we looked at sort of private insurance before the affordable care act, we did not. >> right. >> mr. siegel, i want to sincerely thank you for appearing today. i know you run a small business and you are taking time-out of your small business to be here today. as a small businessman, i know that's a big sacrifice on your part. i want to ask a few questions about your experience with the aca. you testified after being laid off in 2012 you wouldn't have had the ability to start your own business had it not been for the aca. can you explain why that is? >> i wouldn't have had the courage. the reason why i wouldn't have

had the courage is because the prospect of not having insurance especially for my wife is frightening. you can spend tens of thousands of dollars year for medication for ms. even if you don't have relapses or other problems, which we have been spared. and she was 53. i got 53 -- 52 or 53, whatever it was. at least 12 years to medicare. i can't screw around with that. i can't take a chance. she has to have insurance. and the private market in new york before aca, as i said, was incredibly expensive. it is cheaper under the aca than it was before. that's not true of every state, but it is true of new york.

>> as a small businessman myself, i understand the risk of going out on your own. we want more people to do what you did. we want people to go out on their own and create new businesses and new jobs. that's how we create economy. worries about health insurance, whether it is affordable or cover preexisting conditions, can hold perspective entrepreneurs back. and economic effect of repeal are not just anecdotal. according to the common wealth fund, repealing the aca would lead to the loss of 2 million jobs alone mostly from the private sector. can you tell how the threat of appeal affects you and your family today? if the aca is repealed, i'm not sure if i could get insurance for my wife. my kids, i don't know. they will turn 26, 27 soon enough.

and i'll pay for them as long as can i get them insurance, but i don't know. it is about that simple. >> what does that do to, you know, what are your anxiety levels right now? >> i have not slept very well since the election, to be honest with you. >> so it's affected your health? >> it affected my anxiety. i don't know about anything else yet. we will see. i hope not. >> mr. siegel, can you tell us about your business and how it has grown since you started? >> sure. we are a small market research firm. we do mainly survey research on product development and we have grown from essentially nothing our first year to this year, i'm not going to tell how much we make because we are an llc and that will tell you how much i make, but i made a good living this last year. let me put it that way. >> great. thank you. >> thank the gentleman from illinois.

mrs. robinson, in your opening statement, you talked about how most statements didn't have any type of accurate accounting for how aca dollars were allocated and what they got from the feds. something to that effect you said in your opening statement. >> thank you, chairman. i think you are referring to the work we did looking at the establishment grant program which looked at cost allocation. so if you've got a marketplace in the states, it is sharing a system. you need to allocate costs between the funding for the establishment grant for the marketplace and other programs that may share the same system such as medicaid eligible -- >> states weren't accurately counting. >> correct. states were not -- >> did the inaccurate accounting, did it result in more federal dollars coming to the state or less? >> what it resulted in often was too much establishment grant funding going to the state. >> imagine that. they erred on the side where they got more.

imagine that. >> in some cases, some could be allocated to medicaid. so we did recommend that cms and the states work together. >> you also said insufficient payment controls that led to wasteful spending. you said cms looked -- lacked control to suggest that atcp payments were made for these making their premiums. seems like a lot of screwing up going on. >> we did find a number of vulnerabilities, yes. >> and the gao, you did, it looks like, an experiment here where you had 15 fictitious folks. 15 fictitious people applied for coverage. how many of those 15 got congress and subsidy and got credit for it all? >> right. in 2016 we had 15 fictitious applicants.

all initially received coverage that would have been subsidized -- >> every single one? >> initially, yes. >> wow. so they didn't catch anybody that was trying to rig the game and mess with the system, did they? >> there was some documentation requested over time. over time you know, one was not retained, it was terminated but initially we did receive all 15 approvals for -- >> even though some fictitious documents were also sent along after the initial entry, right? >> that's correct. >> wow, batting a thousand. in ripping off the taxpayer. not so much as gao guy but citizen, are you familiar with the name jonathan gruber? >> i'm familiar, yes. >> do you remember some of the statements he made back when this thing -- when they were passing the law and statements that came from the administration. do you remember some of those? promises that were made? >> i have seen some of dr.

gruber's research -- >> i just want your comment to know if these were true. many folks said back when this was being debated and passed. if you like your plan, you can keep your plan. did that turn out to be accurate? you can give me some short answers because i have a lot of questions to ask. >> certainly, many newly covered people were covered through the exchanges. >> you've got to give me a shorter answer than that. and also, if you like your doctor, you can keep your doctor. was that accurate for all americans like it was presented? >> certainly to the extent that individuals changed plans to different networks -- >> lots of people had to get new doctors. have premiums gone down like we promised? >> it's hard to compare premiums before and after for a number of reasons. we've seen premium increases

here, 25%. >> so premiums didn't go down on afternoon $2500 either, didn't think? >> we've not compared before or after. this is premiums in the most recent year. >> do you remember when this was rolled out, did the website work very well when this was first rolled out? >> there were a number of challenges and problems. >> all this information, private information, was it secure at the time it was rolled out, do you remember that? >> gao has done looking at that and made recommendations to improve the privacy and security. >> have emergency rooms declined under the affordable care act as it was promised? they've went up dramatically. and what about the co-ops that were supposed to be just apple pie, wonderful, be all, end all, save all, how have they done? >> yeah, so we devalue wait those.

>> so 23 originally, and 18 have already went bankrupt, right? >> and one is in the process -- >> so i count false statements here. so nine false statements, and now we find out we were misled and we find out when the plan is put in place, most states can't and don't have an accurate accounting of how the dollars are spent. cms lacked controls to cms lacked controls to ensure effectively that aptc payments were made only for enrollees who paid their month pli payments and when you guys ran a little experiment and had 15 fictitious people, 15 made up folks who signed up for it they all got the subsidy. and yet we have people say this thing is wonderful.

we've got to keep it. that's just amazing to me. this thing has got to go. and that's what we're going to be working on for the next several weeks. i start from the premise health care gets better and costs less when obamacare is gone. that seems to be the direction we have to go. with that i would yield to if the gentle lady is ready miss norton. we can go to mr. cummings and then we'll go -- >> can does the gentleman yield? i'm next. >> yeah. >> president trump has said he's going to provide health care for and everyone it will be cheaper. can you tell bus that plan so that we can -- so the american people will be aware -- are you aware of it, how that's going to

work? chairman -- >> i thought you were asking our -- >> i'm asking you. >> i'm not sure what mr. trump had in mind. i don't know what you have in mind when you make statements and i don't know what everyone else has in mind. but what i do know is what i just youpt lined. the false statements that were made when the affordable care act was made to the american people -- >> you're not answering the question. i reclaim my time. thank you. i just wanted to know so the general public would know what the president's talking about. i'd like to take a few minutes to discuss what we can expect our health care system to look like under the trump administration. president trump has claimed his replacement to the aca would provide, and i quote, "health care that is far less expensive that far better than the aca. ." end of quote. but based on the action of president trump, actions taken so far, the only thing that

trump care seems to be doing is creating chaos in the insurance market and leaving millions of people uncertain about their health care. january 20th president trump issued an executive order that directs federal agencies to "waive, defer, grant exemptions from or delay implementation of any provision of the act." end of quote. what this will mean for people with the aca insurance isn't entirely clear. since the order is short on concrete details. but it does raise serious doubts about whether consumers including those with employer-sponsored insurance will continue to enjoy the benefits and protections they've received under the aca such as no caps on annual and lifetime limits. free preventive care and comprehensive coverage of essential health benefits.

mr. segal, as a small businessman and an aca plan enrolle, how does all of this uncertainty impact you and your ability to run your business. >> as i said, i have not slept well since the election. to the extent i'm focusing on that instead of focusing on our business, it takes time away. how do i put this? i don't know that this new administration understands. and what wh people don't understand it makes it very hard to plan for the future at alls because you don't know what they're going to do. >> the uncertainty is also affecting insurance companies, mr. segal. the urban institute recently released findings from interviews with executives from 13 insurance companies that

offer coverage in the individual market in 28 states. most of the executives interviewed warn that repealing the individual mandate would drive up premiums, up to 20% more than currently expected. and some insurers warn they might leave the market altogether. mr. dicken, you have studied the insurance market closely, have you not? >> yes. gao has. >> does it surprise you that insurers are wary of repealing fundamental aspects of the aca without having a comparable replacement plan in place? >> certainly insurers in the next few months will set benefits and premiums for 2018 and so certainly need to understand the federal and state rules they will be working under. >> so in addition to creating instability in the insurance market and uncertainty among consumers it appears that the trump administration is taking steps to actively prevent people

from enrolling in coverage, according to a recent political article last week, the trump administration canceled tv advertisements for open enrollment that had already been placed in paid for even though the last day to enroll wasn't until today. but mr. robinson, as you stated in your written testimony, the i.g.'s central mission is to -- miss robinson, rather-s to quote protect the integrity of the aca and other federal health programs. do you plan to look into this issue? i think they reversed that now. right? in other words, they put the ads back up. >> thanks for that question. >> by the way, i was in my district on monday telling my constituents to enroll. but go ahead. >> thank you for that question. i don't have that particular detail about this. i've seen some of the same reports that others have seen. >> even if the money that has been wasted on the ads that never aired is somehow recovered, it is still deeply

concerning that the trump administration would intentionally sabotage the final week of open enrollment in this way, especially since we know that young and healthy people tend to wait until the last minute to enroll. if this is any indication of the future of trump care, we will need the i.g.s to remain vigilant in his oversite responsibilities and as the primary oversight body of the house i hope we will do the same. so we will continue to look over this again. health care in the great country called the united states should not be a privileged but a right. with that i yield back. >> thank the gentleman. the gentleman from michigan is recognized. >> before i joined this esteemed body, i was retired as the ceo of an education group. we had 650 employees. a fair number were part-time. anybody scheduled more than nine

hours a week had health care. they had health care for themselves and could buy health care for their family relatively inexpensively. the affordable care act when that came into place and requirements were finally rolled out by hhs increased the costs for part-time employee health care by 50% year one for my company. so my question for ms. robinson or mr. dicken, did you do any analysis when you looked at the fraud, the waste, the immediate impact on health insurance premiums, never mind co-pays and deductibles, for privately sponsored health care programs and what the impact was in the first few years? >> we have not directly looked at changes in employer sponsored premiums. there are surveys that look at that by other organizations. but gao did not report on that. >> did hhs look at this issue? >> we have not looked that issue. our focus is really on hhs dollars and the expenditure of hhs funds. >> well, but as my constituency,

whether they're money they paid for premiums, whether it's the employer paying for premiums, whether it's their tax dollars they participate federal government, it's all their money. so would it not make sense to look at waste as viewed in terms of the immediate and then long-term impact on health care costs in america by looking at what is suddenly the change in costs were? as i indicate from our company it was dramatic and a number of others i know of. >> certainly, we're glad to work with the subcommittee on looking at health care costs and trends in the markets. certainly employers, long standing increases overall in health insurance cost even for federal employees seeing increases in health care cost in recent years. >> let me change directions. there are concerns with those receiving subsidies or payments. can you tell me how many people in year one received subsidies that are improper or determined inaccurate the first year? >> that's a very important question.

we don't have the number of folks but what we did look at was the risk of programs of potentially weak controls on eligibility. we -- >> let me ask you, why -- we are subjected to audits as company. why did we not know -- how do we not investigate that and not know? >> so congressman, my office does investigate when we get allegations of an improper person being in the marketplace. our work initially set out to figure out whether there were adequate safeguards to prevent fraudulent or improper information from impacting the eligibility determinations. >> so we still don't have any sense of the approximation of the nuv people that received payments that should not have? >> my office does not have that. >> does hhs in general have that?

>> i don't know. >> that would lead me to believe we don't know how much those inappropriate payments total up to be to the taxpayers. is that correct? >> i do not have that information. >> mr. dicken, do you have that information? >> no. but i will note gao recommended that hhs develop a fraud risk assessment to get at questions you are getting at. so they have an overall understanding of what the progress potential is and how they can manage those risks. >> i readily admit, as they say, i'm subject to freshman hazing here as a freshman member of congress. but i spent 35 years in private business and i have to say, oh my god, how is it we don't have the means by which to figure out those that we didn't and how much it's cost us yet we're analyzing fraud and abuse. how did we not think it was a problem? >> congressman, i think you are raising an important question of transparency in government. one thing we have been recommending in the marketplace

is to look at things like the right kind of data to be able to figure these things out and so for example, in our work looking at the accuracy of the subsidies, what we -- >> let me stop you. but if we are making a payment to a private carrier or somebody else we certainly would insist on that kind of transparency. we'd recover the money if it was improperly paid, wouldn't we? >> yes, congressman. >> so we fail to undertake a basic function of the department of government which is to make sure we're not throwing money out the window. >> that's why we've done the work. we've looked at the controls that cms has on the ashts of the payments to be able to make recommendations to strengthen those controls. >> thanks very much. i yield back. >> i thank the gentleman. i think it is a great line of questioning. we can't get an answer to the number of individuals who got payment inappropriately, fraudulent payments, but we can probably conclude that anyone who attempted, who applied fraudulently probably did get paid. how can we conclude that?

because you all ran the experiment. 15 fictitious people. and you found it wasn't one who got paid, it wasn't two, it wasn't ten, it wasn't 14, it was 15 out of 15. so mr. mitchell's question is entirely appropriate. and one we need to get -- think about that. if everyone based on the little xefrmt you a experiment you all ran where you found it was batting 1.000, anyone applying fraudulently might have gotten money they weren't entitled to. not to mention all the other problems we talked about. all the misleading statements, false statements, lies told to the american people before this thing was passed. we would like that number as quickly as possible. we appreciate the gentleman's questioning from michigan. now i recognize the gentlelady from the district of columbia. >> thank you, mr. chairman. i guess it's been reported that this is the last day to sign up for the affordable health care act. and people have been signing up

in huge numbers. people are afraid of a big structural change. and what effects it might have not only on those who were part of the aca, but of course we're talking about a sixth of the economy. and how fooling with this aspect of it could have an effect on the economy itself. in my district, and i represent the district of columbia, a lot of people have health care because they work for the federal government. but 100,000 d.c. residents would lose their insurance if the affordable health care act were repealed. and the estimated cost to d.c. would be $1.1 billion. now, that's a city of 700,000 people. imagine what this means writ large across the country.

i'm interested in mr. siegel. when most people think of the affordable health care act they may not think of enrollees like mr. siegel. but the largest segment of enrollees in the non-group market is self-employed. so i'd be interested in your views on what effect guaranteed access to private insurance has had on the security of your business as a business. >> i always had access. affordable enrollment and coverage has made a huge difference. and the reason it makes a -- >> to your business? >> yes. >> to your business itself. >> well, i buy it on the exchange. sought business doesn't buy it. but for the business it makes a big difference because it would not have me as a participant if it was not for the aca.

and we started out with three partners and our youngest partner died after six months. and you cannot run a market research business with one person. so our business would probably not exist right now. that's my guess. >> without the affordable health care act. >> that's my guess. it's counterfactual, right? >> so let's look at the potential effects of the repeal on your family's access, your business access, to affordable health care coverage. >> new york is a state that will do something. i don't know what. i do know that in new york before the aca private insurers had to take anybody. and that made our costs -- but you didn't have to buy. so only people who needed it bought it so it made it expensive. my fear is we will go back to that and if i can get insurance at all, it will probably now be, and i don't know. but i'm guessing $2,600, $2,700, $3,000 a month.

because it was about $2,000 a month before the aca. and so you're going to see a popback. and at that level i'm going to have to find a job working for an employer. i'm 61 years old. and the market research, that is not easy. and in any case, i'm tired of being a boss and i'm tired of having bosses. i love running a business with a partner i admire, serving clients that i like, and taking care of my family that way. and i don't want to go back. >> mr. siegel, finally, let me ask you about a plan that i read about in the republican study committee guide that would replace the long-standing tax exclusion for employer-based coverage with a standard tax deduction. now, we know that would put health care out of the reach of the lower brackets of americans.

but i don't see how it would account for geography or age or health status. do you have any view on such a replacement? >> i don't have any view on the technical side of it. i can tell you now that health insurance and health care coverage according to our accountant was something i can deduct but i also know that is not as good as -- >> what about a standard tax deduction? >> i imagine i would benefit from it but i don't know that my kids would. employer plans get a much better deal. so just having a deduction for the private side. i don't know. i'm not an expert on the tax system. i'm sorry. >> no one's an expert on how this would work. i can tell you that much. thank you very much. mr. chairman? >> i thank the gentlelady.

i recognize the gentleman from wisconsin. >> mr. dicken, i noticed in some of the information you had in your initial talk you told us a little bit about the number of options americans have as the number of insurance companies involved as dropped. can you recite the numbers again for the last couple of years and the number of options? >> sure. for plan options that would be on the different metal tiers that are offered through the exchanges, silver or gold, we found that most consumers had six or more plan options. in the most recent years the number of issuers that are offering plans has declined. and so we've seen that. hhs has reported that this year 21% of consumers have plan options but only from one issuer. one insurance company. >> so 21 in essence you have a monopoly, correct? 21%. >> for the exchanges, with you different, silver or gold plans but just from the same insurer.

>> at this rate, we don't know how many yet, but how many plans do you think will be out there for 2018? >> yeah. i think there's a lot of uncertainty as to what the future years will bring. certainly insurance companies, it's been very concentrated with many states having only one or two or three insurers having 80% of the market. >> it shot up from like 5% to 21% in one year, correct? >> i don't have early numbers. but it increased. but it has increased. only one issuer. >> is it a concern that some areas would have no issuers? >> certainly it would be important to make sure that consumers under the current system with exchanges have plans that are available. certainly, that's a local decision by the insurers in those areas. >> if we've gone down from three or four or five options to one option it stands to reason soon we'll have no options, right? >> that has not yet been

experienced but certainly a concern that there are fewer insurers. >> what effect on premiums has that had as the number of -- as the competition is disappearing? >> in general i would expect that less competition would mean less pressure on -- >> is that true? right? >> we've not done a causal study looking at that. but that certainly would be the expectation. >> premiums have shot up in this past year, correct? >> on average about 25% increase. >> 25%. and i would say one of the reasons they shot up maybe is there is no competition, right? >> a range of issues as the experience of the exchanges has led some insurers to increase the premiums. >> can you tell us why the number of insurance companies keeps disappearing? >> i think there's a variety of reasons. a couple i mentioned today saw the plans that were available such as co-op plans have made operations, some large national insurers have changed the markets they're operating in or left the exchanges. >> can you let us know why

they've left? a few years ago they were gung ho, thought they could make a go of it. what happened? >> i think those are business decisions by the insurers as they decide what their experience has been. >> could you speculate for us why companies keep leaving the current market that was originally envisioned? >> certainly as they've learned more about the cost of individuals that they're covering and their relative premiums in that market, some have made business decisions that they're not going to compete in that market. >> so it would seem over time given the current framework insurance companies cannot operate, correct? or they wouldn't keep pulling out. and no new insurance companies are jumping in, are they? largely. >> we did look at new entrance and exits. we found that mostly exits were among smaller insurers. there have been some new entrants to the market as well. >> okay.

mr. robinson, you looked at the grant funds and the money that needed to be refunded to the federal government because it's not spent in accordance to your requirements. what's the status of allegation that's money that was misspent be refunded to the federal government? >> thank you for that question. the establishment grant funding i believe most of those recommendations are still opening and we are following up on that. but i think those are still open recommendations. >> are they refunding the money? >> not as far as i know. >> what efforts are they doing to refund the money or is this just considered par for the course now? >> we worked to foum on those recommendations. i don't have at my fingertips but would be happy to follow up on details with respect to the specific amounts we've identified. >> okay. and how many states does that include, do you know? >> we looked at, if ult just give me one moment, we looked at establishment grants at one, two, three -- six states that we had that we looked at.

>> were there problems in all six? >> problems in all six. we had one other that did not have any problems. >> one out of seven. okay. thank you. >> thank the gentleman. the former chairman of the committee we're glad to welcome, gentleman from california is recognized. >> thank you, mr. chairman. mr. dixon -- dickens, you know, we're all watching the affordable care act underperform and we're all concerned that what it sought to achieve one would say it at least partially achieved. there are millions of people on the plan. but let me go through a couple of comparisons that are a little outside your briefing but i think they're well within your competence. you're personally under fehpp, right? >> i think that's correct. >> and you're familiar with the programs that are offered, the 250-plus different options. >> nationwide there are many, yes.

>> so if we were could contrast the 11 million plus people that are in fehpp that are federal employees, retirees and their families, contrast the options between what you expect to have in 2017 in the affordable care act as it is and what half the number of people but the federal workers and their families have. >> about 8 million people covered through the federal employees program as you mentioned nationwide. over 200 plans offered. that includes some national plan offerings, mostly ppos as well as local hmos that are included in specific markets. >> to include kaiser, blue cross, all the major names. >> that's correct. throughout those markets federal employees, retire yooz, and dependents can choose either from those national plans, the largest by far of which is the blue cross standard and basic options, which covers about 2/3 of enrollees.

and under the plan if you go onto a cobra because you leave the federal workforce you pay to whichever health care program you were in as you continue, right? >> cobra would have individual coverage paying the full premium -- >> which means in some cases the health care providers accept a check from an individual. >> in the cobra cases, yeah. i don't know the actual transfer of the money where it would be coming from. >> but in all cases essentially these are private companies who have made a decision to provide a program to whatever amount of female, if you will, any and all from the federal workforce, current or nrt case of cobra cobra that choose their plan, correct? >> they are private plans, yes. >> and just going through a couple of points, they're not gender discriminate, right? >> it's available to all federal -- >> but they charge the same rate regardless of age. >> same premium nationwide. >> so you take advantage of the pool that you're not worried

about whether you're young or old, man or woman, the rate's the same. >> it has one premium for all. >> and your 26-year-old child can stay on it? >> up to age 26. >> or 27th birthday, whatever. >> 26th birthday. >> 26th birthday. and there's no problem switching as a federal worker from program to program on an annual basis based on any pre-existing conditions or any other discrimination. >> during the open enrollment period or for special reasons they can change plans. >> okay. so it's fair to say the fehpp with 200 and some -- my number is 250. but a great many plans. more than the affordable care act in most areas. in fact offers all the same protections to the consumer that the aca handles, right? >> my understanding is the plans meet the requirements of the -- >> okay. and they come in all levels, from relatively stripped down to

essentially the equivalent, the large plans like the postal plan which is pretty good, and so on, right? >> all comprehensive medical. some are high deductible offerings. and some are hmos. yes. >> taking you through this and taxed your expertise for a reason. is there any reason that if the affordable care act were to go away and a transition to enjoying the same programs offered to the federal workforce to virtually everyone who now or h has retired from the federal workforce is there any reason this wouldn't be viable considering these are insurance companies that want access to the 8 million-plus people they now insure, they bid for it every year and if the number were increased individuals and small and even not smul businesses, is there any reason to believe the program wouldn't be able to serve the same purpose, especially considering

at least a subset of fehpp are in fact the same companies? >> gao has not evaluated ex-pangd the federal employees program to other plans and offerings. it is an employee-based plap based on the group of retirees and that's fornt for that risk pool as there's be risk adjustment -- >> well, there is rix adjustment because they bid annually based on the k, right? >> it's based on their experience, yes. but not -- if different plans end up with different risks -- >> i mean, if over time the federal workforce gets older, sicker, whatever, they adjust. >> yes. it would be based on that plan's experience. >> so last question if i may, chairman. it was not considered originally but they are private programs. there are more plans. it enjoys all the same protections of the affordable care act. so when people -- and i'm not trying to be partisan. i'm trying to be very open here against what do we do in the eventuality. there is no inherent reason you

that couldn't have the federal government insure through these national contracts with local and not local companies, there's no inherent reason that that couldn't be offered as a viable alternati alternative, recognizing there's a risk pool change but these companies start off with an incredibly desirable 8-plus million people that they're not going to want to walk away from if others are allowed to join. is that a fair question? and again, we're taxing your expertise for an opinion. >> it's certainly a fair question. we've not evaluated kind of what the effects could be. either for new entrants to that or the existing program. certainly a lost considerations as to the risk pools of individuals involved. some plans have left fehpp over time as well. so there would again be business decisions by the insurers whether or not to participate in that. >> okay. thank you, mr. chairman. >> we can do maybe a quick

question or two from -- does the gentle lady from d.c. have an additional question? how about the gentleman from wisconsin? another minute or minute and a half? you've got another minute and a half. >> then we'll take a minute and a half. >> then we'll come back to the d side and then we'll finish up here. it. >> sure. maybe if i can i'll take two minutes. you give me a minute and a half, take two. ms. robinson, hhs, you conducted several reviews of cms mjts of the health insurance exchange programs and identified vulnerabilities related to federal contracting in oversight and cms's overall management and administration of the facilities. through those case studies of the management administration, what lessons have been gathered? >> thank you for the opportunity to talk about our case study work. where we did look across the management there were a number of lessons. certainly the lesson around needing good acquisition

strategies and good contract planning, lessons around needing clear leadership for projects. on a really important lesson that i think extends across -- particularly for complex technological and policy projects is really to integrate technology and policy staff and thinking and contractors and employed staff in working together without fragmentation, without silos. certainly when we saw that at cms it helped improve their management across the marketplace program. >> thank you. one more question for mr. siegel. i know there are some yashz in which there's robust competition but there are other areas he just heard that only 26% of america you've only got one choice under obamacare. and given this has fallen over time, three four years earlier and now they only have one, does

it concern you for your fellow americans as the number of companies drop off that it's possible, maybe as early as next year, that there will be no options at all? does that concern you on behalf of your fellow americans? >> i only speak for myself. i don't pretend to speak for my fellow americans. but of course it concerns me. i am not in the insurance industry. so i'm not going to speculate why there is only one company in some places. i can tell you that in new york, which has a long tradition of robust regulation of insurance markets and a commitment in many ways to providing insurance to as many people as possible, we by and large have pretty robust choices. i had a choice this year. i'm trying to envision. of the thing they gave us. i had a choice i would guess somewhere between 12 to 20 plans. i can't tell you exactly how many because i can't remember the 8 1/2 by 11, 11 by 14 thing

i saw. >> i'll come back to mr. dicken one more time. again, there are some people, and i've fought it and i think everybody else has fought it, who say we've got to let oba obamacare continue a few more years. because as companies continue to get out of these markets the thing is going to collapse on its own. and when you already see 26% of the areas have one insurance company compared to where we were a couple years ago, common sense will tell you that if we just let this thing go as it is there might be some markets that have no plan at all and others will just have one plan and the rates will keep going up 25% or 26%. and we can just sit here and watch the train wreck and blame president obama. i think almost every republican has stepped forward and said no, we cannot allow this train wreck to happen to the american people. i'll ask you again if you could speculate given the

disappearance of insurance firms from the market how much of america's only going to have one company or maybe no company if we don't act by 2019 or 2020? >> i cannot speculate but i will note that this is the fourth year. it has been dynamic in the exchanges. we saw some increases up to 2018 and the declines as you've noted. that's a concern for the private health insurance market as a whole, as our work required by the affordable care act indicate insurance markets are very concentrated with often only one, two, or three large insurers having the predominance of the market. that is a challenging consideration. >> i think the gentleman's point is the trend lines aren't good. the pattern isn't good. two years ago 23 co-ops started.

today there are five. 18 of them went bankrupt. three years ago most exchange areas had five plans that you could choose from. today it's down to one. you look at the patterns you all did. 15 fictitious people aplierks they all get subsidies. so all the trends, all the patterns in this law are terrible. and that's our point. i think that's mr. grossman's point. so i appreciate his questioning even though it was his first hearing and it was sort of a filibuster there the second round and we -- i'm kigd, mr. grossman. i appreciate that. >> mr. chairman, can i have equal time, please? >> you can have all the time you need. >> thank you so much. are you aware, mr. siegel, that 11.5 million people as of december 24th had enrolled in the aca and we are on record-breaking pace for the number of enrolls in the aca for

the coming year? >> i was aware of that, yes. >> in your opinion, do you think that the fact that there were almost 40 million uninsured folks before the aca and now it's dramatically fallen is a positive trend line for america? >> i think it's a wonderful trend line for america. >> and sir, would you agree with me that there hasn't been any contrary evidence presented today about the amount of waste, fraud, and abuse that existed in the private insurance market prior to the aca, isn't that right? >> i did not hear anything about private insurance fraud at all. >> and would you also agree with me, sir, that there hasn't been any contrary evidence presented that there be millions of jobs lost if the aca's repealed without a replacement, as my honorable colleagues on the other side propose to do? >> i did not hear a discussion

of job loss at all. >> and would you surmise that people in the employer market who have today protections from discrimination against pre-existing conditions and other similar protections would lose those protections once the aca is repealed? >> i don't know whether some states have protection but if that was the end of federal protection and your state didn't step up, yeah, i think you'd be screwed. >> term of art. >> sorry. i apologize if that's a violation of etiquette. i didn't mean that. i don't do this every day. >> and that's why you're such a convincing witness. mr. siegel, what would you like to say to the chairman when he says it's clear that the aca's got to go? >> i would say that if you think

about health insurance, representative cummings said it should be a right. i don't like rights talk but i think it is a necessity in today's world for any person to have adequate affordable health care available to them. and in our country we do it through health insurance. and we must have that if you want people to be able to live lives where they reach their potential. and therefore contribute as much as we can as citizens, as taxpayers, as employees, as business people. >> the aca has improved your life, correct? >> the aca made the life i have today possible, yes. >> i need to ask you a question about the creation of small businesses under the aca. are you aware of others in your friend circle, family circle who similarly benefited from the

aca? >> i don't -- to be honest with you, i don't have a personality friend that i know of for sure, started their business relying on the aca for health insurance. i just don't know. i have some friends who get their health insurance through the aca as well but they are not necessarily in business. >> got it. >> the honest answer to that is i don't know. >> got it. sir, i just want to thank you so much for your testimony today. >> you're welcome. >> i would just -- just to close maybe say look, i didn't say it wasn't a necessity. all i did was point out the facts. and the facts are there were all kinds of statements made to the american people six years ago about the affordable care act that turned out to be false, turned out to be lies. you don't have to take my word for it. you can take the architect of

obamacare jonathan gruber's word. he told us they misled the american people. on all those statements. nine different statements. pp and now we have the aca come along, it's the law, and we see where things are going as evidenced by what mr. issa and mr. grossman pointed out. we started off with five choices for consumers. we're now down to one in lots and lots of places. we started out with 23 co-ops. we're now down to five because 18 of them went bankrupt. these guys didn't look at the private market. they looked at taxpayer dollars. because that's what's involved here. these co-ops took taxpayer money and lost it. and we have all kinds of fraud going on as evidenced by the study that they undertook where it was 15 for 15. think about this. if you're down to one insurer in an area, that obviously is going to drive up costs. that's a monopoly situation. and if you have fraud going on there, that's even more cost to the taxpayers. that's the story of the aca. not to mention the increased premiums, increased deductibles for families all across this

country. and that's why we're looking to repeal this law just like we told the voters we were going to do. just like we promised them we would do. and just like they sent us here to do. and we need to do that. after all, there was an election where that was one of the most important issues. with that i want to thank our witnesses for being here, thank our members for participating, and we are adjourned. friday a discussion on the future of free speech during the trump administration. we'll be live from the cato institute starting at noon eastern here on c-span 3. friday cia director retired general david petraeus joins an event on the role local translators in iraq and afghanistan play in helping the u.s. military. our live coverage from the american enterprise institute starts at 12:30 p.m. eastern

here on c-span 3. in case you missed, it here are a few programs c-span viewers saw last week. kansas congressman mike pompeo's swearing in as cia director. >> that i will well and faithfully discharge -- >> the duties of the office upon which i'm about to enter. >> duties of the office upon which i'm about to enter. >> so help me god. >> so help me god. >> congratulations. >> thank you. >> senators questioning secretary of health and human services nominee congressman tom price. here's senator ron wyden. >> you bought over 400,000 shares at discounts that were as much as 40% cheaper than the price on the australian stock exchange. and you were sitting at the time on committees that have jurisdiction over major health care programs and trade policy p p. yes or no? doesn't this show bad judgment?

>> british lawmakers discussing their prime minister's visit to washington. >> in her forthcoming meeting with president trump she will be prepared to offer up for sacrifice the opportunity of american companies to come in and take over parts of our nhs or our public services. >> president trump's visit to the decht homeland security. >> the secretary of homeland security working with myself and my staff will begin immediate construction of a border wall. >> reporter: house democratic leader nancy pelosi reacting to president trump's claim of voter fraud. >> all we want is the truth for the american people. i frankly feel very sad about the president making this claim. i felt sorry for him. i even prayed for him. but then i prayed for the united states of america. >> freshman congresswoman liz cheney addressing