>>, this morning the senate judiciary committee meets to vote on jeff sessions nomination to be attorney general. see our live coverage on c-span2. >> c-span where history unfolds daily. in 1979 c-span was created as a public service by america's public television companies and is brought to you today by your cable or satellite provider. >> next, the house oversight committee holds a hearing on fraud, waste and abuse in the affordable care act.

>> the committee on health care benefits will come to order without objection, the chair is authorized. my understanding that democrats caucus is not designated who all the members are. well.wrence as we don't know who is all on this committee. we need to do a unanimous consent that all members on the committee be allowed to participate without objection. so ordered. welcome to the new congress. mr. krista morphy, we appreciate you being here and being the making member. we have mr. mitchell and a number of other new members to the oversight committee will be joining us from the democrat side.

i want to welcome mr. mitchell to the committee this afternoon. let's start with opening statements and get to our witnesses. we appreciate our witnesses in your today, talking about an important subject. health insurance premiums are soaring. president obama and the administration promised that the affordable care act would lower health insurance premiums by $2500. american families are still waiting to see those reductions. the health insurance premiums have skyrocketed under the affordable care act. some americans have experienced higher mm increases and had the job coverage because it became too expensive. under the affordable care act, they are not just rising premiums, the americans have seen massive increases in the

cost of their deductible. insurers are seeing unprecedented losses on the exchanges, or reaching into the billions of dollars. the industry -- several insurers are pulling out of the exchanges. according to harris foundation, there were 12 insurers participating. today, only to insurers are participating in the exchanges. in many areas of north carolina there is only one insurer selling coverage on the exchange. we cannot forget the affordable care act was sold as one of the

-- 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 had to apologize for that one. it is important to keep these realities in mind. millions of individuals received coverage, many more are being harmed by the skyrocketing health care costs. today i want to hear from the health and human services inspector general and the gao on implementation of the affordable care act and their recent work in this area. both of these agencies have done excellent work reviewing the affordable care act programs and activities. i want to hear their recommendations on lessons learned on implementation of some of these programs and how to improve future programs. the work is critical to ensuring integrity of health and ancient -- health and human services

programs. i look forward to hearing about the work related to the afford will care act. thank you, ms. robinson, for testifying. i look forward to learning more about their findings. thank you mr. dickens for testifying. we are pleased to have mr. jonathan siegel here to learn about his expenses under the aca. thank you for being here and to testify. august need to find a way to help make sure americans have access to affordable health insurance and can choose among a variety of plans. i would now yield to a ranking member for his opening statement . then we will get to our witnesses and hearing. >> gentleman -- >> thank you, mr. chairman and

thank you to our witnesses. millions of people have high-quality portable health care as result of the afford will care act. one of my constituents wrote, "we are so grateful for the changes brought about by the aca in our situation. i have truly been life-changing for us. for the first time our family has access to dental coverage, this means we go to the dentist. before this, it 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. but the first time, we have hope that we may be able to day out of the mountain of medical debt we have accumulated during a $10,000 a year deductible plan we were locked into because of the existing conditions, because we can now get reasonable coverage through the marketplace . there are millions of people

with similar stories all across the country. all of our officers -- offices are being flooded. businessman, ill know the aca has allowed entrepreneurs to flourish because they don't have to worry that starting a new business means they cannot afford health care. qualityple have high affordable health care, they can afford to follow their dreams, their talents, become , starteneurs like myself 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 siegel. he will testify that the guarantee of affordable coverage enabled him to start a new business, but there is a lot of fear that 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 an 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 joint committee on taxation analysis estimates that 18 million americans would lose their health insurance in just the first year following a repeal without replacement. second, the cbo and joint committee on taxation estimates that premiums will increase by 20 -- 20% to 25%, more than projected in the first plan year. 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-provided insurance plans would no longer be required to offer the same level of care that they do today. employees with pre-existing conditions would have restrictions placed on that care. the lifetime cap on out-of-pocket expenses would disappear. we would return to the days when parents can no longer have young adult children under 26 on their plan. removing these protections will hurt businesses, workers and families in my district and across the country. third, 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 loan would lose 4000 jobs -- my district alone would

lose 4000 jobs. ohio could lose up to 126,000 jobs. repealing without replacing is foolhardy and reckless. what house republicans have -- we will not sit idly by while the aca is torn down without any replacement. we need a replacement that offers coverage at similar to lower costs. i yield the balance of my time. >> i think the gentleman. we have three goals. we want to review the impacts of the aca on choice and access. we want to understand the implication. -- we have a big debate going on and we want to gather as much information as we can, as we are debating the repeal.

those are our three goals. will hold their record open -- we will hold the record open. i want to recognize mr. grossman for being here. he has been a part of the subcommittee and he will like a short opening statement. our vice chair, mr. walker from the carolina. that we are i hope for fill oury promises to the american people, getting to the bottom of some of these issues that we have with the aca. i have been privileged to work with you the last couple of years. heart is to work with all communities. you have a record of that. thanks. robinson, and mr. john dicken and mr. jonathan siegel from rochester, new york.

welcome to you all. all witnesses will be sworn in so please rise and raise your right hand. thesolemnly swear or affirm testimony you give will be the truth, the whole truth and nothing but the truth, so help you god. let the record show that each witness answered in the affirmative. you are aware ahead of me -- you are way ahead of me. let's start with our first robinson.s. you get to go first. , give orive minutes take a few seconds and then we'll go to the next. afternoon,n: good braking member krishnamurthy, thank you for the opportunity to discuss our work with overseeing the federal and state health insurance market places established on the affordable care act. we are committed to combating fraud, waste and abuse and in theng and integrity

programs run by the health and human services. our work looks retrospectively to the sermon -- to determine whether programs have worked whether -- worked as they should. to identify best practices to replicate. to oversee the market, we examined integrity questions. our taxpayer friends were extended -- expended correctly. on the right people getting the right benefits? is the department managing and administering the program effectively? we identified three types of vulnerabilities, one, the need for tighter payment control to prevent wasteful spending. two, the need for more reliable processes to ensure accurate eligibility determination for applicants.

three, the need for improved management. our findings and recommendations are detailed in my written testimony and in our report. let me offer some examples starting with our accuracy work. cms was hampered in its administration of the advanced premium tax credit that provides subsidies to help consumers afford insurance. at the start of the program, cms used a manual, financial process, they did not collect data on enrollee by a morally -- enrollee by enrollee policy methods. datacollected aggregated from insurers. we found that cms was not able to verify the accuracy of the payments to insurers, nor that enrollees benefiting from these payments had paid their portion of the premium as required. we also found deficiencies in the administration of the

establishment grant program that provided federal funding to states to set up walking places. most states we examined failed to allocate costs properly between their establishment grant spending and spending for other programs that shared systems with the market places such as medicaid. this resulted in states over claiming federal establishment grant funding. further, we found vulnerabilities in eligibility verification processes in both the federal and state market places for example, we found the marketplaces are 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 to hire systems integrator to coordinate the work of the

contractor's. we examined management of the federal marketplace across a five-year period. we identified many missteps that contributed to the poor launch website.althcare.gov we identified better management practices. these included defining clear project leadership and fully integrating technical and policy staff. our work offers important lessons to inform the management of the complex policy and technology product -- projects in the future. to close, protecting taxpayer investments and consumers requires vigilance and sustained focused. integrity should be a priority for the design and current and future programs. preventing, detecting and remediating problems is our collective mission.

thank you again for inviting me to appear. i look forward to answering your questions. ask thank you, ms. robinson. mr. dicken. dicken: i am pleased to be here today as the subcommittee discusses the patient protection and affordable care act. ms. robinson highlighted some of these inspector general findings related to the program integrity. my comments focus on the affordable care act in relation to the health insurance market, highlighting findings in recent reports on ensure availability, variation in premiums and enrollee satisfaction. -- manyrdable care act of these provisions to affect in 2014. the act prohibits insurers from denying coverage based on health

status or gender. below requires -- the law -- it also requires the establishment of health insurance in each state. about 11 million individuals purchased health plans to the exchanges in 2016. given the glance of the participation and private health plans, the law requires us to report on competition and concentration in health insurance market. that2016 report, we found insurance markets were concentrated among a small number of insurers in most 2014, where2012 to the three largest issuers had 80% of the enrollment. in 2014, enrollment exchange plans was a generally more

concentrated among if you issuers. gao has reported on consumer access to health plans offered through the exchanges. -- we founds, geo- that most consumers had six or -- foronze, silver or example, 94% of counties had at least six silver tier plans available in 2015. since gao issued the report, a decline in the number of issuers participating in the exchanges in 2017. important to hhs, all consumers continue to have plan options but for 21% of them, the options were limited to plans offered by a single issuer. a considerable variation in health insurance premiums in

2014 and 2015. for example, an arizona in 2015, the lowest costs plan for a 30-year-old consumer was $147 per month. in maine, the lowest silver plan for a 30-year-old was $237 per month. the range of mims also varied suitably by state -- the range of premiums also varied considerably i state. the highest cost of silver plan in 2015 was $545 per month, a .ifference of 270% in contrast, in rhode island, 2015 premiums for silver plan rangeble to a 30-year-old from 215 to $285 a month. premiums for exchange plans increased more in 2017 than in earlier years. an average of 25% from 2016 to

2017 for the second lowest cost of a plan in states that use a facilitated the exchange. 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 the 2016 gao report. most exchange enrollees report being satisfied overall with 2016 plan in 2014 through according to three national surveys. this report satisfaction was lower than or similar to that of enrollees and employers sponsor plans -- employer-sponsored plans. often these were consistent with

long-standing consumer concerns about private health insurance generally, such as affordability of out-of-pocket expenses and difficulties understanding coverage terminology. as to, this concludes my statement. i would be glad to answer any questions. >> mr. siegel, you are recognized. mr. siegel: thank you, mr. chairman and members of the committee. it is a pleasure to be with you. i come as a husband, father and independent businessman, but most of all i come as a citizen. in 2012, i was laid off. i was 56 with one child still in high school and the other having graduated. i was lucky. i got a severance that provided resources for me to continue my insurance through koba for the rest of 2012 and 2013. a friend invited me to be a founding partner. firm, time we started the

the effective launch of the aca was only a year away. because of the aca, i could start this business knowing that my family would continue to get affordable insurance no matter did.usiness we have purchased our insurance without subsidy, a goal plan come on the exchanges since the aca began. our premium is about 1300 $62 a month. 1000 and $62 a month. the matter what happens to me, my family would get a portable health care. affordability is a big issue. .y spouse is 30 years with ms she is the greatest person i know, taking her shots for over 20 years. the cost of her medications is p.m. we do0 a year participate in a manufactured program that gives some people access to the merits without charge.

there is a cost of ongoing doctor visits, mris and other tests. the aca and medicaid expansion also protect my children, now 21 and 23. they are working jobs they do not provide health insurance. it is a great comfort to an aging parent to know that the aca ensures they can continue to have coverage when they turn to -- turn 26. in all of these ways, the aca enhances my security, produces anxiety and for this freedom, not just for me but for all americans. the possible replacement of the aca with insurance options that are unwise and discriminatory threatens us. we may not receive subsidies that we are not making much more than the cutoff points for subsidies. -- i don't know what that percentage will be when purchase becomes voluntary

and insurance can pedal anything they want. without the aca, the cost of adequate insurance goes up to $3000 a month. how can anyone for that lack of for years on end -- anyone afforded that? what happens when no one will ensure her on any price? there are few words more frightening than the terms of misstatement, my spouse is not a high risk, because we don't know what illness will strike us or when. these pools are pools of citizens. that is a complaint that people have about my spouse. that it is cost not the risk that is a problem, it is obviously why so many of us fear high risk pools to work for the patients who need to have clear rules. you need to ensure they get all the care they need.

i have yet to see a proposal that provides these protections. instead we have a vague promises of federal and state support. without these protections, these are vicious cruelty to or near americans who have worked hard, play by the rules but it had little bit of bad luck. a better name for high risk pools without these protections is death pulls. -- death pulls. my spouse is not someone to shut off, to cast away. she is a human being who has a test has as much right to have insurance at a price that she can afford as any of us. i'm for frightened by some -- i'm frightened by some proposals to changes for medicaid. painted as you will, the real goal seems to be punishing low income people for the sin of being low income. there's a good chance that it will not include my children.

my children do not deserve this. they are children of god just like the rest of us. the story of the aca is not just my story, it is first and foremost the story about democracy. democracy is not just a set of rules about who can get power. it is about assuring equal dignity to all citizens. the argument over health care is just the latest battle in the struggle that lincoln described using go, the struggle that defines the united states and the highest purpose of citizenship. thank you. >> thank you, mr. siegel. we will recognize the german from the carolina. i wanted clarification. you currently don't have a plan -- you are not receiving a subsidy from the government or anything else? correct.l: that is

>> you are paying for insurance on your own? mr. siegel: i always have. >> the gentleman from north carolina. walker: -- rep. walker: i'm impressed by how much you love your wife. my wife is a nurse practitioner. most of my career i have spent as a minister, worked in the refugee camps in europe, visited many people, seeing destitute and despair. about theconcerned 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 north carolinians who don't have any insurance of any kind. i don't want to get into all of the it's and kisses of the numbers -- bits and pieces of the numbers.

25% of the population have been damaged by your higher premiums lost insurance when it comes to dealing with obamacare. in fact, even moving it from the individual aspect, it was president clinton that talked about the damage the aca has caused for small businesses. according to gallup polls, 70% believed it should be altered, overhauled or completely repealed. where i want to dial down my is specifically i would like to talk to mr. dicken about questions we have on some broken promises when it comes to the treasury. under obamacare reinsurance program, section 1341, directed hhs to collect $5 billion and send it to the united states treasury to pay for obamacare's cost.

hhs sent money to insurance companies instead and disregarded the treasury and american people. as of 2015, hhs denied the treasury and taxpayers $3.5 billion a road. -- they were owed. in september of last year, jl issued a ruling -- gao issued a ruling. what did gao determined? call -- mr. dicken: they did issue a legal opinion looking at the payment under the program. the affordable care act indicated that both raymond elected for to be provided to the general treasury and reinsurance payments to the pairs. the collections were less than the amounts.

they paid all that to the insurers. those payments should have also been -- come -- rep. walker: can you share of the reasons were -- share what the reasons were? why was it disregarded? mr. dicken: i would defer to -- hhs attorneys that would be up to speak to the legal reasoning, but in general because the collections were less than the amount that were authorized. that was the priority that hhs made. walker: do -- rep. you know how much is still owed to the u.s. treasury?

dicken: i don't have that at my figure tips. rep. walker: is it in the billions? mr. dicken: the requirement was for several billions. theents can be made because deductions for 2016 would be made in 2017. some of that is still being reconciled. rep. walker: chairman, i yield back. >> i recognized a ranking member from illinois. reppo krishnamoorthi -- i want to thank you, mr. chairman. congressmanlcome krishnamoorthi to his first oversight committee hearing.

we are fortunate to have him on our committee. he brings viable perspective as a small businessman and entrepreneur and as a lawyer and a public servant. we also are fortunate that he has accepted the responsibility of serving as the ranking member on this very important health subcommittee. this subcommittee takes up some of the most important issues. ,hat come before our committee not the least of which is the portal care act. recent polls have shown the number one issue even beyond this is another subject that he will touch on at some point, and that is description drugs. -- prescription drugs. that is the number one issue in .egard to independence

in recent years we have had testimony about how mr. chairman in making member, about how the cost of perception drugs, the folks who are improperly and because of greed raising the prices of these drugs, that to is going into the cost of health care. crossroads with regard to the aca. congressional republicans are moving forward to repeal this law without having an adequate replacement. they had a deadline yesterday or today, they did not meet the deadline. they do this, it will be nothing short of disastrous for tens of millions of americans who have gained coverage, thanks to the aca. it will also be disastrous if americans with employer-provided insurance who have benefited from the aca's many consumer detections. -- consumer protections.

have free, preventive cholesterol screenings and mammograms. there is no price you can pay or put on prevention. no price you can put on wellness. they cannot be treated any differently by their insurance company because of a existing condition. repealing the aca would also have disastrous effects on our economy. repeal would completely destabilize the insurance market , drive premiums up and caused millions of jobs across our entire country. it is not what the making people want or need. a lot of times people -- you

need to dig in and discover that there are a whole group of people that once they stand the afford care act. 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. mr. ranking member, you were not in theen we voted affordable care act. i have told my constituents many times that in my 14 years as a member of the maryland 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, because i have absolutely no doubt that we have saved lives and we will continue to save lives. we can repair -- there are things that need to be done, but we must make sure that the american people are healthy and that, i would think the chairman and i yield back. >> i think the gentleman. gentleman.the >> thank you, mr. ranking member. i agree with your comments. it appears to me that we should mend the aca and not ended. -- and not and it. i was heartened to learned from his today can that the people on the aca were about as satisfied in terms of their satisfaction levels, as compared to those in

employer plans. is that generally correct? generallyveys were satisfaction levels in the 70% to 80%. krishnamoorthi: eyesight -- i would surmise the satisfaction levels would go down if there were no replacement. mr. dicken: this was satisfaction with their health plans. rep. krishnamoorthi: ms. robinson, thank you for your testimony. i presume that you do not look at waste and abuse before the aca was instituted, right? sorry, thank you for the question. we did a lot of work looking at waste and abuse in the medicare

and medicaid programs before the afford will care act. our jurisdiction is to look at programs of the department, so if you're asking if we looked at private insurance before the afford will care act, we did not . rep. krishnamoorthi: mr. siegel, i want to thank you for appearing before the subcommittee today. i know you run a small as this and are taking viable time out of your small business just taking valuable time out of your small business. i want to ask a few questions about your experience with the aca. you testified that after you were laid off and 2012, you would not have had the ability to start your business without the aca. can you explain why that is? mr. siegel: i would not have had the courage, because the prospect of not having insurance, especially for my wife, is frightening. you can spend tens of thousands

of dollars a year on medication for ms, even if you don't have a problem with relapses and other problems which we have been spared. she was 53. 52 or 53. that's at least 12 years to medicare. i cannot screw around with that. i cannot take a chance. she has to have insurance. private marketings new york was incredibly expensive. it is cheaper under the aca than it was before. that is not true of every state but it is true for new york. >> as a small businessman, i understand the risks. 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 is how we grow our economy. worries about health insurance, whether it is affordable a cover pre-existing conditions can hold prospective entrepreneurs back.

the economic effects of repeal are not just anecdotal. according to the commonwealth fund, repealing the aca would lead to the loss of 2.6 million jobs in 2019 alone, mostly from the private sector. -- mr. siegel, can you tell the members of this committee how the dirt -- how the threat of repeal affects you and your family today? mr. siegel: if the aca is repealed, i am not sure i would -- i am not sure how i would get insurance and if i would get it for my wife. my kids, i don't know, they are going to turn 26 soon enough. know, i will pay for them as long as i can get them insurance, but i don't know. it is about that simple. rep. krishnamoorthi: what does that do -- what are your anxiety levels?

mr. siegel: i have not slept that well since the election. rep. krishnamoorthi: it has affected your health? mr. siegel: it has affected my anxiety. i don't know if it has affected anything else. rep. krishnamoorthi: can you tell us a little bit about your business and how it has grown since you have started? mr. siegel: we are a small market research firm. we do product development and we have grown from essentially nothing our first year to this year, i am not going to tell how much we make because we are an llc. i made a good living last year. rep. krishnamoorthi: great. thank you. >> i think the jim demint from illinois. -- i think the gentleman from illinois. ms. robinson, you said something

in your opening statement. ms. robinson: i think your talking about looking at the establishment program. if you have a marketplace in the state that is sharing its system, you need to allocate the cost between the funding for the establishment grant for the marketplace and other programs that may share the same system as -- such as the medicaid. in many of the situations we looked at states not accurately -- >> did a result and more federal dollars come to the state -- did it result in more federal dollars coming to the state? state.much coming to the >> they got more. >> in some cases, some of that funding to be allocated to the medicaid program so we did recommend that cma and the state work together. >> there were controls that led to wasteful spending.

said cms like control to ensure effective payments were --e only to the enrollees sounds like a lot of screw ups going on. guys did al, you little experiment where you had applied fors folks coverage. how many of those 15 debt coverage and got the subsidy and credit for it all, mr. dicken? withn role -- mr. dicken: 15 applicants. all those initially received coverage. >> everything one? mr. dicken: yeah. there were some that mentation that were requested over time --

there were some documentation that was requested over time. approvals.ive all 15 >> even though some fictitious documents were sent along after the initial entry, right? mr. dicken: that is right. >> ripping off the taxpayer. i am curious, nasa much a gao guy, but -- are you familiar with johnson gerber? -- jonathan gerber? do your member some of the statements he made when they were passing this law? i have seen his research. remind you. i want your comment. many folks back when this was being debated, they said if you like your plan you can keep your plan. was that an accurate statement?

him -- certainly, there were dynamic changes. many newly covered people were covered to the exchanges. >> you have to give me shorter answers. you said if you like a doctor, you can keep your doctor. did that turn out to be true? mr. dicken: certainly to the extent that individuals change plans. >> lots of people had to get new doctors. have unions gone down? -- have premiums gone down? >> we have seen premium increases. downemiums did not go $2500, did they? >> we do not compare before and after. >> do you remember when this thing rolled out, did the website work very well?

mr. dicken: there were technical challenges. >> the private information, was it secure? mr. dicken: gao did work looking at it. >> have emergency room visits declined on the affordable care act? gao evaluatednk it. >> what about the co-ops? they were supposed to be wonderful. 23 of them created. how have they done? >> we've i waited though -- we have evaluated those, there are five. ,> 18 of them went bankrupt right? ical nine full statements. -- i count nine full statements.

-- nine statements and now we find out that we were misled. the plan is put in place in most states cannot have an accurate accounting of dollars spent. -- cms lackedol control. guys ran a little experiment and had 15 fictitious people who signed up for it, they all got the subsidy. yet we have people say this thing is wonderful. we've got to keep it. that is amazing to me. this thing has got to go. that is what we are going to be working on here over the next several weeks to put in a plan. i start from the premise, health care gets better and cost less

when obamacare is gone. that to me seems to be the direction we have to go. . would yield to ms. norton we can go to mr. cummings. rep. cummings: this gentleman yields. let me ask you, president trump provide he is going to health care for everyone. it would be cheaper. can you tell us about that plan? so the american people would be aware of it. chairman? i am not sure what mr. trump has in mind. i don't know what you have in mind sometimes when you asked a midst. -- when you make statements.

what i know is what i outlined. the full statements that were made when the of what will care act was presented. cummings: i reclaim my time. i want to knows to the general public would know what the president is talking about. i would like to take a few minutes to discuss what we expect our health care system to look like under trump administration. resident trump has claimed that his replacement to the aca would provide health care that is far less expensive and far better than the aca. based on the action of president trump, actions taken so far, the only thing that trump care seems to be doing is creating chaos. leaving millions of people uncertain about their health care. on january 20, resident trump issued an executive order that directs federal agencies to "

wave, defer, delay implementation of any provision of the act." what this will mean for people with the aca insurance is not entirely clear. the order is short on concrete details. it does raise serious doubts about whether consumers, including those with employer-sponsored insurance will continue to enjoy the benefits and protections they receive under the aca, such as on annual and lifetime limits, free preventive care and comprehensive coverage of essential health benefits. mr. siegel, as a small businessman and aca plan enrollee, how does all of this uncertainty impact you and your ability to run your is this? -- run your business?

mr. siegel: i have not slept well since the election. to the extent i am focused on that instead of focusing on our business, it takes time away. how do i put this? know that this new administration understands, and what people don't understand, it makes it very hard to plan for the future at all. you don't know what they are going to do. the uncertainties affecting insurance companies, mr. siegel. the urban institute 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 warned that repealing the individual mandate would drive up premiums. up to 20% more than currently

expected. some insurers warned that they might be -- that they might leave the market altogether. mr. dicken, you have studied closely, have you not? can go i have -- mr. dicken: i have. you cummings: does it worry that there is no copy visible -- no comprehensible plan in place? mr. dicken: we need to understand the roles that will be working. in addition to creating uncertainty among consumers, it appears that the trump administration is taking steps to actively prevent people from enrolling in coverage, according to a recent politico article. the trump administration canceled tv advertisements for open enrollment that had already been placed and paid for, even though the last day to enroll wasn't until today.

mr. robinson, that's ms. robinson, your central mission integrity."ct the this --and to look into do you plan to look into this issue? by the way, i was in my district on monday telling my constituents to enroll. ms. robinson: thank you for the question. i don't have that detail. rep. cummings: even if the money that has been written on the ads that never. is somehow recovered it is concerning that the trump administration would intensely sabotage that's intentionally sabotage it. we know that young and healthy people tend to wait until the last minute to enroll.

if this is an indication of the future of trump care, we will need the ig's to remain vigilant in the oversight. as the primary oversight body of the house, i hope that we will do the same. we will continue to look over this again, health care. thanybody's scheduled more nine hours a week on a regular basis had health care. health care for themselves or they could buy health care for their family relatively inexpensively. when the requirements for the affordable care act were finally rolled out, a in increased

50% year one.sts my question is, did you do any analysis when you looked at the frog and the waste at the on privatelyt sponsored health care programs in the first few years? atwe have not looked employee-sponsored programs. there are some surveys that looked at that and other organizations. tracks did hhs look? >> did hhs look? not. did >> my constituents, whether it's money they paid for premiums, tax dollars, it is all their money so would it not make sense to look at waist in terms of immediate and then long-term

costs of health care in america at what is suddenly the change in cost? as i indicated, at my company and was dramatic and also for others i notice. tocertainly we are willing look at that. long-standing plans increased costs. let me change directions. there are concerns that those receiving subsidies and payments, can you tell me how many people in your one receive subsidies that were improper or inaccurate that first year? important a very question. what we did look at was the risk to the program of potentially weak controls on eligibility. >> let me ask you.

we not know how many people received subsidies that were found to be inappropriate and in fact fraudulent? we not how would investigate that and no? ms. robinson: congressman, when we get information about an inappropriate person being in the marketplace, our work first whether there were adequate safeguards to prevent fraudulent or improper information. at this moment, we still don't have any idea of an approximation of the number of people that received payments that should not have? ms. robinson: we do not have that. do we know how much that tallies up for the taxpayers? ms. robinson: no.

mitchell: do you have that? >> no. >> i greatly admit, i am subject to freshman hazing as a freshman member of congress but i spent 35 years in business and i have to say oh my god, how can we not think of this? how did we not think it was a problem? arecongressman, i think you raising a very important question about transparency in government and one of the things we're been recommending is to look at things like having the right kind of data to be able to figure these kind of things out. for example, in our work, looking at the accuracy of the subsidies what we -- we are making a

payment to a private carrier or somebody else, we would certainly insist on that kind of transparency and recover the money if it was improperly paid, wouldn't we? ms. robinson: yes congressman. rep. mitchell. so we did not.l: ms. robinson: so we wanted to be able to make recommendations for that control. >> i think it is a great line of questioning. if we cannot get an answer to the question about how many people got fraudulent payments, we can probably conclude that anyone who attempted to apply fraudulently probably did get a. how can we conclude that? you ran an experiment. 15 the dishes people and it was not one who got paid, it was not too got paid, it was not four. it was 15 out of 15, so mr.

mitchell's question is entirely appropriate. that.an about if anyone based on that little experiment you ran, they were batting 1000, anyone who apply fraudulently made in fact have gotten money they were not entitled to in that is a concern not to mention all of the other problems about the aca. the misstatements, the lies told to the american people before this was passed so we would like to get that number as quickly as possible and i appreciate the gentleman's question from as you get there and now i recognize the gentlelady from the district of columbia. -- this isreally not really the last day to sign up for the affordable care act and people up in signing up in huge numbers. people are afraid. of big, structural change and what effect it will have not only on those who are part of the aca but of course we're

the economyt 1/6 of and healthfully with this aspect of it could have an effect on itself ended my district, and i represent the district of columbia, love people already have health care because they work or the federal government. but 100 thousand washington, d.c., residents would lose their insurance if the affordable care act were repealed. and the estimated cost to washington, d.c., would be 1.1 billion dollars into that is a city of 700,000 people. imagine what this means writ large across the country. i am interested because i think when most people think of the affordable care act, they may mr.think of an release like siegel. -- they may not think of it and

enrollees like mr. siegel. a large portion of our self-employed -- a large portion of them are self-employed. so i would like to know what you feel the impact has been on your business. had access.i always coverage has made a huge difference. crimes your own business or the business itself? mr. siegel: it makes a big it would notcause have me as a participant if it was not for the aca. we started out with three partners and our youngest died after three months. our business would probably not exist right now. without the affordable care act.

that is my guess. >> let's look at the potential effects of the repeal on your families access, business access to affordable health care coverage. siegel: new york is a state that will do something. i do not know what. i do know that in new york, before the aca private insurers had to take anybody. and you did not have to buy. so only people who need it up on its automated expensive. my fear is that will go back to that and if i can get insurance at all it will probably be, i don't know, but i'm guessing $2600, $2700, $3000 a month. pop back.ing to see a in marketars-old and research that is not easy.

in any case, i am tired of being a boss. i am tired of having bosses. i love running a business with a partner i admire, serving clients i like, and taking care of my family that way and i do not want to go back. >> mr. siegel, finally let me ask you about a plan i read about a new republican study committee guide that would replace this long-standing tax exclusion for employer-based coverage with a standard tax deduction. now, we know that was health care out of the reach of lower brackets of americans. but, i do not see how it would account for geography or age or health status. such ahave any view on replacement? mr. sigel: i don't have any view on the technical side of it.

i can tell you now coverage according to our county is something i can deduct but i also know that is not as good as -- rep. barton: what about a standard tax? mr. siegel: i don't know if i would benefit from it, but my children might. just having a deduction for the private side, do not know what it would be. if you made it as good as an employer's maybe would have an effect, i do not know. if you don't, definitely not. i am not an expert on the tax system, i am sorry. : well, no one is the next one this i can tell you that. thank you. notice some ofi the information here, you told us a little bit about the number as theons americans have number of insurance companies

have dropped. can you recite those numbers again, the number of options? sure.cken: for plan options, on the different tiers offered on the exchanges to be silver or gold, we found that most consumers had six or more plan options. in the most recent years, the number of insurers offering plans have declined in so we have seen that hhs reported this year 21% of consumers have plan options but only from one issuer. one insurance companies. >> on essence, it in monopoly. four to exchanges, there are different silver and gold plans. >> and how many plans do think 2018?e out there for mr. dicken: there is a lot of willtainty as to what it

bring. certainly it has been concentrated with many states having only one or two or three inches. 20it shot up from like 5% to 1% in one year, zechariah? mr. dicken: i don't have the numbers but it has increased. grothman: is there any concern that some will have no issuers? is dicken: certainly it important to make sure insurers under the current system have them available. you know, it is a local decision by the insurer and those areas. it stands to: reason that it is entirely possible we will have no options, correct? what effect on premiums has the number of -- the competition disappearing had? >> less competition would mean less pressure on keeping it. rep. grothman: is that true?

done aken: we have not causal study but that would indicate. 25% increase. rep. grothman: maybe one of the reasons it shot up was there was no competition, is that right? >> that could have led the insurers to increase the premium. i think her is a variety of reasons. think there is a variety of reasons. some plans, national insurers have changed the markets they or left theg in exchanges. rep. grothman: can you let us know why they left? a few years ago apparently they were gone home. what happened? ung ho. were governme

could you speculate for us why companies keep leaving the current market that was originally and visioned? >> certainly as they have learned about what they are covering, some have made business decisions that they are not going to compete in that market. >> so it seems insurance companies cannot operate, correct? or they would not keep rolling out. none are jumping in, are they? >> we found most of the exits were among smaller insurers, there have been some new entrants as well. rep. grothman: you looked at general,the inspector what is the status of your

recommendation of money misspent? question.ou for your most of those recommendations are still open and we are following up. rep. grothman: are they refunding the money? what efforts are they making to refund the money or is this just par for the course now? ms. robinson: so, i would be happy to follow up with you. i don't have them at my fingertips. rep. grothman: how many states to set include? six.obinson: we looked at rep. grothman:: weather problems in all six? ms. robinson: yes. there was one that did not have any problem. one out of 6, 1 out of seven? ok, thank you.

>> thank you mr. chairman. mr. dickens, we're all watching the affordable care act underperforming and we are all concerned at what it sought to achieve one could say it at least personally achieved. there are millions of people on the plan but let me go through some comparisons. they are a little outside of your briefing but i think they are well within your competence. you are familiar with the programs and the 250 plus .ifferent options so, if we were to contrast the illusion million plus people -- , contrastlion people the options between what you expect to have in 2017 and the affordable care act as it is and

what half the number of people of the federal workers and their families have. dicken: about 8 million people covered as mentioned nationwide under 200 plans offered, that includes some national plan offerings, mostly ppo's as well as local available in specific markets. to include kaiser, blue cross, all of the major names. mr. dicken: true. eithern choose from those national plans, the largest by far of which is blue cross standard and basic options which covers about two thirds. >> under the plan, if you go undercover if you leave the federal workforce, you pay to as youer plan you run continue, right? mr. dicken: the individual would

be paying the full premium. >> which means in some cases the dusth care provided provider has accepted a check from the individual. dicken: yes, do not know exactly where would be coming from. >> as essentially these are private companies that have made a decision to provide a program to whatever amount of people, if you will, any and all from the cobra thatkforce for jews their plan, correct? mr. dicken: they are private plans, yes. >> they are not gender discriminant, right? they charged the same rate regardless of age. so you take advantage of the pool and are not worried about if you are young or old, man or woman, the rate is the same. injured 26-year-old child can stay on it? 26-year-old child

can stay on it until the 26th are they? mr. dicken: yes. >> and there is no discrimination based on pre-existing conditions or other conditions? mr. dicken: yesterday open enrollment. tribes so is it safe to say, 250, -- >> and so it is safe to say it offers the same protections to the consumer that the aca handles, right? mr. dicken: my understanding is the plan meets the requirement. >> and they come in all requirements from the stripped to others like the postal plan is pretty good, right? mr. dicken: summer high deductible. >> i am taking you to this and taxing your expertise for a

reason. that if the reason affordable care act were to go away and a transition to enjoying the same programs offered to the federal workforce to virtually everyone now has retired from the federal workforce, is there any reason that would not be viable, considering these are insurance companies that one access to ande 8 million plus people they bid for it every year and if the number were increased both for businesses and not small businesses, is there any reason the program and inherently would not be able to serve the same purpose, especially given that at least a subset are the same companies? mr. dicken: we have looked at expanding the federal employee program. it is based on the group of federal retirees. it is important for that risk pool.

risk adjustment because they bid annually based on the risk, right? mr. dicken: if different plans and up with different -- >> i mean, if over time the federal workforce gets older, sicker, whatever, they adjust. mr. dicken: yes. was not i may, it considered originally, but they are private programs, there are more plans, they enjoy the same protections as the affordable your act, so if people -- i'm not trying to be partisan, i'm trying to be open -- what do we do in the eventuality, there's no inherent reason you could not have the federal government insurer through these national contracts with local and not local companies, there is no reason that cannot be offered as a viable alternative recognizing there is a risk will change --

poolwill change -- risk change. the companies will not want to walk away if others are allowed to join, is that correct russian -- mr. dicken: if others are allowed to join? dicken: some plans have left a php overtime. it would be business decisions by insurers whether or not to participate. >> thank you mr. chairman. rides we could maybe do a question or two. does the gentleman from d.c. have a question? what about the gentleman from wisconsin? another minute and a half? then we will go back to this side and

finish up. can i will give you two minutes. i gave you one and half, take two. >> hhs, you conducted several reviews and identified vulnerabilities related to federal contracting and oversight and chs overall management of facilities. through those case studies of the management and administration, what lessons did you learn? you for the: thank opportunity to talk about this. there were a number of lessons. certainly, acquisition strategy and good contract planning, lessons around meeting through leadership for projects and a really important lesson i think extensive cross, 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. >> i know there are some areas where there is robust competition but there are other heard 26% oft americans only got one choice on obamacare, they had three or four and others now only have one. does it concern you for your fellow americans that the number of companies drop off and it is possible maybe as early as next year there will be no options at all? does that concern you on behalf of your fellow americans as you watch?

>> i only speak for myself, i don't speak for my fellow americans but the question concerns me. i am not in the insurance agency so i'm not going to speculate why there is only one company in some places. i contended that in new york, which has a long tradition of insurance and providing as much insurance for as many people as possible, by and large a robust trace this year. i had a choice of somewhere between 12-20 plants. i cannot tell you exactly how many because i cannot remember but it was on a big 11 by 14 bang that i saw. >> i will come back to mr. dicken again. i fought it, other people fought it, some said let it continue a

few more years because as companies try to get out of these things, it will collapse on its own. when you already see 26% only has one insurance company compared to where we were a couple years ago, as it is there might be some markets that have no plan at all and some will just have one plan and the rates 25% or 26%oing up 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, we cannot allow this train wreck to happen to the american people. can you speculate, given the disappearance of insurance firms from the market, how much of america is only going to have one company or maybe no company if we do not act by 2019 or 2020? >> thank you.

i cannot speculate but i will fourthat this is the year. it has been dynamic in the exchanges. we saw some increases up to 2019 and the incline you noted. that is a concern for the private insurance health market as a whole. often havearkets only one, too, or three insurers having predominance. as a market, whether these exchanges or the market overall, that is a challenging constraint. >> mr. dicken, i think the gentleman's point is the trend line is not good. the pattern is not good. 18 went bankrupt. three years ago, most exchange areas had five plans that you could choose from. today it is down to only one. when you look at patterns, look at the pattern you did.

15 fictitious people applied, they all got subsidies. so all of the trends, all of the patterns are terrible. that is our point. i think that is mr. grossman's point. was mr.nk that grothman's point. >> can i have equal time, please? thank you so much. thatou aware, mr. siegel, 11.5 million people as of december 24 had enrolled in the aca? we are on record-breaking race for the number of enrollees in the aca in the coming year. i was aware of that, yes. thinkyour opinion, do you the fact that there were almost 40 million uninsured folks before the aca and now it has

dramatically fallen, is it a positive trend line for america? mr. siegel: i think it is a wonderful trend line for america. >> server, there has not been about anyony today abuse prior to the aca, has her? >> i did not hear anything about private insurance fraud at all. >> would you also agree that there has not been any contrary evidence presented that there would be millions of jobs lost a the aca is repealed without replacement as my honorable colleagues on the other side pose to do. >> i did not hear a discussion about job loss at all. >> would you surmise that people in the employer market who have today protections from discrimination against

pre-existing conditions and similar protections would lose those protections once the aca is repealed? mr. siegel i do not know of some states have protection but if your state did not step up, yes. i think you would be screwed. that colorfulor response. mr. siegel: i apologize if that is against etiquette. i did not mean that. >> that is why you are such a convincing witness. mr. siegel, what would you like to say to the chairman when he says it is clear the aca has got to go. mr. siegel: that with if you ,hink about health insurance representative cummings said it should be a right. but iot like rights talk, do think it is a necessity in today's world for any person to have adequate, affordable health --e available to them full

to them. in our country, we do it to health insurance and we must add that if you want people to be able to live lives where they can reach their potential and therefore attribute as much as they can assistance, taxpayers, employees, this is owners is, to our society. >> the aca has improved your life, correct? is just legal: the aca meet the life i have today possible, yes. sir, i need to ask you a question about the creation of small businesses because of the aca. are you aware of others in your friend circle, family circle, who similarly benefited from the aca? siegel: to be honest with you, i do not have a personal friend i know what for sure who started their business relying on the aca for health insurance.

i just don't know. i have some friends who get their health insurance from the aca as well but they're not necessarily in business. the honest answer to that is i don't know. it.ot just want to thank you for your testimony today. >> in closing i would like to say, look, i did not say it was a necessity all i did was point out the facts will stop the fact is there were all kinds of statements made to the american people six years ago that turned out to be false. turned out to be lies. you do not have to take my word for it, you can take the architect of obamacare's word for. on all they misled statements, nine different statements. now we have the aca come along, it is the law, and we see where these are going as evidenced by

what was pointed out. with five out choices, we are now down to one and a lot of places. we started with 23 co-ops, we're down to five. they went bankrupt. that is what is involved here. taxpayer money and we have a lot of fraud going on as evidenced by the said he they undertook with the 15. if you are down to one insurer that will drive up costs and you have fraud going on, that is even more cost. that is the story of the aca. not to mention increased premiums, increased deductible or families all across this country and that is why we are looking to repeal this law just like we promised we would do and just like they sent us here to do. we need to do that. after all, there was an election where that was one of the most

important issues. i want to thank our members for being here, think our members for participating, and we are adjourned. the nomineeoday, for the veterans affairs secretary appears for his confirmation hearing. our coverage begins at 2:30 p.m. eastern on c-span3. you can also listen on c-span.org or listen for free on the c-span radio app. "in depth"sunday, will feature a live discussion. we will take your tweets, facebook questions, and phone calls during the program. still by far and away the greatest country in the history of the world.

nick adams is the author of "america the greatest " and he is also the founder and executive director of the foundation for american greatness which combats anti-americanism worldwide. watch sunday on tv on c-span2. hisresident trump announced choice to replace justice scalia. here is the 15 minute announcement. [applause] president trump: thank you. thank you very much.