Coverage of HHS Secretary Kathleen Sebelius Testifying Before Congress Concerning The Obamacare Website
HHS SECRETARY KATHLEEN SEBELIUS: No, it -- I'll get you the information, but there are three levels of testing, one of them is independent for every piece of this contracting, yes.</s>REP. FRED UPTON, (R)-MICHIGAN: Ms. Castor.</s>REP. KATHY CASTOR, (D)-FLORIDA: Good morning. When open enrollment began a few weeks ago the people back home in Florida who are helping their neighbors sort through the new options for coverage, the navigators, were taken aback by how grateful people are to have new pathway to the doctor's office and the care they need, affordable options. The -- they are no longer being discriminated against because they had cancer, and diabetes or asthma. They are very grateful. They said -- they said to me directly, it's like they found water in the desert. Right now they are surprisingly -- they said it's taking time, because people want to sort through all of these options before they finally sign up at the end of the 26-week enrollment period. So we must fix the marketplace. We must to meet their expectations and we have high expectations for you and the administration. But I think it's important to point out the Affordable Care Act is more than just a website. It -- despite all the obstruction by Republicans in my home state of Florida, nationally, the -- even going so far as to shut down the government, millions of Americans are already benefiting and there are benefits that are not tied to healthcare.gov. Some Madam Secretary, let's clarify what's working despite healthcare.gov. Is it correct to say many of the improvements that the ACA makes to employer coverage and Medicare were the vast majority of Americans receive their coverage are not dependent on healthcare.gov.</s>SEBELIUS: That's correct.</s>CASTOR: And -- so the delays and problems with healthcare.gov do not affect the millions of individuals thanks to the ACA who no longer have to worry about lifetime monetary caps on their coverage that previously sent them to bankruptcy?</s>SEBELIUS: That's absolutely true. And I think the quote that the president was quoted recently saying, "If you have health care, you can -- you don't have to sign up for the new marketplace," was referring to the large portion -- the 95 percent of insured Americans who plans are solid and stay in place and move forward.</s>CASTOR: And I understand the frustration with the website. What I don't know why people are not similarly outraged by the lack of Medicaid coverage in many of our states. Do you find that hypocritical?</s>SEBELIUS: Well, I think it's very troubling that millions of low income working Americans will still have no affordable option if states don't take advantage of the expansion program leaving states bearing the cost of uncompensated care, families bearing the cost of parents who can't take care of their kids, workers not able to go to work and people still accessing care through emergency room doors, the most expensive, least effective kind of care they could get.</s>UPTON: Gentlelady's time has expired. Mr. Gardner?</s>REP. CORY GARDNER, (R )-COLORADO: Thank you, Mr. Chairman. And thank you, Secretary Sebelius, for being here. Here's my letter. This is the letter my family got canceling our insurance. We chose to have our own private policy back in Colorado so we could be in the same boat as everyone of my constituents. And yet my insurance policy has been canceled. The White House website says if you like your health plan you have, you can keep it. Did I hear it wrong?</s>SEBELIUS: Again, sir, I don't know how long you've had your policy--</s>GARDNER: Why aren't you losing your insurance?</s>SEBELIUS: Pardon me?</s>GARDNER: Why aren't you losing your health insurance?</s>SEBELIUS: Because I'm part of the federal employees--</s>GARDNER: Why aren't you in the exchange? You're in charge of this law, correct, why aren't you in the exchange?</s>SEBELIUS: Because I'm part of the federal employee health benefit plan.</s>GARDNER: Why aren't you in the -- why won't you go into the exchange? You're a part of this law. You're literally in charge of this law. Should you be any different than all of the other Americans out there losing their health insurance?</s>SEBELIUS: I'm part of the 95 percent with affordable available health care coverage.</s>GARDNER: You're part of a plan that most Americans aren't (sic) available to them. Why will you not agree--</s>SEBELIUS: I'm not eligible for the exchange, because I have coverage in--</s>GARDNER: You can decide to drop your coverage of your employer. You have the choice to decide not to choose--</s>SEBELIUS: That the not true, sir.</s>GARDNER: I chose not to go--</s>SEBELIUS: Members of Congress are now part of the exchange thanks to an amendment that was added by Congress, but I'm not eligible.</s>GARDNER: Madam Secretary, with all due respect--</s>SEBELIUS: If I have affordable coverage in my workplace, I'm not eligible to go into the marketplace, that's part of the law.</s>GARDNER: Madam Secretary, I would encourage you to be just like the American people and enter the exchange and agree to find a way--</s>SEBELIUS: It's illegal.</s>GARDNER: .. and I would like to show you an advertisement that's going on in Colorado right now. This is an advertisement that a board member of the Colorado exchange has put forward, do you agree with this kind of advertising for Obamacare?</s>SEBELIUS: I can't see it. And again--</s>GARDNER: It's a college student doing a keg stand.</s>SEBELIUS: If the Colorado exchange did that--</s>GARDNER: Do you approve of this kind of advertising?</s>SEBELIUS: -- they are a state based marketplace.</s>GARDNER: Do you approve of this kind of advertising?</s>SEBELIUS: I don't see it. I don't know what it is, and I did not approve it. This is a state based marketplace--</s>GARDNER: That's a pretty big font. That's a pretty big picture of a keg and you can't see it?</s>SEBELIUS: Do I approve of it? I've--</s>GARDNER: You have the ability to opt out, by the way, as a federal employee. You could take the insurance. So I just--</s>SEBELIUS: If I have available employer based coverage--</s>GARDNER: I would also like to submit a waiver for my district from Obamacare and hope you consider waiving Obamacare for the Fourth Congressional District.</s>UPTON: Gentleman's time is expired.</s>UPTON: Mr. Matheson?</s>REP. JIM MATHESON (D)-UTAH: Thank you, Mr. Chairman. And, Madam Secretary, thanks for your time. I just want to ask on the issue of the fixes to healthcare.gov, we've had a lot of conversation about that today and we've talked about confidence levels for being ready by a certain time. But, I think one question that a lot of us have is, can you define what the magnitude of the problem is? Is there a scale or metric by which we can understand how bad this is today, and how we're going to get to where we go to have it fixed?</s>SEBELIUS: Well, again, sir, I've been informed that the problems are in -- the reports I've seen are really in two areas. They are in the performance area, which is speed and reliability. It's too slow and doesn't have reliable transfers and in functionality, there are parts of the system that don't make accurate transfers. So we have done an extensive assessment. They are prioritized, as I indicated earlier. One of the priorities is the enrollment features, which pass individual information to the companies where they want to enroll. That is not reliable at this point. The companies are not getting accurate data. So it's an example of the kind of thing we know we need to fix.</s>MATHESON: And is there a way to -- if you set up metrics figure out if we're making progress in terms of fixing those issues with speed and performance and functionality.</s>SEBELIUS: Again, with the team and Jeff Zients at the head of it, reporting to Marilyn, there are definitely a comprehensive set of issues going forward that will be measured and accelerated.</s>MATHESON: Do you have target dates along the way if you want to meet the November 30th time -- assume it's functional of what you want -- do you have target or metrics along the way to make sure you're on the path?</s>SEBELIUS: My understanding is, yes, there are sort of groups of targets that fixes that can be loaded together. It isn't one at a time. So they don't take days, but they are try being to determine with a specific path, one of the charges that QSSI has, really looking at the umbrella of what needs to be fixed, prioritizing them, figuring out what destabilizes if something else is fixed, how they can be grouped together. And that report will be in later next week.</s>UPTON: Gentleman's time is expired. Mr. Pompeo?</s>REP. MIKE POMPEO, (R )-KANSAS: Great, thank you. Thank you for coming, Secretary Sebelius. I would like to talk about Kansas a little bit today. Much like with some of my colleagues have made references to the "Wizard of Oz", I don't think anybody not from Kansas should be able to do Oz allegories. But, my story -- the way I think about it, is those folks worked awful hard to go down the yellow brick road. At the end of the day, when they got there and pulled back the curtain, they found there was nothing they didn't already have. And as we pull back the curtain on the Affordable Care Act, I think people are finding it's not exactly what they're gonna have worked so hard to find their way too as well. I want to talk about two stories. There's this commitment, if you like your plan you can keep it. I have a letter I'll submit for the record, from Mr. Breeto (ph) in Kansas. You might know him. I saw him the other night in Benton. He got the following letter from Blue Cross Blue Shield that says, "Because your current plan does not offer the benefits standard specified you'll be discontinued on December 31st," and this says good news. And then there's a group of folks, Pizza Hut -- you know the company from Kansas, franchisees founded there -- lots of folks have now taken employees, families who are working there, and they've gone from having full-time jobs to part-time jobs. So they aren't able to keep the health care plan they had either and the one they wanted.</s>POMPEO: What do you tell -- why -- why were the plans that these folks had good enough when you were the insurance commissioner in Kansas and when you were -- Kansas as governor, but those plans today aren't good enough for those hard-working Kansas families?</s>SEBELIUS: Sir, I would tell you, in the roles I had the honor of serving of in Kansas, I worked every day to try and eliminate some of the discriminatory features of the insurance industry that finally, with the Affordable Care Act, are gone. My successor and elected insurance Republican commissioner Sandy Praeger and I worked on a whole series of plans to expand coverage. So I did work on these issues. We were not able to necessarily--</s>POMPEO: So you -- you -- to use your words, you say these were -- I think you said "lousy" plans. And Ms. Tavenner said "not true insurance." Do you think that the plans that were offered when you were the insurance commissioner weren't true insurance?</s>SEBELIUS: In the individual market, the insurance commissioner in Kansas and virtually every place in the country does not have regulatory authority--</s>SEBELIUS: -- over the plan. There's a lot--</s>POMPEO: -- a yes-or-no question: Were they true insurance plans when you were the insurance commissioner?</s>SEBELIUS: A lot of them are not true insurance plans, no.</s>POMPEO: Thank you. I yield back.</s>UPTON: Gentleman from Vermont, Mr. Welch.</s>REP. PETER WELCH, (D)-VERMONT: Thank you. I'm gonna try to just summarize quickly what I've been hearing. Number one, the website must be fixed. You've been very forthright, and you're gonna fix it. Number two, I'm hearing a tone change. We've had a real battle about health care. We had a battle in this Congress. It was passed. The president signed it. The Supreme Court affirmed it -- a really brutal battle. There was an election where the American people affirmed it. And then the last-gasp effort was the shutdown and the threat of debt default. But what I'm hearing today is that there are problems and people want to fix 'em because all of us represent people who are gonna win or lose depending on how effectively this is rolled out. Third, there's some significant question about existing insurance policies, what the president said and so on. But let's acknowledge something: A lot of insurance companies were ripping off innocent American people by promising them insurance until they got sick, and then it got canceled because they, quote, "had a pre-existing condition," that wasn't, quote, "disclosed." That's gotta end. The challenge for us going forward is to make health care affordable. So Madam Secretary, my question is, is there any indication that there's been a slowing of premium increases as a result of the Affordable Care Act? Because unless we can keep those premium increases down -- they can't rise faster than the rate of inflation, wages and profits -- all of us are gonna lose.</s>SEBELIUS: Well, I would say, the trends in the private market over the last three and a half years are that cost increases have slowed down, are rising at a lower rate than the decades before. And in fact, in this individual market, the old individual market, the typical increase was 16 percent year in and year out rate increase. And often that came with additional medical underwriting. So it gives a sense of how the costs were. We know that Medicare costs are down. We know that Medicaid costs actually had a decrease per capita last year, not an increase per capita, and underlying health care costs are down. These rates in the new marketplace have come in about 16 percent lower on average than was projected -- not by us but by the Congressional Budget Office. And we know that in many of these markets, they're much more competitive. I believe in market competitiveness. That actually drives down rates. The states where the most companies are participating have the lowest rates. And new companies have come in significantly below the old monopoly companies that often dominated this individual marketplace. So we're on a pathway. Are we there? No. But you're absolutely right, affordable coverage, at the end of the day, for everybody is the goal.</s>WELCH: OK. I yield back. Thank you, Madam Secretary.</s>UPTON: Madam Secretary, I'm trying to make sure that you're out of here by 12:30 before we start the second round of questions.</s>UPTON: Mr. Kinzinger?</s>SEBELIUS: That was a joke, right?</s>REP. ADAM KINZINGER, (R)-ILLINOIS: I see -- I see sheer panic. Madam Secretary, thank you for being here. You stated earlier to Mr. Harper that you give the president regular updates on the marketplace. The president stated that he knew nothing about the status and functionality of the marketplace. How often, and what were the subjects of those updates?</s>SEBELIUS: Well, I think there were a series of regular meetings with the president, with some of our federal partners, with offices of the White House from the OMB to others on a monthly basis giving reports on policy and where we were going. None of those, I would say, involved (ph) detailed operational discussions. That wasn't the level. It was, are we coming together, do we have companies--</s>KINZINGER: Sure.</s>SEBELIUS: -- do we have plans.</s>KINZINGER: And I understand that. I mean, obviously, when it comes to the president of the United States, certain level of details you have to see at kind of a 10,000 foot, 20,000 foot overview. But in terms of the actual functionality, whether it's the website or the marketplace, he was legitimately caught off guard on October--</s>SEBELIUS: Well, I assured him, and -- that we were ready to go. Everyone knew with a big plan that there were likely to be some problems. No one--</s>KINZINGER: OK.</s>SEBELIUS: -- anticipated this level of problem (ph).</s>KINZINGER: And just second -- a quick question. Where is HHS getting the money to pay for these fixes? Is it coming from other HHS accounts? Have you used your transfer authority to move money from non-ACA programs to pay for the cost of implementing the president's health care program? And if so, from which programs have you drawn money to help with the fix that's not ACA-related?</s>SEBELIUS: Well, as you know, Congressman, it's been two years since we've had a budget at HHS. And we also have not had at the president's requested implementation budget authorized by the Congress. Each of those years we have used not only resources internally but I do have legal transfer authority that I've used and a non-recurring expense fund. We will get you all the details of that--</s>KINZINGER: Great. Thank you. So the answer is yes, though, there is some non-ACA money being transferred and used for the implementation of--</s>SEBELIUS: There is money that is specifically designed for either outreach and education, so the health centers have hired education and outreach people as part of their outreach for health personnel. I would say it's -- it's definitely a related cause to get expanded health care.</s>KINZINGER: Thank you. Thank you, Mr. Chairman.</s>UPTON: Mr. Sarbanes?</s>REP. JOHN SARBANES, (D)-MARYLAND: Thank you, Mr. Chairman. Thank you, Madam Secretary, for being here. My understanding is that a lot of the -- the companies, insurers that have been offering plans in the individual market, the ones who are sending out these notices, are actually repositioning themselves in the health insurance exchange to offer alternative plans. Is that correct?</s>SEBELIUS: Yes.</s>SARBANES: And in addition to -- to those insurers who've been in the individual market (inaudible) have a lot of other companies and insurers providing plans in the health insurance market?</s>SEBELIUS: That is true.</s>SARBANES: So the way I look at this is -- you know, I went to buy Oriole tickets awhile back when the season was still under way, and I was standing in line. And I got up to the ticket window and they closed the window. But I didn't have to go home because they opened another window a few feet away. So essentially what's happening is people are coming up on the renewal period. They're getting up to the window of the individual market. They're being told, well, that window's closed but if you go right down the line here there's another window that's open. And by the way, when you get there, you'll get better coverage potentially at reduced premiums. And if you go down to window 3 there's some subsidies that may also be available to you. So this notion that people are being turned away from an affordable product that provides good, quality care is preposterous. And in fact they're being steered to a place where they can get good, quality coverage, in many instances much better than the coverage that they had before, at an affordable rate that is supported by the subsidies that can be available to many, many people. This is -- this is what's so promising about the Affordable Care Act. And so I think it's important for people to understand that that window's not being shut. They're just being steered someplace else where they can get a good opportunity.</s>SEBELIUS: And I think the first option for those companies is to say, 'We'd like to keep you here, and here are the plans we're offering.' But to be fair, customers will now have an opportunity to look across a landscape, which they couldn't before. They will have entry into those other windows, which many of them didn't have before with a pre-existing condition. And as you say, about 50 percent of this market will have financial help in purchasing health insurance, which none of them had before.</s>UPTON: Gentleman's time expired. Mr. Griffith?</s>REP. MORGAN GRIFFITH (R)-VIRGINIA: Thank you, Mr. Chairman. Earlier in your testimony here today you said a couple times, "plans we enjoy but then," as you noticed with Mr. Gardner's eloquent testimony, that we're not going to be in the same plan that you're in after January 1. I was one of those who thought it was a good idea as a part of a proposal that was floating around the halls here in Congress that the president and Cabinet secretaries ought to also be in the marketplace and not have a special federal plan that -- that you will have after January 1, but we will not. The president, while that was being discussed, issued a veto threat. Did you discuss the veto threat with the president before he made it? And have you discussed it with him since then? Yes or no on the first?</s>SEBELIUS: No, sir.</s>GRIFFITH: No. And then I would have to ask you, relating back to the contractors involved in this, CGI told us that the Spanish Web site was ready to go, that they thought everything was ready, just as they did with the regular site. And, obviously, that didn't prove out. But that they were told not to implement it. Likewise, the shop-and-browse section was ready to go. Do you think that they were misleading this committee when they made those comments?</s>SEBELIUS: I think what they believed is that that product independent of the entire operational site was ready and tested. What -- a determination was made -- I was involved with the Spanish Web site and the Medicaid transfers to say, let's minimize the risk for the whole site, let's load a week later.</s>GRIFFITH: But that raises the next question up, because one of the -- of the other contractors, QSSI, I believe it was, indicated to us that -- that part of the problem was that, once you took away the ability to browse, everybody had to go through the business of setting up an account, and you stopped -- or CMS stopped one of the browsing options as well, and that that actually contributed to the logjam and contributed to the problems. So, isn't it -- is he correct on that, that not allowing people just to look without having to sign up, wouldn't that have made it easier for the American people?</s>SEBELIUS: In hindsight, I think that probably would have been advantageous, I can tell you that the reason the decision was made going forward was to minimize risk, that didn't work so well. But adding additional features that didn't involve people actually wanting to get to what they would independently pay and what they would qualify for and what the plans were, seemed to be things that could be added down the road. It was wrong.</s>UPTON: The gentleman's time has expired. Mr. Bilirakis?</s>REP. GUS BILIRAKIS (R)-FLORIDA: Thank you, Mr. Chairman. I appreciate it very much, Thank you, Madam Secretary, for testifying today. Madam Secretary, over the weekend, the New York Times wrote the following, "Project managers at the Department of Health and Human Services assured the White House that any remaining problems could be worked out once the Web site went live. But other senior officials predicted serious trouble and advised delaying the rollout." Can you confirm if this is true? Did any senior department official predict serious problems? And did any senior department officials advise delaying the rollout of the exchanges or parts of the exchanges on October 1st? Could you--</s>SEBELIUS: I can tell you that no senior official reporting to me ever advised me that we should delay. You heard from the contractors on the 24th that none of them advised a delay. We have testing that did not advise a delay. So not -- not to my knowledge.</s>BILIRAKIS: Did they indicate to you that there were serious problems?</s>SEBELIUS: They indicated to me that we would always have risks, because this system is brand-new and no one has operated a system like this before to any degree. So, we always knew that there would be the possibility that some things would go wrong. No one indicated that this could possibly go this wrong.</s>BILIRAKIS: Can you name some of these officials that gave you the advice, that there were serious problems?</s>SEBELIUS: Again, I -- we had series of meetings with teams from CMS. I was always advised that there is always a risk with a new product and a new site, but never suggested that we delay the launch of October 1st, nor did our contracting partners ever suggest that to us.</s>BILIRAKIS: Thank you, Madam Secretary. Thank you, Mr. Chairman, Appreciate it. I yield back.</s>UPTON: Mr. Johnson?</s>REP. BILL JOHNSON (R)-OHIO: Madam Secretary, thank you for being here with us today. CMS was the integrator of the Web site prior to and leading up to the 1 October rollout--</s>SEBELIUS: That's correct.</s>JOHNSON: Correct? You've testified you've now hired an outside company to serve as the integrator--</s>SEBELIUS: One of the contractors has taken on an additional role--</s>JOHNSON: Who is that company?</s>SEBELIUS:  QSSI. JOHNSON:  QSSI. SEBELIUS: Who built the hub.</s>JOHNSON: OK.</s>SEBELIUS: Yes, sir.</s>JOHNSON: This is the same company that told our committee last week that they were not only the developer of the hub and the pipeline, but also an independent tester of the system.</s>SEBELIUS: Yes.</s>JOHNSON: You've acknowledged in your testimony today that inadequate testing played a significant role in this failed launch, so aren't you concerned that QSSI has lost its ability to be an objective independent arbitrator in addressing the problems that plague the system now? Because they're part of the tester, part of the developer, part of the problem.</s>SEBELIUS: No, I haven't lost my -- my confidence in them. I think the testing that they did is validating the pieces of the equipment. What we've said since the launch is that we did not do adequate end-to-end testing.</s>JOHNSON: OK.</s>SEBELIUS: That was not the QSSI responsibility.</s>JOHNSON: All right. And in this new role as integrator, are you going to be paying QSSI more than they were to be paid under their original contract? I -- I would expect with this expanded role they're going to get paid more, right?</s>SEBELIUS: That discussion is under way in terms of what the role will entail, what the outlines are, yes, sir.</s>JOHNSON: OK. Well, hard-working American taxpayers have already paid for this implementation once. Do you think it's fair to ask taxpayers to pay more so that QSSI can now attempt to do something that Administrator Tavenner and her CMS team were unable to do right the first time?</s>SEBELIUS: Well, sir, I think the American taxpayers expect us to get the site up and running. As I told you earlier--</s>JOHNSON: Oh, I'm certain that they did. They expected it the first time.</s>SEBELIUS: I understand, and so did I. We have not expended the funds that have been encumbered for the contracts. We have not -- and we will monitor every dime we spend from here on in, and re-audit things that are going forward.</s>JOHNSON: Well, with that, Mr. Chairman, I yield back.</s>UPTON: The gentleman yields back. Mr. Long?</s>REP. BILLY LONG, (R)-MISSOURI: Thank you, Mr. Chairman. And thank you, Secretary, for being here today and giving your testimony. Earlier today, you said that "I'm responsible for the implementation of the Affordable Care Act." I've heard you referred to, and maybe yourself, as the point person for the rollout, the architect of implementing Affordable Care Act. So you are kind of the president's point person, are you not, for this rollout?</s>SEBELIUS: Yes, sir.</s>LONG: I -- earlier, you were asked, and there's a lot of things striking about the rollout of this and about the Affordable Care Act altogether. But the thing that's most striking to me is that when we have the point person for the rollout here, and you're not going in to the exchange. Now, I've heard you say that, and you got some advice from the folks behind you, but I'm asking you today: Can you tell the American public, if your advisers behind you, that if they happen to have given you some wrong information, if it is possible for you to go into the exchange like all these millions of Americans that are going with the exchanges, will you commit to forego your government insurance plan that you're on now and join us in the pool? Come on in. The water's fine. All the congressmen, all of our staff have to go into the exchanges. We have to go into the D.C. exchanges. And I will say that I tried to get on the website. I was successful during the hearing earlier, and I got to the D.C. exchange, which is where I have to buy from, I got part way through. And then when it got to the point to enter my Social Security number, I could not bring myself to do that, from what I've heard from people like John McAfee and folks about the security. Will you tell, if your advisers are wrong, and it is possible for you -- I'm not saying it is -- but if it is, if it's possible for you to forego your government program you have now? Will you tell the American public that, "Yes, I will go into the exchanges next year like everyone else"?</s>SEBELIUS: Sir, the way the law is written--</s>LONG: It's a yes or no -- I'm -- let's say that you're wrong on that. Yes or no, if -- if you're wrong, will you? Yes or no?</s>SEBELIUS: But I don't want to give misinformation to the American public--</s>LONG: You what?</s>SEBELIUS: -- who may be -- I don't want to give misinformation. If you have affordable coverage--</s>LONG: I want you to go home and research it. If -- if you're wrong--</s>SEBELIUS: -- if you have affordable coverage--</s>LONG: -- will you go into the exchanges?</s>SEBELIUS: I -- if I'm--</s>LONG: If you can, will you? That's a yes or no. If you can, will you?</s>SEBELIUS: I will take a look at it. I don't have any idea--</s>LONG: That's not an answer. That's not a yes or no.</s>UPTON: The gentleman's time has expired.</s>LONG: You're the architect of the whole program and you won't go into it with the rest of the American public.</s>SEBELIUS: I did not say that, sir. I think it's illegal for me to--</s>LONG: If it's not illegal. If it's legal, will you go in?</s>REP. HENRY WAXMAN, (D)-CALIFORNIA: Mr. Chairman? Mr. Chairman?</s>LONG: Come on in, the water's fine.</s>UPTON: The gentleman's time has expired.</s>WAXMAN: I have a unanimous consent request. I'd like to -- Madam Secretary, I'd like you to answer for the record. If you were able to do what the gentleman just suggested or follow the recommendation of Cory Gardner, our colleague from Colorado, and went into the bought -- to buy an individual policy, would you be able to find one that would protect you from cheap shots? Or do you think that has to be mandated for coverage?</s>UPTON: Yeah, we'll wait for that response to come back.</s>SEBELIUS: I would gladly join the exchange if I didn't have affordable coverage in my workplace. I would gladly join it. And the D.C. market is an independent state-based market, even though D.C. is not a state. We do not run the D.C. market in the federal marketplace.</s>UPTON: The gentlelady from North Carolina, Ms. Ellmers?</s>REP. RENEE ELLMERS, (R)-NORTH CAROLINA: Thank you, Mr. Chairman. And I have a couple of questions. Thank you for being with us today, Madam Secretary. I'd like to go to the issue that has been raised by my colleagues on the left here about accurate information. Number one, I've heard the issue of Medicare Part D brought up many, many times. Although my colleagues all voted no against it initially, now they're extolling the virtues of Medicare Part D. Is Medicare Part D a mandate or is it voluntary?</s>SEBELIUS: It is voluntary.</s>ELLMERS: It is a voluntary program.</s>SEBELIUS: Yes.</s>ELLMERS: That's the first accurate -- piece of accurate information I would like to get. You know, we're asking or we're actually forcing millions of Americans to go to find a health care premium in some way, whether it's to go to the exchange or whether they are to be insured.</s>ELLMERS: Many of my constituents are reaching out to me, those with individual policies, and they are saying to me that my -- my rates are going up 400 percent; my rates are going up 127 percent. These are my constituents. Now, you know, we're talking about open enrollment, but it's forcing the issue, is it not, that if an American does not have health care coverage, they are essentially breaking the law. Is that not correct?</s>SEBELIUS: If someone can afford coverage and has that option and chooses not to buy coverage, they will pay a fee on their (inaudible) next year's tax.</s>ELLMERS: And it is a law, so therefore they are breaking the law.</s>ELLMERS: OK. You also brought up the issue when you were in Kansas, that you fought against discriminatory -- discriminatory issues. Now, I, you know, as far as the essential health benefits, correct me if I'm wrong, do men not have to buy maternity coverage?