Transcripts For CSPAN House Oversight Hearing On Affordable Care Act Enrollment 20240712

Health insurance, provided by the Affordable Care act. Called to order, subcommittee and oversight, thank you everyone for joining us today. We are holding this hearing virtually. In compliance with the regulations for Remote Committee proceedings. House resolution 965. Before we turn to todays important topics, i want to remind everyone of a few procedures to help you navigate this virtual hearing. , consistent with regulations. The committee will keep microphones muted to limit background noise. Members are responsible for an muting themselves. Members are witnesses must have their cameras on at all times. If you need to step away from the proceedings, please leave your camera on rather than logging out. Rule, we will observe the and go in order of seniority. Ultimately between minority and majority. Beginning with members of the oversight subcommittee first. , thely, without objection representative is authorized to serve as chair in an event that i have some technical difficulties or whatever. Thank you all for your continued patience as you navigate this technology in order to continue serving our country together. I will now turn to the important topic of todays hearing. Maximizing wealth coverage inollment in the ministration sacrifice. This sounds like a movie. Good morning, everyone. Or good afternoon. Our hearing today will focus on access to Health Coverage in the Trump Administration, continued unconscionable sabotage of americas care. Since its passage over a decade ago, Republican Leaders have treated the destruction of the Affordable Care act like captain ahab treated the white whale. Since 2011, the nsi has voted more than 70 times to eliminate the aca. In 2017 they even held an Outdoor Party at the white house after passing the plan that would cause millions to use to lose their Health Care Coverage. That same year, one of the greatest abuses of power in this era and the dead of night republicans came within one vote of ending the aca and in making 1 6 of the american economy. On a bill introduced hours earlier. The president recently bragged about his health care. Of course he has great coverage. Coverage paid for all of us. All of us. By the same taxpayers who stand subscription by if the administration succeeds in the courts. The administration is in court right now demanding to destroy the aca. To destroy protections of millions during a pandemic. They are using virtually every tool to dismantle the Health Care System. They have green lit sham junk plans without any protections. They have imposed a gag rule for having access to Reproductive Health care. They have gutted funding for cevigators and assistan while failing to crush the aca. They are destabilizing the American Health care system to a breaking point. The administration has gone out of its way to prevent americans from getting and maintaining coverage. Between february and may of this 21. 9 million workers lost their jobs. Of these workers, 5. 4 million became uninsured due to this job loss. In march, i joined my Colleague Health subcommittee chairman Lloyd Doggett and their 100 house members calling for a special Enrollment Period for people to seek aca marketplace coverage during the covid19 pandemic. Even during the pandemic, hhs refused, likely dooming Many Americans to suffer. No other word that i can think of except sabotage. Between seeing the administration and my friends across the aisle swear up and down they support protections for preexisting conditions. They assert with a straight face while spending 10 years attacking the aca. Lets repeat, republicans have sought to terminate preexisting protections over and over again. Its on the record. In contrast, some states are working hard to expand access to coverage. One of them is the great state of new jersey. We have Witnesses Today from new jersey and colorado to discuss how they are making the aca work best for its citizens. As Senate Republicans raced to confirm a new justice, they are downplaying their challenge to the aca. If the republicans have changed their minds on the aca, why would be joining us in defending the law . When we voted in june to protect the aca, 177 of 179 were given a republicans opposed it. Dont have a calculator handy, thats 99 . So given the chance, 99 of our colleagues across the aisle voted against protecting preexisting conditions. We know why. In just a few short weeks the Supreme Court will give the aca a vote. The future of our Health Care System hangs in the balance. I want to yield down to the ranking member. I am going to keep you for five minutes. You saw what happened last time, we went over. We talk too much. [laughter] michael, you are up. Thank you for calling me. This is really a tough time. I put all my thoughts and prayers to anyone dealing with the virus. There is nothing been more devastating in our time than the china flu and during this time the cost of health care is on the minds of almost every americans. So i appreciate the opportunity to discuss the issue today. While far from being perfect, our Health Care System is the best in the world. With a hearing like this im reminded how fortunate we are to live in a country with axis to the most Innovative Health care on the planet. I hope we can use this hearing to put something in to perspective and correct some of the myths about the American Health care we are having a hearing on on the campaign trail. Today i want to talk about two things. I want to talk about some Successful Health Care Developments we have achieved over the last several years. I want to correct the record on the rhetoric we have been hearing about American Health care. A lot of this rhetoric seems designed to scare the American People in advance to the election, and i think that effort has been both unfortunate and very misleading. The idea that this administration has sabotaged our Health Care System, if thats the truth i cant actually look at this say if we are really going to fix it, lets fix it, lets not talk about things that sound good on the campaign trail but ring hollow when it comes to truth. We have made some very positive progress on stabilizing the aca exchanges. Premiums are down, coverage choices are up and enrollment is stable. This administration has made many strides towards more Affordable Health care options to Many Americans who may not be able to afford some of the acas coverage plans. He can speak further to the successes, including the restoration of shortterm plans and major enhancements. These crucial events or reforms have actually provided options to family letting them choose what is best for them. Again, emphasizing, letting them choose what is best for them and not having something shoved down their throats that they dont have a choice in. Getting rid of the individual mandate we have saved lower and middle income taxpayers 695 a year. That is huge. Democrats have been trying to block these efforts and i understand why, and also using scare tactics to block the progress of this administration. What tactics . Like saying republicans would eliminate coverage for people with preexisting conditions, which could not be further from the truth. On protecting preexisting conditions, democrats wont take yes for an answer. It makes no sense to me, but thats where we are at. The first legislation offered by republicans in the 116th Congress Said no one and i mean no one should be charged more or denied coverage based on their preexisting conditions. Democrats rejected that offer to preserve it as an election issue. Any suggestions that republicans wont bite to protect americans from preexisting conditions is just flat out wrong and a great miscarriage of the truth. Instead of working together on a bipartisan efforts to improve our Health Care System, 118 democrats have cosponsored medicare all. This deal and enormous program would destroy our current Health Care System starting with the repeal of the Affordable Care act. Sadly, Many Democrats simply want an unpopular and partisan government takeover of health care. When we should be working together to lower costs and coverage for everybody. Get more options to the American People. This onesizefitsall approach is absolutely wrong. It doesnt make sense to anybody other than somebody trying to push an agenda the wrong way. This will take away a choice from hardworking americans in my district and will also destroy their Health Care Options. The Affordable Care act is 10 years old. Much of that law has changed on a bipartisan basis, yet democrats keep looking to the past rather than working together to preserve the future by continuing to bring down premium prices and increasing coverage choices for all americans. Increasing the number of options available and people can actually buy something that fits their needs. And something they can afford. I hope we can stop all the fear mongering on this issue and Work Together for bipartisan reforms that will improve the lives of our constituents. Mr. Chairman, i want to thank you for holding this hearing. I want to thank all of our panelists for taking time out of their lives to come and talk to us. Thank you so much. I yield back, sir. I say to you and to all that democrats and republicans who were on last week with our last hearing, i thought going over everything after the hearing, tremendous questions from both sides of the aisle on the subject of tax fairness. I think its tough to get people together before an election. I want to complement both sides for doing what i think was a spectacular job. We are going to hear from our panel and thanks to our witnesses for taking the time to appear before us today to discuss this very important issue. I will introduce our witnesses and then turn to each of them for their testimony. Our first witness, commissioner marlene. She is the commissioner currently leading new jerseys department of banking and insurance. Previously she was a member of the new jersey General Assembly representing the 36th legislative district. Our next witness is kevin patterson. Mr. Patterson has served as the chief executive officer of connect for health, colorado since april of 2015. He has a long history of public service. Including as interim chief of staff to governor john hickenlooper. Andyhird witness is slavik. Mr. Slavik currently turn serves as the board chair. Previously he was the former acting administrator of the cms. And our final witness is chris pope. Mr. Pope currently serves as a senior fellow of the manhattan institute. His research focuses on health, Health Care Payment policy , and Insurance Market reform. Each of your statements will be made a part of the record in its entirety. I would ask that you summarize your testimony in five minutes or less. To help you at this time, please keep an i on your clock. That should be on the screen. If you go over your time i will notify you with the gavel. Commissioner, you may begin. Thank you and good afternoon everyone. Andk you chairman pascrell ranking members of the committee. Of the newmmissioner Jersey Department of banking and insurance. Banking andthe Insurance Industries and now operate the state Officials Health marketplace that launched this morning. And in the leadership of governor murphy, new jersey has lead in protecting the Affordable Care act. Insurance market and increasing access to coverage based on the guiding principle that health care is a right. The state has moved in a deliberate way opening our statebased exchange, making coverage more accessible and affordable for our residents, and providing more Financial Health than ever before for those purchasing health care on our open enrollment. In 2018 the state enacted two major policies. We took first in the nation action to continue a requirement to have coverage after its elimination from the federal level. And we implemented a reinsurance 2019 tobeginning with cover high costs claims that reduces rates in the additional market. The two laws result in Health Insurance rates in the individual markets that were 22 lower than they would have otherwise been. Decided to establish its own marketplace in order to better have access for affordable quality for residents. Sending funds to washington for the use of the federal marketplace. We continue to see policies enacted that threaten the policies made by the Affordable Care act and made our more challenging. Enrollment in the individual market dropped for the First Time Since 2014, and continue to drop the following year. When new jersey to control of outreach and enrollment assistance in 2020 as a statebased exchange on the federal platform, we begin to reverse that trend. Get covered new jersey will open for enrollment on november 1, and will keep more than 50 million in our state to strengthen the marketplace. Residents will see benefits that include new state subsidies on top of premium tax credits. The estimated average subsidy for an individual would be at least 578 a year and at least 2313 a year for a family of four. The average net monthly premium for those eligible for Financial Health is estimated at 117 a month 2021 compared to 164 a month in 2020. Increased navigators to provide three point million dollars. 16 navigators from one navigator in 2019. Three months to enroll compared to a six week window under the federal government and residents will also benefit from our ability to respond to the needs of the state with a special Enrollment Period such as for covid19 and qualifying life events, including pregnancy, which improves maternal health, which has been a focus on this committee as well as the focus of the first lady of new jersey. We have taken deliberate progressive steps to stabilize our market and improve access to coverage, all leading to the establishment of our marketplace for this open Enrollment Period beginning november 1. What the Public Health emergency we are facing, we believe there is no better time than now to make this transition. Chairman, thank you for the opportunity to speak before you and your panel. Chair pascrell commissioner caride, i am very honored to see you again. You happen to live in my district, right . Commr. Caride thats correct. Chair pascrell trying to get that commercial in. Our next witness is kevin patterson. Mr. Pattison has served as the chief executive officer of Health Connect in colorado since april of 2015. Of course he was an interim chief of staff to governor hickenlooper. Mr. Patterson, please. Mr. Patterson thank you for the opportunity to submit testimony. About the Insurance Exchange in colorado and the people who are getting coverage through the individual market. My name is kevin patterson. Im the ceo for connect for health colorado. Our mission is to increase access, affordability for families and employers purchasing Health Insurance. Im proud of the innovation to reduce the uninsured rate and increase enrollment. How thissed to share unique division allows us to expand health to the people of colorado. Since we opened for business in 2013, we have helped hundreds of thousands of coloradans at the desk get the coverage they need to protect their health and livelihood. Increasing health care started years before the passage of the Affordable Health care. In 2006, a Bipartisan Group of lawmakers studied models under then republican governor bill owens. With the passage of the aca, our state legislator passed a bill creating that colorado benefited exchange as a public nonprofit entity that had the bipartisan legislative oversight committee. Board members are appointed by the governor and both democratic and republican members of the legislator. I joined connect for health in april when the state reached their record of 6. 7 , one of the lowest in the country. Charged with further increasing access for our residents, i knew we had to prioritize meeting people where they are. Whether im having a conversation with a single mom in denver or a farmer on the eastern plane, i am listening and learning about Viable Solutions for accessing health care in their community. Generally every fall i visit many Rural Communities to hear from them and share the upcoming open Enrollment Period. This year these challenges by leading me to have these conversations virtually. I thankful for the opportunity to still see our partners, Community Leaders and partners outside of denver. We have funded our navigator program, or what we call our assistant network at 2 million a year at 45 sites. Success integral to our in providing Health Insurance. Our assistant sites have also built relationships with Small Businesses, regional hospitals and surrounding communities. Their work is vital to reach especially vulnerable populations, including families with low income, disabled populations, immigrants and folks in rural places of the state. The state the ongoing Public Health emergency has underscored our relationships with local counties. In midmarch we made the decision to open a special emergency Enrollment Period in response to covid19. In early april the Adams County Commissioners informed me that their constituents were still experiencing hardships as in efforts to combat the coronavirus. We listened and extended our special Enrollment Period through the end of the month. Our assistant networks and brokers were ready to field questions from those without coverage. As a result, 14,000 individuals enrolled in the special enrollment peirod. We continue to explore ways to expand coverage with policymakers. We will be integral in the passage of two new programs in the colorado legislator this year. The easy Enrollment Program and the affordability enterprise. I am excited we can extend access for coloradans with visible active checking a box. Im looking forward to greater stability for the cost reinsurance program, especially those were not qualified and are still struggling to access coverage. With job loss at an alltime high and our state, its more important that we provide Affordable Health care options like those offered through our marketplace. Amidst the challenges we face as a statebased marketplace, i am encouraged that we have flexibility, crucial relationships and capability to ensure our residents have access to coverage that they need. Thank you. Chair pascrell thank you, very much mr. Patterson for your remarks. I deeply appreciate that. Our third witness is andy slavik. He currently serves as the board chair for the United States health care. Previously he was the former acting administrator for the cms. Mr. Slavik. Slavik i am the former head of the sentence for medicaid and Medicare Services founded in 2018, u. S. Of care represents a movement of nonpartisan citizens , former policymakers and experts who are committed to working for the everyday single american and quality Affordable Health care regardless of status or income. Before i continue i want to recognize the late chairman lewis for his service to this nation. Thank you for inviting me to step to testify in the Affordable Care act. We sit at a moment for american history. A global coronavirus pandemic has taken hundreds of thousands of American Families in a matter of mere months. As many as 14. 6 Million People have lost their Health Insurance coverage along with their jobs at a time when the health of each american is more connected than ever before. Unfortunately, covid19 is not the only threat americans are facing right now. Rather than support americans to americans through these trying times, the Trump Administration has added to the uncertainty facing americans by attacking the very existence of the Affordable Care act. The aca serves two main functions. Patient protections and Affordable Care. The law provides every single american a guaranteed set of protections including prohibiting Insurance Companies from discriminating on the base of a preexisting condition and outlaws Insurance Companies from stopping coverage due to arbitrary limits. The aca has provided coverage to tens of millions of americans through expanding medicaid and the aca. This has been lifechanging. The aca is saving americans 4000 per family and many now can afford their prescriptions and to see their doctor for the first time. The aca saves 12 million seniors, at an average of 2200 in their Prescription Medication and eliminates the aged tax that made insurance unaffordable to those 50 and older. Implement the Lies Congress intended, over the last four years, this administration has undermined the law with a clinical callousness. These actions have included cutting funding for navigators who assist people in enrolling coverage and advertising by 90 , shortening the open Enrollment Period. And attempting to end payments to insurers to discourage them for participating in exchanges. Limited benefits raise the price of insurance and brings back the fine print gotcha policies that get so many people from getting the Health Insurance they thought they purchased. I served in the Obama Administrations i had responsibilities for administering the laws passed by democratic and republican controlled congresses. I understood i had a duty to implement the laws passed by congress to the best of my ability, that the executive branch did not choose which laws we liked and did not. Not so with this Trump Administration. They have taken this to a new level by refusing to defend the people in a case brought by Republican Attorneys general in to invalidate the Affordable Care act and to take their Health Care Coverage. The public faces uncertainty. Just as a deadly and serious virus is making its way almost completely unchecked through the country. The effect of the lawsuit would to be successful would put 130 america 130 million americans in a situation where they could be uninsurable for prior illness. With covid19 this is more troubling, its the ultimate preexisting condition. The virus attacks organ systems, our immune systems, our entire body becomes a preexisting condition. In 12 days the open Enrollment Period for the season will commence. Despite the efforts of repeal , despite the refusal of congress to build on the law, despite the negligence and sabotage, millions of americans will get Health Insurance coverage for their families. Americans cannot understand why protecting their families has been controversial and opposed by this administration. Americans would like nothing more than the bipartisan fighting over their health to stop. At times like these people expect the support of their government, not to make lives more challenging. All people ask is to be able to care for their families, keep them healthy and not have bankruptcy at the first side first sign of illness. They would certainly like to stop fearing the very government they elect. In this country that should not be too much to ask. Chair pascrell thank you, mr. Appreciate your presentation today. I will call on our last witness, mr. Pope. You have five minutes, try to summarize and we are honored to have you here. ,r. Pope chairman pascrell, ranking member, thank you for the opportunity. As the American People prepared to head to the polls, the committee is giving them a service to review the arguments made and the claims made against them in the evidence regarding how they have worked out. Now, it is clear that the Affordable Care act subsidy expands guaranteed coverage to the individuals with preexisting conditions. But it would not just protect people with preexisting conditions, and also a dysfunctional change in market rules. The Affordable Care act requires insurance to be priced the same for people who waited until they got sick to get insurance, as it was for people signed up before they got sick. Premiumsequence the spiraled up, insurers panicked and tried to restrict the networks and many dropped out of the insurance industry, or at least the individual market altogether, and we have been left with a situation where, four years ago the average the deductibles that a family would pay to get coverage would be 22,000 for they had any medical care paid for. That is not an attractive Insurance Market or something that will be appealing. It was an urgent necessity to establish an alternative source of coverage and a source of appropriately priced insurance that would give people value if they signed up before they get sick, and in proportion to their risk and need and rewards them for signing up prudently in a timely manner. The Short Term Limited Duration was not perfect but it was the best opportunity to do this. For an individual to enroll in the market, they are able to get Better Benefits at the same price, for the same price as the Affordable Care act. And, a much cheaper price. At the same price for an equivalent aca plan, they will find Better Networks and these plans had a higher satisfaction ratings. The administration was right to try and make the plans more available. Congress was right in repealing the mandate or zeroing it out. The mandate is in effect. Because so many exemptions were being created under the Obama Administration, what remained was an unfair and in a global inequitable tax. A lot of claims remained that the sky would fall if the mandate was zeroed out, and the plans were be allowed to be made available to the americans. Cameof these projections predictions came true at all. The mandate was repealed. Since the mandate has been eliminated, premiums have been stable. In fact, slightly reducing. Enrollment itself has also been stable since the mandate has been zeroed out. Theas been the effect with regulation. If you look at the states where plans are being made available, premiums on the market have increased and enrollment has not plummeted anymore than it has in the non fdldi states. There is no harm done to the aca market or under the provision of the plan. Millions of americans have been able to buy affordable insurance. The majority of which would have been uninsured. Plans, this is nobody idea of Insurance Market. In a Regulatory Framework that had been established by the Affordable Care act. Restricting links to three months as had been done under the Obama Administration, creates a huge compliance to restrict longterm coverage of product conditions. These are real problems. They are solved by guaranteeing maneuverability. So thating restrictions an individual develops a condition of all enrolled in the short term plan, the insurer has the coverage this year, next year and into the future. Under a proposal to restrict shortterm plan maneuverability. If an individual enrolled in the planning got cancer, the insurer would be forced to drop the coverage and would be banned from covering them again. Thats exactly the wrong way. We should protect consumers, not eliminate protections from them. Mr. Pope, thank you for your presentation, we appreciate it. At this time i will open the viewing for questions. Each member will be recognized for five minutes to question our witnesses. If the witnesses will respond with short and concise answers, all members should be able to ask questions. As mentioned earlier, will not observe the gibbons rule in the remote setting. We will go through the order of seniority for questioning. Alternating between minority and majority. Beginning with members of the oversight committee. Members are reminded to unmute yourselves when you are recognized for your five minutes. I will begin by recognizing myself. Mr. Pope, let me have a quick question before i start. My questions, which i had prepared, do you advocate that we eliminate, or that the courts eliminate the aca . Is that what you are advocating . Chris no. Chair pascrell no . That is interesting. Thank you. I have a question for the entire panel. Please answer with a yes or no. The nation continues to battle the coronavirus pandemic with over 8 million cases and more than 220,000 deaths. Too many families are struggling to make ends meet. Do you agree that access to Health Insurance is more amidst thehan ever ongoing coronavirus pandemic . I will start with the commissioner. Yes or no, mr. Patterson . Mr. Patterson the answer is yes. Yes, chairman, the answer for new jersey is yes. Mr. Slavitt yes, mr. Chairman. Mr. Pope yes, mr. Chairman. Chair pascrell thank you. Commissioner, why did new jersey decide to establish a statebased marketplace rather than relying on the federally facilitated marketplace . Commr. Caride thank you, chairman for that question. As i had mentioned previously, we were sending funds to washington and the money that we were sending, we were not being able to utilize it properly. And, on top of that we were seeing policies coming out of washington that were creating confusion, making our job much more challenging. By keeping those funds in new jersey, we are able to tailor it specifically to our residents. We have been able to use that money to improve, and expand our navigators program, outreach, education. Chair pascrell will you explain . Commr. Caride yes, chairman. The navigators are individual organizations in the communities that help our residents to enroll them on the exchange and educate them about the exchange, to explain the exchange. Had one navigator in 2019, while under the governments federal platform, and we have managed much more money now, 3. 5 million, and expanded it to 16 navigators for this coming open enrollment. Chair pascrell thank you very much. , how destructive would it be for the Supreme Court to overturn the Affordable Care act during a pandemic . Mr. Slavitt mr. Chairman, there is never a good time to take Eagles Health Care Coverage away from them. But at a time when they are getting a Mysterious Illness that we do not understand, that many children and College Students are getting an illness that appears to be asymptomatic. Decades from now they could develop things like heart arrhythmia or asthma. The Insurance Companies would be able to deny coverage on the basis of preexisting conditions if the Affordable Care act is eliminated. A vast majority of americans do not want to see the aca eliminated and it would be a significant mistake. I would add that in a pandemic it is important that people report their illnesses so that we can Contact Trace and stop the spread. Once people worry about Insurance Coverage they will not disclose illnesses and the virus will spread more rapidly. , isr pascrell mr. Slavitt this an exaggeration on my part, that during the pandemic, millions of people lost their jobs, and many of them lost their insurance . Is that an exaggeration . Is that a hyperbole . Mr. Slavitt no. In fact, press reports and Data Analysis suggest that you are exactly right, mr. Chairman. Chair pascrell what will happen to these folks if the Supreme Court says, thats enough, no more of this . Mr. Slavitt i think americans will go into bankruptcy, they will avoid getting medical care, we will be back to where we were in the early 2000s but worse with a disease spreading around the country nearly unchecked. Chair pascrell and finally, have you seen the republican plan to replace the aca . Mr. Slavitt i have not. Chair pascrell thank you, i , i appreciate that. I want to recognize my friend, mr. Kelly. Rep. Kelly i am a small employer myself and we do provide insurance for the people on our team. And most small employers really look at their workforce as family. Not as some unimaginable group of people, they are the people who work for mutual success. I want to go over one thing. In his written testimony he says that there are 14. 6 million americans that, and heres the key, may have lost employersponsored insurance since the pandemic began. But according to the cbo, about 3. 9 Million People are dealing with permanent job loss, and an offer of employment based insurance. Of those 3. 9 million americans who may have permanently lost their job, 1. 3 million are estimated to be uninsured. One third of those are estimated to be uninsured while others have obtained new coverage. There is no question that the pandemic has been a strain on all of us. But there are threats that the administration is trying to sabotage the aca. The Trump Administration and House Republicans have committed to ensuring the Health Care Options and americans want needs. Any indication that this administration is sabotaging the Affordable Care act is not supported by the fact. Health care premiums are down, right . Choices are up. Competition between insurers are up. And republicans have confirmed time and time again our support for protections with those with preexisting conditions. Stop saying that is not the republican plan, it absolutely is. Despite that and making it an affordable for many. Isan expert, you think this an issue that should be solved by washington, and if not, what can our congress do today to bring down the rising costs throughout the entire Health Care Sector . The big problem is mr. Pope the big problem with the Affordable Care act essentially said you could have any Health Care Program you wanted so long as it is obamacare, that is not a real choice. There has to be a broader array of choices and it cannot just be the plans out there and that you sign up after and before you get sick. People need to have a reward for signing up early and get a good value plan that is priced appropriately. And, if we make available options to individuals who are signing up early for coverage, then as they develop conditions, it will not become a preexisting condition because they will always have had Insurance Coverage. Rep. Kelly thank you. One thing that i want to point out, that is part of the Health Association lannett 2016, both house and Senate Republicans were talking about allowing people to actually become part of Association Health plans, that means they could spread the risk of Health Insurance across larger number of people that have access to the same lower costs and high quality Health Coverage as large employers and unions have. Democrats in several states have sued to block this. Mr. Pope, could you tell us why Association Health plans are a potential benefits to Small Businesses and so proprietors and the selfemployed. Mr. Pope if you look at where traditionally has been the strongest Health Insurance coverage in america, it has been large employers. And that is in large part because large employers are exempt from state regulations. So Association Health plans allow smaller employers to bundled together and set up associations and have benefits and regulatory freedoms and flexibilities in helping Health Insurance costs. So, really it would level the Playing Field and allow small employers to do what big businesses have always been able to do. Rep. Kelly i appreciate that. Again, as a small employer myself, there is nothing more valuable than the people who come to work every day. We cannot mutual success. I thank you for being here and all the panelists for being here. The Supreme Court is really about the constitutionality of the Affordable Care act. Lets make sure that we actually put that in the right light. Mr. Chairman, thank you for the opportunity to have an exchange with our panel and i yield back. Chair pascrell thank you, mr. Kelly. And now the chair recognizes ms. Delbene. Delbene thank you, mr. Chairman and thank you to all of our witnesses for joining us. During a Global Pandemic of such devastation it is vertical that we turn our attention to maximizing Health Care Coverage throughout the country. Pattison, like colorado, though Washington Health exchange has been quite successful. Proposed rates for next year are expected, on average to. Ncrease by 2. 3 if everything goes as expected, this would be the second year in a row that rates have gone down. Washington state took several steps to counteract and stabilize the aca in the marketplace. The best way forward is to expand the risk. The ministry should slash funding for marketing. Left marketing, less people signed up for coverage and a smaller risk for with higher premiums. Washington state chose to Fund Marketing up assistance. Mr. Pattison commented did colorado take similar steps and were you successful . Mr. Patterson weaver wework partners. Ly with our ,e have a very diverse state Eastern Plains and a lot on the western slopes. We actually just go out and meet with people and we try to make sure we have navigators in every corner. At about 2unding it million per year. First it was a grand. We permeated those funds out of our own revenue. That has been important to make sure we are able to work with communities that are being missed, or that have language barriers. So, we have a lot of work from brokers and a sisters assisters indifferent languages and not just along the front range, where a lot of the population is, but in all corners of the state. I hope that answers your question. Rep. Delbene and 2018 the administration allowed limited duration plans to be expanded to three years. These are intended to serve as a bridge between coverage because they do not have the protections that qualified aca plans have, they do not cover all essential Health Benefits like maternity, Mental Health, they do not have limits, they do not have to cover preexisting conditions, so allowing customers to sign up for these plans for extended periods of time fractures the individual market and drives up prices in the aca marketplace. In washington we are fortunate that our insurance commissioner limited shortterm plans to only three months, preserving a robust market. Has colorado been able to halt shortterm limited duration plans . Mr. Patterson thank you, congresswoman. In january, i believe of 2019, our division of insurance and insurance commissioner michael conway, did put different restrictions and regulations that they updated around shortterm limited direction plan, a lot of them around making sure they have essential Health Benefits as colorado law covers Preventative Services and Prescription Drugs, maternity, ands, newborn care. All of those pieces were in their and they looked at some of the age ratings, a lot of the components that the commissioner would be a lot better at answering. I do know that that has been an effort that we have seen in colorado and partly with our division of insurance to help implement. Rep. Delbene just collectively, have the actions that you have , how have they impacted premiums and enrollment . Mr. Patterson we have done a lot around reinsurance and last year we saw a 20 reduction in rates. We are also looking at large reductions in some of the high cost areas in the same vicinity, but an overall rate reduction is about 1. 46 in colorado, if my memory serves me correctly, and we have added carriers. We used to have seven carriers last year, weve got eight going into this year. And, about 160 plans, standard plans for people to choose from. We have been able with a lot of the outreach, a lot of the work we have been doing on the ground, talking and listening, more importantly listening to our citizens in every corner about what they are needing and trying to facilitate the right kind of approach that has given us success that we are proud of. Rep. Delbene thank you so much. Thank you, mr. Chairman, i yield back. Chair pascrell thank you. I forgot to mention this before. Based on the members in attendance and consistent with committee practice, we will move 21 questioning. Now i want to move on to my friend representative walorski. Walorski thank you. Here we go again. Instead of having a hearing on how we can find Bipartisan Solutions we are back to the only thing we have seen so far which is political messaging. We all know americans have been chaotica coyote Health Care System but under the said ministration we have made progress in these areas but these are issues that need to be improved in my district. Thats what i think we need to be focused on. The only thing we get from the other side is fingerpointing and accusations that republicans and the administration has undermined the aca. I think, if we put politics aside and work on this in a bipartisan way, if we had all of the rankandfile members together i have no doubt that we could build a better patient centered system that would lower costs and maintain protections preexisting and no lifetime caps, give states more flexibility and give individuals more choices over their own health care. The committee was able to pass a bill to end surprise medical billing, so americans would not have to worry about unexpected bills. Even though the bill has not become law, at least we are able to come together in agreement on fixing the problem. I still think we can Work Together and expand access to coverage while lowering cost and increasing choice, giving individuals more control in maintaining Important Patient protections. Mr. Pope, we watch the majority try everything they could to entice people into aca plans , going so far as to outlaw other Insurance Plans. Speaker pelosis latest covid package attempted to throw more money at the aca problem, even allowing millionaires to receive thousands of dollars in subsidies. Can you walk us through some of the reasons why, in 2019, two thirds of aca eligible americans opted for different options . Mr. Pope that is a very different way of putting the context to us. I think the Affordable Care act problems, in terms of the individual market, come down to one thing, price. The plan, they are far too expensive for what they are. The benefits, the deductibles are high, but if the premium was low, the deductibles would be ok. The networks arent very good. But if the premiums were low, the networks would be ok. The covered benefits are fine. The premiums are far too high relative to what people are getting. Especially if they sign up before they get sick. If you are a cancer patient, as the safety net, as someone who never got insurance before and you need social care, the obamacare plans are fine as a safety net and a last resort. But as a goodquality source of Insurance Coverage that gives people a reason to sign up before they have a Major Medical condition, it is not good enough. Rep. Walorski how would you characterize our Health Care System across these three areas. First, what happened to premium costs in the four years following the establishment of acas reforms and in the two years individual mandates were repealed, and on the number of options available to the public and the number of enrollees in the aca . Mr. Pope the premiums increased by 105 from 2013 to 2017 and 2017 as the acas Insurance Regulations were changed. Thats more than doubling, really. We have seen that a lot of people said that this was going to be outweighed by the impacts of rolling back shortterm insurance, repealing the mandate, eliminating the mandate. Those two policies recently happened and had no impact on premiums. Premiums have leveled off. In fact, what we saw and what we have seen again yesterday is the and enrollment is as stable as it has been in years. In terms of options, the marketplace was in chaos, and it is starting to come back in and some of the major insurers are starting to realize that they know what they are dealing with. It is not great Insurance Coverage. But as a safety net it is. Rep. Walorski i yield back. Chair pascrell thank you. I would like to call on the ms. Tlelady from california, sanchez. Sanchez for the last decade we have been so busy working to protect patients. We know more work needs to be done and this pandemic has magnified to us that we must do more to eliminate the systemic healthful disparities affecting our communities. That is why i am so tired of the president and his administrations blatant attacks to make health care harder to access. They are making people fear for their health care during a over 8 million americans have contracted the virus, and 220,000 have lost their lives. Its an absolute disgrace. An executive order saying that you protect nations with preexisting conditions does not negate the fact that the administration is in court right now trying to overturn the aca. Overturning the aca means removing the protections for over 300,000 people under 65, with preexisting conditions and a district i represent. The protections help our patients with cancer, diabetes, Mental Illness and other conditions. Apart from preexisting conditions i want to talk about another provision of the aca. The authorss one of that stopped Health Insurance companies from engaging in gender. Simply the aca does not allow a woman to be charged more than a man for the same Health Care Plan simply because of her gender. I want to start my questions with you. Do you imagine that this gender rating provision would be protected if the aca was overturned in court . And what would that mean for women in this country . Mr. Slavitt thank you, congresswoman. Way to tell that is the Short Term Limited Duration plan that we talked about. Also, to deny them essential things that are important to everyones Health Insurance coverage. Even provisions that affect both genders, like Mental Health. From coverage, incredibleies do a disservice. Americans dont know what they will need as a disservice as a service. Rep. Sanchez rep. Sanchez would it be fair to say that women would pay more for their Health Insurance if the aca would be taken away and would probably not get the services they need . They did before the aca and they would after. Rep. Sanchez i also want to discuss specifically how communities of color are impacted by the aca. Mr. Slavitt, could you talk more about how the acas important in reducing Health Inequities and how has the administrations attacks impacted communities of color . Mr. Slavitt there is terrific news from the aca. There were reductions of disparities in cancer care, cardiology, infant health, and in things like homeownership and bad debt. That is good news. Unfortunately, without the outreach that the aca and this congress included in the package, there is no way to help them enroll for coverage. That is why we have seen reductions in coverage, increases in the uninsured rates. Rep. Sanchez would be fair to say that they have been trying to undermine or sabotage the coverage the aca could provide . Mr. Slavitt they have in fact undermined and sabotaged the Affordable Care act. Commissioner carradine and mr. Patterson, i am interested in why the administrations messaging is so detrimental. You will have to be brief. Thank you, congresswoman. We went from one navigator in 2019 we have now increased to 16 navigators and will be able to blanket our state, reaching communities that are uninsured. As a latina, it kills me to see that my community is double in percentage of uninsured when compared to the rest of the uninsured market here in new jersey, and if you look at the Latino Community throughout the country, it has one of the highest uninsured rates. So we have in our communities as well as our navigators. Rep. Sanchez i believe my time is up. Before i yield back to the chairman, i ask that mr. Patterson be allowed to respond in writing at a later time. Rep. Pascrell thank you. Ms. Chu. Rep. Chu thank you, mr. Chair. Let me say, to those on the other side of the aisle that use the term china virus in this hearing, the scientific term is Novel Coronavirus or covid19. By not using the scientific term, you are stoking the flames of xenophobia that has resulted in hate crimes and incidents. Mr. Slavitt, thank you for joining us today. I would like to focus on what is at stake for our 135 million americans with preexisting conditions should the aca be struck down. The democrats created a multipronged approach to protect those with preexisting conditions. Under the aca, you cannot be denied coverage for having a preexisting condition, but you also cannot be charged more for it and you are required to offer minimum essential Health Benefits like hospital stays and Prescription Drugs. Although the president s and republican proposals have paid lip service to protecting preexisting conditions, their proposals fall short of doing so. Last month, President Trump issued an executive order that he claims would protect those with preexisting conditions. Mr. Slavitt, would you say mr. Trumps executive order protects those vulnerable americans . And if not, why not . And why have republican proposals to replace the aca fallen short . Mr. Slavitt my parents taught me to watch what people do, not what people say. And unfortunately, the continued actions of the Trump Administration to eliminate the aca, to sue to get rid of it, to propose laws that do not cover preexisting conditions, like short Term Duration plans, show what they want to do. If any american was to print out an executive order from the president saying that they had preexisting condition coverage and brought it to an Insurance Company, the Insurance Company would laugh at them, because an executive order like that does not have the power of law. I would encourage americans to look at his actions, not at his statements. Rep. Chu thank you. Mr. Patterson, i would like to ask you about the wonderful work colorado has done on its Family Planning Program Thanks to a grant. Colorado was able to expand access to contraceptives for young people, including the longlasting iud. Thanks to this investment, the birthrate for girls ages 15 to 19 dropped by more than half, falling 59 from 2009 to 2017, and the abortion rate amongst colorado teens fell 60 in those years. These are remarkable statistics. However, if the aca were struck down, patients would again be required to pay for contraceptives and familyplanning care, and that could be thousands of dollars. For young people, the cost can be a barrier to accessing the health care that they need. So, mr. Patterson, how would losing the services of the aca impact familyplanning in colorado . Would losing this benefit increase costs for patients in the state . Mr. Patterson thank you, congresswoman. You are going back to my time with the governors office, but one of the things we were proud of back then was the longlasting contraceptives. Great strides in reducing those costs. The outcomes would be the opposite if those resources were not there. Rep. Chu mr. Slavitt, i am proud that my state of california is one of five that have prohibited the sale of shortterm plans on the marketplace. Can you expand on how these junk plans will undermine the aca marketplace . Are these a sufficient replacement for the aca . Mr. Slavitt i think it is important, an important point that mr. Pope brought up earlier, which is to say, what kind of choice should americans have . I think americans believe there should be some choice, but guardrails should exist. There are benefits that americans are in no position to say i do not want to have, hospital coverage, Prescription Drug coverage. Those are good ideas until that occurs. Those are not expensive provisions, by the way. Mental Health Coverage is about 1 to 2 of all premiums. It is as if we have a Fire Insurance policy and find that it is not cover the kitchen. There are certain basics that americans want and should agree to. For a three month period, a transitional period, it is probably acceptable for people to be in that circumstance, but to have Insurance Coverage for their family that does not cover things that were covered routinely under the aca would be prior to the aca would be an enormous issue. Mr. Pascrell using that term, china virus, congresswoman chu, is unacceptable on this committee. Period. I will now call on mr. Wenstrup from ohio. Doctor . Rep. Wenstrup thank you, mr. Chairman, and thank you all for being here today and contributing to this conversation. I want to start by echoing what my republican colleagues have said about preexisting conditions. The preexisting condition component of the aca is not something we are against. We stand with patients with preexisting conditions. We will continue to ensure those remain the law of the land. There is a difference between challenging the existence of the aca versus the constitutionality of a component of it, and i would never want to take the right of any american away to challenge the constitutionality of a bill we passed. Bigger than that, republicans want to put patients back into the drivers seat, especially when it comes to their health care. You know, the word sabotage keeps being used, and i am sorry, but i cannot help but think of a line from the princess bride, where he says, you keep using that word. I do not think it means what you think it means. Patients were sabotaged. I am reminded of what mr. Gruber said when working with the Obama Administration about the cadillac tax. They proposed it and it passed because the American People are too stupid to understand the difference. Mr. Slavitt worked with mr. Gruber and that, to me, is sabotage. The aca does not give options. Families can now take advantage of Health Reimbursement arrangements, Short Limited Duration plans, and hopefully, in the future, Better Association plans. Another way we put patients in the drivers seat is by expanding Health Care Price transparency. I can tell you as a physician that is a big deal and it has to take place. At a time when americans want to see their leaders coming together to restore our way of life, i am disappointed we have gathered today for yet another partisan hearing, predicated on halftruths and manufactured fear. We have done a lot of impactful bipartisan work on this committee. And on the Health Care Task force, which i am the cochair of, i think is a great example of how we can Work Together on our shared goal of improving the Health Outcomes of americans. I hope we can move past the notion that republicans do not support preexisting conditions, because we do. There is no part of me as a doctor that does not want all americans to have access to health care. It is too important. As the only one here who has served patients, i can tell you that the burdensome regulations the government has put in place over time has taken the joy out of taking care of people. House democrats have determined to end another onesizefitsall washingtonapproved plan that is dangerous. Republicans want to expand the plan options available to all americans so they can decide what is best for their family. Mr. Pope, could you talk about shortterm coverage and why allowing folks to choose the coverage right for them is important . And if obamacares coverage is so great, then why are [indiscernible] so fast . Mr. Pope. Mr. Pope the Affordable Care act plans were designed around preexisting conditions. Not everybody has a preexisting condition. Having an Insurance Plan [indiscernible] it is important, but find coverage a long time before they develop cancer or a major heart condition, so you need to entice people to buy coverage, but insurance that is priced in proportion to that risk, and that is what the short insurance option does. It basically creates the opportunity for people to buy insurance in proportion to their risk without having any negative impact on the protections for people with preexisting conditions that the exchange provides. It exists alongside it. It provides a better alternative and a more appropriately priced alternative, which is really the core problem of the aca. It comes down to price. Rep. Wenstrup you would say it has helped Many Americans . Mr. Pope yeah. We do not know how many exactly, but millions, surely. Rep. Wenstrup i yield back. Rep. Pascrell i want to thank my friend from ohio. Mr. Pope, we thank you also. I would like to ask the gentleman from wisconsin gentlewoman from wisconsin, ms. Moore. Thank you for being here today. Rep. Moore thank you, mr. Chairman. I have enjoyed this hearing and appreciated the comments. Of all it is frustrating to not be able to ask questions of each of them. Since we have had a lot of discussion on we were talking about the Affordable Care act. I just want, i think, mr. Andrew mr. Slavitt, please, i want you to clear up some things for me. Was the theory of the case around the Affordable Care act that, by requiring the individual mandate, we are going to draw in healthy people, like young people, and therefore reduce the cost of reduce the cost of care for everyone such that it could be affordable to everyone . Wasnt that the theory of the case . Mr. Slavitt i believe that was the intent at the time. Rep. Moore ok. So wasnt the theory of the case also that really the government would provide things like the costsharing reductions to make it more affordable and also the risk corridors so, as we provided enrollment to these younger people, the amounts of moneys lost monies lost, we would share in the cost that these companies endured . Wasnt that also part of the theory . Mr. Slavitt yes. Rep. Moore where im going with this is when we talk about there being no intention of getting rid of coverage for preexisting conditions, was it the theory of the case that we would be able to support people like me, who has cancer, because we are getting premiums and getting the mix . Therefore the math does not work at all when you take out the mix of younger people. So the notion mr. Pope shared that younger uninsured people or, you know, we had the court just five years later said that the United States has to pay those risk sharing costs, because we had Insurance Companies all over the country just go out of business and leave people stranded as a result of that particular sabotage of the obamacare. Wouldnt you agree with that . Mr. Slavitt i would agree. Rep. Moore help me with the math while i still have time. Tell me about these shortterm, limited duration Insurance Plans. I will give you an example. I have a nephew, 20 years old 10 years ago. Playing basketball, having a good time. My sisterinlaw, seeing something was wrong, rushed him to the hospital. Long story made short, he was on a waiting list for two years for a new heart. Never smoked or anything like that. What would a short Term Duration Insurance Plan for a 20yearold like he was have done once that happened . Mr. Slavitt no idea. [indiscernible] rep. Moore he would have had an affordable plan, a choice of a plan, but once that basketball game was over, what would have happened to him . And we sabotaged the Affordable Care act. The math does not work here and i am sorry about that. Without the protections for preexisting conditions, you can make all kinds of speeches about it or resolutions to protect people, but if you do not have the incentive that we gave the Insurance Companies that we have this broad base of people paying, then the math does not work. Do you agree with that, mr. Slavitt . Mr. Slavitt yes. Rep. Moore i would give an opportunity to mr. Pope to respond. I do not understand your assertion that the insurance rate has gone down. According to the only data i have seen, it has gone up. I am sympathetic with your notion that it costs too much, but you never mention stuff like the risk sharing, the other kinds of sabotage that this administration did, including not marketing it or anything. Would you stipulate that that also has something to do with the Affordable Care act not being as good as it could have been . Mr. Pope the Census Bureau found that the uninsurance rate went down this year in one of its surveys. The key thing with the rep. Moore just skinny plans. Mr. Pope yeah. I agree there are problems. I think the core problem is that review ability is limited. So your nephews problem is a problem that still needs to be fixed. The short term plans cannot be renewed for more than three years, and in some cases not more than six months. That is why these people are not able to have protections from the shortterm plans, because the insurance is banned from renewing them and continuing those protections over the long haul. That should be allowed. That is something the congress should do. Rep. Moore my time is expired. Thank you. Rep. Pascrell the chair now recognizes for five minutes the gentleman from pennsylvania, mr. Boyle. Rep. Boyle thank you, mr. Chairman, for holding this hearing. Health care would be an important topic at any time, but especially as we are now eight months, though it seems like eight years, into this covid crisis. We are unfortunately the country that is leading the world in most covid cases and deaths. That is not just because of our population. We are 4 of the World Population and still account for more than 20 of the covid cases and tragically more than 20 of the covid deaths. Speaking of covid, i would like to thank all of the witnesses, but especially you, andy slavitt. I personally follow your twitter. Throughout this covid crisis, i have found the information you provide very helpful and a real service, so i want to thank you for that. I would also direct my first question to you. As you know, and as has come up exactly three weeks from election day, the Supreme Court will hear another argument on the constitutionality of the aca. Given it was only found to be constitutional by a 54 vote in 2012, could you bring it home to my constituents in pennsylvania, and you are able to direct what the consequences would be . I know they would be nationwide, but specifically for my stay, what would be some of the consequences if the aca would disappear . Mr. Slavitt thank you, congressman, and i appreciate the question. I know the people of pennsylvania and in your district, millions of whom in pennsylvania, hundreds of thousands in the philadelphia area, received coverage for the first time. I know what that means because i was part of the turnaround process that was implement in. I received and read many letters from constituents, including in your area. One i recall, from a woman who said after the aca was the first time she allowed her daughter to play volleyball because, before that, she was concerned that if she got injured she would not be able to afford her medical care. When you add all the letters up and think about the law going away, it puts americans who are already fearful of a pandemic in a more fearful state. It puts them in a state when they are not sure they will be able to pay for their health care if they do get sick, and if they will ever be insurable again. So the decision to strike down the Affordable Care act would be calamitous at any time. It would be especially calamitous today in this environment. I cannot imagine how people would be able to recover from that. This is a time when we look to our government for help. We hope that the government will help us, not undermine us. Rep. Boyle thank you for that. I would just further point out that, specific to my state, it would not just be the people on the exchanges that would lose out, it would also be all those who benefited from the Medicaid Expansion, which happened several years later because of the aca. Those are people in particular who are the working poor, people who are working fulltime that are not covered by their employer for Health Insurance. Mr. Slavitt seniors as well receive the Prescription Drug benefit. Rep. Boyle correct. Glad you pointed that out. In the minute i have left, moving ahead to mr. Patterson, if the aca is found to be constitutional, we still have, long term, the issue of ensuring that the exchanges are vibrant and that there is plenty of competition on them. I know, especially early on, when the exchanges world out in some states and marketplaces, there was a challenge of a lack of competition. What are some Things Congress could do at a federal level to ensure we have as much competition on the exchanges as possible and as much choice for the consumer . Mr. Patterson in terms of what congress can do, i should be careful of my answer, but i think just giving us the flexibility we need. I think all states have a little bit different you know, we are about 104,000 square miles in colorado. It is a lot to figure out how we leverage the right networks and choices. Just allowing states to have the flexibility to fit the needs of their own state is really important. Rep. Pascrell i think the gentlemans time is up. I would now want to ask mr. Smith of nebraska, the gentleman, to start his fiveminute question. Thank you, mr. Smith, for being here. Rep. Smith thank you, mr. Chairman. I appreciate the opportunity to have an exchange here. I do regret that the entire Health Care Issue has become so political. The mere title of this hearing is evidence of that. It is interesting to hear one of the witnesses say that he participated in the turnaround of that aca or obama care. I do not want to take the time to get into the socalled turnaround. I wish there was room on the panel to hear from my constituents who have faced such high premiums that some are opting not to buy it. That contributes to some of the because it has become more expensive. Throwing more money at it is not sustainable. I do not think we could carry that on very long time. But i am absolutely puzzled as to the numbers and premiums. Before the aca we had the highrisk pool, which i will tell you had offensively high premiums, but now when folks in the individual market pay a similar high premium that we used to find offensive, i do not hear the concern for those folks who are paying such high premiums now. And i realize that many of my colleagues here today, they think that the aca is just fantastic and has been performing so well, but it hasnt. And i am going on what i hear from my own constituents. Now, there was relief offered with some Association Health plans. Of course, the opponents to these consumer driven choices, uh, have been sabotaging by all means sabotaging these consumer choices. I think that is unfortunate because i think that is based on politics. I am for a day when we can have a thoughtful discussion about how we can get more people covered with Affordable Health insurance and Affordable Health care. But lets face it, that aca just shifted around payment, paying for what . The net result is more americans paying more of their income for high premiums for Health Insurance. I think that we can do so much better. It is interesting, i just heard mr. Patterson say how he would like to go, and i cannot agree more. He noted he hefted be and to be careful with how he worded that. I can imagine. But clearly we need more flexibility. We need consumers to feel the empowerment to be able to decide for themselves what is best for their households, for them as individuals, and exercising the freedom to choose among plans, hopefully, more plans rather than fewer plans. There were so many promises made about the aca. I think about the Health Insurance coops and how much of a disaster that was, where we had a hearing after more than half of the coops had collapsed, and we had a hearing from the Previous Administration saying everything is just fine. I do not know what metrics should be used in making that analysis, but we can do so much better. We, as elected officials, i think owe the American People a better discussion than what has been taking place. I am certainly willing to purchase debate in that. Mr. Pope, with the Association Health plan, you know, we know that there are antagonists out there that are opposed to consumers deciding for themselves to enroll in a plan of their choosing. Can you tell me what would be necessary to revise these Association Health plans that so many consumers have found benefits with . Mr. Pope they are for Small Businesses that group together. It is an employer processed health care option. Traditionally, the large employers have been the ones given flexibility in terms of what Health Insurance can be offered to their staff. So, the Association Health plan expands that option expands of that right to small employers, so they can get together to offer those that are exempt from state regulations, the same plans the large employers can. Rep. Pascrell mr. Smith, your time is up. Thank you, mr. Pope, for responding. The chair recognizes the representative from illinois. Thank you for being here. Thank you for holding this very informative hearing. And i also want to thank you for giving me the opportunity to be on it, although i am not a member of the committee. But i think that Health Policy and health care is so important, that it touches everybody in our country. And so, this has been a very delightful discussion. And i want to thank all of the witnesses for participating. Representative boyle mentioned earlier that the United States Supreme Court has health care on its agenda in a couple weeks. And they are going to be discussing the same issues that we are talking about today. And im a big fan i make no bones about it of the Affordable Care act. I think it is one of the best things thats happened to health care since the indians discovered cornflakes. And that the aca is the best thing we have had in modern years since medicare and medicaid, because it give poor people, low income people, an opportunity to have care paid for, which the previously did not have. I think that all the witnesses mr. Slavitt, let me commend you for your tenure when you ran cms. Its a complex agency with complex issues in question. And i think that you did an outstanding job, so i commend you for that. There are many components of the Affordable Care act that we have heard about, and we have heard about them. But let me ask specifically, in terms of the disparities we have learned about as we have discussed and dealt with covid19, African Americans have tremendous disparities in terms of Health Status, health care, followed by latinx communities. If the Affordable Care act did not continue, or was dismantled, what would be the impact of that action on the Health Status and health care for africanamericans and other minorities in this country . Thank you, senator davis. You know, i think that anybody who is disadvantaged in this country, whether africanamerican, whether they live in a rural community, whether they are poor of any color, and whether they are women or older, they are disadvantaged or were disadvantaged under the system before the Affordable Care act. Disparities have shown over the last five years for africanamericans. I will give you one example. Cancer care, um, disparities and outcomes were reduced after a fiveyear period of the Affordable Care act, so it would be a shame i think right now the difficulty that many africanamericans and other minorities are having, accessing the Health Care System during covid19, and to take away that one lifeline that has shown improvement. Rep. Davis what has made it possible for colorado to enact the policies you have discussed . I do not think i heard the first part of your question. Rep. Davis what environment existed in colorado that has enabled you to do what you have done . My apologies. I think that we have a way that we reach out because we have a Great Network i have spoken to. Listening to folks, hearing where they are struggling. I have heard the Business Owners say that insurance was more than his mortgage, and we have been able to find more affordable programs, having options is the key. Rep. Davis thank you very much. I commend the state for its efforts. Rep. Pascrell thank you, mr. Davis. We appreciate your questions. Just before i call on representative sewell to ask her questions, i would ask a congresswoman chu to take over the chair for a few minutes. You ready to do that . Rep. Chu absolutely. Rep. Pascrell you are in charge. The next speaker will be the congressman from michigan, i believe. Ok . Yes, thank you. I want to thank you for hosting todays hearing. I am glad that we are able to be joined by andy slavitt and officials from new jersey and colorado, two states that have made Great Strides in expanding coverage and access. Holding our states accountable for their Health Coverage choices, i believe, is imperative. And we should start by focusing on the damage that republican governors have done to their citizens that did not expand medicaid. Both of your states have expanded their programs, neither state has had a closure since the Affordable Care act was enacted. Unfortunately, my home state of alabama has had seven hospitals go under. Alabama has some of the highest uninsured rates and a low percentage of folks covered by employersponsored coverage. Mr. Chairman, no one wins when states like alabama do not expand medicaid. Today, there are nearly 6 million americans who fall into the medicaid gap in the 14 states that did not expand medicaid. They are hairdressers, maintenance workers, servers, cashiers, these are working americans who make too little to qualify for subsidies, or to afford coverage in the private market, but too much to meet their states requirements to qualify for medicaid. Even with alabamas barebones minimum plan, what this means is a single parent of two in alabama cannot qualify for medicaid if she makes more than 4000 annually, not monthly, annually. Thats 4000. To make matters worse, as americans work to earn at least of the poverty line so they can afford Health Care Insurance with subsidies, the Republican Attorney generals across the state have, of the same states, are also currently denying them coverage in courts, as was said earlier. One of the greatest injustices is those in the poorest states are left with the worst Coverage Options because of failed leadership on the state level. The consequences are cyclical and compounding, especially combined with the Global Pandemic that has really left people suffering with chronic illnesses, especially those of racial minorities. I think about a Third Generation farmer in the rural part of my district named hank. He was able to afford insurance for the first time in his life in 2014 because of the Affordable Care act and its subsidies. He signed up for a plan months before he was in a terrible farming accident, which would have he would have lost his arm if he was not airlifted to a hospital, which saved his life and his family from being bankrupt. Hank admitted if he knew it was called obamacare, when he was signed up, or he signed up, he probably would not have signed up when the person who knocked on his door told him about the chance to get insurance through the Affordable Care act. My question is twofold for andy. Why is protecting and enforcing the Affordable Care act important for those whose health care, who cares about health care inequities, particularly in Rural Communities and underserved black communities . Can you also talk about the advantages of expanding medicaid . Secondly, if Republican Attorneys generals are successful in the Supreme Court on november 10, would alabamians like hank lose their subsidies . Thank you for all of you thank you for all you have done regarding the Affordable Care act. Mr. Slavitt i think the message people get around the country, when their state does not expand medicaid, or if they are not offered affordable coverage, is you do not matter enough to earn Health Care Coverage. That you have to either be of a certain social status, you have to be of a certain income level, you have to be of a certain race, you have to live in a certain zip code, then coverage is for you. The Affordable Care act is far from perfect. But we have made an effort to say this is no longer about the Insurance Companies, who could to make whatever rules they want, but it is in fact about us as individuals, families and americans. And so, it is a vital part of our message that health care in this country is not something to be earned. It is something that we this is our ultimate source of freedom because it allows us to live better, more prosperous lives. So now, if the court case or anything was to take away the Affordable Care act, your constituent, and all your constituents, would be back to a situation where they would be uninsured. That wouldnt mean they wouldnt get medical care, but they would be going to emergency rooms, waiting until their cancer progressed, instead of getting mammograms. We saw that all over that was before the aca, and unfortunately it would be the norm again. Rep. Sewell thank you. I believe health care should be a right and not a privilege. Thank you again for all you have done to shore up health care in america. I yield back. Rep. Chu the ladys time has expired. The chair recognizes the congressman from michigan for five minutes. Thank you, madam chair. Thank you to the chairman for organizing this important hearing, which comes at an important time. I have a couple questions to get into, but before that i want to give mr. Patterson an opportunity to clarify, i think the way that his statement around flexibility may have been interpreted. I assume, mr. Patterson, that you would agree that the flexibility granted to the states is the flexibility that would build upon the existing protectional foundation of the aca, not flexibility to get away from those . Is that a more fair characterization of what you articulated . Mr. Patterson im sorry, i was on mute. The flexibility within the congress within the Affordable Care act to the best of our ability in the state. Not flexibility to undermine the foundational characteristics of the aca. I think flexibility can be interpreted different ways, and i took from one member that he may have interpreted your point to be flexibility to move away from what the aca provides, and i want to be careful that not be a position i do not believe that works with the way that you represented yourself so far today. Mr. Patterson i would agree with your characterization, yes. I wonder if i could turn to mr. Slavitt on the issue of preexisting conditions. In michigan, before the implementation of aca, about 11 of our states population had no Health Insurance. By 2018, because of the aca, we cut the number by more than half, but i am worried that despite the rhetoric and promises, that what some of our colleagues on the others said about protecting people with preexisting conditions, they have to accept the fact that they are suing to take away all the provisions of the aca, including those provisions. Can you talk about the damage that would be done, number one, to people with preexisting conditions, like my daughter who has diabetes, my wife who has multiple sclerosis . I i wonder if you might couch it in these terms. Even if somehow the reported promise of destroying coverage for people with preexisting conditions is a genuine one, would returning the aca also allow insurers to return to annual or lifetime caps, for example . Would it allow the premiums paid by people with preexisting conditions to be so onerous that they only have the right to coverage in name only, but cannot afford it . I was wondering if you could comment on that. Thank you you, congressman. The truth is that if in fact the aca is overturned, americans would once again find themselves in the position they found themselves in 2008, when the Insurance Companies would not be required to cover them for preexisting conditions. They might say that your asthma, cancer or Mental Health condition, or your heart arrhythmia is excluded. Or they may say that you can have those things, but we will charge you an unlimited amount of money more. That is what discrimination is and it would affect consumers directly. In the pandemic, the situation would be even worse, because no one knows what covid19 brings in terms of conditions that will come from it. We do not know yet. So it is a blanket path to pass to Insurance Companies to say i do not even want to cover you again. So for people like your daughter, once again it would be hazardous for her to change jobs, it would be hazardous for her to disclose to people that she had diabetes, because if she did, she may not be covered. Imagine trying to handle a pandemic with everybody in the country with the incentive did not disclose they have covid19, imagine trying to Contact Trace or get people to agree to testing. It would be worse than where we are today. Rep. Kildee thank you. If you could also comment on the lifetime caps, what would happen with that . Mr. Slavitt was think about what that is. Typically, if you have a 500,000 cap, if a baby is born a three weeks early, or if there is a bad case of cancer, that is it. Those are arbitrary lines. Those are the lines that the aca does not allow the Insurance Companies to cross. They are able to eliminate that, so much more freedom for people. That would go away, of course, if the Affordable Care act is overturned. Rep. Kildee i yield back. Rep. Pascrell thank you for your questions. I now call on mr. Schneider, the gentleman from illinois. Rep. Schneider thank you, mr. Chairman. I appreciate you having this hearing. It is hard to know where to turn our energies. But this hearing put this issue on the front burner, especially in light of the covid19 pandemic, and its longterm impacts it is likely to have. The administration has taken steps to undermine what has been the law for decades. Not only before, but during the health crisis, we lost more than 220,000 american lives. Millions of people have the infection. And most are likely to have lifetime related effects. In other words, covid19 is likely to be a preexisting condition. As you noted, early evidence indicates that it could impact the brain, kidneys and immune systems. You also noted, mr. Slavitt, that you are dutybound to implement the laws of that congress intended. The administration should not pick and choose to enforce the laws. This is true of all laws, but especially those in question that will be beneficial to somebody millions of americans many millions of americans. Theres no doubt the Health Care System is stronger because of the aca. 130 million americans have preexisting condition protections and it is noted that that number will grow because of covid19. Free preventative care, expanded Medicaid Eligibility and in the list goes on. These benefits are valuable in normal times, but have proven absolutely critical during the pandemic, when getting care when you need it is at a premium. But those critical improvements will be of no value if we have an administration that tries to sabotage the law. Trump is promoting plans at that do not cover preexisting conditions. He is getting support for enrollment assistance. As we convene, his administration is looking to invalidate the law through the courts. However, less eyecatching, but just as disappointing is any laws as large as the aca is bound to need improvements, but for a decade any effort to build on the acas successes, fix its shortcomings and explore ways to improve health there have only been met with disdain by our republican counterparts. This should not be controversial. But that has been the political reality for too long. So, mr. Slavitt, i follow you on twitter and i appreciate your insight. My question is, if you were still serving in the administration, what would be the top suggestion that you would immediately make to improve the aca for all americans . Mr. Slavitt thank you. I think that the first thing is to absolutely reach out to the communities in need of coverage and to hear them, to tell them that this is available for them, in most cases under 75, and to reach out to young people and continue to expand the aca. We had five years in a row where we reduced the uninsured rate from 70 to 8 or 9 . That has gone up. If you believe government should be about results, not about actions, those are the results we would have to commit to deliver again. And also work with congress to correct some of the things that mr. Pope and others pointed out, can be improved upon. There are opportunities to make the law better. It was passed 10 years ago. It was not intended to be the final word. It was intended to be a great start. There are plenty of opportunities, if congress would Work Together, to build on what we have, not eliminate or reduce it. So i would say that this is what americans want, they do not want both parties fighting over their health care, they want support in times of need. Thank you you, i could not agree more. We need to find a way to come together and improve health care for all, so that they have it as a right, not a privilege and they can get the care they need from doctors that they trust. That is also important. As my time expires, i want to enter into the record the most recent report showing an increase in the number of uninsured, not a decrease as was mentioned earlier. Rep. Pascrell ok, thank you very much. I appreciate that. That is entered into the record without objection. Rep. Schneider thank you. Rep. Pascrell now, the last congressman from nevada. You have five minutes. Thank you for being here. Thank you for letting me be here, mr. Chairman, and for holding this hearing today. And the reason i came to congress, the reason i have worked so hard to join this committee was to increase access to health care and bring down the outofpocket costs of Prescription Drugs for people across the country. And i agree with my colleague and those who have spoken today, that we need to improve on the Affordable Care act. We want to make it work for all people. And address the weaknesses that may exist in order to improve on it. Well, instead of doing that, President Trump has time and time again made it his number one goal to strip Health Care Away from americans, with no plan to replace it. It is one thing when the administration and colleagues on the other site repeatedly sought to repeal the Affordable Care fought to repeal the Affordable Care act, but now, in the middle of a Global Health pandemic that has taken the lives of more than 220,000 americans, the likes we have never seen before, this administration is running, running, racing literally to undermine our Health Care System, one that has already been stretched too thin. Instead of focusing on Cutting Health care to americans, we should be improving access and coverage, because now is the time that americans need that the most. That also means strengthening Health Systems by expanding telehealth for Rural Communities, protecting frontline workers, and implementing real testing, tracing and treatment strategies for covid19. No more american lives need to be lost. Yet, here we are again discussing the full onslaught and assault of the Affordable Care act, which would dismantle nevadas Medicaid Expansion for 371,000 nevadans. When this bill was passed, i was in the state senate and i worked with our republican governor at the time, and he was the first republican governor in the country to enact the Medicaid Expansion. It was bipartisan. Because we knew it was important to put nevadas health above any party. This administration is now looking to strip away protections for over 1. 2 million nevadans with preexisting conditions, which now includes the coronavirus. So, i want to underscore that right now in nevada, because of the ongoing effects of covid19 and its impact on the economy, we have nearly 200,000 individuals who are out of work. And many are furloughed, laid off currently. They have the opportunity through some employers to maintain Health Insurance, but some are relying on coverage until they are able to return to cobra coverage until they are able to return to work, covid coverage. That is why i introduced the Worker Health care protection actto provide Financial Assistance to workers and their families by covering the cost of premiums for people who lost their jobs or had their hours reduced. So, in your testimony, mr. Slavitt, can shared that there was an estimated 14. 6 Million People who may have lost their employersponsored Health Coverage. The Commonwealth Fund found in the last three quarters of 2020, one third of those who lost employersponsored insurance through pandemic related job loss, will become uninsured. So, if the trump aca lawsuit succeeds, what will happen to these americans . Why do we need to protect the aca for individuals like those that are covered through their employersponsored plans . Mr. Slavitt thank you. I think that two things will happen. First, more people will lose coverage and not have a place to get it. Secondly, as they continue, those with preexisting conditions, including anybody who contracted covid, will be in a situation where they may not be able to get coverage again. So we will be back to a situation that is worse than we were 10 years ago, and i suspect the uninsured rates will go back, from the 10 they came down to, to over 15 , which would be a travesty for American Families. Thank you, that is why i will continue to work to safeguard the aca. [inaudible] and across the country so that they can have access to the aca, to protect the hardfought benefits that americans have sacrificed for. The gentlemans time has expired and all members have completed questioning, so i want to thank our witnesses for joining us today. Be advised that members have two weeks to submit written questions to be answered later in writing. Those questions, and your answers, will be made part of a formal hearing record. With that, the subcommittee stands adjourned. [captions Copyright National cable satellite corp. 2020] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] republicans need to pick up 21 seats in the november elections to win a majority in house. According to the cook political report, 91 of those races are considered competitive including virginias second congressional district. Isgresswoman elaine luria running for reelection against republican scott taylor in the district which includes virginia beach, williamsburg, and part of nor folk. This is live coverage on cspan. He served in the navy for two decades as a Surface Warfare officer. She retired as a rank of commander. She graduated from the u. S. Naval commander position and received a masters from old dominion university