Transcripts For CSPAN Senior Health Company Officials Testif

Good morning. Senate committee on Health Education labor and pensions will please come to forward. Were holding our fourth hearing this morning on stabilizing premiums and ensuring access to insurance in the individual Health Insurance market for 2018. Senator murray and i will each have an Opening Statement and then well introduce our five witnesses. Welcome to you. After their testimony, senators will have an opportunity to ask the itnesses five minutes of questions. To begin with, we ought not to take for granted the three hearings this committee has had over the last ten days. For seven years hardly a civil word was spoken between republicans and democrats on the Affordable Care act. It was trumpcare versus obamacare day in and day out. But for the last ten days senators from both sides of the aisle have engaged in serious discussion for several hours at a time about what congress can do between now and the end of this month to help limit premium increases for 18 illion americans next year and begin to lower premiums in the future. And also to prevent insurers from leaving the markets where those 18 million americans buy insurance. Last week, between the meetings held before our hearings, such as the one we had today, and the hearings themselves, for two consecutive days half of the members of the United States senate participated in bipartisan conversations about getting a result on Health Insurance. I want to thank senator murray once again for her leadership in helping make that happen. These have been focused hearings. They have been bipartisan hearings, as Health Insurance. I want to thank senator murray again for her leadership in helping make that happen. These have been focused hearings, bipartisan hearings. And i think they have been refreshing for most of the members of the senators were hungry for the opportunity to see if we can Work Together to get a result. Then we heard from commissioners and governors and experts in state flexibility and during those hearings, three themes emerged, that represent a working consensus for stabilizing premiums in 2018, first is congressional approval of temporary funding of costsharing payments second, senators from both sides of the aisle suggested expanding the socalled copper plan, already in the law so anyone, not just those 29 and under to purchase a lower premium high deductible plan that keeps a medical catastrophe from turning into financial catastrophe. And third, give states more flexibility in the approval of coverage, choices for Health Insurance. Most of the discussion is on amending section 1332 because its already a part of the Affordable Care act. In looking at 1332 we heard another number of common sense suggestions about how to improve and speed up the process. Such as reducing the sixmonth application review time and allowing a copycat application so senator Murray States get something approved why cant tennessee come along and say we want to do it washington did with one change. This will make it easier for states to use 1332 a restrict rate programs like the Reinsurance Program in alaska or the high risk pool in maine to help cover higher cost individuals. At tuesdays hearing of state flexibilitys they recommended how to recommend 1332 to give states the authority to offer a larger variety of Health Insurance plans with varying benefits. That was discussed on hearing on tuesday by all five witnesses. Several suggested actuarial equivalency. As a useful way to do that. It means wall states might be able to offer plans with varying levels of benefits, the value of those plans to consumers has to be similar to the plans offered on the Affordable Care act exchanges are the individual market. Former governor suggested that with this approach plans would be of equal value but would not have to be carbon copies of one another. Used to cars example. He looked at several 25000 cars one might have a backup camera, one might have more horsepower but theyre still 25000 cars. So plans might have different benefits but they have to be of the same value. He testified this equivalence we give states the ability to construct an option many of benefits in providing for the state or consumers with the ability to choose plans that way those differently. The governor massachusetts made a similar suggestion last week. He said with current regulations and guidance there administered in a way that massachusetts cannot offer anything but an existing affordable Character Exchange plan. He testified that greater flexibility is needed around benefit design. Value based design approaches seek to align patients outofpocket cost such as copayments and dr. Bills with a value of services. He said it is committed to providing quality it increases flexibility in more effective ways. It gives them an opportunity for more personalized Health Insurance plan. It can benefit healthy individuals as well as those with chronic medical conditions. I make clear that i am not in any way proposing that we change the Patient Protection guardrails already written section and 1332 including the preexisting condition protections that nobody can be charged more if they have a preexisting condition and everyone is guaranteed to be sold insurance. The requirement that it cannot be rescinded in those under 26 can remain on their parents insurance and no annual lifetime limits on your Health Benefits, that is not a part of the proposal, changing any of that. We want to come to consensus by early next week so we can hopefully with the sport of several republican and democrats can hand senator mcconnell and schumer an agreement that they can pass by the end of the month will help limit premium increases next year and prevent insurers from leaving the market for the 18 million americans by insurance. What happens if we dont succeed . Last year, 4 of american counties had one Insurance Company on the exchange. This year, 36 have one assure on the exchange. For 2018, cms tells us one half of counties will have one or zero insurers on the exchange. In tennessee at 75 counties. We heard that this by itself this monopoly drives that premiums because it creates those monopolies. Without costsharing the congressional budget office, the joint committee on taxation and its witnesses have said premiums will increase 20 in 2018. So premiums go 20 , the deck goes up 194 billion over ten years of 5 of the people will be live in and bear counties after just one year. So lets keep in mind also that even if President Trump wanted to extend the costsharing payments the courts might not allow him to do that unless we act. The Federal District court of columbia has said that the president , whether president obama or trump does not have the authority to continue those payments because Congress Never appropriated the funds. I want a result. And one that limits premiums and begins to lower premiums in the future is flexibility for states coverage, choices and prices. Republicans will have to agree to something that many dont want to agree to come additional funding through the Affordable Care act and democrats will have to agree to something thats more flexibility for states. Thats called a compromise. I simply cannot go to the republican majority in the senate or the house and to the republican president to extend costsharing payments without giving states more meaningful flexibility. Now, were looking at what patients are facing if we dont reach a compromise. Well hear from a patient in the hospital but what happens when a plan leaves your state and when you lose your doctrine the middle of your care. Its clear to protect patients we need to stabilize the market, limit premium increases lower premiums in the future. I look forward to the testimony of our witnesses. Thank you. Im grateful to you for returning us to this process. Its been very productive. This is the way things ought to go in the way we should be getting things done. I appreciate your leadership. I think our College Joining us today in our witnesses were taking time out as well. This is our last scheduled hearing for the Insurance Markets that millions of americans will face higher premiums of pure Coverage Options in 2018 and beyond. Im pleased that weve had productive conversations over the last two weeks. Weve had who care deeply about making sure Health Care System works better. Im grateful for the input and it indicates an enormous amount of Common Ground it issues. I want to take this opportunity to talk about that in detail. Weve heard from many people including republican and critic witnesses who see the need for multiple years of certainty out of cost to assist states and strengthening markets. We acknowledge the importance of making sure outreach round open enrollment is robust and effective so families are informed about their coverage option. I was glad to hear that we agree on the need to uphold Patient Protections in any deal. Been glad to hear ideas inside the sigurdsson out for a framework flexibility to states. Many of which take approaches that dont undermine our core goal of stabilizing the markets. Governors have suggested ways to speed up and streamline the process in ways that dont result in coverage lost a race patient costs. Commissioners and patients have talked about ways to increase flexibility and allow for improvements for patients both out putting Insurance Companies in charge or undercutting core Patient Protections. To be clear, some proposals would leave people vulnerable to negative consequences like undermining the Health Benefits were taken us back to a time when plans do not cover Maternity Care or Substance Abuse disorder or Mental Health. That would be unacceptable. I dont think either side expects that we settle on that in this current negotiation. Im confident theres room for Common Ground right here that makes it easier for states to innovate in ways that make Healthcare Work better for patients. I look forward to the discussion on that. Im optimistic there is more than we agree on the disagree. I think many of us here feel the same way. I express my appreciation for all your work for getting us to this point. People are looking to congress for solutions on healthcare. Its a deeply personal issue its been too partisan and devices for too long. I hope our conversations can mark a turning of the page away from that we can take steps and then i hope we keep the conversation going in the months ahead. With that i think all of our witness for being here and for your input and will trend willingness to share your ideas. Thank you. Please welcome my five witnesses i think each of you for taking the time to testify. First is doctor manny, president of healthy tennessee and orthopedic trauma surgeon from nashville. He and his wife are founders of healthy tennessee, Nonprofit Organization design to promote preventative healthcare across the state. His assistant professor at vanderbilt and a director of Institute Center for health policy. Senator baldwin, would you like to introduce our next witness. Thank you. Im honored to introduce doctor susan ceo of the Marshfield Clinic Health System in marshall, wisconsin. The dr. Has a wealth of experience including practicing the internal medicine physician. She is also held leadership position in the wisconsin medical society. Marshfield Silver Silver 1 million rural wisconsins through its Health System and its Insurance Plan Security Health plan. The population is older, has lower average incomes the most interstate which is why they have a critical story to share about the benefits of the health loss protections. But also why we need to ensure immediate and longterm stability for the wisconsin market to allow marshfield to maintain the success. We recently expanded our state to make sure that we would not have a bear county after another insurer left. We must now do our part and provide longterm federal certainty. Doctor, welcome to the committee and thank you for joining us to share your expertise and experiences. We appreciate it. Thank you. Senator bennett. It really is a privilege to have two people here for my home state of colorado. Christine is the rocky mount regional director for Nonprofit Research organization working to expand Economic Opportunity for young adults. Previously she served as a consumer representative to the National Association for Insurance Commissioners. Her work appeared in national and state news outlets. Robert serves as Vice President for anthem where he oversees the market business across 14 states including colorado. He has extensive experience in healthcare. And the governor who testified before the Committee Last week appointed him as the original board member of the colorado Health Benefits exchange. Is also an alum of the university of colorado at boulder. Spent a good month for state and a good month for committee overall. I apologize to the witnesses. Of two other hearings this morning. Senator scott, please introduce a remaining witness. Its my pleasure and honor to reduce reformer to the committee. He has distinguished himself as a study leader in the humble man of integrity guiding our state through times of uncertainty. A veteran in his field he comes stress with over four decades of experience previously serving as a deputy insurance commissioner of Enforcement Division and later as Vice President of the american insurance association. Over the course of his career hes been recognized for his contributions for the public good. Recently elected as secretarytreasurer for the National Association of Insurance Commissioners affording him inside into the insurance across the country. His Knowledge Base and experience in core values has made him an indispensable resource for me, my staff, interstate. Grateful for him to be here today. I look forward to your testimony. Thank you. Now we asked the witnesses to take five minutes and please summarize your testimony alone will have a round of questions. A morning. Thank you so much for the invitation to discuss the very serious challenges tennesseans are facing in obtaining Health Insurance. I serve as the president of healthy tennessee, Nonprofit Organization my wife and i found it over seven years ago. Our mission has been to improve the lives of those into the sea by way of preventative care. Practicing orthopedic trauma surgeon and today speak on my own behalf. Im a product of rural tennessee and the american dream. My parents were immigrants from india and doctors in a small town of manchester. I learned my first lessons about how by riding shotgun in my dads oldsmobile as he would make house calls. Thirty years have passed but we continue to rank near the bottom for almost every Chronic Health condition, an issue central to the survival of the individual market in our state. We face many Health Challenges in tennessee. One problem is not a dearth of government funding. Last year alone we spent 12 billion, 3 of her state budget on medicaid. We must get on the front side of the problem with prevention before its too late. Our organization has traveled across tennessee one community at a time hosting Free Health Screenings for those in the and educating citizens about the benefits of living a healthy lifestyle. Our efforts are powered by local communities and all volunteer army of local nurses and doctors with boots on the ground who give of their time to help a neighbor knee. From rural appalachia to memphis, we seem patients who cannot afford the rising premiums of the market. Many who lost coverage when an insurer pulled out. My dad used to tell me, people dont care what you know until they know that you care. At our event we start with a lot of listening. We spend months Meeting Community leaders in each area to determine the best path forward. I will never forget a trucker and met in hawkins county. His Blood Pressure was 200 over hundred which is out of control. His bmi was 50 indicating severe obesity. As i spoke with him i heard the story of a proud and hardworking man who wanted to make ends meet. He did not want to hand out. Heres the problem, his income was too high for a subsidy on the market and he cannot afford the insurance