By the end of this month. The step is not so big that 18 million americans, songwriters to government workers, those who dont get Health Insurance from the government or on the job, 18 million is only 6 of those who have helped her in in america, so that is the individual market. Nearly 300 million americans have insurance. Health insurance. Buy it from a market. 18 millionthat is 6 of all of the insured, and 9 million of those 18 million have no Government Health to by their insurance. Byy are the ones most hurt higher premiums and higher copays and deductibles. Let us take someone in tennessee. Making 35 million 35,000 a year receives no tax benefit to cover his 7,100 per year premiums. She takes him 91,000 after taxes, which means a fit of her takehome pay is spent on premium, and this does not include detectables or copays. Next year, the Tennessee Department of insurances premiums are going to go up as an average of 42 , an increase of 1500 and 3000 more in premiums next year, and that doesnt include increases in deductibles and copays. She ought not to have to pay a fifth of her income for Health Insurance. Tennessees insurance commissioner who is here today has described the states individual market as very near collapsed. At the end of september last year blue cross, our largest , insurer, pulled out of the individual market in knoxville, nashville, and memphis. Withust for tennesseeans Affordable Care act subsidies, but everybody. That could happen again at the end of this september if congress doesnt act. And if it happened again, up to 350,000 tennesseeans and millions of americans could literally be left with zero options to buy insurance in the individual market. Last year, only 4 of american counties had one insurance commissioner on the exchange. This year, 36 have one insurer. And for 2018, one half of the counties will have one insurer only on the exchange. In tennessee it is 78 of our 95 counties. If we do act, we can limit increases in premiums next year, 2018. We can continue support for copays and deductibles for many lowincome families. We can make certain that Health Insurance is available in every county, and lay the groundwork for future premium decreases. I would suggest we do this by taking two actions, although there may be others that come from these hearings. One, appropriate costsharing payments through the end of 2018 to help with copays and deductibles for many low income americans. Two, amend the section 1332 waiver already in the Affordable Care act so states can have more flexibility to devise ways to provide coverage with more choices and lower costs. On the first, costsharing payments are extra subsidies or discounts really for low income individuals who receive premium subsidies under the law. They help these individuals pay for out of pocket costs like copays and deductibles, but their overall effect is to lower premiums in this individual market. On the second, the section 1332 waivers are already written into the Affordable Care act under care act. Under some circumstances they will allow states less ability from certain elements of the law, such as essential health benefits. But they do not in any way reduce the patient protections most of us support, including protections for those with preexisting conditions and ensuring those under 26 may remain on their parents insurance and have no annual or lifetime limits. Right now 23 states have begun steps to apply for the 1332 waiver. Seven states have applied. Two states, alaska and hawaii, have received 1332 waivers so far. To get a result, democrats will have to agree to something. More flexibility for states. That some may be reluctant to support this. And republicans will have to agree to something, additional funding through the Affordable Care act, that some may be reluctant to support. That is called a compromise, and much smaller but similar agreement to the compromise that created this United States senate in 1789. When the founders created a senate with two members from each state and a house of representatives based on population, that was a compromise. This is a compromise that we ought to be able to accept. Temporary costsharing payments were included in both bills to repeal and replace major parts of the Affordable Care act. The section 1332 waiver is already in the Affordable Care act, just havent been very appealing to states because it is a difficult tool to use. We hope to hear more about that from our witnesses today. If we were able to take the big steps i mentioned earlier, we fixed no child left behind, passing 21st century cures, we ought to be able to take this small, limited, bipartisan step on Health Insurance. If we dont, millions of americans will be hurt. Timing is a challenge, so i propose that we come to a consensus by the end of next week. When our hearings are complete so that congress can act on what we recommend before the end of september. Otherwise we will not be able to affect insurance rates next year. That is because the department of health and Human Services requires Insurance Companies to submit their final rates by september 20, and the Department Plans to put those rates online by september 27. We can do it here because were plowing familiar ground. Our goal is a small step, and so Many Americans will be hurt if we fail. If we do not do it, it will not be possible for republicans to make political claims blaming democrats, or for democrats to make lyrical hate blaming republicans. Political hate blaming republicans. The winner will be on everyone of us, and deservedly so. We are beginning these conversations at an important moment. There is a lot of work that needs to be done to undo the damage the administration caused within the Health Care System because this administration is still trying to create trumpcare by sabotage. Our Healthcare System is more stable than President Trumps believe,uld have you but it is weaker as a direct result of steps being taken. The president has undermined outreach and consumer assistance efforts and put forward executive orders, seemingly designed to inject uncertainty into the market. Just last week, the administration cut funding for outreach by 90 and funding for consumer assistance by over 40 . And another pressing example is threats to cut off payments to reduce coverage costs for low income people. Should these outofpocket cost reductions be discontinued independent analysis suggests that premiums could be an average of 20 higher next year for the most popular plans on the exchanges. There will be even more uncertainty in the markets, and patients and families will likely have fewer options when they pick their plans. That is unacceptable and it is avoidable. Congress can act right away to confirm once and for all that outofpocket reductions will continue, and we will have a very narrow window to do that as the chairman said before insurances finalize their plans for 2018 later this month. I am very glad that there are members on both sides of the aisle who agree that we do need believethis step, and i it is critical we work toward a multiyear solution in order to provide the kind of certainty that will have the most impact on families premiums and choices in the marketplace. And take plans months to develop their rates. If we dont find a multiyear solution, we will be back trying to solve the same problem a few months from now. And that is simply not what certainty looks like. This kind of discussion around strengthening our Health Care System is exactly what democrats have hoped for over the last two years few years. As i said before, if we were Work Together, i am more than ready to consider additional ideas on the other side of the aisle to make our Healthcare System work better for families and education. To be clear, that means moving forward, not backward on affordability affordability, coverage, and quality of care. Family have rejected the damaging approach on it with have raised costs and gutted critical protections for preexisting conditions. I think we all agree threading the needle will not be easy, but i believe an agreement that protects patients and families from higher cost and maintains the guardrails of our Current System is possible. This kind of agreement will not only make a real difference of for the patients and families that we serve, but it could provide a bipartisan foundation for future work. I have said many times before this work did not end when the , Affordable Care act passed. It is certainly true today. There is much more we need to do to strengthen the Health Care System to lower costs, extend , coverage, and improve quality of care. And these are the issues we should be able to Work Together on in a bipartisan way. I hope with todays conversation, we continue to turn the page away from trumpcare and partisanship that have that we have seen way too much of and start working on Health Care Policies to help our patients and families up for the care they need. Because that is the goal we should all be focused on. My name is mike kreiser, i am the insurance commissioner for the state of washington. I want to thank you for your bipartisan commitment to address the challenges that we as Insurance Commissioners are facing but also you are facing in the coming months. This is especially true for the individuals and families who buy their own Health Insurance, some 330,000 people in the state of washington. They really are the health of that market is the canary in the coal mine. If theres a problem in the individual market, it is a problem for all of us. This is made up, as you pointed out, chairman alexander, of early retirees, selfemployed, people who work for employers who do not offer Health Insurance. The individual market is a clearly very critical safety net. Where we rely there are relying on us to find a path forward. It offers a great deal more certainty than what we have right now. Washington state has fully embraced the Affordable Care act from the very beginning. We have a stable market since 2014. Our uninsured rate has plummeted from 15 down to under 6 in the state of washington. But this year there has been a serious jolt of the system. Initially we had two counties in the state of washington that didnt have health insurers. We solved that problem, thankfully, but i am nervous about what will happen next year. Because of the growing uncertainty and actions by the administration, our individual Health Insurance market are in serious peril. The proposed average rate increases that we have seen for 2018 are 23 . In years past it has been under 10 . Nine Rural Counties have only insurer. Oneone major insurer. Taken frome that was western washington where most people live. The next two weeks will be very telling. Insurers will be making final decisions as to whether they are going to participate in the Health Insurance marketplace or not. Congress must act quickly to address these growing uncertainties. You must permanently fund the cost sharing reduction payments. That is something that is going to help a great deal in our marketplace. It affects some 72,000 people in the state of washington. For a low income family in the state of washington, the deductible is the difference of being 1200 with the csrs or 14,000. I urge you to create a federal Reinsurance Program this year. Doing this would show your commitment to stabilizing the market. It worked very well the state of washington for the first three years that we had a Reinsurance Program. We would like to see it continuing to go forward. Another way of reassuring the Insurance Market that the doesnte carriers, it help them financially, but it gives predictability and helps us hold down rates. Make sure you maintain the coverage and affordability guardrails in the 1332 waivers. We are learning to play by the rules. What we dont want to see is the essential health benefits, guarantees on outofpocket are eroded away. As a Consumer Protections we dont want anyone to see with the marketplace. In closing, let me say that you must take bold action now for the markets. Millions of hardworking people and individuals are counting on us. In Washington State, we got firsthand experience what can happen when violating a secure insurance principles are allowed to occur and they are occurring , right now. We tried this in the 1990s, and we saw the individual market in the state of washington totally collapse. Believe me, that is something no one wants to go through. Let me be a harbinger. If you do will happen not take action now. That is how critical it is in the Insurance Market. To make sure we do not have that kind of collapse we saw in washington happen for the whole country in the individual market. Lives depend on it, our lives rest on your bipartisan efforts. Thank you, mr. Chairman. Pennsylvanias market has experienced difficulties, but our individual market is not collapsing. Our individual market insurers file for an average increase in 8. 8 in 2018 assuming no changes. I am pleased to report the insurers are seeing improved experience with this market, and that is reflected in the rate increases. But im also very concerned that it is on fragile ground because of the uncertainty surrounding the future of the aca and in particular payments for costsharing reductions. I cannot stress enough how difficult this uncertainty is on our markets. These payments have a Significant Impact on rates. Failing to make a longterm commitment will drive up costs for consumers. This will further hurt the 1 to 2 of pennsylvanians who do not receive subsidies. Because those who do will be shielded mostly from these premium increases, if their insurer state in the market. Ultimately rate have to be finalized based on finite assumptions. Pennsylvania consumers will be left to bear the burden of premium increases or lesson choices necessitated by uncertainty. Congress should allocate funding through at least 2019 to give insurers the predictability a need. For years oklahoma has been dealing with the consequences of negative obamacare. They have been worrying about spiking rates, general market instability for too long. My warnings have been ignored at the federal level. I would like to see how congress will address these problems. What is happening now, we cant expect oklahomans to have no market and no options. Not only do they have one marketplace carrier to choose for, but rate increases have gone up 130 . 30,000 individuals who do not qualify for premium assistance exited the group market in 2016 and 2017. People who are the back rather oklahoma economy are struggling. Are the backbone of oklahoma economy are struggling. Many people have an average per capita income just above 25,000 annually are being forced to pay for a policy they cannot afford to actually use. Large lossesined in the marketplace. It turns out you cannot always keep your doctor. Many other states are facing similar issues. Recent efforts to repeal and amend obamacare have ailed, and states are left holding the bag. I am encouraged by the trump administration. In oklahoma we have no other options at this white. Oklahoma submitted a waiver 1332 application under the obamacare framework. This application focuses on the creation of a Market Stabilization Program using federal passthrough funding and statebased assessments. This will create a Regional Program for carriers operating in the marketplace. This initial plan will reduce premiums and increased enrollment for 2018. Subsequent waivers will regain control over other obamacare requirements. However, i am not convinced that obamacare waivers are going to be the solution to our problem. What we really need is an Innovative Solution that returns power back to the states, to implement ideas tailored to fit each states specific needs and Health Insurance. That is why i have been encouraged with proposals that are out there like the ones from senators graham and cassidy, which would repeal the individual employer mandates, block grant dollars to the United States. This kind of leadership for the longterm stability of the markets. If some states want to keep their regulations from obamacare, thats great. That works for them, but it is not working for oklahoma, and we should have the opportunity to do something different, or else we face an uncertain future. Let me ask about the issue of cost share. It has been raised by everyone. I think we recognize that uncertainty within the market is deadly. You cannot move with accuracy. There have been some that have suggested i believe it was the chairman said we need to extend the cost sharing subsidies through 2018. 2019 is another day that has been out there. I think the governor is, in fact, asking for an extension at least through 2019. If we were to do it just through 2018, does that provide sufficient certainty, or does it need to be longer, year 2019 or beyond, to give the certainty . Right now we are giving monthtomonth, and we know that does not work, so could you speak to that . I believe it has to be at least two years. Right now there is enough consternation in the market that the insurers looking to remain are looking for more than a oneyear commitment. At least 2019 . I say it has to go further than that because insurers are already planning the 2019. It is two years out already. In order to give them that predictability, you have to give them more certainty going into the future that it is going to be there so they dont leave the market, and that is the biggest concern i have. Somebody will yell fire in a crowded theater and they all leave. We have seen it happen in Washington State in the 1990s, and it should not be replicated for the rest of the country. Announcer 1 the Second Senate Health Committee hearing on the individual Insurance Market featured a Bipartisan Group of governors. Republican bill haslam of tennessee, democrat Steve Bullock of montana, Republican Charlie Baker of massachusetts, Democrat John hickenlooper of colorado, and Frank Herbert of utah. Here now are the governors Opening Statements from the september hearing. It is an honor to be here with this group of governors who i consider friends and who i know to be problem solvers. My request to this committee this morning is that you do two things. First, that you move quickly to stabilize the individual Insurance Marketplace. Second, that you undertake an effort to Work Together to improve the cost of health care. As chairman alexander said, these are good times for tennessee. Our Unemployment Rate is the lowest in history. We became the state in the first nation to offer two three years of Community College to all of our citizens. Our tax is a percentage of income, and our debt per capita is among the lowest, if not the lowest, in the country. But the crisis of health care and the uncertainty of its future threaten our states citizens and the state budget. The primary difference between governing tennessee now and when a very young governor Lamar Alexander led the state 30 years ago is the impact that health , care has on the state and Everything Else we do. Today, tennessee finds itself with only three insurance carriers offering aca compliant coverage. In more than 80 of our counties, citizens have only one insurance option, and these are limited options provided to tennesseeans with substantial cost increases. This is not sustainable. We are on a path where citizens will not have an option to purchase from the Insurance Marketplace or cant pay for the limited options that are available to them. Either way, the system fails. Congress should take steps now to prevent the total collapse of the Health Insurance market by, number one, funding cost share reduction payments, two, creating a shortterm Reinsurance Program, and three, providing flexibility to the states. In tennessee, about 60 of our federallyfacilitated marketplace participants are enrolled in csr plans. Failure to fund csr payments will increase premiums significantly, create even more uncertainty around the future of participating carriers, and actually increase the federal deficit due to higher premium tax credits. Clearly this is not a recipe for success. But it is also important to understand that our marketplace was facing collapse before this current discussion of csr payments. And other actions and reforms will be needed to address the crisis. Second, congress can take additional action to stabilize markets by funding a shortterm Reinsurance Program that would limit losses to carriers that provide coverage in the marketplace. This should produce lower premiums, which in turn should attract new, newer healthier individuals to the marketplace. A third critical way to provide more stability is to offer flexibility to the states to address their unique challenges. A waiver approval process should be expedited, and guardrails currently placed upon waiver requirements should attract younger, healthier individuals to the marketplace. I realized some of the things i just outlined around stabilization cost more money, and i am asking for this at a time when many governors including myself are emphasizing the skyrocketing cost of health care. But the reality is that failure to address the immediate stabilization needs while Congress Works on the bigger issue of cost will almost certainly result in collapse of the market. Some may say the only way to ensure legislative action on cost and realize real reform is total collapse. I dont subscribe to that line of thinking. I think every governor here and those back home believe that we can move to stabilize the market now while we work to take on the issue of Health Care Costs. Having held to stabilize the market, it is my strong hope that this committee will turn sights to the cost of health care, which is crippling businesses and families and overwhelming all the other needs that should be addressed in state and federal budget. We must all recognize what has been missing in the argument over the Affordable Care act. The law was supposed to solve two Critical Issues around health care in america. The first was the large number of people who did not have Health Insurance or could not afford coverage. Secondly, the Affordable Care act was supposed to make Health Care Affordable. Unfortunately it has provided coverage or government subsidies for millions of people to have coverage at the same exorbitant costs. One of the criticisms of the Affordable Care act is that it took the easy part, saying that we would provide free or subsidized insurance to more people without simultaneously addressing the hard things , addressing cost. We should not kid ourselves. Addressing cost is difficult politically and otherwise. One of the drivers of Health Care Costs is the misalignment of incentives that is created when we compensate providers based on the volume of care they provide, rather than on outcomes or efficiency. In tennessee, we are working to change the way we pay for and deliver health care so that providers are compensated based on value, and congress should make a clear commitment to this type of payment innovation. All of us, republicans, democrats, and independents, should agree that our current path is not a sustainable during one. All the debate about the Affordable Care act, there has been a lot said about how immoral it would be to have millions lose health coverage. I understand the argument. I am a republican governor who proposed a conservative plan to increase Medicare Coverage in our state. However, cant we all in knowledge that it is just as morally questionable to cover everyone with Health Insurance and put the bill on a credit card to be paid by our grandchildren and not do everything we can to make Health Care Affordable now . Thank you again to the entire committee. As governors, we stand ready to partner with you and strengthen the individual market and our entire Health Care System. Thank you, governor haslam. Governor bullock, welcome. Chairman alexander, Ranking Member of the committee, members of the committee, thank you. First, thank you for inviting governors, democrats and republicans, to appear before you today. Whatever comes out of washington dc or does not come out of it, were on the frontlines of dealing with it. Your recognizing of the importance of our involvement in the discussion is significant. Second, thank you for working together. As we learned from the passage of the aca, meaningful and lasting reform will be substantially hamstrung if implemented over the uniform objection of the minority party. I applaud the chair and members of the committee for doing all you can to ensure that congress does not repeat errors of the past or even errors of the past months. And third, we are all familiar with the old adage, the only way to eat an elephant is one bite at a time. My thanks for a singular focus on the immediate steps congress can take to stabilize premiums and help individuals in the Insurance Market. Anymore governing in dc may seem like a zerosum game, a few winwin scenarios. If you are earnest in adding greater stability to the overall Health Care System and the individual markets, i do believe that your efforts will reap political rewards on both sides. Some may call me a dreamer, but it might even prove to be a model for further efforts. Following the eating the elephant analogy, it may be only one bite that this committee is taking, but it is an important one. Last time i was with chairman alexander, again with the bipartisan governors, he handed out his pocket guide to the basics of Health Care Coverage. Sure, patients on the exchange only represent 6 of all those insured 4 of the total by the individual market, but stabilizing the individual market impacts all areas of coverage and also has a highly pronounced impact on places like where i live. Rural montanans like rural americans are less likely to have that option of employersponsored insurance. Today 80 of those insured montanahe innovaro in rural montana are on the individual market. Three out of four enrolled in a marketplace planner for rural or frontier areas of our state. 84 of all montanans enrolled in a marketplace and have received tax credits to make the payments affordable. I do believe that we can find Common Ground in driving down costs, and stabilizing the marketplace, and the time to do it is now. While Health Care May be complex, it certainly does not take a brain surgeon to figure out how to stabilize the individual market. The effort i have been involved in led by governors hickenlooper and offers a roadmap and a number of actions that this committee can take. While the perspectives of the five governors appearing before you this morning are certainly of diverse landscapes, we are uniform in insisting the cost share and reduction payments be continued. All of us in our testimony urge you to create a temporary Stability Fund. We all agree that you need to make sure both a healthy and the unhealthy continued to be covered in order to spread the risk. We must maintain important Consumer Protections. If this committee will work across the aisle with one another to undertake even those four measures, you will accomplish your aim in stabilizing the individual market. If you just did the csr payments, you would take significant steps to do so. It also does not take a brain surgeon to sabotage our Current System. Be in action and messages coming in from dc are doing it now. Messagesaction and coming in from dc are doing it now. In montana, our largest insurer has proposed a rate increase for next year 10 times higher than it would be, because of the uncertainty that the president and d. C. Has created. Finally, more important than being governor, i am a parent. During my first state of the state address five years ago, i urged policymakers to act like our kids are watching and learning from our behavior, our words, and our deeds, because indeed they are. I implore you to do the same. In a time of seeming dysfunction, this committee and this congress can Work Together to destabilize the individual market, beginning to eat that elephant one bite at a time, and who knows . We all might find that working together is not only good for congress, but it is good for our country. Thanks for having me and my colleagues here. Look forward to the conversation we will have over the next couple of hours. Thank you, governor bullock. Governor baker, welcome. Thank you, very much. Talk . T says yeah. [laughter] thank you, chairman alexander and Ranking Member murray, and members of the committee. I want to thank you for this opportunity to testify on stabilizing premiums and helping individuals in the Insurance Market. I am honored to be part of this group of governors that are testifying today because we deal with these issues every day, and we want to work with congress and the federal government on Health Care Reform. Massachusetts has achieved near universal coverage with the highest rate of individuals with Health Insurance in the nation. That is nice because we have been working and reworking it for 10 years. The reason for our bipartisan success is the believe that Health Care Coverage is a shared commitment, not the singular responsibility of government. As you consider members to stabilize premiums and address the individual market i would , like to emphasize four key points. First, bipartisan cooperation is essential to achieving quality affordable Health Care Coverage , and stabilizing any market. Second, congress should take affirmative steps to resolve the federal costsharing reduction payments until longerterm reforms are enacted. Carriers, providers, and employers, and people all need certainty about what rates are going to be an monthtomonth resuscitation of cost hearings is not stabilization. They should be stabilized for at least two years. As future reforms are considered, a key to market stability is the presence of younger and healthier people in the market. When massachusetts launched its universal Health Care Law in 2006, we included an individual mandate, which i support. For starters, no one really knows when they might get sick or have a tragic accident, and once it happens, they will seek care, and it will be provided. And in many circumstances, they will be unable to pay for it, and that means everyone else who has insurance will be paying for the Health Care Services rendered to those without coverage. In addition, if people have unlimited access to purchase coverage, many will purchase Health Insurance only when they need it and then drop it once their care is provided. Defeating the whole point behind insurance in the first place. Coverage with incentives and consequences is a critical element in ensuring everyone is treated fairly. Different stage states can choose different approaches, but if we want to make insurance affordable for people who do not have access, the coverage to work and not qualify for public coverage we need to nudge , everyone into purchasing coverage and then keeping it. Third, congress should establish broader parameters for Insurance Market reforms that include greater latitudes for states that meet the needs of their health care residents and marketplaces. 1332 waivers should be brought for greater state flexibility. It is no secret that massachusetts is committed to continuing to provide access to highquality, affordable Health Insurance to all of our residents. An increased waiver flexibility would ultimately allow us to meet that commitment. Three changes were 1332 waivers would be significant for the benefit design and budget neutrality. Massachusetts is a strong benefits state. We support essential health benefits. However, even in our state, and would be it was a challenge to adapt to the overly strict federal framework of the aca. Fourth, congress should take a debt should take action to address healthcare costs, and one critical driver is rising pharmaceutical costs. Among other actions, safely expediting the fda approval process, increasing competition by ensuring generic drug availability, and creating greater opportunities for public payers to negotiate prices should be pursued. As you consider these and other reforms of our Healthcare System, i would ask if any legislative changes occur on a gradual timeline, ideally with stateless ability to opt out or grandfather in existing programs in order to prevent market shocks and to improve market stability. Finally, as governors, we are responsible for the Fiscal Health of our states as well as the physical health of our residents. Reforms cannot can place states at risk. Any reform should not shift greater financial burden onto states. Complex legislation requires finetuning and adjustments. And in massachusetts, we have repeatedly revisited Health Care Reform as we have learned from implementation and its conditions have changed, and our commonwealth is better for that. I urge congress to commit as we did to returning to the table in a bipartisan fashion to review and revise any reforms in the coming years. I thank you for the opportunity to provide testimony on this important issue, and we look forward to working with you and other members of congress as you consider legislation. I submit written testimony that goes into greater links on these greater length on these issues and would be happy to take questions on that or governor hickenlooper, welcome. Governor hickenlooper good morning. Thank you, chairman alexander, Ranking Member murray, and all the members of this committee. I appreciate the opportunity to testify and briefly share our bipartisan plan for stabilizing the individual Insurance Market. In 1932, Justice Louis brandeis popularized the idea that states are critical to democracy. A state may serve as a laboratory and try social or economic experiments without the risk of the rest of the country. States are were the rubber meets the road on the highway of the american experiment. In colorado, we have implemented the Affordable Care act for seven years, as long as i have been governor. For many coloradans, it has been a success. With bipartisan support we , expanded medicaid and created a statebased marketplace. Around 600,000 coloradans now have care because of the aca, thats 10 . But many people are angry, and they have the right to the. They have a right to the. The United States is on a lonely island of our high income nations. We spend almost twice as much for worse care, and this has been the case long before the Affordable Care act. We need to move toward a system that compensates quality and good health, not quantity. For the coloradans in the marketplace, many continue to struggle. Colorado has 14 counties almost , 25 of our counties with only one insurer on the exchange. It is also home to some of the highest premiums in the country. A 60yearold in rural colorado making less than 15,000 will pay over 12,000 in premiums. That is simply unacceptable. Even worse, insurance premiums are projected to increase by as much as 27 . Thats a big problem. Our bipartisan governors have been working on a common sense set of solutions to help make insurance more affordable and markets more stable for this crucial 7 of the population. We can do a lot more at the state level, especially with congressional support. Our plan asks you to explicitly fund costsharing reductions at least through 2019. Funding through 2018 alone will only put us right back where we are now in a matter of months. It will foster uncertainty, threatening to drive up premiums and force insurers out of the , market. We also need your support by creating a Stability Fund that will help us set up reassurance reinsurance or similar programs. Hope you will fully fund and strengthen programs. We are requesting Tax Incidence tax tax incentives for Insurance Companies to enter counties with only one insurer, while giving americans to live in these counties the opportunity to buy the same insurance that federal workers have. Section 1332 of the aca gives states the ability to innovate to lower costs, while ensuring that certain basic guidelines are met. Existing regulations limit our ability to come up with creative solutions. Thats why we are asking for a streamlined way for submission and approval process, and additional flexibility in applying the budget neutrality provisions of this section. We believe all this can be done in a fiscally responsible way by offsetting costs. We need to address the underlying drivers of healthcare costs as well. Thats why we are asking federal government to empower consumers with price and quality information. We cant stabilize the market without Funding Priorities of that reduce costs like weight , management, family planning, and injury prevention. Governors have proven we can innovate. We are like startup companies. We learn from the states. We tweak, constantly improve. Fine is never good enough. Thats part of being laboratories of democracy. In colorado, we are trying to stretch federal dollars and pinch pennies. We are reducing costs and promoting a competitive market while improving care and increasing transparency. We have a lot to be proud of, but recent federal action and inaction is undermining our effort. It is time for the federal government to work with us, not against us. Without your help, it is like climbing a Colorado Mountain without a parka or crampons. It cant be done. We need immediate federal action, and responsible reforms that preserve coverage gains and costs. I appreciate your efforts in calling this hearing. Lasting solutions that make Health Insurance more affordable and markets more stable will need support from both sides of the aisle and leadership from states. I look forward to answering your questions. Thank you, governor hickenlooper. Governor herbert, welcome. Governor herbert we are honored to address you on this important issue. The markets for affordable Health Insurance protect the families of utahs entrepreneurial selfemployed. It will be in responsible to allow these markets to collapse simply because of political paralysis. Having served as chair of the National Governors association, and soon to be the next president of the council of state governments, i have a broad appreciation of the role that states have in our federal system. I would therefore urge congress to get past the hope karen bass the healthcare impasse and delegate through responsibly to find solutions to the laboratories of democracy, as governor hickenlooper mentioned. I ask each state to take on the full role of regulating our Health Insurance markets. You can diversify the show that social, economic, and political risks. You can let the states experiment as laboratories of democracy to determine what policy works and does not work. For your information, the state of utah has one of the lowest healthcare costs in the nation. That stems from our local culture and favorable demographics, but it also comes from such practices as evidencebased measures of effectiveness, innovative use of managed care organization, and empowering doctors and patients alike to make more informed choices. I believe if you empower the states to determine their own healthcare destiny, the states will innovate and create Practical Solutions for the most complex healthcare issues of the day. We will learn from each other, and therefore he will improve. Under current law, empowering states means rater flexibility and defining essential health benefits, and simplifying the state innovation waiver process. Selfdetermination goes well beyond coming to the u. S. Department of health and Human Services on a bended knee and with a hope for favorable treatment. True selfdetermination would mean a block grant of medicaid and Affordable Care funds that get us to funding parity in the 50 states. Before achieving the vision, Congress Needs to provide immediate certainty to the individual Insurance Markets. To that end, i recommend establishing a defined transition period. This would allow markets to incentivize the broadest participation and individual Insurance Market. This should be done while anticipating the adjustments. I am personally not a fan of costsharing reduction payments. Nevertheless, in the near term, individual Insurance Markets need predictability in order to price their products adequately. The sudden demise of csrs was destabilize utahs Insurance Market, putting at risk utahns who benefit from this program. Funding should be included through at least 2018 or 2019. We should also look to market oriented incentives to increase continuous participation and individual Health Insurance markets. For example, congress could immediately reduce the cost of premiums by eliminating the Health Insurance tax. Insurance products can be better tailored to demand by allowing insurers to offer a wider array of products, including more high deductible plans. Participation could be incentivized by greater flexibility in Health Savings accounts. The government should fund a temporary Insurance Program for high risk schools with an option for states to offer their own risk stabilization programs. At the bottom of all this, Health Insurance needs to be able to do its job in protecting against unforeseen healthcare costs instead of being used for some vehicle for social justice reform. To get there, the excessive burden of Regulatory Reform restrictions that we have placed on insurance policies needs to be peeled back, and that needs to be done with predictability and transparency. Frankly, most of americas consumers dont care whether or not a law is repealed or replaced. Or modified and improved. When utahns want to know that they will be able to purchase reliable Health Insurance to protect them against lifes Unexpected Health challenges. They need to know that if they experience a medical catastrophe, there is a safety net that will prevent them from spiraling into a financial catastrophe. The states are able to better address these issues for the unique populations and unique demographics than the federal government, which is too often trapped in a onesizefitsall mentality. I would urge you to consider a healthcare future that gives back to the States Alliance share of responsibility. This is something that both sides of the aisle can support, giving more authority to governors and state houses. Returning control to the state is prudent policy, but also prudent politics. Thank you for listening. Host utah governor gary herbert there, saying he wants decisionmaking to be in the states as far as health care is concerned. Joining us is jennifer. That brings us back to the Cassidy Graham proposal, and republicans continued efforts to repeal the Health Care Law. Why didnt the bipartisan approach work . Jennifer i think they ran into a lot of trouble early on. Trying to get weve been talking about the Affordable Care act for eight years, and it has always been so entrenched in politics. Republicans had to line up against the law. Have to line up saying they would repeal it if they could. Democrats had to line up saying they were never going to do anything to undermine it. I think it was hard to get out of those entrenched positions, so some thought that when a repeal bill died, you would be able to turn to this discussion, clearly that was not the case with the state possibility of repeal still on the table. I think in the talk, republicans were ready to give him funding for costsharing payments, a part of the Health Care Law that the president has the power to pull at any moment. Democrats seemed unwilling to give on that in some flexibility to a part of the law that republicans had been eyeing, which was giving the states more flexibility to do what they can with a plan they want. Even if senator alexander and senator murray were able to come to a deal, it is hard to see that it would have gotten 60 votes in the senate. Maybe they would have had a chance, but i think it would have been tough. Host looking ahead to next week, what can we expect from capitol hill and congress . Jennifer i think it is going to to be a mad dash. Senate republicans are going all in to get Kassie Graham passed on the 30th. They are still short of bobo. Short of a vote. I think we are going to see a lot of scrambling. If they do but to talk the floor, democrats will try hard to stop it. They have one tool they can use, the votearama, unlimited amendments. Any senator can offer any amendment, and it would get a vote. In theory, democrats could offer hundreds of amendments. Typically it is not go that long. It is more like dozens of amendments. But if democrats are serious and view this threat as serious, i think we will see them put up a real fight. It is going to be a long week. Host anything that you know ahead of the Senate Finance hearing that has been scheduled . Jennifer that will be on monday, and senator john mccain, one of the folks who is skeptical of this bill, he has made clear that he wants regular order. Regular order would Mean Committee hearings. Senate finance chairman orrin hatch scheduled a hearing for monday. I expect to see a lot of partisan talk. I think we will see democrats trying to defend the law, republicans trying to say the healthcare law needs to be repealed and Graham Cassidy needs to be put in its place. I dont know if we are going to have a ton of substance, but definitely a lot of politics. Host we will have that on cspan next week on monday, and we will follow your reporting at politico. Com. Thanks for your time. Watch more on health care. Go to our website, cspan. Org. [captions Copyright National cable satellite corp. 2017] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] the bill sponsors senators Lindsey Graham and bill cassidy were scheduled to testify. Live coverage of this hearing begins monday afternoon at 2 00 p. M. Eastern. This weekend on American History tv on cspan3. Tonight at 8 00 eastern on lectures and history. Temple University Professor Andrew Eisenberg on the Environmental Movement in the 1970s. When i want to argue here is that the noble savage environmentalist was a kind of product that was sold to American Consumers like big macs or cars. At 10 30 p. M. , father and daughter pilot john penney and talk about their experiences during 9 11. We take off and headed northeast. Peaceful and and silent sky. Theres no one airborne. Out to the northwest we had out to the northwest, and never find anything. We were not heroes that day. The passengers on flight 90 three were the heroes. On sunday at 6 00 p. M. Eastern on american artifact, two or the harriet of met underground radio Harriet Tubman underground railroad visitor center. It opened up a new world for her. We think she got lobe epilepsy, which allowed her to have these amazing visions in connection to god. She heard people singing, she saw these Amazing Things and had vivid dreams. It was terrible on the physical side, that it was amazing for her faith. At 7 00 on oral histories, it continues with eric draper. That image that shows dam bartlett pointing to the tv, that was the first time we started seeing the replay of the second tower getting hit. American history tv, all weekend, every weekend only on cspan3. Cspan, where history unfold daily. In 1979, cspan was created as a Public Service i americas Cable Television companies. It is brought to you today by todays son of your satellite provider. Today, north koreas foreign minister spoke with the United Nations general assembly, and responded to President Trumps threat to totally destroyed north korea. His whole speech is just under 20 minutes. Give the floor to his go readrihanna young ho. Mr. President , first of all allow me to congratulate you on your election as president of the 72nd section of the United Nations general assembly. I look forward to the fiscal out some of the decision of able guidance. Before going into the main point in my debate, i feel forced to make comments on the speech just four days ago i someone called the u. S. President that renders this sacred u. N. Arena tainted. Since trump uttered such reckless and violent words, provoking the supreme dignity of the democratic peoples republic of korea at this very platform, i think it is fair enough to me to make a response in the corresponding tone. During his eight months in power, he has turned the white ofse into a noisy place full crackling sound of advocacys, now he has tried to turn the u. N. Arena into an event where money is respected and bloodshed is the order of the day. That trump,reality a mentally deranged person, full of megalomania and complacent, the person who has chastised who is chastised by american people. He is holding the seat of the u. S. President and the dangerous threats and all of the schemes to require a patch of land. These are will constitute the gravest threat to the international these and security today. His liking of basic common knowledge, his attacking of a sick comic not knowledge, of common by doing so, he committed on your reversible mistake of making our rockets visit the entire u. S. Mainland inevitable all the more. Trump himself is on a suicide mission. Of the innocent lives u. S. Armed because of this suicide attack, trump will be held totally responsible. Of respected Supreme Leader mandprk comrade stated as a representing the dprk and on behalf of the dignity and honor of my state, as people and on my holdingll make the man the supreme command in the u. S. Paid dearly for his speech calling for totally destroyed the dprk. Awaremight not have them what is uttered from his mouth, but we will make sure far beyond his words, far beyond the scope of what he can handle even if hes ready to do so. That was early on, when i believe trump was had just announced, they were worried that he was going to be bad for them in terms of women voters. Considering how far back they have had an antiwoman platform. Pay,ductive rights, equal andunday night on q a thomas. Pence, is Vice President i dont remember who did the interview, but he did interviews and said Something Like he never goes to washington dinners without his wife. I thought ok, this was a gift. You dont have any problem voting about a womans personal reproductive choices, which is probably the most personal and intimate thing a woman can deal with, but you want to go to dinner where a woman only close is at the same table. Sunday night at 8 00 eastern on cspans q a. Cspans washington journal, live every day with news and policy issues that impact you. Coming up sunday morning, republican political consultant will be on to look at his recent combat in the hills, he believes the president is not a conservative. More about the president and his outreach to minorities, Bruce Lavelle of the National Diversity coalition for trump will join us to explore that. The diplomatic talks to reduce tensions with north korea. U. S. Former u. S. Acting ambassador will be on to talk about. Be sure to watch cspans washington journal sunday morning, join the discussion. In his weekly address, President Trump talked about his plans for tax reform. Representative john permit of kentucky as the democratic address. He talked about the Health Care Law. Americans, the American Family has always been the heart of our great nation. In homes across this country, families teach their childrens to work hard, to love each other, and to make the most of their talent in pursuit of their dreams. For too long, American Families have been hurt washingtons policies that put the interests of other countries before the interest of our country. In my administration, we are pursuing tax cuts and
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