Labor and pensions will come to order this morning. We are holding our third of for hearings on stabilizing the cost of premiums and ensuring americans are able to purchase insurance in the individual Insurance Market in 2018. This is the market were 6 of insured americans, that is 80 Million People by their insurance. Those who dont get insurance through medicaid while on the job. For the past fee years, the cost of premiums in the individual market copays deductibles up and skyrocketing in many states. Half of these 18 million americans have government subsidies to cushion the blow of the rising prices. Many of those who find themselves in the other half are being priced out of the Insurance Market that they simply cannot afford. That is why these hearings have a narrow objective. Congress and the president do between now and the limit the month to help premium increases in 2018 and lower premiums after that. We heard in our hearings last week that there was also a danger that if we dont act, americans of sun counties wont have insurance to buy because Insurance Companies will pull out of collapsing markets. The other reason we have a is that thistive committee can resolve contentious differences on many issues. We have been stuck in a partisan political still make for seven years on Health Insurance. A small bipartisan step would break this and hopefully lead to some other steps. This morning we will hear from experts who work in or with states as they develop plans to stabilize their individual market or implement other Broader Health care reforms. Will eachrray and i have an Opening Statement that we will introduce our five statements. Senators will have an opportunity to ask the witnesses five minutes of questions. I want to think senator murray for working so well with the committee to focus to agree on the witnesses and to make these hearings bipartisan and aimed towards a result rather than an opportunity for us to make speeches about our various points of view. The hearing is how can we give states more flexibility in improving Health Insurance policies is one way as creating better coverage or choices and lower prices, despite our partisan differences, our two hearings demonstrated a real hunger by many senators on both sides of the aisle to come to a resolve. Between the meetings held before last weeks two hearings and the hearings themselves, for two consecutive days, half the members of the United States senate attended. We had a good number of senators who met the Witnesses Today before this hearing who were not members of our committee. Because temporary costsharing payments were part of both the senate and the House Republican and replace the Affordable Care act. The second thing, senators from both sides of the isles suggested expanding the copper plan already in the law. Anyone, not just those 29 and under to purchase a lower premium, higher detectable plan that keeps a medical catastrophe from turning into a financial catastrophe. The insurance commissioner suggested that we would give young and Healthy People more options to buy insurance. , advocated byg state Insurance Commissioners and governors and senators from both sides of the aisles is to give states more flexibility in the approval of coverage, choices and prices for Health Insurance. That third piece is what we are discussing today. Most of the discussion about flexibility is centered on giving states greater flexibility by amending section 1332 this day innovation waiver that is already in the Affordable Care act eyes. We heard from every witness last week that an application for section 1332 is too cumbersome and expensive. Some 23 states have taken steps to start the process, so far to have succeeded. There was no shortage of suggestions about how to make section 1332 work better. It came down to this. But sees the process of applying for that more states can do what alaska has done but faster. Lets give states actual flexibility in their approaches like massachusetts requested. Done, and went minnesota, iowa and maine are considering doing is to use the section 1332 waiver as a way to take care of higher cost individuals and lower premiums without using additional federal funds. Include reinsurance, stability funds, or invisible high risk tools to help individuals with complex and chronic conditions. This, theates do recommendations from witnesses included, reduced the sixmonth application review. Allow a copycat application. Why can tennessee come along and say we want to do what Washington State did with one change . Allow the governor to apply for a waiver and not wait for the legislator to have to pass a law , since some state legislators only meet every two years. Extend the waiver length. Fasttrack process for emergency waivers. Usined budget neutrality over the entire term of the waiver, rather than a single year. Eliminate the socalled firewall between the section 1115 waivers and the section 1332 waiver. Eliminate the 2012 regulation in 2015 guidance, which will make these process suggestions were better. We also heard from several witnesses, including the governor of massachusetts, that the current rules on which type of Health Insurance can be offered under section 1332 waivers, they are so rigid that anything cannot offer but an existing Affordable Care act exchange plan. Real state flexibility means giving states more authority. Ables a wire variety wider variety. Allowspe of approach individuals the opportunity to have a more personalized Health Insurance plan. It is an approach that can benefit healthy individuals, as well as with complex and chronic medical conditions. For example, as governor baker of massachusetts testified greater flexibility is also needed around benefit design. Value base insurance to benefit design, seek to align patients outofpocket costs, such as copayments and deductibles with. He values of Services Massachusetts is committed to providing access and affordable Health Insurance to residents, rather than walking away from that commitment. We believe increase flexibility would allow us meet that in more effective ways. Thered caution members are still significant differences to deal with, and a true compromise requires democrats to accept what republicans want, more flexibility to states and republicans to accept what democrats want, costsharing in the Affordable Care act. Both sides have been supportive with the socalled copper plan. The chairman of the Events Committee on friday questions, continuing costsharing without significant Structural Reforms in the Affordable Care act. On the other hand, Civil Democratic members have insisted that what they call garden roles in the law not be changed. As for guardrails, i want to be clear that i am not in any way proposing we changed the Patient Protection guard rails already written in the section 1332. Including that nobody can be charged more if they have a preexisting condition. The requirement that everyone is guaranteed to be sold insurance. The requirement that your insurance policy cannot be rescinded. That those under 26 may remain on their parents insurance and there may be no annual or lifetime limits on your Health Benefits. As for the essential Health Benefits, states already may waive those under the express provisions of section 1332 of the Affordable Care act. That needrails examinations are the severe restrictions on benefit design that governor baker was talking about the effect the result that would be achieve when Human Services approves a state waiver application under section 1332. That is where we need to have further discussion. We had a good deal of discussion among senator franken and others. They discuss that with our witnesses earlier today and i hope we will hear more about that. You can help us a great deal if you can help us resolve this part of the problem. Rules,ection 1332 waiver the results achieved under a waiver has to be a plan that is as comprehensive and comprehensive in benefits, outofpocket costs as an Affordable Care act exchange plan. Cover a comparable number of individuals with the same cost to individuals and at increase cost of the federal government. This means that no other type of nfa designed for Health Insurance plans is allowed. That would be like a restaurant menu with only one item. Or travel agency with only one destination. Or if dr. Seuss had written a book entitled the place to the go. Witnesses have experience in helping states design policies of approving insurance. We look forward to your advice on how to give states real ways thaty in increase coverage, choices and lower prices. Senator murray. Murray i get to our witnesses for being here. Before i began i want to say a few words on the ongoing situation in the gulf and Atlantic Coast and in the wildfires out in the west. Our hearts continue to be with the families who have lost loved ones and all those whose lifes wives have been upended by harvey. I want to see we extend our deepest appreciation to the countless first responders, neighbors and volunteers who have inspired us all for their selfsacrifice. I, like everyone, commit to all of us working to make sure these people have the federal resources and partners they need. Community is behind me in saying that. I am eager to continue our conversation on bipartisan steps we can take to restore certainty to the individual Insurance Market for patients and families across the country who are worried about being able to afford the care of any. Next year and be on. So far we have had focused discussions in our first two hearings. Many conversations on areas of significant Common Ground around those goals. That is due in large part to the members of this committee. All of ourhank colleagues on both sides for their efforts. As chairman alexander has mentioned, our steps to open up this process to members off the committee, we are committed to opening up this process since the beginning. I know i speak for many of us when i say that the morning conferences have been extremely helpful. As i said last week and i will repeat today. On the we dont agree cause, we do agree on the challenge facing this committee. Families will see higher premiums have your options as a result of uncertainty in our Health Care System. The also agree that we need to act very quickly. Everyone knows we have a very narrow window to do so. Last week we heard some valuable recommendations in our conversations. Insuranceand state commissioners from all of our country, republicans and democrats agree that we need certainty for outofpocket cost reductions. Discussed, many insurers are already making their plans and setting premiums well beyond 2018. If we want to provide the kind of certainty actually needed to lower cost for patients and families doing the better minimum, doing the bare minimum is unacceptable. Alongis a consensus that with outofpocket cost reductions, we should consider additional ideas to make health for patientst are and families. When i did is establishing a Reinsurance Program to help the cost associated with covering the enrollees. That is something that has come up consistently throughout our hearings, as have other options. Third, democrats have been very focused on this from the start, the agreements that the damage being done by this administration on open enrollment and Consumer Outreach is having an impact and could potentially undermine our efforts to restore stability to the markets. Like my colleagues, i strongly believe we need to adjust that issue. Are just a few examples and there are many more areas where we have seen agreement. Todays hearing on specific provide could take to flexibility to states and communities is an important discussion. I have to say, among the many measures excited, as pressing priorities by our witnesses so far, state flexibility is not need to stabilize the market in the short term. All we have heard interesting suggestions worry could increase outofpocket costs for families. It is making care more affordable not less. I am committed on my end and my democratic colleagues do as well to listen to the ideas presented today. I hope we can stay focused on the common goal of lowering costs for patients by stabilizing our markets as soon as possible. Mommy underscore where i have said many times. This has to be a conversation about moving forward, not backwards when it comes to affordability, coverage and quality of care. I want to emphasize that because democrats will reject any effort to this discussion if it you rose the guard rails and protections that so many patients and families rely on. This is going to be a difficult needle to thread. It is possible. As we know governors kasich are in consultation with nearly other 20 other governors and before the the market stabilization plan which maintain protections in current law for patients, like those and preexisting conditions women seeking maternity care. I know we will not agree on everything, but if we can keep todays discussion focused, work through these issues in a specific and balanced manner while keeping our larger goals in mind, i do believe we can get a result as chairman alexander would stay say. I do just want to say, i am disappointed that there are still some vendors china push us down a partisan cap on health care. Republicans and democrats are finally working together, and it is refreshing and needed. We have make critical progress. It would be disappointing if another partisan debate over trumpcare interrupted and derailed our efforts. Those senators will join these bipartisan conversations instead of doubling down on harmful repeal efforts again that people across the country have rejected. How that, i want to say much i appreciate all your work on this. Everybody participating and i look forward to todays discussion. I askan alexander now each of our witnesses if they will, to summarize each of their statements in five minutes. We have a lot a senators that would like to ask questions. I will briefly introduce them. Governor mike leavitt is the former governor of utah, the chairman of the National Governors association and the republican Governors Association ahead of the department of health and Human Services, he brings lots of experience. He is now in the private sector. Senator franken would you like to introduce her . Franken a pleasure to introduce her. When it came to Insurance Exchange rollouts, the Minnesota Health exchange, like many other exchanges, it had a pretty rocky one. After that, what i like to call the minnesota affected 10. It got better and is now one of the highest exchanges in the nation. Minnesota now has a 96 insurance rate. The is a record and the second highest in the United States. The minnesota affected not happen by itself leadership matters. Under her leadership they have experienced two years of recordbreaking enrollment, increase system stability, bettered Customer Service and has led the nation the last two years in a row and the percentage of new enrollees. Miss oldschool, thank you for your miss otool thank you. Im happy to see here. Chairman alexander our third of the is the Ceo Foundation for government accountability. Yes testified several times before committees in congress. He has worked with several states on innovative models to stabilize our Insurance Market. Thank you mr. Tyson for coming. He is the ceo of Kaiser Foundation health plan. One of americas leading integrated Health Care Providers and notforprofit health plan that serves nearly 12 million members. Nd tammy tom check she is a principal at oliver wyman actuarial consulting, specializing in Health Insurance. I cannot tell you how many times the senators have been sitting around coming up with ideas. Somebody would say, where is an actuary . We are glad you are here today. Governor leavitt . Gov. Leavitt des moines to senator alexander and the rest of the committee. It appears very much to me to be about the age old dilemma of how to divide the responsibility for governing between state governments and the federal government. Having served as governor, and also as a member of the cabinet, i have come to understand that there is a role for both. Governmentsederal see the role flexibility with difference. I have often joked that governors flexibility means, just leave money on a stump in the woods at night and we will take care of everything else. I have come to understand as a cabinet member that the partnership requires some degree of flexibility. In my cabinet roles at epa, and at hhs, i dealt with these issues over and over because both of those departments, our agencies were to it on a partnership with the states. Developed, in my own mind, a basic strategy. I would commend that to you as you wrestle with this dilemma. They can be expressed in forwards. Standards states solutions. I felt over and over again that the federal