We have five state Insurance Commissioners. Thank you for coming from long distances, some of you, to be with us to give your testimony on how to help the 18 million americans in the individual Insurance Market. To give an idea of how many people are interested in this, senator murray and i invited senators who were not on our committee, which has about a quarter of the senate is on this committ committee, to come to a coffee with the five commissioners that weve just completed for an hour. We had 31 senators there. Thats a remarkable level of interest. Senator murray and i will each have an opening statement. Then well introduce our five witnesses. After their testimony, senators will have an opportunity to ask witnesses questions and well do it in fiveminute rounds. This includes 23 United States senators. Nearly onequarter of the members of the senate. It includes senators with the widest divergence of views. It has a republican majority of only one. Yet working together the last two years weve been able to agree on big steps, on big issues about which we have big differences of opinion. Such as fixing no child left behind, which president obama called a christmas miracle. 21st century cures, which senator mcconnell says was the most important piece of legislation that passed Congress Last year. The first over haul of Mental Health laws in a decade. In early august after two years of work and i want to thank the staff for that two years of work especially we passed new agreements to help speed safe drugs and devices in the medicine cabinet and provided 9 billion in funding. I congratulate senator murray and democratic as well as republican members of the committee. This is the way americans expect the United States senate to work. Now, those were big steps. This hearing is about taking one small step, a small step on a big issue which has been locked in partisan stalemate for serve years, Health Insurance. It is a step Congress Needs to take by the end of this month. The steps not so big to 18 million americans, songwriters to selfemployed farmers, those who dont get their Health Insurance from the government or on the job. About half of them have zero Government Support to help buy that insurance. 18 million is only 6 of those who have Health Insurance in america. Thats the individual market. Nearly 300 million americans have Health Insurance. 18 million buy it in the individual market. Thats 6 of all the insured and 9 million of those 18 million have no government help to buy their insurance. Theyre the ones most hurt by higher premiums and copays and deductibl deductibles. Shes an estimated take home pay of 39,000 after taxes, which means almost a fifth of her take home pay is spent on Health Insurance premiums. And this doesnt include deductibles or copays. Next year the Tennessee Department of insurance says premiums are going to go up by an average of 2142 . Thats an increase for her between 15 1500 and 3,000 more next year. She ought not to have to pay a fifth of her income for Health Insurance. Tennessees insurance commissioner, whos here today, has described the states individual market as very near collapse. At the end of september last year, blue cross pulled out of the individual market in knoxville, nashville and memphis, not just for tennesseeans with Affordable Care act subsidies but for everybody. This could happen again this september if congress doesnt act. If it happens again, up to 350,000 in tennessee and millions of americans could 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 on the exchange. And for 2018, onehalf of the counties will have one insurer only on the exchange. In tennessee, its 78 of our 95 counties. If we do act, we can limit increases in premiums next year, 2018. We can connell support for copays and deductibles for many low income 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 cost sharing 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, cost sharing payments are extra subsidies or discounts really for many low income individuals who receive premium subsidies under the law. They help these individuals pay for outofpocket 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 some circumstances, they allow a state flexibility 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 who preexisting conditions 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 a section 1332 waiver. Seven states have applied. Two states, alaska and hawaii have received the 1332 waivers so far. Now, to get a result democrats will have to agree to something, more flexibility for states than some may be reluctant to support. 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. A 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 the house representatives based on population, that was a compromise. This is a compromise that we ought to be able to accept. Temporary cost sharing payments were included in both the senate and the House Republican bills to repeal and replace major parts of the Affordable Care act. The section 1332 waiver is already in the Affordable Care act. It just hasnt been very appealing to states because its 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, fixing 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 try to come to a consensus by the end of next week when our hearings are complete so that congress can contact act on what we recommend before september. Otherwise we wont be able to affect insurance rates next year. Thats 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 on health care. Gov by september 27. I believe we can do it here because were plowing have familiar ground. Our goal is a small step and so Many Americans will be hurt if we fail. If we dont do it, it wont be possible for republicans to make political hay blaming democrats. The blame will be on every one of us and deservedly so. Now let me conclude with a word about process. Well have four hearings. Were hearing from state Insurance Commissioners today. Were hearing from five state governors tomorrow. Well hear from various experts on state flexibility next tuesday and a variety of helpful perspectives next thursday includining representatives fro doctors, Insurance Companies and commissioners. This is a bipartisan hearing. That means that senator murray and i have agreed on the hearings, on its topic and who the witnesses will be. The purpose of the hearings is to provide a forum and create an environment for reaching a consensus that we can act on quickly during the month of september. Now, note that we do not have jurisdiction over taxes, including the Affordable Care act tax credit subsidy, nor over medicare or medicaid. Those belong to the finance committee, although there are at least nine members of that committee on this committee. Senators who are not members of our committee are being invited to coffee before each of the four hearings. As i said, 31 senators came to the one today. Senator murray and i have inv e invited them to do that and to participate in this process. My goal is to get a result on a small bipartisan and balanced stabilization bill. Where it makes sense, well work with other members and committees to get that result. Health insurance has been a very partisan topic for a long long time. But the bottom line is 18 million americans need our help. I hope we can stay focused on getting a result. Senator murray. Thank you very much, chairman alexander. I do want to start by expressing my appreciation for your leadership in holding these hearings. It is refreshing to have an opportunity for frank and bipartisan discussions on the Health Care System and consistent, as you said, with longstanding tradition of working across the aisle on this committee. So thank you very much. Im also grateful to each of the Insurance Commissioners who have come a long way to join us today. Your perspective is incredibly valuable in this discussion. Im looking forward to hearing from each of you. And i particularly want to acknowledge commissioner Mike Kreidler who came all the way from Washington State today. Good to have you here as well. Were beginning these conversations at an important moment for patients and families. Theres a lot of work that needs to be done to undo the damage this administration has caused within the Health Care System because this administration is still trying to create trump care by sabotage. Our Health Care System is more stable than president trumps tweetins would have you believe. But it is weaker as a direct result of steps taken. Just last week, this administration cut funding for out reach by 90 and funding for consumer assistance by over 40 . Another pressing example is the 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 likely will have fewer options when they go to pick their plans. That is unacceptable and it is avoidable. Congress can act right away to confirm once and more 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 of both sides of the aisle who agree that we do need to take this step. And i believe it is critical we work towards 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. It takes plans months to develop their rates. If we dont find a multiyear solution, were going to be back in this room trying to patch the same problem a few months from now. Thats 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 few years. We put forward a number of ideas that would help stabilize markets and lower costs in the near term. As i said before, as we Work Together, im more than ready to consider additional ideas from the other side of the aisle to make our Health Care System work better for families and patients. To be clear, that means moving forward, not backward on affordability, coverage and quality of care. Families have rejected the damaging approach taken in trump care which would have raised families costs and gutted critical protections like those for preexisting conditions. And congress should listen. I think were all aware threading this needle will not be easy, but i do believe in agreement that protects patients and families from higher costs and uncertainty and maintains the guardrails in our current Health Care System is possible. This kind of agreement would not only make a real difference for the patients and families that we serve, but it could provide a bipartisan foundation for future work. Ive said many times before this work didnt end when the Affordable Care act passed. Its certainly true today. There is much more we need to do to strengthen the Health Care System, to lower costs, to expand coverage and improve quality of care. 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 trump care and partisanship that weve seen way too much of. Instead, start working on Health Care Policies to help patients and families afford the care they need. Because that is the goal that we should all be focused on. Im so glad weve seen interest on both sides of the aisle for coming together and working to find Common Ground on these issues. I want to thank all of the commissioners and all of our colleagues joining us today. Thank you, senator murray. Our first witness is julie mcpeek, shes commissioner of tennessee insurance. Welcome. Our second commissioner is Mike Kreidler. Senator murray has already welcomed him. Hes washingtons eighth insurance commissioner. The state of washington and the countrys longest serving commissioner. Ill ask senator mccowski to introduce the next witness. It is a pleasure to introduce to the committee an individual who has been before us before, director laurie wing hire is alaskas director of insurance. She has been in that position since 2014 and has done an exceptional job. We recognize not only her service there but she is also the chair of the American Indian and Alaska Native Liaison Committee on the association of Insurance Commissioners. She is, as you have noted, one or alaska is one of two states that has received a 1332 waiver and it has been under the guidance of director wing hire that we have seen that come about. I thank her not only for being here today but for her leadership and persistence in working not only with the Obama Administration but with the Trump Administration in getting that final signoff. Thank you. Senator casey would you like to introduce the next witness . Im pleased to introduce Theresa Miller whos pennsylvanias acting secretary of Human Services and former pennsylvania insurance commissioner. Secretary miller served as insurance commissioner from 2015 through august of this year when she was nominated by Governor Wolf to serve as secretary of Human Services. In her role as insurance commissioner, shes been a vocal supporter of pennsylvanias Health Insurance marketplace, demonstrating a deep understanding of the Insurance Industry while advocating for policies in the best interest of pennsylvan pennsylvan pennsylvanians. Thank you for your testimony today. Our fifth witness is john doke. We welcome you back. You were here before to help us understand the issues. Hes commissioner for oklahomas department of insurance. Hes well known for Holding Healthcare innovation. If you could please summarize your remarks in about five minutes, well then turn to a series of questions from senators to follow that up. Lets begin with ms. Mcpeek. I am commissioner of the Tennessee Department of commerce and insurance. Today i plan to highlight tennessees history with the aca and discuss some Immediate Solutions that congress can consider to stabilize the individual Insurance Market. Before i get started, i would like to thank you for holding todays hearing and for inviting so many of my state regulator colleagues. I characterize tennessees individual Health Insurance market as very near collapse. In the 1