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 witnesses 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 million 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 and i think they have been refreshing for most of the members of the senators who are hungry for that sort of opportunity to see if we can Work Together to get a result. At last weeks hearings we heard from state Insurance Commissioners then from governors, on tuesdays, from experts in state flexibility. During those hearings, three things three themes emerged in my opinion that represent a working consensus for stabilizing premiums in the individual Insurance Market in 2018. First, the first theme is congressional approval of continued temporary funding of the costsharing payments that reduce copays and deductibles for many lowincome americans on the exchanges. Second, senators from both sides of the aisle suggested expanding the socalled comper plan already in the law. So anyone not just those 29 or under could purchase a lower premium higher deductible plan that keeps a medical catastrophe from turning into a financial catastrophe. Third, advocated by state Insurance Commissioners. Governors and senators. Give states more flexibility in the approval of coverage, choices and the prices for Health Insurance. Most of the discussion about flexibility is centered on amending section 1332 state innovation waiver because it is already a part of the Affordable Care act. In looking at 1332, we heard a number of commonsense suggestions about how to improve and speed up the process. Such as reducing the sixmonth application review period. And allowing a copycat application so that if senator murrays state gets something approved why cant tennessee come along and say, we want to do what Washington State did with one change. Such changes will make it easier for states to use 1332 waivers to create programs like the Reinsurance Program in alaska. Or the invisible highrisk pool in maine to help cover highercost individuals. At tuesdays hearing on state flexibility, witnesses recommended how to amend 1332 to give states authority to offer a larger variety of Health Insurance plans with varying benefits and payment rules. That was discussed extensively at our hearing on tuesday by all five witnesses. Several witnesses suggested that actuarial equivalency is a useful way to do that. That means that while states might be able to offer plans with varying levels of benefits that the value of those plans to consumers has to be similar to the plans currently offered on the Affordable Care act exchanges or the individual market. At our hearing on tuesday, former governor michael leavitt, a former secretary of state of health and human services, suggested that, with this approach, plans would be of equal value but wouldnt have to be carbon copies of one another. He used a car as an example. He said, if you looked at several 25,000 cars, one might have a backup camera, one might have more horse power, but theyre still 25,000 cars. So health plans might have different benefits, but they have to be of the same value to the consumer. He testified that this actuarial equivalence would give states, in his words, the ability to construct an option menu of benefits and provide either the state or even consumers with the ability to choose plans that weigh those differently, unquote. The governor of massachusetts made a similar suggestion last week at our hearing. He said that, with current regulations and guidance, 1332 waivers are administered in such a way that massachusetts cant offer anything but an existing Affordable Care act exchange plan. Governor baker testified, quote, greater flexibility is also needed around benefit design. Valuebased insurance design approaches to benefit design seek to align patients out of pocket costs such as copayments and deductibles with the value of services. He continued, massachusetts is committed to providing access to quality affordable Health Insurance for our residents rather than walking away from that commitment. We believe that increased flexibility would allow us to meet this commitment in more effective ways. End of quote. This type of approach to insurance allows individuals the opportunity to have a more personalized Health Insurance plan. It can benefit healthy individuals as well as those with complex and chronic medical conditions. I made clear at tuesdays hearings, and i want to repeat, that i am not in any way proposing that we change the Patient Protection guardrails already written in section 1332. Including the preexisting condition protections that nobody can be charged more if they have a preexisting condition and that everyone is guaranteed to be sold insurance. The requirement that your insurance policy cant be rescinded, that those under 26 may remain on their parents insurance, and there may be no annual lifetime limits on your Health Benefits. Thats not a part of the proposal, changing any of that. Our goal is to see if we can come to a consensus by early next week so that we can hand senator murray and i could hand with hopefully the support of several republicans and democrats, could hand senator mcconnell and schumer an agreement that congress can pass by the end of the month that will help limit premium increases for 18 million americans next year and begin to lower premiums after that and to prevent insurers from leaving the market where these 18 million americans buy insurance. So thats our schedule. Now, what happens if we dont succeed . Last year 4 of american counties had one Insurance Company on the exchange. This year, 36 have one insurer on the exchange. And for 2018, cms tells us that one half of counties will have 1 or 0 insurers on the exchange. In tennessee its 78 of 95 counties. We have heard from the state Insurance Commissioners that this by itself, this monopoly in so many counties, drives up premiums because it creates the monopolies. Without costsharing reductions as has been pointed out by several senators, the congressional budget office, joint committee on taxation and our witnesses have said, that premiums will increase an additional 20 in 2018. So, premiums go up 20 . The federal debt goes up 194 billion over ten years to pay for the higher premiums. And 5 of the people will be living in bare counties after just one year according to cbo and joint tax and our witnesses. 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 District Of Columbia has said that the president , whether its president obama or President Trump, does not have the authority to continue costsharing reduction payments because Congress Never appropriated the funds. Thats what the court said. I want a result and a part of a result that limits premiums in 2018 and begins to lower premiums in the future is flexibility for states in the approval of coverage, choices and prices. To get a result republicans will have to agree to something that many dont want to agree to. Additional funding through the Affordable Care act. And democrats will have to agree to something that some are reluctant to agree to, and thats more flexibility for states. Thats called a compromise. I simply cant go to the republican majority in the senate, the republican majority in the house, and to the republican president , to extend the costsharing payments without giving states more meaningful flexibility. Now to todays hearing. Were looking at what patients are facing if we dont reach a compromise. For example, we will hear from a patient, a doctor and a hospital about what happens when an Insurance Plan leaves your state and when you lose your doctor in the middle of your care. Its clear that to truly protect patients we need to stabilize the market, limit premium increases and begin to lower premiums in the future. I look forward to the testimony of our witnesses. Senator murray. Thank you very much, chairman alexander. I am really grateful to you for returning us to this committee process, and i think its been very productive. This is really the way things ought to go and the way we should be getting things done in the senate. I really appreciate your leadership in this. I want to thank all of our colleagues who are joining us today and our witnesses who are taking time out as well. As the chairman said, this is our last scheduled hearing on bipartisan steps we can take to stabilize the individual market. Insurance market, so that millions of americans wont face higher premiums and fewer Coverage Options in 2018 and beyond. I am really pleased that we have had very productive bipartisan conversations over the last two weeks. And the coffees weve held with witnesses and in the hearings themselves we have gotten valuable input from governors, experts and members on both sides of the aisle as well as from senators who dont serve on this committee but care deeply about making sure our Health Care System works better. I am grateful for all of this input, and i think it indicates an enormous amount of Common Ground on key issues. So i want to take this opportunity to talk about that in a little bit of detail. We have heard from many people, including republican and democratic witnesses, who see the need for multiple years of certainty on out of pocket Cost Reductions as well as the need for reinsurance to assist states in strengthening markets. And we acknowledge the importance of making sure outreach around open enrollment is robust and effective so that families are informed about their Coverage Options. I was also glad to hear in tuesdays hearings that we agree on the need to uphold Patient Protections in any deal we reach. I have been glad to hear ideas inside these hearings and out for offering more flexibility to states. Many of which takes approaches that dont undermine our core goal of stabilizing the markets and lowering costs for families. Governors have suggested ways to speed up and streamline the process in ways that dont result in coverage loss or raise patient costs or undermine quality of care. Insurance commissioners and patients have talked about ways to increase flexibility and actually allow for improvements for patients but without putting Insurance Companies back in charge or undercutting core Patient Protections. So i am really encouraged by that and hopeful we can get a result. To be clear, some of the proposals i have heard discussed would leave people vulnerable to negative consequences like undermining the essential Health Benefits or taking us back to a time when plans didnt cover Maternity Care or Substance Use disorder for Mental Health or Prescription Drugs. That would be unacceptable. And i dont think either side expects that we settle on those larger issues in this current negotiation, but i am very confident there is room for Common Ground right here in the coming days that makes it easier for states to innovate in ways that make Health Care Work better for patients, and i am looking forward to continued discussion on that. I feel optimistic that there is much more we agree on than disagree, and si thii think mans here today feel the same way. I want to express my appreciation for all your work mr. Chairman for getting us to this point. People across the country are looking to congress for solutions on health care. It is a deeply personal issue and one thats been far too partisan and divisive for too long. I hope that our conversations over the last few weeks can mark a turning of the page away from that kind of partisanship and that we can take steps in the next few days in a very short amount of time. Then i hope we keep the conversation going in this committee in the months ahead. So, with that, again, i want to thank all of our witnesses, again, for being here for the coffee this morning, for your input and for your willingness to come share with us your ideas. Thank you very much, mr. Chairman. Thank you, senator murray. I am pleased to welcome the five witnesses to todays hearing. I thank each of you for taking the time to testify. First dr. Manny sethe. President of healthy tennessee and an orthopedic trauma surgeon from nashville. He and his wife are founders of healthy tennessee, a Nonprofit Organization designed to promote Preventive Health care. He is an assistant professor at Vanderbilt University and the director of the Vanderbilt Institute center for health central. Senator baldwin, would you introduce the next witness. Thank you mr. Chairman and Ranking Member. I am honored to introduce susan tourney. Ceo of the Marshfield ClinicHealth System in wisconsin. Dr. Tourney has a wealth of experience, including as a practicing internal medicine physician. She has also held leadership positions at the medical Group Management association and the wisconsin medical society. Marshfield serves over one million rural wisconsinites through its Health System and its Insurance Plan, Security Health plan. The population is older, has lower average incomes than most in our state, which is why they have such a critical story to share about the benefits of the health laws protections but also why we need to ensure immediate and longterm stability for the wisconsin market to allow marshfield to maintain this success. In fact, Security Health plan recently expanded in our state to ensure that we would not have a bare county after another insurer left. We must do our part and provide longterm federal certainty. Dr. Tourney, welcome to the committee. Thank you for joining us to share your expertise and experiences. We really appreciate it. Thank you very much, senator baldwin. Senator bennett, would you introduce the next two witnesses. Thank you, mr. Chairman. Its a privilege to have two people here from my home state of colorado. Christina postalowski is the Rocky Mountain regional director for a nonpartisan research and Advocacy 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 has appeared in national and state news outlets. Robert ruiz moss serves as Vice President for anthem where he oversees the companys individual market business across 14 states, including colorado. Mr. Ruiz has extensive experience in health care. In fact, governor hickenlooper, who testified before the Committee Last week, appointed him as an original board member of the colorado Health Benefits exchange. Mr. Ruizmoss is also an alum of the university of colorado at boulder. Its been a good month for our state and the Health Committee and i think its been a good month for our committee overall. I apologize to the witnesses. I have two other hearings this morning so i am going to be going back and forth. Thank you. Thank you. Senator scott, would you introduce our remaining witne