Transcripts For CSPAN3 Federal Officials Testify On Affordab

Capitol hill. Gao officials and health and Human Services Department Inspector general testifying in a hearing that just got under way, house subcommittee, hearing about potential areas of fraud and abuse in the 2010 health care law. Youre watching live coverage here on cspan 3. Welcome mr. Mitchell to the committee this afternoon. Lets start with Opening Statements and get right to our witnesses and we appreciate our witnesses being here today, talking about an important this important subject. Health insurance premiums are soaring. President obama and the administration promised multiple times that Affordable Care act would Lower Health Insurance premiums by 2500. American families are still waiting to see those reductions. Instead, the Health Insurance premiums have skyrocketed under the Affordable Care act. Theres about 25 average increase in premiums just this year. Some americans have experienced even higher premium increases and had to drop coverage because it became too darn expensive. Under the Affordable Care act, they are not just rising premiums. Many have seen massive increases in the cost of their deductible. Health care cost are one of the top care costs for families and people with insurance often times cant afford to use it, especially individuals enrolled in High Deductible Health plans under the aca. There are promises from the administration about increased competition. In fact though, in most parts of the country there are only one or two insure yrs participatingn the exchange. Losses on the exchange are reaching into the billions of dollars. Several large insure urs aers a pulling out of the ex change. There were 12 participating in north carolina. Today only two are participating in the exchanges in that state. In many areas, there is only one carrying coverage on the exchange. The american Affordable Care act was sold as one on one of the biggest political misleading statements of all time. If you like your plan, you can keep it. If you like your doctor, can you keep your doctor. Even the president today apologize for that one. As we examine health care proposals, it is important to keep this in mind. While many received coverage under the Affordable Care act, many more are harmed by the skyrocketing Health Care Costs. Today i want it hear from health and Human Services Inspector General and gao of the Health Care Act and their work in this area. Both of these agencies have done excellent work reviewing Affordable Care act premiums and i want it hear their recommendations on how we can use Lessons Learned from implementation of some of these programs to improve future programs. The work of hhsoig is critical to ensuring health and Human Services programs and im constantly impressed with the great work that comes out of their office. I look forward to hearing about the oigs work relating to the Affordable Care act. Thank you, mrs. Robinson, for testifying on behalf of oigs office today. The office has done great work examining early impact of Affordable Care act on private Health Insurance markets and i look forward to learning more about their finings. Thank you for testifying on behalf of gao today. We are pleased to have mr. Jonathan seagull to hear about his experiences under the aoc. I look forward to your discussion today. Congress needs to find way it make sure americans have access to affordable Health Insurance and can choose among a variety of plans. With that i would now yield to our Ranking Member for his opening statement, then right to our witnesses in our hearing. Gentlemen, from illinois is recognized. Thank you, mr. Chairman. Thank you to our witnesses for joining us today. Millions of people now have high quality Affordable Health care as a result of the Affordable Care act. One of my constituents wrote this to me and i quote, we are so grateful for the changes brought about by the aca in our situation. They have truly been lifechanging for us. For the first time our family has access to dental coverage. This means we actually good to the dentist. Before this, was a rare thing and only when in pain. For the first time our Preventative Care is covered. This means my children are uptodate on their vaccines and physicals because it is not costing me hundreds of dollars out of pocket. For the first time, we have hope that we may be able to dig out of the mountain of medical debt we have accumulated through a 10,000 a year deductible plan that we were locked into because of preexisting conditions because we now can get reasonable coverage through the market place. Mr. Chairman, there are millions of people with similar stories all across the country and all of our offices are flooded by correspondents relating the same. In addition, as a former Small Businessman, i know that the aca has allowed entrepreneurs to flourish because they dont have to worry that starting a new business means they cant afford health care. When people have high quality Affordable Health care they can afford to follow their dreams, their talent, become entrepreneurs like myself, start businesses, create jobs and grow the economy. When they are fearful about losing their Health Insurance or are buried under medical debt, none of those things are possible. The Affordable Care act empowered millions of people. One of them is a witness today, mr. Jonathan seagull and thank you, sir, for joining us. He will testify that guarantee of affordable coverage under the aca enabled hip m to start a ne business. There is fear those gains will be taken away by House Republicans if and when they repeal the Affordable Care act. In fact, today, house rep republicans have not offered an alternative to replace ca that offers the same coverage at a similar or lower cost. Let me repeat that. Today House Republicans have not offered alternative to replace ca that offers the same coverage at a similar or lower cost. The consequences will be seriously harmful to americans. First, a recent cbo and joint committee on taxation analysis estimate that 18 million americans would lose their Health Insurance in just the first year following repeal without replacement. Second the cbo and joint Committee Estimate that premiums would increase by 20 to 25 more than currently projected in the first planned year following repeal. These consequences are not limited to those who bought their health care on exchanges. Aca protections apply to all health plans including those that Many Americans get through their employer. Employer provide insurance plans would no longer be required to offer the same level of care that they do today. Employees with preexisting conditions would have restrictions placed on their care. The lifetime cap on out of pocket expenses would disappear. And we would return to the days when parent could no longer have young Adult Children under 26 on their plans. Removing these protections will hurt businesses, workers and families in my district and across the country. Third, and finally, the economic consequences of repeal without replace would be catastrophic. My home state of illinois stand to lose over 100,000 jobs and 13 billion in gross state output. My district alone would lose 4,000 jobs. Ohio, your state, your home state, sir, could lose up to 126,000 jobs. Repealing without replacing is full hardy and reckless. What House Republicans have proposed so far inspires little trust their plans will actually help americans. We will not sit idly by while the aca is torn down with no replacement. Reneed a replacement that offered coverage at similar or lower cost. I yield the balance of my time. Thank you, gentlemen. We have three goals for today hearing. One, the impact of aca on Health Insurance market including afford gilt quality and access too. We want to see how tax dollars were spent. If there is any waste, frayed in those areas. Uyed in those areas. Ed in those areas. D in those areas. We have a big debate in congress and we want as much information as we can get. So those are our three goals. Well hold the record open for five legislative days for any members who would like to submit a written statement and i want it recognize mr. Growthman for being here. First time he has been part of the subcommittee and recognize if he would like a short opening statement. Our new vice chair, mr. Walker, from north carolina. Jim, thank you for your work as chairman. And hope we are able to really fulfill our promises to the American People in getting to the bottom of some of the issues and concerns we have with ca as a whole. I have been privileged to work with you the last few years. We look forward to seeing what we can get done. Thanks. Privileged to be part of it. Ms. Vicki robin sson is withs today as well as mr. John dicken, director of health care at Government Accountability office. And jonathan seagull, welcome. All will be sworn in. Please rise and raise your right hands if you would please. Do you solemnly swear or affirm the testimony you are about to give will be the truth, whole truth and nothing but the truth so help you god . Please show each of you have answered in the affirmative. You are way ahead of me. Lets start with our first witness, ms. Robinson, you ha. Good morning. Thank you for the opportunity to discuss our work overseeing the federal and state Health Insurance marketplaces established under the Affordable Care act. We are committed to combatting fraud, waste and abuse and impro monthsing integrity and effectiveness in programs run by the department of health and Human Services. Our work looks retrospectively to determine whether programs have worked as they should and prospectively to identify weaknesses to avoid and best practices to replicate in the future. To oversee the marketplaces we examined core Program Integrity questions. Our taxpayer funds being expended correctly for their intended uses. Are the right people getting the right benefits. Is the department managing and administering the programs effectively and efficiently . We identified three types of vowelenerbilities. One, the need for tighter payment controls to prevent wasteful spending. Two, the need for more reliable processes to insure accurate ability terminations for applicants. And three, the need for improved management. Our findings and recommendations are detailed in my written testimony and in our reports. Let me offer some examples starting with cms. Cms was hampered in its administration of the advanced premium tax credit that provides subsidies to help consumers afford insurance. At the start, cms used a manual financial process that did not collect data on enrollee by enrollee policy level payments. Rather cms collected only aggregated payment data from insurers. As a result we found that cms was not able to verify the accuracy of payments to insurers nor than enrollees benefitting from the payments had paid their portion of the premium as required. We also found efficiencies in th the establishment Grant Program. Most states we examined failed to allocate cost properly between their establishment Grant Funding and funding for other programs that shared systems with the marketplaces such as medicaid. This resulted in states overclaiming federal establishment Grant Funding. Further, we found vulnerabilities and eligibility verification processes about the federal and state marketplaces. For example we found the marketplaces did not always properly verify Social Security numbers, citizenship, and household income. Finally, we identified weaknesses in management of the federal marketplace including poor oversight of the many contractors engaged to build it. For example, cms waited far too long no hire a systems integrated to coordinate the work of the contractors. We examined cmss management of the federal marketplace across the fiveyear period. We identified many missteps that contributed to the poor launch of the healthcare. Gov website. We also identified better Management Practices that contributed to subsequent improvement. These included for example a signing clear project leadership and fully integrating technical and policy staff. Our work offers important lessons to inform management of complex policy and Technology Projects now and in the future. To close, protecting taxpayer investments and consumers requires vigilance and sustained focus. Program integrity should remain a priority for the designed a operation of current and future programs. Preventing, detecting, and remediating problems is our collective mission. Thank you again for inviting me to appear today and i look forward to answering your questions. Thank you, ms. Robinson. Mr. Dicken, youre recognized for five minutes. Thank you. Im pleased to be here today as subcommittee discusses the Patient Protection and Affordable Care act. Ms. Robinson highlighted some of the Inspector General findings related to Program Integrity. My comments focus on the Affordable Care act in relation to Health Insurance markets highlighting findings from recent gao reports on insurer availability variation in ream yums and enrollee satisfaction. Many of these provisions took effect in 2014. For example the act prohibits issuers from denying coverage or premiums based on Health Status or gender. There are tooeriers, gold, silv and platinum. Also haej Insurance Exchanges in each state from which participants select from a plan. About 11 million puarticipants purchased in 2016. The law required gao to report on competition and concentration in Health Insurance markets. In a 2016 report, we found that Health Insurance markets were concentrated among a small number of issuers in most states from 2010 through 2014. Before the three margelargest is had at least 80 of enrollment. During the first year, it was generally more concentrated among a few issuers and true for overall markets. Gao is also reported on consumers access to health plans offered through the exchanges. In 38 states for which gao had sufficiently reliable data, most had six or more broad, virl asi and gold tier plans available. For example, 94 of counties had at least six silver tier plans available in 2015. Since gaoish id the report, hhs reported the decline in the number of issuers participating in the federally facilitated exchanges in 2017. According to hhs all consumers continue to have multiple plan ochgss but for about 21 of them the options were limited to plans offered by sage issuer. Gao also reported on the considerable variation on premiums available to consumers in 2014 and 2015. For example, in a arizona in 2015, the lowest cost silver plan for a 30yearold consumer was 147 per month. But in may, the lowest cost silver plan for 30yearold was 237 per month. The range of premiums also varied considerably by state. While the lowest cost silver plan for a 30yearold arizona, the highest cost silver plan was 545 per month. A difference of 270 . In contrast, in rode island 2015 premiums for silver plans available to 30yearold range from 217 to 285 per month. A different of just 3 it . More recent analysis by hhs found premiums for Exchange Plans increased more in 2017 than in earlier years. Average of 25 from 2016 to 2017 for the Second Lowest cost silver plans in states that use federal facility of exchange. In comparison average premiums for these plans increased 2 from 2014 to 2015 and 7 from 2015 to 2016. Finally, rhelet me close with k findings from a 2016 gao report on Enrollee Experience answers health plans offered through the exchanges. Most Exchange Enrollees report being satisfied overall with their plans in 2014 through 2016. According to three thagsal surveys. This report satisfaction was either somewhat lower than or similar to that of enrollees and employer sponsor plans. While most enrollees express overall satisfaction, concerns in enrollees experiences with Exchange Plans were revealed in other information gao collected from literature. Often consistent with long standing consumer concerns about private Health Care Insurance generally such as fordbility of out of pocke