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tv   State Governors Testify on Health Care Insurance Market Stabilization  CSPAN  September 7, 2017 9:07pm-12:18am EDT

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and when organizations outside of government are taking solutions a modernizing, government cannot afford to fall behind a keep its head in the sand. these are management issues that have been important to address and now we'll tackle it head on. >> cr conversation with veteran affairs secretary david on friday a p.m. eastern on c-span. >> c-span, where history unfolds daily. in 1979, c-span was created as a public service by america's cable television companies. it's brought to today by a cable or satellite provider. >> max, bipartisan group of -- meet to talk about the insurance
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market. the governors of massachusetts, montana, tennessee, utah and colorado spoke with members of the senate health committee about issues including allowing states to innovate and create healthcare pools. the hearing is just over three hours. [inaudible] [inaudible] [inaudible]
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[inaudible] [inaudible] [inaudible] >> the senate committee on health education labor and pensions will come toward her. were holding are second to four hearings on stabilizing premiums and ensuring access to the individual health insurance market for the year 2018. that is our focus. we are delighted and honored to have the governors of five states here with us today. thank you gentlemen. we know how busy you are. you have come long distances to be here. we appreciate it with the court learning from you. senator murray and i will have an opening statement to introduce the five governors. sounds like a singing group. then senators will have an
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opportunity to ask witnesses five minutes of questions. we just left a meeting where the governors met with senators [inaudible] our committee, we had 30 senators there similar to yesterday we had state insurance commissioners here. thirty-one senators most [inaudible] the committee meet for an hour and then we had 22 of 23 members. for two consecutive days we've had half members of the united states status and focus on a single narrow objective. what can we do in the next couple of weeks? that's a tall order. the next couple of weeks that the senate, the house can pass that will help 18 million americans in the individual insurance market. the individual insurance market is 18 million americans, just 6% of those who have insurance and
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about half of those don't have government help to buy insurance. enter those americans getting hammered by the higher premiums and higher co-pays and deductibles. tennessee's insurance commissioner testified yesterday. she said her states individual market is near collapse. blue cross pulled out of the individual market last year in knoxville, nashville and memphis, not just for the subsidies, but for everybody. even the people who do not get government subsidies could invite from blue cross in those markets. just yesterday and ensure in virginia announced it will pull out leaving 62000 virginians facing the real prospect of having zero options for insurance next year.
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this could happen again next year in tennessee and virginia if congress doesn't act. in our state up to 350 tennesseans, songwriters come self-employed, farmers and millions across the country could be left with their options a sum in virginia might be. if we do act we can limit increases in premiums in 2018, we can continue support for co-pays and deductibles for low-income families. we'll make sure health insurance is available in every county and laid the groundwork for future decreases. yesterday we had a focus hearing on the narrow part of the market. we asked our witnesses as we do today to focus on individual market and what we can do to keep premiums on a 2018. were interested in anything you have to tell us but that is our focus today. yesterday i heard thing three things, dressing high-cost individuals three reinsurance or some other model, continuing the
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car sharing reduction payments and more flexibility for states and the laws 1332 waivers. one discussion is how to address the high cost of care for the sickest population. seems to me the senators on both sides of the eye understand that discussion is like to be part of any long certain term solution on the individual market. the individual market has sick people, it's small we have to find some way to deal complex cases. some have suggested a new federal program but under the minnesota and alaska plans states are using the federal money they're getting to set up reinsurance programs and it was predicted 20%. we heard a number of good ideas for the short term. one thing i would like to know
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is, is there anything we can do to section 1332 specific in the next two or three weeks to make it easier for more states to do it alaska minnesota are doing with their reinsurance program. as a former governor, unless this is changed over the next few years according to the congressional budget office the government will be spending about $1 trillion on medicaid expansion. 866 billion new dollars to subsidize insurance market. to subsidize insurance market. number comes out to about $4200 in the individual market. the federal government has a 20 trillion-dollar debt. so if we need to address complex health issues why don't the states to it? for example, alaska came up with
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its own state plans to come up with its own plan. every designating them then they came up with more money planning to use roughly hundred 35 million in state funds that it was already getting. maine did it by adding a 4-dollar precharge health insurance policy per month. says we think about the need for more complex health cases we need to think about the state cheryl to be. yesterday's hearing we heard suggestions for the short-term on improving the 1332 waiver. these suggestions ought not be to controversy including reducing the six-month waiting period, allowing a copycat application if montana gets a waiver why should they have to go through the same things again.
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that i to speed things up. another is to allow just the governor or perhaps insurance commissioner who'll apply for the waiver and not wait for the legislators to pass a law since i made only every two years. i was intrigued because of the budget neutrality requirement in a commonsense way to support states long-term plan. then is there way to combine the waiver with the state medicaid 1115 waiver. another new hampshire is trying to do things in that area and even the democratic governors a republican governor supported they're not able to do it. another possibility mentioned by several senators on both sides of the aisle would be allowing lower cost copper plans to be sold. that is already in the law.
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plans that are more appealing to younger and healthier people. right now if you are 29 and under you can buy the plan with higher deductibles and lower cost but not if you're over 29. that's a shortlist that might make real difference in the 23 states have started the process. i'm hopeful maybe some continuation of continual cost-sharing and significant changes in flexibility with statements probably through changes the first two things might provide a basis for action that we might take this month on them will count on the president to take advantage of that. this would not in the process, that would be step one and then we go quickly on the step two
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and hope we can spend most of our time of the larger issue of healthcare costs. i mentioned yesterday but it's worth repeating. several governors mentioned it that for seven years we've been stuck in a partisan stalemate on health insurance. most of the argument about 6% of the insured americans to buy their insurance on the individual market when we really should've spent more time on the fundamental problems of the healthcare system that caused it to grow to consuming 9% of the gross domestic product in 1980, about 40 years ago to nearly 18% in 2015. at the same time of the phenomenon of 5% of those who receive healthcare consuming 60% of the cost. we should be doing more and those larger questions of healthcare costs. no question about it. look at how we pay to go to the
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hospital, how much pace paperwork increase our costs. what can be done to encourage wellness and prevent more serious illness and disease we should look at the real ways to bring down the cost of healthcare which is the best way to reduce the cost of health insurance. >> thank you very much permit. after so much partisanship run the future of healthcare in a country i'm glad these hearings give us an opportunity to take a different approach and find common ground. i appreciate your leadership in starting this conversation and i'm grateful to all colleagues were joining in. want to thank the governors who are here today. i know there neighbors either started be your age, was a requirement or did that just
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happen? great to have you here today as well. governors at a valuable purse active to the healthcare discussion so far. i'm glad we can get your input as we gather the next face to stabilize the markets and lower the cost for constituents. there is a lot many democrats and republicans agree and when it comes to the school. even if we don't all agree on the cause, we do agree on the problem itself. families are facing higher premiums of your options as a result of uncertainty. democrats have a number of ideas which i'll discuss with you. i'll give a few examples we reduce to multiyear fix to reduce reductions. we'll need long-term stability for the program if we want
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insurers to stop worrying about uncertainty long enough to lower premiums for patients. senator kanan carper put forward -- other senators have proposals on how we prevent bigger counties moving forward and many are interested in ensuring open roman is expected as possible given the decision to flash efforts to help people get coverage. not just democrats in the senate were looking at ideas to strengthen markets and lower healthcare costs. governors case again -- have put forward a plan including policies that parallel those i've mentioned. their plan should help inform our conversation in congress. i was pleased that the plan would maintain protections for
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patients with pre-existing conditions in women seeking maternity care. we need to move the health care system forward not backward. it's not an opportunity to rollback protections for patients or hand power back to the insurance companies. i hope we can focus on areas of common ground if we could do this, i believe a bipartisan agreement on healthcare reform as possible, not easy, but possible. i'm hopeful we can succeed and build on the near-term steps to tackle largish challenges families face in getting the affordable care they need. i want to thank the chairman for moving us forward on this in the governors who are here to help with the discussion. >> thank you. i think people know how much respect a have for senator murray.
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this committee has gotten big results on issues we've had in the past. were trying to take a small step here that will lead to bigger steps. leonard is the first two witnesses in : senators warren, bennett, and hatch to introduce the other senators. the first is governor bill has of tennessee. i think i'm right, tennessee has the most taxes and debt investors improving schools and number one state for jobs. that's her story and we're sticking to it. governor has been indispensable and been terrific governor. governor bullock from montana. steve bullock is a democratic governor in the state with the republican legislature, they work together to expand medicaid
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he's but the state checkbook online so montanans can see how tax dollars are spent. we welcome you and thank you for coming across the country for being here today. >> thank you mr. chairman. i'm pleased to introduce massachusetts governor charlie baker. he served as governor massachusetts since 2015 is currently the cochair of the national governors association health and human services committee. particular reason to have them here today, he previously served as massachusetts secretary of health and human services as well as secretary of administration and finance. before becoming governor he served as a decade as the president and ceo of harvard -- healthcare insurance company basin mostly, massachusetts.
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it serves the entire new england region. massachusetts has a long history of bipartisan cooperation on health reform. it's one of the reasons our state healthcare system has become a model for the rest of the country. the governor and i have continued that and i'm glad congress is starting to that direction as well. thank you for being here and for contributing your expertise to this conversation. >> welcome governor. senator bennett thank you for your bipartisan approach to the work that's in front of us. there is an anybody i know who epitomizes bipartisanship more than my governor. i was his chief of staff. some things he knows he came to colorado as a geologist and he promptly lost his job and his
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insurance by the way. that didn't stop him. he created the first microbrewery that existed between chicago and los angeles and he became a very successful businessman. he became mayor of denver and he went out wrangle 34 mayors in the denver metro area, many republicans to raise sales tax to pay for what is now the newest light real system in the country and covers an area the size of connecticut. he continued that work and brought environmentalist and industry together to create the first methane regulations in the united states. he has worked with john king sick from ohio to create a bipartisan path forward that other governors have supported.
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in closing, we have the lowest unemployment rate in the united states of america. that's our story, were sticking to it. >> thank you. welcome governor. >> i'm pleased to be here today to introduce my friend and colleague, governor gary herbert. his guidance and leadership has been important to both myself and many on a variety of issues, in the great state of utah. the governor has been a leader in addressing opiate abuse and a trailblazer and how the opiate crisis addresses homeless populations. state and transformative policies in our country. governors deserve our respect and appreciation for their timeless advocacy to improve daily life for their citizens. under his leadership utah has
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been at the forefront of providing innovative cost-effective high-quality healthcare to its constituents. i'm pleased he's here to share his perspectives. we have frequently discussed the issues plaguing the individual market as a result of obama care. he's engaged in the policies and is aware of how they interact with other state efforts that aim to provide access to critical care toll you toss. he's aware of the need to deregulate the individual and small group health insurance markets to put the power back in the hands of the state. it requires structural reforms obama care not just bailouts. we are fortunate to have the governor here today. i look forward to continuing to work with him to advance the health and wellness of all utah's. i wish i could stay for the discussion but i need to go chair my committee on children's
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health insurance. i leave the commentary to you to in the capable hands of our beloved governor i'm happy to say is a close and personal friend. i appreciate you allowing me to do this the madam chairman. >> welcome and thank you. the governors information when it comes to taxes, medicare medicaid the finance committee and our system has jurisdiction over that. . .
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these are good times our unemployment rate is the lowest in history and became the first in the nation to offer two years free community college or technical school to all of our citizens. taxes and income and debt per capita are among the lowest if not the lowest in the country but the crisis of health care and uncertainty of the future threaten the citizens and budget. the primary difference between governing and now and governor
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lamar alexander 30 years ago is the impact the cost of healthcarhealthcare has on ever. today, tennessee finds itself with insurance carriers offering compliant coverage and more than 80% of the counties, citizens have only one insurance option and the limited options have prevented substantial cost increases. the experience of fewer choices and higher cost is not sustainable from the insurance marketplace or can't pay for the limited options that are available to them. either way the system fails. congress should take steps to prevent against the collapse.
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in tennessee about 60% of the federally facilitated marketplace participants are enrolled in plans. failure to fund payments will increase premiums significantly concrete even more uncertainty around the future of participating carriers and increase the federal deficit t. this is not a recipe for success but it's also important to understand the marketplace is facing collapse before the current discussion of payments and other actions and reforms will be needed to address the crisis. second, congress can take additional action by funding a short-term reinsurance program to provide coverage in the marketplace this should produce lower premiums which in turn should attract newer healthier individuals to the marketplace. a third critical way to provide more stability is to offer flexibility to the states to
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address the challenges and circumstances the waiver approval process should be expedited and the guard rails placed upon the manner that would attract younger healthier individuals to the marketplace. i realize that some of the things i just outlined around a stabilization cost more money, but i'm asking for this at a time that many governors including myself are emphasizing the skyrocketing cost of health care. but the reality is the failure to address the immediate stabilization needs while congress works on the bigger issue of cost are almost certainly the result of the collapse of the market. some say the way to ensure its total collapse. i don't subscribe to that line of thinking. i think every governor here and goes back at homthose back at hy can move to stabilize the market now while we work to take on the issue of health care costs. having helped destabilize the
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market i hope the committee will turn its sights to the cost of health care which is crippling the businesses and families in overwhelming all the other needs that should be addressed in state and federal budgets. we must all recognize that has been missing in the argument over the affordable care act. of the wall was supposed to solve two critical issues in america. at the first was the large number of people who didn't have health insurance or couldn't afford coverage. one of the criticisms is that it took the easy part two provide free or subsidized insurance to more people without simultaneously addressing the hard, addressing cost. we shouldn't kid ourselves. addressing cost is difficult politically and otherwise. one of the drivers is the
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misalignment of incentives this created when we compensate providers based on the volume of care that we provide rather than the outcomes on efficiency. in tennessee we are working to change the way we pay for and deliver healthcare so that providers are compensated based on value and congress should make a commitment to this innovation. all of us, republicans, democrats and independents should agree that the correct path is not sustainable. during the debate about the affordable care act cometh there's been a lot said about how amoral it would be to lose health insurance coverage. i understand the argument. i'm a republican governor that proposed a plan to increase medicaid coverage in the state. however, can't we all acknowledge that it is questionable to cover everybody with health insurance and the bilputthe bill on a credit carde paid by the grandchildren.
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as governors we stand ready to partner with you to strengthen the market and the entire healthcare system. >> thank you, governor. welcome. chairman alexander, ranking members of the committee thank you first for inviting governors, democrats and republicans to appear before you today. whatever comes out of washington, d.c. or doesn't we are on the frontlines of dealing with it and you recognize the importance of the involvement of the discussions are significant. it's the uniform objects and of the minority party i applaud the members of the kennedy for doing
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all you can to ensure congress doesn't repeat errors of the past or of the past months. we are all familiar with the old adage the only way is one byte 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. any governor in dc may seem like a zero-sum game. we see a win-win scenario. if you earn 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 the further efforts. following the elephant analogy is maybe only one byte of the committee is taking but it's an important one.
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last time i was with chairman alexander again and a bipartisan group of governors handed out a guide to the basics of health care coverage. they only represent 6% of those and 4% of the total insured. it impacts all areas of coverage and has a highly pronounced impact on places like where i live. what rove montana is less likely to have that option of employer-sponsored insurance. today, 8% of those injured in montana are on the individual market. three out of four enrolled in the plan are from the rural and frontier areas of the state. 84% of all in montana and rolled in the marketplace plan received tax credits to make the premiums affordable and have perceived the cost-sharing reduction
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payments. it does not take a brain surgeon to figure out how to stabilize the market. the effort led by the governor pick a number and case that offer roadmap and a member of options the committee can take. while the perspectives of the committees appearing before you today are certainly as diverse s of the landscape that we represent, we are uniform in insisting the cost sharing reduction payments to be continued. all of us in our testimony urge you to create a temporary stability. we all agree to be covered in order to spread the risk.
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if the committee will work across the aisle with one another to undertake the measures you will accomplish your aim and stabilize the individual market. if you just did a csr payments, you would take the contestants to do so. it also doesn't take a brain surgeon to sabotage the current system. in action and the message is coming from some in the arguing it is now. the largest insurer proposed a rate increase for next year ten times higher than it would have been because of the uncertainty the president and the dc has created. finally, more important than being the governor, i am a parent and gripping my first state of the state address five years ago, i urged policymakers to act like our kids watching and learning from behavior, our words and the because indeed
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they are. i would implore you to do the same in the time of seeming dysfunction, the committee and the congress can work together to stabilize the individual markets 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's good for the country. thanks for having me and my colleagues here. i look forward to the conversation that we will have over the next couple of hours. >> governor, welcome. thank you chairman and alexander and ranking members of the committee. i want to thank you for the opportunity to be here to testify on stabilizing premiums in helping individuals and individual insuranctheindividua. i'm honored to be part of the group of governors testifying
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today because we deal with these issues every day and want to work with congress and the government on a healt health-cae reform. massachusetts has achieved near universal coverage with the highest rate of health insurance in the nation and that is a story i'm sticking with. we have been working this for more than ten years at the center of the bipartisan success is the belief that health care coverage is a shared commitment is not the singular responsibility of government. as you consider measures to stabilize premiums and address the individual market i would like to emphasize two key poin points. affordable care coverage and stabilizing in the market. congress should take immediate steps to resolve the federal cost-sharing reduction payments until longer-term reforms are enacted. their ears and employercarriersd people all need certainty about what the rates are going to be
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and month-to-month resuscitation is not stabilization. it should be maintained for at least two years. the reforms are considered and a contributor to the younger and healthier people in the market. massachusetts passed its line in 2006 we included an individual mandate by support and for starters, no one knows when they might get sick or have a tragic accident. once it happens it will be provided. everyone will be paying for the culture service has been rendered. many will purchase health insurance only when they needed anneed itand drop it once the cs provided.
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there's a critical element in ensuring that everyone is treated fairly. different states can choose different approaches but if we want to make it affordable for people who do not have access to coverage that work and don't qualify for public coverage, we need to manage everyone into purchasing coverage and then keeping it. third congress should establish parameters for insurance market reform that included greater latitude to meet the needs of the marketplace is. they should be brought in for the state flexibility. so secret massachusetts is committed to continuing to provide access to high-quality affordable insurance to the residence and the waiver flexibility would allow more effectively to meet that commitment. three areas where the changes would be significant benefits to the state or a central health benefits compliance and budget
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neutrality. massachusetts is a strong benefit state and we support essential health benefits however even in our state it as a challenge to adapt the aca. congress should take action to address the costs and one critical driver is the rising pharmaceutical costs. among other actions, safely expediting the approval process and increasing competition by ensuring generic drug availability and opportunities for the public appears to negotiate prices should be pursued as you consider these and other reforms in the system i would ask any adjustment of changes that occur on a gradual timeline ideally with state flexibility to opt out of existing programs in order to prevent market shock and improve stability. finally if the governors are responsible for the health of the state's as well as the residence before they play a
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significant risk any reform should shift a greater financial burden on the states. complex legislation requires fine-tuning adjustments and we have repeatedly revisited software reform as we learned implementation and its conditions of change and the commonwealth is better for that. i would urge congress to commit as we did returning to the table in a bipartisan fashion to revise any enacted reforms in the coming years. thank you again for the opportunity to provide testimony on this issue and we look forward to working with you and other members as you consider legislation. i submitted testimony that goes into greater length and we will be happy to take questions on that or anything else. thank you, governor baker. governor taken hit hi.
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thank you all the members of the committee i appreciate the opportunity to testify and to share our bipartisan plan for stabilizing the individual health insurance market. in 1932 for the laboratories of democracy he said and i quote the state may if the citizens choose serve as a laboratory and choose economic experiments without risk to the rest of the country. in colorado we implemented the act for seven years as long as i've been governor. for many it's been a success with bipartisan support the expanded medicaid and created a state-based marketplace. around 600,000 in colorado now have care because of the aca.
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that's 10%. but many people are angry and have a right to be. the united states is a high lonely island and we spent almost twice as much for worse care. it was poverty and health not quantity. for the 400,000 colorado individual marketplace, many continue to struggle. colorado has 14 counties, almost 25% of the counties that only one in sugar on the exchange and home to some of the highest in the country. a 60-year-old in colorado making less than $50,000 will pay over $12,000 a year on premiums alone around 25% of their income. that is simply unacceptable. even worse, the division of veterans is projected to premiums will increase by as much as 27% for 2018.
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that is a big problem. our bipartisan group of governors including the governor that is not here have been working on a common sense set of solutions to make the market more stable for this crucial part of the population. our plan asks you to fund the cost-sharing reductions through 2019. funding for 2018 alone will put us right back where we are now in a matter of months and foster uncertainty threatening to drive up premiums and force insurers out of the market. we also need your support by creating a stability fund to help us set up reinsurance or similar programs. we hope you will fully fund and strengthen federal risk sharing
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programs if they are also requesting tax incentives for insurance companies to enter counties only one insurer bill giving american americans to woe counties the option to buy the same insurance for federal workers have. 1332 gives states the ability to innovate lower cost while ensuring certain guidelines are met that existing regulations limit the ability to come up with solution and applying the budget neutrality provisions of this section. to empower consumers with price and quality information and we can't stabilize without the priorities of the cost light weight management, tobacco cessation, family planning and
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injury prevention. they've proven we can innovate. we learn from mistakes. that's part of the laboratory for democracy. we try to stretch federal dollars and pinch pennies. we are reducing the cost and promoting a competitive market with proven care and increasing transparency. we have a lot to be proud of with the action and inaction it's time for the government to work with us, not against us. one of the famous mountains without a parka it can be done. we need immediate action and reforms to preserve and control costs. i appreciate your efforts returning to their regular order in the senate the solutions that make it more affordable and markets more stable we need
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support from both sides of the aisle and leadership in the states and i look forward to answering questions. >> thank you chairman alexander and members of the committee we are honored. it protects the family in utah that are not self-employed it would be irresponsible to allow these markets to collapse simply because of political paralysis or an action. serving on the national governors association and the western governors association and soon to be the next president of the council and state government, i have a broad appreciation for the role the states have in the federal system. therefore i would urge congress to get past the health care in passing a delegate the responsibility to find solutions to the laboratories of the democracies as the governor mentioned. i would recommend allowing each
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state to take on the role of the health-insurance markets. you can diversify the social economic and political risk associated in the policy change by letting them experiment as luxuries as democracy to determine what policy works and what policy does not work. the state of utah has one of the lowest costs in the nation that certainly stems from the local culture and demographics but also comes from such practices as evidence duplication of services innovative use of managed care organizations and empowering doctors and patients alike to make more informed choices. i believe if you empower the states to determine their own health-care destiny that states will innovate and create practical solutions for the most complex healthcare issues of the day. we will learn from each other and therefore we will improve. in the current law, it means greater flexibility and defining
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essential health benefits and simplifying the state innovation waiver process. but self-determination goes well beyond coming to the department of health and human services on bended me with a hope for favorable treatment. self-determination but when mean getting the funding parity in the 50 states. but before achieving that vision of the state-based approach, congress needs to provide immediate certainty to the insurance markets. to that end i recommend that transition period that would allow markets to incentivize the participation and the individual insurance market. this should be done while anticipating the adjustments in the market based on the level of autonomy. i personally am not a fan of cost share reduction payment, nevertheless in the near term market predictability in order
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to price the products adequately they would destabilize the insurance markets putting at risk some 110,000 that benefit from the program and transition should include funding for at least 2018 and 2019 and we should look to market oriented incentives to increase continuous participation and individual health insurance markets for example, congress could immediately reduce the cost by eliminating the whole venture and stacked in the products could be better tailored to the demand by allowing insurers to undermine a cost-effective product including more high deductible plans. participation could be incentivized by greater flexibility and health savings accounts. the federal government should fund it and other reinsurance program with an option for states to operate your own risk stabilization programs. at the bottom of all of this, health-insurance needs to be
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able to do its job protecting against unforeseen health care costs instead of being used for a vehicle for social justice reform. but the excessive burden of regulatory restrictions that we've placed on the policies needs to be peeled back and done with predictability and transparency. frankly, most of america's consumers don't care if it is repealed and replaced or modified and approved. what they want to know is if they are prudent in their planning and budgeting that they will be able to purchase reliable insurance to protect them against life's unexpected health challenges. and they need to know that if the experience of medical catastrophe that there is a safety net that will keep them from spiraling into a financial catastrophe. the states are better able to address these issues for that unique populations and demographics than the federal government which is often trapped in a one-size-fits-all
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mentality. so i would urge you to consider a hope or future that gives back to the states alliance share responsibility that if something on both sides of the aisle can support giving new authority to the governors and state houses returning control to the states as both a prudent policy but also prudent politics. thank you for listening. >> thank you mr. chairman and ranking member and governors. i'm going to refer to what we are trying to do. to make this more bipartisan
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there is no intent and we have a problem that we have to solve so you are kind of at the heart of the laboratories being able to do that i served in the wyoming legislature and of course didn't have a lot of confidence in the ability of the legislators. earlier today, we talked about section 1332 and having to possible for the if it is approved doing it for all. that was part of a discussion i would add to that and i know there is a difference. i've always suggested that there be an opt out or opt in by the governor provided when the legislature meets they agree.
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i am certain that there would be some good suggestions for would come out of that. yesterday we talked to the insurance commissioners and they talked about the need for reinsurance and risk pools and an invisible height risk pool that could be useful again provided there was an opt out. we also have a good explanation yesterday of the small business health plans and how that could help reduce the individual market that it would have more clout for doing the legislating. let me start my questions with governor baker.
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i guess i would be interested in all of your opinions on this where are you in the process for changing the way for. >> let me say we are failing a 1332 waiver of this week but that's the official filing. we submitted a template or outline of what it is we would like to be giving under 1332 previously and one of the innovations set instead of a waiver and then getting into a debate how about i file a pro forma of what it is you would like to do and review the game
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plan and then we will help you make sure by the time you have a document we have an agreement about what is you are trying to do and what the opportunity might be. and i felt i was administratively a terrific reform. the one thing that i would say generally about this is that there are things that are program issues which are all of us have consequences about how they deal with the legislature on this with a lot of the administrative stuff is the relationship that goes on between the states and federal government and is not particularly useful to us and isn't particularly useful to the federal government but it chews up an enormous amount of time and if i had to pick the one thing i would say if you could help washington figure out the difference between what to debate over that would be great
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because there is a ton of time that's being spent on the administrative stuff and it doesn't translate too much value for anyone. anyone. >> do you care to quickly comment on the difference between utah and massachusetts? >> there are significant differences. he has more people than we have for one thing. we have a younger population. our health care needs would be different. that's why i say we need to respect the differences and the demanddemands in of the marketpr health care coverage. they are not all the same and that is why we have the flexibility. the biggest problem takes so long to and we put in a way for ourselves this past august and still have not received an approval or denial so streamlining the process i expect every state would have some idea of what it would look like and what they would meet in their respective states we need to streamline the process and once it's been approved by one
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state cannot be automatically approved by another state. >> thank you for all of you being here. working to propose solutions to stabilize the individual market, it is my hope we can use some of that and i appreciate your input. in your proposal with the other republicans and democratic governors, he made several organizations to immediately stabilize the market. one of those is to establish funding for reinsurance. can you talk about why that would help bring premiums down? >> yes and thank you as you say there's a record of solutions to
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the state. if we have any committee in whose hands to put our faith i am glad that you guys. we looked at the insurance cost sharing is the most important thing but the insurance is a close second because so many of these end up being dominated by the least healthy individuals and the people that have chronic diseases, and stage ended in dialysis all the time. they are very sensitive patients when they end up in one pool and especially three different patients that cost more than $5 million a year that raises everyone's premiums would have been used you are able to find a cost sharing via the disease and the cost of the patient but it
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happens in every other industry than you are able to drive down the premium cost. one of our greatest challenges is to make sure we get more people participating in the system because that is what drives down the premium cost and it is reinforcing the feedback loop and whether we do that by the alaska model i think they saw a 28% reduction in the premium cost that's remarkable. >> i was glad to see you didn't think we should roll back the guard rails and i appreciate the input as well. governor, thank you for being here. it's great to have a fellow
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montana and here to talk about this on the second hearing of stabilization and that's the word we heard from the insurance commissioners about the steps that they are being forced to take because they don't know whether the administration is going to maintain the out-of-pocket cost reduction program. the governor noted in his testimony almost as soon as the rate is filed insurers will continue the proposals for 2019. in the recommendations that you made with the governors, you proposed congress provide more than just one year of certainty for out-of-pocket cost reduction. talk about the one near certainty. >> i recognize congress will continue to work on healthcare reform as we talk about immediate stabilization in the market.
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in montana we have three insurers in all counties that are covered and as i said in my testimony, the increase for 2018 because it's already filed because the uncertainty about the payments going forward. but the same insurers are already working on the 2019 rate and so the only way that we are going to get some sort of certainty is that insurance companies and others know there will be predictability for a period of time while you all discuss greater reform i don't think the cost sharing reduction payments of one year is sufficient for that. i would like to see three years in the overall reform you can turn that back if you send a message to the market there will be some stability and they will plan accordingly.
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i know your state is always looking at ways to promote stability and bring down cost. it continues the out-of-pocket cost reduction and i assume that developing the premium stabilization requires a lot of state resources. open enrollment begins in the next 30 to 40 days you have a lot of people who made a lot of decisions including people who buy insurance based on
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assumptions about what products are going to be available and pay for them and i think that the reason it's so important that this time it creates stability and a sense of consistency for people at a point in time when they are literally going to be purchasing coverage for the next year. we basically had the people priced this stuff on the assumption that it's in place and if they are not in place, the carriers the market is nonprofit who are local. if they are not in place they will have to reprice the products and go up by 20% which will be a real problem for the people who buy those plans and it will shift the whole budget spending to the advanced premium tax credit to support those people that would have been in
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the support of the csr. senator isakson? we have a bipartisa bipartisan g problem that will require a bipartisan solution and i appreciate you recognizing that so we do the same in the committee. you are a great neighbor that
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you were rude guests when we opened up the mercedes dom. great football game, congratulations. we stayed up later than we should have. he was president of the university of tennessee. we share a lot of things together and i think tennessee does in the loss of hospitals in the state are you all doing with that in tennessee? >> that is a pretty national hq. we definitely are. we have some issues on coverage but quite frankly it is changing a lot as a consolidate i think a lot of us are afraid of the trend will lead to lose more hospital beds than the local areas and over challenge is more
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about the local economic development, keeping jobs and people in those areas and that is what will attract the hospital beds. it is a little bit of a chicken and egg situation if you attract jobs. they were in the individual market place and i believe that we have a disproportionate share of those folks in tennessee.
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the bad demand have been. of those payments are going away which is causing problems and which is one of the major health centers. do you have any suggestions on the share that we should do in the short-term? >> ultimately i think it is part of this larger issue. those hospitals were caught in a particularly difficult situation. in terms of short term what we can do, i don't have an answer for that. >> i think that the governor mentioned this as well. one of the key things is to find a way to get everybody covered and everybody participated and thainthe pattern off at high rir disease in the earlier years to help us anyway.
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the cost and those like me going to the hospitals with higher cost. i was listening to utah can't remember when i was in the state legislature in the 1970s and 80s in terms of automobile insurance and liability insurance i forgot the first states one at a time you couldn't get your car tags to drive the car unless you have a liability. liability. is there a comparison in terms of health care in the states? where you could have a quid pro quo >> in massachusetts basically, you have to demonstrate that you have coverage and if you don't, then you pay a fee and that goes
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into the fund that goes to the uncompensated care. the employers that haven't been taking it took it and that is the single biggest move with respect to the number of people covered. a lot of people do have access to coverage they just choose not to take it for a lot of different reasons thank you mr. chairman. let me concur with everybody by thanking you for holding these hearings.
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i think a lot of pain and time would have been saved rather than going through what we went through but i want to thank the governors for being here. i am more than aware there is a lot of innovation at the local and state level and federal government can learn a lot about what happens locally. in your opening remarks as you talk about the need to ask questions and i think that is exactly right. the young and healthy people today may have an accident and won't be so healthy. i've talked to people that are scared of losing their health insurance and that raises a
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larger question. it's not a question of whether you are young and healthy or old and sick. if you are an american should you be entitled to health care as a right and increasingly the american people believe that is the case and that is a question that we have to address. the affordable care act had significant success. it's no small thing that's 20 million have insurance that previously did not and we eliminated the obscenity of the conditions and brought some others. but i think that the time has come 60% think we should take responsibility working with the
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states and guaranteeing health care to people as a right, something i believe. number two, and the governor made this point that we are spending about twice as much per capita as the people in any other country. i think it's great we have the governors here and we should do more of that but we might want to ask our friends from canada or the uk or scandinavia award germany what they are doing. and we might ask why it is a but we are spending all of $10,000 per person on health care today which is clearly unsustainable while others are spending more and they are as good or better than they are in this country like the expectancy abroad, child and current mortality. those are some of the larger questions and a third question, we keep talking about the insurance companies. let me break the bad news.
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the function of insurance companies is to provide quality care to people. it's to make as much money as we possibly can and maybe insurance companies are part of the problem as why we are spending so much money on health insurance. in terms of some of the questions, one of the factors is the high cost of prescription drugs we are spending more than any on earth. the last statistics i've seen it plus $50 billion in profit. let's go down the line. what do you suggest we do to the worthy outrageous cost in this country? >> there's a couple things that come to mind. speeding up the approval process for generics is one. looking at how the government is a major fear to negotiate for
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the cost. >> number three, i think one of passing the affordable care act has done has sent about the states and medicaid programs to limit the number of prescriptions. we lead the nation in prescriptions in the top two or three and have programs in place that we felt were effective at providing the care that we needed that took away their right to do that so those are three things that come to mind. >> there may be some unique ideas but from the perspective governor baker spoke eloquently on the idea of how long it takes for generics to pass through. that allowing more ability to negotiate i think would be significant.
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>> what about the reimportation of drugs? >> i think that certainly health and safety standards need to be met and it is worth a discussi discussion. but it took 19 extensions to get a highway bill through. i worry in some ways we need to address but it's what's going to come out of this congress. i think it has to be worked on getting the ability for the formularies and programming is
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around the prescriptions you talk about opioids for example, we consume 80% of the world's opioids. >> we are running over. >> one thing i would argue the transparency of prices. there are acts that could make those choices available. >> if it takes 20 years and a billion dollars to get a drug approved, that is too long and causes the pharmaceuticals to try to re- cost. >> thank you, senator sanders. >> thank you mr. chairman. first, let me thank the governor for appearing today to offer
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your excellent testimony. your insurance commissioner yesterday testified about the benefits of the reinsurance and said it should bring premiums down remarkably. that is consistent with the experience in my state of maine and also in alaska, and it suggests the reinsurance pool could be successful dragging down the cost of premiums. unfortunately, as a practical matter in many states, they are simply not in the position to immediately stand up their own high risk pools and to finance them. alaska was created using savings in the premium tax credit i think that was $55 million into the plan. so, my question for you is is
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there a need for financial assistance in the federal government in the short term to help set up reinsurance? >> getting it through the legislature and number two where the fund is going to be. but i assume it's in the neighborhood. we can and we will run them better. >> i'm just worried about the short term. >> i think the commissioner was right for the first year you have to have the federal government help on that and let the states do it. >> governor baker it is great to see you here again. another key to driving down
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premiums is broadening the number of people in the individual market. you have an individual mandate and obviously the aca has an individual mandate which is extremely unpopular and we know people can stay on their appearance policies until the age of 26. but then that is the vulnerable group and what i hear is they would rather pay the fine is because it is less expensive for them particularly if they don't qualify for the hefty subsidy. they would rather pay the fine then get insurance. so, senator cassidy and i at the beginning of the year introduced a bill that called for auto enrollment of individuals with the opportunity to opt out if
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they wanted to. we know with the experience of f the planned a few auto enroll employees, they stay in the plan overwhelmingly. i think it is something like 75%. if you handed them a pack of information and may never get around to signing up. so, i realize the mechanics are difficult, but if the individual mandate for her to go away which is not something you support, i know, but if it were to go away, what would you think of our having in auto enrollment system so that you could get people into the insurance plans to study and then allow them the option of opting out. >> i'm glad you're thinking about stuff this way and maybe
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it's just because i'm a governor and not a senator, there's a lot of ways for people to broaden the pool. you could do it with an individual mandate, a penalty for people who don't think coverage and access to certain kinds of plans and not others if you don't maintain coverage. there is a whole bunch of ways and frankly i would leave it up to the states and let them figure out which way works best. you could put criteria and this would make sense financially, you could put criteria that says if you want us to play in your reinsurance pool, you have to do something to encourage people to be covered because as the governor pointed out, 5% of the
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population spent 50% of the money arafat is in a random risk pools. you get into the individual market where there's a lot of people that know they are going to need the system and that's why they buy it in the first place but it's a different game and there's definitely an opportunity for state and federal to work together to do things collectively that would broaden the risk pool, lower the premiums, encourage people to share some of the risk but i believe you want to make that a flexibility to do the things that are going to work best in the them to apply across all 50. >> thank you mr. chairman and i want to thank you the ranking member again for holding these hearings i found yesterday's
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hearing with the commissioners to be informative and constructive as it is today. there is a 1332 waiver and this would bring down the cost of premiums by a whole lot, like 20% more. speaking of getting more people in, there is a bigger risk pool. and on the cost of sharing a, without the cost sharing is as ththatthe rate was up 20% and be the rate would g go up and the federal government has to stay in the subsidy the deficit would go up to talk about a no-brainer on the cost sharing.
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it has the same dynamic. if we are hoping for any day now our health premiums will be 20% lower than they would otherwise be in the 2018. in the hearing we talk about how the insurance programs can be financed. the state estimates that the reinsurance program would cost 230 million the pay somewhere between 10,432,000,000 even with
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significant financial commitment as documented in a letter all of the offices received 12 insurance marketplaces and other states face budget constraints that limit the ability to fund the state level insurance program or federal matching requirements for the federal state reinsurance program like the one proposed in minnesota. the letter argues for a federally funded reinsurance program that would help boost competition and stabilize the individual market over the long term. the panel of the bipartisan insurance commissioners would yesterday offered a similar support. to all the panelists, with your state be able to fund and sustain the match under the 1332
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waiver? >> again, if you give us a year, we could run that ourselves. it would be better to start at this level and we have a legislature that mean meets 90 days every two years but also show the insurance. it's a question of time more than anything else in figuring that out. there are federal and state dollars.
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the picture was with respect to federal funds and we understand the complete picture with respect to state funds and how it would affect what we are all spending now and it may make it possible for folks like us to apply more appropriately funds to support the reinsurance pool. it's something we would be very interested in doing in figuring out. >> i would echo that connectedness and above large network it sounds like that doesn't come into the correct aspect but without question, it would create and allow the
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jurisdiction on that that is coming up at the end of the month so it is worth being aware of that is an important thing. i see him happy and animated. i would be happier if they were adequately funded. it would be a difficult step but we would do it absolutely. >> the answer is yes they worked very well and i think the issue is transition and the model identified the high-cost conditions to redirect the insurance pool as something we can all look out and copy and emulator so the answer is yes.
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my first question went a minute over and i will have questions for the second, third, fourth and fifth rounds. [laughter] >> thank you chairman and governors for being here. the near-term focus is to stabilize the individual marke markets. the governor mentioned in the testimony we could turn to what i would regard as more exciting questions and lay some of them out. how can we spur artificial intelligence, how can we increase the use of nonphysician medical labor and cost effective education or nursing, health sciences and medicine and empower patients to manage
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better their own health. we all want to end up here. the cost of health insurance is going to continue to go up. you are the chief executive officers of the democracy so i would like to hear from you the innovation does occur at the state level in addition to the local level, federal level to a lesser degree than we would like and i would like to hear what you've done in your state to promote innovation to the end of the cost per gallon and then touch on the federal barriers. we are free market people in utah and that is what has made america great. most innovation doesn't come from government, it comes from
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the private sector we carry around these iphone's with more computing power than we had in world war ii with the capabilities we have access to the internet etc. comes from the private sector innovation. in utah we have a significant growth sector of life sciences and medical health devices and a number of companies innovating things all the time. one of the challenges we have is the attack on medical but stymied innovation and makes it less affordable for those who need to have a medical device. >> thank you so much. we have something called the reachable care cooperatives with 29 clinics that allow medical that they are basically bare-bones and focuses to make sure we get ahead of chronic diseases were issues well before they become a cost driven issue
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that they often are. we also peal transparency is going to be the most important thing we all talk about controlling health care costs knowing what you are buying whether it is pharmaceuticals were getting a broken leg in a hospital fixed what it costs one place versus another in real time and your copayment will go a long way. >> you did mention the 1332 waiver. governor baker. >> i agree about transparency. same service fro, person, out ce the price can vary. there is a huge opportunity and i really do believe we are getting there.
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i would also say one of the things we are doing with our medicaid program is contracting with healthcare systems and basically saying you have a big group of folks you worry about and make the decisions with respect to the best way to serve them and try to get out from under this volume-based approach which i think everybody agrees doesn't necessarily deliver high quality but delivers high-volume and the other thing i would point out is it may be small but it had a big impact we did our remodeling program and made it much more 21st 21st century and as a result, we have like five times the number of searches being done and it's had a real
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impact on prescription writing. >> time is limited so i was at a question for writing. we refer to laboratories is a democracy on a regular basis but i think there's opportunities for improvement in terms of sharing best practices between laboratories and that may or may not be something that in the federal government we need to do to provide a clearinghouse for the best practices that bring down cost and so forth but it may be an area we can make some improvements so perhaps we can work together on that. >> want to call the attention to
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what we said at the outset and i am so deeply grateful for his bipartisan approach to this work and that is that we need to address larger questions. it's consumed politics over the last eight years as the individual market that covers only a 6% of people that are insured in this country and what we really need to be doing and it's important for us to do in a bipartisan way but what we really need to grapple with is the fact we are spending twice what any other industrialized country in the world is spending on healthcare and we are getting worse results. that is unsatisfactory to people in colorado whether they support the affordable care afterward they don't they are deeply unhappy in the way they intersect in the health-care system. so i want to thank all of you for being here and for
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bipartisan leadership for people i represent is not a political issue they need to make choices about their lives and small businesses that nobody else in the industrialized world is having to make because system is fundamentally broken and they know that. and i agree that it's surprising that transparency is a very important part of this. there is no other market in america where you can't know what something costs and by the time you finish typing with your insurance company you don't even know that you are being charged anymore. i hope will come back t you wilo deal with these issues. you mentioned the collaborative and i wonder if you might be wanting to talk a little more about that to save over $100 million by implementing the
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program which fosters innovation and collaboration across providers that resulted in better outcomes for the medicaid program and savings from the state. i wonder if you can talk a little more about that and whethewhether they might informe work we are doing on the individual market. >> it took about a year and i have to think it through and implement but the idea is that in each region of the state there is a central integration that includes mental health so now you go to your basic care provider and have some serious depression, whatever, your child is acting really bizarre. anyway, the idea is to integrate that care so we have different clinics and they are set up and different reachable care collaboratives.
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one is they cannot diminish quality, the whole focus is to make sure nothing stays the sa same. then the second is how can they control costs and better focused relentlessly on controlling the cost and with that effort obviously, i think that they've done a good job expanding coverage and the notion we can give to people that have potentially crippling diseases and we can make sure they get the care that they need to avoid those drastic conditions. >> i hope we pay attention to that going forward. i have one additional question and that is 600,000 have been covered as a result of the affordable care act and we are now at a record low 6.7% of
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uninsured people, but we still have a lot more to do. especially in our rural areas where there's 14 of the counties and they only have one in sugar and it is especially difficult. the idea that people in such counties might be able to buy into the federal employee health benefit plan and i wonder if you can talk about that a little bit and how you came to that proposal. >> we have 64 counties in cover-up, 14 counties have the insurance company so we want to provide incentives for others to avoid all taxes and a number of different tax incentives to encourage that competition but
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also we want to make sure the federal employee benefits program people could choose to be a part of as well. for some it would be the right choice but expanding those choices i think the goal is to make sure that the plan is available in those states where we have the greatest challenge. >> i know that another possibility here as i heard my plea for people to buy into a state employee plans as well. these are all interesting. >> we didn't want to speak for all the other states and governors. >> senator cassidy.
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>> i apologize you may have already addressed this. each of you as you were speaking i think we talk about the need for flexibility and frankly you don't look at her job and more bang for the buck than we do. now with that said, attired and the normal rate of inflation and this one you cannot control. but with flexibility do you think you can bring down the rate of inflation of health care in your state? >> with flexibility you can do reinsurance programs and you name it you can work with that. >> i will make a couple of
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comments to talk about innovation there's nothing that makes you innovate quite as much as having to balance your budget and i guarantee we balanced however many for however many years but that causes us to think innovatively and so the market thinks of innovative ways to change products that's not our job, our job is to think of creative ways to address that. >> the question is then coverage will suffer. so they make sure they don't have adequate coverage. >> the question particularly would be to you care about the least of these if we give you that. this committee just went through an exercise last year where you
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pass an unprecedented amount to the local governments and schools and i think you are going to see that process work. i think the ability to innovate in the consumer protection safeguards on the sides we can do a lot with it. i do worry about one of the things the affordable care to did is provide health benefits that did not exist prior in so many areas. >> with me and took up because i'm limited on time. it gets you a benefit package essentially and i think about it as a vehicle to give you that safeguard with perhaps a little bit more flexibility. >> i think looking at the flexibility and the funding is very meaningless in the proposals that i've seen i'm not
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going to be able to do. >> but if the funding is adequate then it's a little more cost-effective. >> is defined by the terms of the senator or the governor may be two different things. >> we are providing the coverage to the states to substantially change what can be done no matter how much flexibility we are giving. >> one thing i've noted the expansionist generous but could be required to put up 20% to draw down so frankly my state-of-the-art $310 million it's still a lot of money. for the expansion it's going to be problematic or we can handle it no big deal.
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i can just tell you we started covering more people through a variety of their waivers back in the 1990s and we negotiated the fifth federal waiver over the course of the past 20 years and signed it last fall just about a year ago now and that has certain parameters on the federal side and state decide that we have to live with and our assumption is we are going to deliver on our share of that and expect them to deliver on their answers all kinds of shared responsibility and accountability. >> but again the 10% on the 2020 medicaid expansion, and that is a chunk of change for states that are paying more than their traditional medicaid and enrolled a lot of people.
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>> we have a five year extension and expect to live up to our e end. >> anyone else? >> it's real money but it's dropped by 25% by overall insurance rate it's dropped from 20% in 2013 to 7% today. if i don't have health care in those communities i lose those communities, so it is a big chunk of money and an investment that will be able to be made, yes. >> senator white house? >> thank you very much. i know the chairman and the ranking member had to go onto other things it's a very busy time here as you all know from the issues you have in the other committees as well if i want to join my colleagues in expressing
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my appreciation before the bipartisan nature of the committee's work that senator alexander and senator murray have led and also in particular the commitment this morning that he wishes to move on to address other issues, cost related issues in the system. i can must take a look at a couple questions and then get back to it because i'm going to make a bet once we get to the market stabilization i'm not sure we will get back before we move on. these are questions i will ask for the record so have your
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staff get back to us but i think it would be helpful when we move onto the next area to get your view on some of the specifics.
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my time is up but let me just brag on the primary care practice and physicians in another big practice in rhode island both of whom have demonstrated that they are driving down the cost euro per year on an average
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>> >> and often because
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graduating from high school with entry-level jobs does not provide insurance or going to school there the insurance offerings may be lacking. all sorts of barriers for young people so we're talking about the growing consensus that the same time congress is working together we have that administration that has announced recently some changes in spending plans and other administrative policies that may work against that war will work against that with the 90 percent cut in the
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>> >> to come forward with some suggestions this is exactly what many of us have been hoping to have an opportunity to do with this level of the engagement. we can and do a lot here in the capitol in washington d.c. but you'll have to translate on the ground and the fact with this so ben
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dialogue at this time with this issue i think part of what is taking so long to get here so thank you for that it is described how we approach this day and i appreciate the chairman's leadership focusing on discrete areas to stabilize the individual market. bible tell you i know how to eat the whale. [laughter] is a prescribed way that you cut it so it is shared according to tradition i will not suggest i have all the answers of health care and to have some guidance here.
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and looking at what we have done but it does provide an example. so with the approach the chairman and the ranking member have taken to stabilize the individual market. dealing with the us tsr one-year or two-year we can figure that out but it is about the of predictability. in it has to be bipartisan as just have the answer that health care just was not the answer either.
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and the process is better but the of question that senator baldwin posed how we deal with insuring with significant numbers yesterday there was discussion of cuts to the navigator program because the insurance commissioner wall is in alaska we don't so to do recognize looking at of demographics but the opportunity to underserved
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markets. the proposal that you cannot buy into the of health benefits plan is intriguing to me with 18,000 people on the individual market and that is it why are we creating a new system for 18,000 people? so let's talk about the discussion you had a moan of governors with these proposals how to deal with the underserved market?. >> and you represent a different part of the united states we talked to over 20 governors to collect information so how do you distill that down into a set
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of material like those individual markets in certain parts of the world? the federal plan is a viable solution if you look at it for the individual markets it is too expensive it isn't a perfect solution for those incentives to go into these markets to get a fighting chance with a sliver of profit is the most important . and we do disagree a lot about this but we have dave big rural population and that is a consistent effort with more bipartisan support working with the governors as well.
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>> thank you, mr. chairman. so talking about north korean sanctions so to make sure everyone has high-quality affordable health insurance has not been a partisan issue. to make sure everyone has access to health care so governor baker if president trump follows through on his threat refusing to pay the cost sharing reduction then massachusetts would lose $146 million in 2018 alone. does that mean it will save $146 million for expenditures?. >> actually, no.
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this is what we talked to with respect where federal money is involved with health care. according to the cbo at the federal level could pay more from the various premium tax credits if you don't have the of csr and net net it would be a negative for the government. >> $194 billion nationwide. if insurance companies and people in massachusetts would get federal money either way than why do you care whether president trump makes the cut to the cost sharing problem? so to the behavior of people in the
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market whether the health insurance plans or individual to figure the rules of a game where the federal government's rules to participate? net you need to put this in place with those larger issues we have been talking about because you need to create some certainty for those who participate with those exchanges. >> it makes no sense financially for the federal government or for the of families can you think of any policy justification the reckoning to blow up the marketplace? by
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deliberately driving up cost?. >> listening to the impact of the program of what it would be in our state representing a 20% increase in the cost of insurance for individuals and small businesses and the fact it'll think the federal government would save money. to said before it would be a good idea but or to create stabilization in the market that needs it. >> so what about market stability. that in order to improve the aca insurance markets with the quality of coverage they
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can buy weaker and weaker plans so governor baker to stabilize the markets this massachusetts allow those garbage plans? or let insurance companies offer plans with higher deductibles that people will go bankrupt even though they have health-insurance?. >> we have a fairly robust exchange with 10 carriers carriers, 60 plans with at essential benefits framework to have a different level of kashering. depending on your particular interest. and they think that is a high cost eight and then
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with the national average people in massachusetts have lower out-of-pocket compared to personal income than the national average level. even though we have robust plant designs plus or minus higher but nowhere near as high as they think it is. with success in tune with market stability. and what i did say earlier that the ability in the market over 10 years to encourage people to participate with the mandate has been a better way to manage costs. so this gets back to the
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question of risk sharing and reinsurance we do support with funding we do think this is a good idea to make sure they have access in this is part of a the conversation in massachusetts if we head down this road. >> thinking very much massachusetts is the example that we can have a strong insurance plan to protect families and at the same time have market stability that works for everyone. >> i don't usually do this i will give her time she wants , i don't disagree with what she said about the cost sharing payments except the one of the facts is united states district court from the district of columbia ordered the president to stop saying that kashering
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reduction payments because he is not authorized to do that under the constitution because we have the rise of payments but did not appropriate the money so what we would like to do is clear that up so that the president did the do it. >> i needed no rebuttal if the congress moves forward to authorize to give our states of the ability to stabilize their markets i am all in. >> could we agree. >> things to you and your
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some of my favorite people thank you for offering that different perspective and with the insurance commissioner and to hell with that problem solving to find a way for word. and with all of you that have come together and that helps us to focus on problem-solving. >> and that seems to be every betty's focus to immediately stabilize the markets and to last quickly
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the discussion we have had with the federal government to fund that contemporary reinsurance option if the states have the wherewithal and i sat here thinking that would be making the argument because the feds will save money with the insurance program so is that the belief that is both on the state side and the federal side if the federal government could put up the seed money?. >> so with padded vans premium tax credits and the
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money spent on medicaid generally yes. if you reduce the cost then that will impact all the other things to pay for the cost of coverage for girl. >> senator with a cost-benefit analysis and to spend it in a better way we want stability in the marketplace. in looking at a different set of rules here in congress so if you say seed money for any of their kind of money if we confine the
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cost benefit reduction than that is a good thing for girl that is the concern many have if we are approaching $20 trillion how much more can you generate?. >> if you are talking up the actual programs it is opposed to using that money. with that cost-benefit. >> and with short-term also long-term. >> i know others may want to try bin but i want to move to one other point been governor baker will start with you combating the heroine in tokyo a crisis in our state is an epidemic around the country so could
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you comment on the importance of having predictability and participation in the insurance coverage market in the central health benefits with that capacity?. >> the fact we already had universal coverage made it much easier for us to extend our recovery and treatment that we have done over the past couple years with the support of 50% but the other thing that i mentioned earlier that made a difference was to our collaborative the with our colleagues in the region which because the system is more 21st century and user friendly and that data is
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unjust in terms of the person that is in front of them but were they sit relative to their peers the people who died in massachusetts when down we have a long way to go but that goes up every single quarter literally for 15 years and i do think having a system for the most part coverage was the first question they had to do with made a big difference. >> my time is up we talk about transparency because that has been the freer talking about the cost of their care and combining
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those networks is important. >> thanks to you for these bipartisan hearings it is good news for the country with bases playing out you all have very difficult jobs every day the time you're spending your to give testimony and answer questions but with your advocacy and a sense of urgency with us see as our payments and other issues to get a consensus we are grateful. del was going back and forth from one hallway to the
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finance committee with another matter of urgency with the children's health insurance program deadline. on those two major health care issues so what has been evident a couple of weeks that there is consensus about the need to make the kashering payments as chairman alexander has indicated there was a discussion about that 1332 waiver and governor baker to start with you, on the
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combined savings from both waivers one concern raised is even though by combining those waivers, the intent is to help people in the marketplace is that the cost for the adverse impact on medicaid or beneficiaries? anything you can tell us about that? be mcfadyen is why we appreciate the opportunity to think about this stuff in our conversations that the federal level the number of different revenue streams and programs that the fed financed college at
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100 percent of poverty those that don't typically have access as directly that are automatically qualified because of the status or they are very poor or those who have access because they're working 20 years it doesn't affect their ability of the employer based coverage. so this has state and federal money and one of the things we believe that is helpful is to be sure that we can account for all of that to deliver the highest to benefit the most appropriate level even with
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the federal level plunged in as well. >> i am sure it on time but in response to an additional question governor thank you for the work you have done in a bipartisan fashion including other is that the table are equally engaged because we have some from pennsylvania we will direct this to you with regard to the age limit some states propose balancing the of risk pool which is of great said the africans and priority but some states propose balancing the risk in a way that potentially could impact seniors.
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with that a trading limits or any concern you have there?. >> yes think we all have a lot of concern on that expanding a the calculations to pay more seems unconscionable and to approach that discrepancy either real issue is how you get more young people to join up but if you talk to do a rp or those advocates for older americans they get very agitated mitt is unfortunate to take that direction when there are other choices.
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>> these are great hearings and the chair mentioned yesterday there was an announcement the major company that was thinking of going into the market and then and then decided not to do that in virginia will grapple with the urban and suburban and rural communities so that a&m decision will hear a rule virginia the hardest in one of the issues to grapple with we don't want to become too nations separated between rural america and the rest of the country. most of america admirers worry do on the front line and to be uniquely situated
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to do this job that has governors, mayors, doctors and insurance commissioners and small-business owners professional therapist we have the bases covered. i fake we can do good work by a obstruct of the commonality. . .
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>> bailing out insurance companies, that's a rhetorical question. but, it's interesting that sort of critique that someone level about about reinsurance in particular. as i understand the payments are basically payments to deal with out-of-pocket costs. deductibles and co-pays, and you've done a good job each of you as you collectively describe the benefits of reinsurance, you can bring in or young, healthy people, and other people who just find affordability more attractive obviously. by lower premiums you reduce the tax credit on the federal budget. you can protect tyrus people and
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send a signal of stability to ensure they'll be stability. the strategies were talking about it will be validated yesterday and today, bipartisan leaders at the state level are anything but a bailout, they're designed to help people. and to provide temporary stability with the predictability that will enable us to find bigger picture items. i will ask a general question along the line of senator white house, since there is consensus around the basic points, will gets a longer-term discussion if you come across the table like will be the one thing you would most want us to focus on if we get to step two in the stabilization steps? >> we need to align incentives. and some of you talked about
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reform on the payment side. you need to do something on the user side as well to incentivize better behavioral choices. it's like going to the grocery store, the assistant made sure me to get to the catch register and they say thank you very much. you can see why were where we are, and we know the history. but aligning incentives is where i would start. >> i largely agree, we need to move from pain from repeated services and test a pain for value. it's also important, i think montana has done reform, as you go forward, don't mess with things like that because were trying to good do good work already and payment reform is starting to look at court care coordination which denies exist.
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>> to build our my colleague said, just said the transparency issue being discussed before there's a lot of variation. not just in the way care gets delivered but how much we pay for the same things. but this issue on around variation in both approach to providing care and outcomes. there's a lot of research on the and not a lot of it finds its way into daily practice. that would be a great place i think for frankly the federal government to take the lead. have a lot of resources and knowledge and opportunity. >> could i allow the governor to answer? >> had reemphasized transparency. i think that'll be the next big
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opportunity just look at going to walmart or any big target and they have hundreds of thousands every little thing you can buy, yet hospitals and care providers to there's too much complexity and we can't predict what something might cost. we have to have some system by which people know and can easily through their handheld device or whatever will get it sense of what is going to cost to get a broken leg fixed stores to be serious medical procedure. and whether co-pays going to be what the quality will be at the five different places that are within a five minute drive of where they live. >> i agree with what's been said. i think we learn from each other. massachusetts has a great plan and people of utah like it will probably adopt it but you shouldn't be mandated to us.
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i do believe we need to move the conversation once the stabilization there's got to be a discussion about the cost of healthcare and the rise of premiums and insurance. why are not putting more doctors in the office place, how about reform? what about information consumer choice where they can pick and choose and be informed on their medical issues. that will help us drive the cost to drive down the cost of insurance. >> senator murphy is here, and governors have been very generous with their time this morning including the hour they've spent with about 30 other senators. after senator murphy, i'm going to have to wrap up the hearing, unless senators unless you may have other comments, do want to speak? >> i do.
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>> okay that will make time for that. and i will ask and give the governors a minute or two each in case there's one more thing you'd like to say that will wr wrap. >> yesterday we briefly discussed the graham cassidy proposal to i have a great deal of respect for both senators graham and cassidy. the cassidy were here i would say more for graham. [laughter] but he's not here, but i have grave concerns with this proposal will want test panel about the plans for potential implications. although the plant specifics have changed over time and reportedly will change again, we know from earlier versions of
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this can't plan in recent news reports is that it could eliminate funding for premium subsidies, eliminate the cost-sharing reduction payments and illuminate the enhanced federal funding for the medicaid expansion. instead, in 2020 the federal government would return some but not all of the funny back to states in the form of a block grant. this means states will receive less money under the block grants than they would be projected to be received under the aca. the proposal also redistributes funding across states stretch the that states that it been more proactive in enrolling individuals the medicaid expansion and marketplace coverage like governor baker, yours in my state will see
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billions in lawsuits. while others, more sparsely populated states those not expanded medicaid coverage can see and increases in the initial years. after 2026 the state funding would be eliminated which means states would be on the hook for all costs associated with medicaid expansion, premium subsidies another caution reduction payments. earlier versions of the plan include a proposal to cap a cut medicaid funding just like the proposal in the republican bill to repeal the aca which failed to pass the senate a few weeks ago. governor baker, based on what we know about the graham cassidy proposal, is this reform that you could support for massachusetts?
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>> i'm also big fan for senator graham cassidy, but, no. the proposal but dramatically negatively affect. were talking billions and billions of dollars over the course of the next for five years. that's not to say they're not planning programs for the federal government block grant money is work. a lot of our child welfare money comes through block grant. we get money for substance abuse services and black services. some of the transportation money we get looks like a block grant. but this proposal, in part because of its design has major consequences for state like massachusetts. i also argue that were talk about medicaid generally, your
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income level and wages estate is calibrated into what you get from the feds. were a 50% match state. governor versus 70% federal match rate. i think summer 65%. higher income states should get a lower share of reimbursement and lower income states. i understand that. but that formulas framed in a way team to be equitable. the problem i have with the graham cassidy piece that assumes the cost of healthcare across the country should be the same everywhere. were a high wage state, because of that wages make up about 70 or 75% of the cost of healthcare at the provision level in most states. which is why we get paid less on
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the medicaid match then some states. but to promote the idea that you could build it under cost to care higher massachusetts that i might be in florida because somehow florida is smarter and better, that's not accurate. the truth is we have higher wages than they do in florida and that's why are healthcare costs are higher. >> i'm out of my time. but i would note that 99% of children are covered in massachusetts more than 96% of all massachusetts residents have healthcare, these are the highest rates in the country and with a bipartisan effort, massachusetts developed a system of health coverage that works, i know that this grant cassidy plan would not be beneficial to states like yours like mine.
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they do cover, i think we may be. >> you just need to know that my mom is a democrat for rochester, minnesota. >> so love you. >> will go to senator murphy. >> and the will conclude the hearing. >> thank you. you been fantastic forgiveness your time. i want to ask this question guardrails. understand the need to allow for states to be laboratories of experimentation lord knows we still more experimentation to figure out what works and doesn't. also exist a national count me with fluidity between people and businesses. there's argument that having some for on what insurance plans cover protect states and create stability in the overall economy. you've all recommended giving
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states more flexibility. where's the natural end of that? i think there is some benefit to knowing the matter what state you go to you'll be able to have folks that are sick or have higher levels of medical acuity be insured. but some relatively uniform standard of benefit. maybe not exactly what's in the sea today but some regularity. talk to me if you see some benefit in having some floor of benefits or protections and how far you are going taking down the guardrails? >> we talked about this in great length and trying to come to consensus and in the end we support the concept of essential health benefits as they are now. we don't address that.
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what we focused on was how do you make the bureaucracy easier seeking of these waivers that all of us agree that cost savings and may improve the outcomes of healthcare delivery. so some point that will get discussed and debated. that's a longer issue than we have. we're specific to makes sure those health benefits, those guardrails should be maintained. within that there are places where can be done less expensively. governor baker talked about the alignment of medical dental benefits rather than having a basic insurance company set up new systems. if companies who do that already. and they were not permissible under the affordable character. those waivers are the driving
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force of change will see in the short term. if one status qualified others should qualify as well. >> undoubtedly you're right, but it's out of whack now. the balances back to governor herbert come states going to the federal government had in hand. there's an assumption from the federal government and the little offensive that says you won't care for the least of these unless we tell you exactly how to do it. you trust us with education and so many other things, there's a sense in which we don't trust you care for the least of these, i know governors of all types, we understand as part of the deal, were so caught up in the bureaucracy that we know there's dollars being wasted. >> on another topic, governor baker want to talk to about the individual mandates. as part of the executive order
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in the beginning of the year you require the irs starts to unroll the enforcement of the individual mandate. they declared unfit very 14th they would scrap plans to reject tax returns that don't include information on the status. this uncertainty is contributing to about 10% of the premium rise. your first out-of-the-box is a state to understand the importance of the individual mandate. can you talk about your experience with the mandate and what it does to rates if there is at the very least great uncertainty from ushers as to whether anyone will bear consequences if they don't abide by? >> i wasn't sure once, not anymore so i don't want to speak
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for them today. i would say the mandate, at least massachusetts did three things. it encourage people who had access through their employers to take it. that report represented a huge increase after the mandate took effect. we're think about it mostly as a way to make sure everybody was in the game, including folks had historically just chosen not to buy. the second thing is we've been at it for ten years, it does create a certain level of shared responsibility in the cultural understanding that there's a reason why you buy insurance is you don't know if there's a point time when you might need to use it. were also mandatory auto insurance state. i think it helps stabilize the market in some respects.
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i believe the csr issue is a bigger issue for the carriers the what shows up on your income tax return. this is may be in the governor is supposed to senator, i would push you to think about encouraging states to come up with ways if you're going to create insurance pools to create some semblance of a reasonable market. there's a lot of ways people can encourage folks to buy insurance and keep insurance other than a mandate. i like it because it's what were using an people understand it massachusetts. but this is one thing that states that are closer to people could pursue a variety of different options and you find some work better than others especially if you decide you want to get in the business of doing shared insurance pools. >> governors, thank you and i
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want to give you the last word in a minute to ask you to take a minute and is there anything you'd like to emphasize, first, there's been a good deal of talk about attracting younger people into the individual market. a few senators on both sides of the aisle have suggested that with what is now the copper plan and the affordable care act which is a low deductible, low premium high deductible alternative, you could call it a catastrophic plan the goal is to keep a medical catastrophe from turning into a financial capacity fee. in the affordable care act you can only buy the if you're 29 or younger. the suggestion was, to take off
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the age gap and allow anyone of any age to buy the plan, do any of you have an opinion about that? if it were part of a bipartisan package that included extension of csr and other things? what are the pros and cons? >> i don't know enough actuarially to know how big a difference it will make. >> i think when you're hearing some real consensus on what needs to be done to stabilize it, if charlie baker doesn't know what it will do, chances are none of senators will. i think it goes further than where we have to be talking about it for looking at immediate stabilization. >> going back to when we did healthcare reform ten years ago,
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we did set up plans you could buy if you are under the age of 29. this is before the federal law said you could carry your parents until 26. that was designed to encourage young, healthy people two in purchase insurance, many are thinking differently about this than other people are. i don't know what the actuarial impact of applying that more broadly across the marketplace would be. it be good to some to have someone do the analysis. massachusetts was designed to serve a particular purpose and that purpose only. it wasn't made available to the home market for recent. we wanted to make sure the market overall maintained some
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degree of soundness within the folks who are over the age of 30. >> i would agree, we don't have actuarial information but there is a huge process of discussion that went into the decision to put the age limit. if you get a change it it's not impossible to look at changing imprint incrementally. look at what you might add or take away and how you might adjust the agent someone. >> again come i don't know if we know the impact they do believe more choices better than less choice. i think government puts barriers in place and it distorts the market. so there's a demand out there for lower-cost high deductibles we should allow that to happen and see what the market would result in.
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>> thank you. this is the kind of thing you deal with interstates and with your legislators. i'm looking for a way to get a result. we can argue about how long it should be and that's one thing. we'll have no chance of getting that unless in addition we have some restructuring of the market. and part of which could be with making section 1332 work better. the reason i emphasize that, i think there's a consensus about their comments already in the law. so it's easier for people to accept on the democratic side who approved the law, and so for fixing it that's easier for them to do. but to get a republican president, house and senate just a vote for more money won't happen in the next two or three
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weeks less there's some restructuring. a different policy which is already under the law some restructuring would be welcomed by a number of the senators. i have two questions to ask in a number of you have your staff and commissioners here. it would help if you could give us a specifically of the things you would like to see us change and flexibility on 1332. you can 1215 if you want. those two waivers very specific, for example, the waiting time, the me to plan. if you can give them to us in the next three or four days. we've written down what you have said, but this trade might move to the station. this a chance to change those things. if you want to tells what those are and we have a by the middle
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of next week, we could use it and it would help us get a result. same would be true if you can think of anything that would help states to unalaska and minnesota have done. any change in the law is helpful to that. many of you have talked about reinsurance. it's one way to deal with complex care. but creating a brand-new federal reinsurance approval and the next ten days is not going to happen. always see an alaskan minnesota's you are using dollars already there in a way that doesn't cost any more. you're actually reducing premiums without more federal dollars.
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if there's any impediment from others during it that would be help to know. another thought is pilot programs for good ideas. senator high camp suggested association plans which we go back and forth about. she suggested before the searing astride pilot program for a few states who have ideas about association plans. if that idea were peeling that would be helpful. or if there's another pilot program we might include. i'm trying to be very specific this is what you do all day, trying to get a result out of competing points of view. so we have democrats have no trouble voting for more money for the affordable care because they wrote the act, passed it and would like to fund it.
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you have republicans who have seven years of opposing more funding. those are the two things that will help us get results to help stabilize individual market in 2018. the other ideas are welcome, anything that has to do with taxes for example the health care tax is 145 billion over ten years, there's no way will figure out how to do that in the next ten days. plus, all of those things are jurisdiction of the finance committee and it would be more complicated. trying to keep it simple, we know how to do big issues, we saw complicated problem on mental health and i think we've been so much at a stalemate on this that any small step that help stabilize the market would keep the premiums down and that
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would include some extension of the csr's. be a signal to the market in the country that we know what we're doing. as can ask the question but i will just stated. intrigued by the fact that maine set up its own reinsurance program. you can pay for these, i think there's general consensus among republicans and democrats than individual market that small, has people who don't fit into other markets, that any long-term solution will have to address some amount of people with complex cases. that takes money. but different places the money can come from. from federal dollars or savings, it could come from state tax
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dollars. your budgets are balance word 23 trillion in debt. so, little money problem here or what meaning did is they just tack for dollar and every policy and it worked well for them. i think there is a state role in the says we move on. and finally, thank you for coming. i know how busy you are, you give us an enormous amount of time and have been specific and helpful. i hope we can come to some result this month. >> i would just say, i think we have a group of people who are willing to help. when you want to the political situation would deal with that every day and we want to help.
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i need to beg your forgiveness, have to jump out. take you for hosting us. >> i would say ditto to my col colic. what was striking to me as i read the testimony of the five of us, how much similarity there was. i think we'll know what we need to do. think congress knows what we need to do in the immediate term under your charge and i fundamentally believe that if this committee in congress could take this step the sense a much more significant message as far as opportunities for reform going forward. >> i would also just add there a number of things so be interesting to incorporate into a bill that would involve reform
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one is section 125 plans. we used to have this pretax basis they buy coverage and qualify for coverage at their employers, another thing the aca wiped away. a lot of people who used to play in that space, it's a good solution for people. it's unfortunate it's gone. the family glitches a total winner, republicans and democrats should be all in. states that have established rating factor models their small group and individual market was just wiped away by the federal reform. i don't understand why we should be running rating factors for individual and small group insurance and's 50 states out of washington d.c. doesn't make sense. >> i think there's a bunch of
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things we can offer a. >> in the final thing, i really appreciate your leadership on this and i have always appreciated the tone of the civic minded approach you've taken to everything you do in public life, thank you. >> i want to tackle that too. i will go the gratitude, it is refreshing, not just for us but all the governors and people around the country to see this work being done on a bipartisan basis in governors being the people who have to implement these laws and sets of regulations, we find it very important for us to be involved in the process. we recognize the work you have to do is not easy. i want to emphasize the family glitch but that has been done
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already. one of reemphasized community health centers and making sure people have a medical home at the least possible cost with the highest possible quality. also to frame the question that gets into the partisanship. the republican inclination to is that more folks around individual freedom and responsibility, democrats around the power of efforts, but democrats cure just as much about that self responsibility and freedom when i was in business, spent 15 years renovating buildings and restaurants, aligning self-interest we can get both sides to see a benefit from a possible compromise is a single reliable way to make progress to difficult issues. this is a classic case in point. all the different players we
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talked about, talk about the care providers and can go right on the list. there is a way by having them at the table that we can thread the needle and begin to control costs for the first time may be a 50 years at the same time improving quality and expanding access. >> let me say, think it's an opportunity for us to address and give you what we think is a common sense approach to thing is a former governor you understand that. i wrote down three things i learned. one, their philosophical differences. some argue healthcare is a right and others think maybe it is not. we have different the same chemicals, we different process.
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that's a debate to have around here all the time. how we get there is where we have disagreement. we also went emphasize that we are different rules, we balance our budgets, we have to do that. they don't do that in washington and you're approaching 20 trillion in debt and rising. how much is too much and what we do about it? you're going to have to decide how much you can commit on healthcare. that's a decision yet to be made. it's one you'll have to look at. we can't let perfect be the enemy of good. there's great solutions and opportunities but sometimes they get stymied. if you look at our immigration debate forever and yet we can't get anything done because we are
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perfect be in the enemy of good. last but not least, there is a lack of trust exhibited in my opinion by congress toward the states. that's why they feel like they have to put it all out on what we need to follow, no but he cares more about utah than people in new talk. please give us the confidence will find the way. at the states be the laboratory of democracy and will find a better solution. if massachusetts has a better way, utah will be the first in line to copy and emulate. if we think it's good or bad will modifier proof in the utah way. i would say the same thing for all states. give us that opportunity and will solve the problem more effectively, more efficiently, with lower cost and better outcomes. >> thank you governor. i noticed the former chairman of the national governors association has been sitting in
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the front row for most of today. senator king was here as well. on september 12, committee will meet to hear about state flexibility in advance the topics mentioned today. record will be open for ten days for comments and questions. thank you. the committee is adjourned. [inaudible] [inaudible] [inaudible] [inaudible]
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>> i favor making bringing down premiums. societally bringing down premiums i favor making the 1332 waiver work better. reason for hearings is for me to learn and listen. also does senator murray another senators and come to a conclusion about what we think we can pass. i want to be able to go to senator mcconnell senator schumer and said this proposal within ten days or so. and say we have 25 or 30 of us at both parties who think we have to do it by the end of the month. we'll see if we can do that.
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>> city for the insurance commissioners in governors, we have others coming next week and among the things we heard were six-month waiting time it takes too long. there's talk about the me to application of connecticut is approved for 1332 waiver and their marilyn wants to do the same thing. why should they have to go through such a long process so, were looking for a list of those. swim attracting more young people to the market. >> have you get any pushback from democrats that they don't want to change 1332 as much? >> i'm not getting pushback, this is been a remarkable two days. yesterday we had 31 senators almost all [inaudible] the
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committee come to a private meeting same thing happened today, 30 senators and almost everybody was here today despite competing meetings. think everyone's looking for result. you don't rule things out. >> any action on medicaid this year with was going on with healthcare? >> when i am focused on over the next ten days is how can we reduce premiums by stabilizing the individual market were 60% of the american people get their insurance. >> we look at the family clinch. >> that's a bonus. were making that working list of suggestions were getting a good list of ideas they will almost all have to not cost money
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because it will be a hard thing to do to deal with taxes the next ten days. but most of the suggestions i heard didn't cost money. >> i've talked to secretary price and called him monday to update him a what we're doing. until the might be back in touch we had a result. >> to have a sense of what might go on with the debt ceiling? >> that's not my job. my job is to work with senator murray and see if we can get small, limited bipartisan package that stabilizes the market, lowers premiums and sends a signal to the country that we have broken a seven-year political stalemate and are beginning to solve the problem. thank you.
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[inaudible] >> on the next "washington journal", will take your calls and good not tatum preparations for hurricane irma. our first guest is elinor smail the feminist majority foundation on the trump administration decision to review obama era rules on campus sexual assault. then i will congressman steve king's perspective of the deferred action for childhood arrivals program and what to do with undocumented immigrants. "washington journal", 7:00 a.m. eastern on c-span. friday, look at the evolution of terrorism from 9/11 to today and how counterterrorism strategies have changed.
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former commission chair tom king and lee hamilton speak an event hosted by the bipartisan tom king and lee hamilton speak an event hosted by the bipartisan next, look at a report on substance abuse and behavioral health issues. health and human services secretary tom price took part in the event hosted by the substance abuse and health services administration. this is one hour and 40 minutes. >> good morning welcome. i'm director of the sampson center for mental health services and umc for today. each year sampson releases most recent findings from the national service on drug use and health. it's commonly referred to as listed. were releasing results from the


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