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tv   House Democrats Hold Policy Meeting on Affordable Care Act Changes  CSPAN  July 26, 2017 8:24am-10:03am EDT

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order our hearing, action now, updating and improving the affordable care act to lower costs and ensure options for families. the democrats take great pride in the success in the aca lowering costs and protecting families. ensuring previously uninsured america's are covered -- americans are covered just the start of it. but whatre important,
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is also important are the over 100 million people who have expanded benefits at lower cost and more access under the affordable care act feared quality for every american no matter where they get the coverage. health care cost growth has been slowed by the lowest on record. republicans have been working since day one of the trump administration to sabotage the marketplace as a pretext for re.sing trumpca i want to focus on the word cost, cost, cost feared every hition of trumpcare would americans with skyhigh deductibles, soaring out-of-pocket costs. for example, a middle-aged, middle in game -- middle income person would increase their
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deductible from $5,000 to $13,000 or pay hundreds or thousands more in premiums. costs are still going up with hired deductibles and higher co-pays for premiums. of4-year-old with an income -- $56,800, would be forced to pay $11,000 more for the same level of coverage he or she has today. $1700 under the affordable care over $14,000 under their bill. according to estimates, premiums for those under 40 could be up to 70% more expensive if they want maternity coverage. without covered, giving birth cost an average of 30,000 -- $30,000, or $50,000 for a
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c-section delivery. that is totally unacceptable. said, if mynnell site is not able to agree on an adequate replacement, some kind of action to the health insurance market must occur. includes also provisions democrats have called , to drive down costs. republicans must end the sabotage and join us to pass stabilizing measures before the august recess. again, we are honored to be joined by our act exports -- our experts on health care. to theng to yield distinct cochair of the steering and policy committee, a leader in protecting the good health of the american people, a champion on this cause. thank you very much, madam
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leader, and thank you for putting together an organizing what is today a critical hearing. i want to welcome our catalyst -- panelists this afternoon to discuss the ways we can improve and strengthen the affordable care act for the middle class. cochair willand be here as soon as he can. the intelligence committee and they have a full plate today. you in about what all of your testimony have spoken about , the leader has talked about, and that is today to focus on stability in the marketplace. and what that means. today, or tomorrow, the senate will hold a procedural vote on health care appeal, and while we don't know exactly what they are voting on, we know that the republican proposals to repeal and replace the aca would
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unravel protections for patients with pre-existing conditions. it would eliminate coverage for essential health benefits. what are essential health benefits? prescriptionab -- drugs, maternity and newborn care, lead paint poisoning screening and testing. it would make health care unaffordable by raising premiums and deductibles. a repeal without a replacement would also mean 32 million people without insurance. appeal,of pursuing an we ought to work and it bipartisan manner to reform the current system and fix the problems that exist feared we cannot leave the american people behind in this process. we need to stabilize the marketplace and inshore -- ensure there are options for people living in bare counties. we need to bring premiums down
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and stabilize the marketplace, which can be done with a reinsurance program similar to medicare part d reinsurance program. it is also interesting to note that we have in a document , reinsurance, house republicans, house democrats, senate republicans, senate democrats and republican governors also proposed reinsurance, a reinsurance program. we are deeply disturbed by the trump administration attempts to sabotage the affordable care act, a law they are entrusted to uphold. despite the narrative of so-called implosion, more than 10 million americans find the coverage in the aca marketplaces in 2017 beard the enormous uncertainty created by the trump administration's refusal to continue cost-sharing payments have caused insurance to propose
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2018 premium increases. the biggest economic challenge of our time is that too many people are in jobs that do not pay them enough to live on. we cannot put more american families in jeopardy by raising the cost of health care. we need a country and a health for thetem that works middle class and be vulnerable, not just the wealthy and those with the most lobbyists. with that, i want to say thank you to all of our speakers today. thank you for your work and all to do to inform our debate. we look forward to your discussion. i will now introduce our panalists-- our c and we will start with testimony. we will start with the former director of the congressional
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budget karen dean of the john f. kennedy school of government at harvard university you would he previously served as director of the hamilton project at the brookings institution. he is a lifelong public service who has examined the relationship between academic research and public policy how it affects the lives of people and how they are living. in the fight to have these for the act, he knows better than anyone how the organization determines cost to the american people. canook forward to how we make sure the middle class is not left hind feared -- left behind. teresa miller, pennsylvania is the fifth-largest insurance market in terms of premium, market, and the 15th largest
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insurance market in the world. she has talked about urgent action needed. aca marketplace stabilization. during her tenure as insurance commissioner, she has increased outreach and advocated for working families. she is an expert who deals with the insurance market every day. she works to inshore pennsylvania has no bare counties and is a national expert on these issues. she served as acting director of the state exchanges group, the oversight group and the insurance program group at the federal centers for medicare and medicaid services. gary coheo introduce n, the vice president of public affairs of blue shield of
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california, where he leaves the government affairs team and advancing their public policy initiatives, such as reducing the uninsured rate, stabilizing the individual health insurance market, topics we look forward to hearing more about from him today. , gary, whowas you said in your testimony that stabilizing the insurance market is a pocketbook issue. has more than 30 years of experience. he served as vice president of enterprise regulatory strategy .nd policy at kaiser permanente with medicaidked and medicare services, which was instrumental in implementing the report in the private market. thank you all for joining us. we will begin our testimony and start with you.
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>> i am very pleased to be here today. you are taking a critical subject of how to stabilize the marketplaces in which millions of americans by private health insurance for themselves and families. some members of congress and senior members of the trump administration have asserted the marketplaces are intrinsically unstable because of flaws in the design of the informal care act feared the evidence does not support that assertion. the evidence shows the marketplaces helped millions of americans by health insurance and in turn has enabled them to obtain the health care they need. the numerous independent analyses have concluded that
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before the current administration took office, the market place would be stable for years to come. enforcement, evidence also shows the marketplaces can be destabilized by the administration. if the marketplaces collapsed, it would be because the trump administration takes or does not .ake certain important actions responsibility will lie with the trump administration, the consequences will be felt by millions of americans. in my judgment, three actions are paramount to stabilize the private individual health insurance market. first, payments to ensure is for the cost-sharing reductions they are required to provide to lower income enrollees must continue. without those reductions, the enrollees would face much larger deductibles and copayments and would be effectively unable to obtain health care they need. without the payments to insurers to require those reductions, the
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insurers would be in an unstable position. this is already allowed insurers to raise premiums and others to leave the market, what hurts individuals and costs the federal government more in the men's feared the administration should that cost the federal government more in the end. the congress should pass legislation to ensure that happened feared -- happens. the penalty for not buying health insurance should continue. if you could wait to buy health insurance until you need it, some would wait. but then it would not longer be insurance, bought by a large group of people come with some of whom need help and some of whom do not. buyine if you could wait to auto insurance until after you had an accident.
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allowing people to wait until they need -- wait to buy health care until they needed will affect everybody else. the administration should continue to enforce the mandate to buy insurance in the aca and congress should make sure that happens. third, the marketplaces must continue to be administered by people to buy insurance weather than discourage them. that includes advertising so people can learn about options they have. it includes customer service so people who call can get answers. it includes an open enrollment period for people to collect information and make decisions. the administration should state that it will administer the market leases in ways that encourage, rather than discourage enrollment. the congress should make sure that happens. these three steps do not represent a complete list of actions.
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reinsurance, which was in place between 20 and 2016 would help the market. and other steps that my panelist will discuss. i want to conclude that the subsidies and market rules enacted in the affordable care act has significantly increased the number of americans who have health insurance. through both medicaid and the new marketplaces for private health insurance. repealing those subsidies and rules, with and without a replacement provision in some of the bills would make health care unaffordable for tens of millions of americans of modest means who can afford care today. that would be a terrible step backwards for our country. repealing the affordable care act, de-stabilizing the health insurance market, as the trump administration is currently trying to do, would hurt millions of americans. i urge the congress to prevent this damage.
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>> miss miller. you, good afternoon leader pelosi and members of the committee. they queue the opportunity to be here today. topplaud the committee highlight the urgency of the need for certainty and stability as we strive to make our health-care system and health insurance market work for all of those who need it. while the state of the current repeal andal -- to replace is unclear, that does not mean there are things that need to be done to move our market stability. things i think it be done in a bipartisan way and things that can be done now. i will not sit here today anti-you the aca is perfect, it is not. the narrative that the republicans in washington are pushing, that the aca is failing and that unless congress takes action it will implode, it is false. millions of americans have benefited from the aca.
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a majority of the markets where people get their insurance has costs.moderation of there are legitimate issues in the individual market, but this is a small market covering 5% of the population. this is the market that is heavily subsidized by the aca. thenerally hear from about one to 2% of pennsylvanians in the market who do not have access to financial assistance. it is that small population that the market may not be serving as well as it could. the individual market in pennsylvania set -- pennsylvania is not failing. it will not implode unless the federal government takes adverse actions. like cost-sharing reductions that would cause it to implode. we need to make common sense changes that would improve the aca and make it work better for the people it is not working for today. thoughts offer a few on issues we currently face. how the current congressional
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proposals will impact these problems, and what a bipartisan solution that would improve the aca could look like you're it i mentioned our individual market is stabilizing. the insurers proposed rating increase our further evidence that our market is on a path to stabilizing. while i am pleased, that stability is on fragile ground because of uncertainty here in washington. we quantify the uncertainty as part of our rate review process. insurers tell us that if it is not paid, our statewide average increase would be 20% instead of the 8.8%. if the individual mandate is not enforced, the average increase would be 23%. if both of these things happen, we would look at increases of 36% on average, statewide. that is assuming our carriers stay in the market. i cannot express enough how difficult this is on our insurers. ,f you asked me what single
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most important step is, the answer is easy, commit to paying the csr payments on an ongoing eestnet -- basis and do it now. and rather than repealing the mandate, or failing to report sit, we need to mandate it. it is critical to adequately incentivize everyone in the market, especially the hung and -- young and healthy. allen's risk for with those in need coverage as well as the young and healthy. risk pool with those in need of coverage as well as the young and healthy. this program medicated the impact of high patients and claims and was estimated to reduce rhenium by 10-14%. this is an area right for bipartisan action. republicans recognize the value of the programs. both proposals allocated funding for a reinsurance program.
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a program in the context of a bipartisan plan could be an effective way to scale back the premiums we see. i would be remiss to fight in not say something about the cost of health care. . . . . experiencing astronomical growh and costs. for of us are looking solutions at the state level, but these are national problems that merit a national solution. the health reform debate has been without question, partisan. the goals are not. real problemse that exist in our health-care care system should not be either. my hope is that we can talk about health care differently as a nation. we all want americans to have access to health care that they need and to be able to afford it. we want them to have choices. aat means supporting competitive health insurance marketplace that can provide those choices.
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let's recognize where consumers may not have had that affordability and look for solutions to address the problem. ,et's continue paying csr's enforce the individual mandate and put in place the insurance program to -- moderate programs for consumers. we need to look for ways to moderate the growth of health care costs to ensure we have a health coast this -- health-care system of those who need it now, as well as those who need it. i hope we can move away from the drastic proposals that would jeopardize the financial security of millions of americans and focus on solving real problems with common sense solutions. thank you. we are going to recess for the moment, go upstairs and vote. i am looking at all of my colleagues. there is a requirement to come back. [laughter] >> we will resume the hearing.
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the doctor wanted to ask mr. cohen if you will provide your testimony. thank you to our colleagues who have come back, somewhere new additions, i'm sure we will get other folks as well. the committee, thank you for the opportunity to be here today. i have had the privilege of having served as a state insurance regulator under congressman garamendi and serving in the obama administration, now working at blue shield of california. eight not-for-profit health insurer that has the largest membership. -- eight not-for-profit health not-for-profit health insurer that has the largest membership. number one, the time is now, time is to why, the lower out-of-pocket costs for americans.
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rates are being locked in. if the goal is to lower premiums and adaptable's, the time is to act now. i have heard it said recently that health care is complicated. actually, what needs to be done now is not complicated. payments established a premium stabilization fund, such as the reinsurance plan that existed in the affordable care act for the first three years and exists today. enforce the individual mandate and invest in education so people know what benefits are available to them, and have the help they need to sign up. these beings should not be controversial. everyone should want people to sign up. formore people who sign up insurance, the lower premiums are for everyone. as we have seen, getting in person help is critical for people to sign-up for insurance,
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particularly for those who have never had private insurance. i hear some people say that what they want to do is get more people off of medicaid and onto private insurance plans. if that is what you want, you need to make a market that is competitive and that will be affordable for people in order to achieve that goal. why it matters? some people argue that risk mitigation programs, like reinsurance and risk quarters are bailouts. they seem to forget that these programs in medicaid part d was april -- was a blueprint for the affordable care act. to beeople claim concerned about areas of the country that have no insurers offering products in exchange, should consider -- they should consider that no one wants to be the only ensure that has to cover the high cost individuals that cost for so much of health care. that was the problem in iowa where it was one person whose
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annual cost exceeded $1 million, that led to insurance leaving portions of that market. as her cautionary reduction, they are not a bail out. they are a benefit that reduces the out-of-pocket costs, the deductibles, co-pays and co-insurers for the lowest income people in the plan. the law requires that insurers provide this benefit. all we are asking is that we be providing thecost benefit that the law requires us to offer. think if a manufacturer were to offer consumers a 10% discount at the retailer in the cost of a product. ok, youiler would say, now need to pay need a 10% i gave up when the person bought the product. if the manufacturer said, i will not bail you out, with that be a regional -- reasonable
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response? no. we are required to provide that to people and make it possible for them to go to the doctor. congress should fulfill its responsibility to make sure we get repaid that money. lastly, as my other panelist have said, it is important that we move from the conversation we have been having for the last seven years. are we going to cover everybody? how will we pay for it? and how will we adjust the cost? is reason health care expensive is because the unit cost of health care. we need to start thinking about how we will grapple that. the more time we spend fighting over these issues that are consuming our time today, the harder it will be to get to that discussion. thank you, again. wonderfulosi:
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underlying common purpose and solution. with that, let me ask my colleagues and cochair of this committee to make his comments and we will proceed to the ranking members. >> thank you chair and leader pelosi. i think we are demonstrating to the american people that, while the public waits for what the senate will do, and it looks like their intent is to take away health care for millions of people and make it more expensive, and put exide he into so many families homes, we are putting forward ideas. that are ideas that
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republicans have put forward as to what they would do during the two years standby >> has extended to them the certainty and not having to worry about where they will get their health insurance. temporaryem take jobs, or jobs that do not have portable benefits, but right now they have a portable benefit of the affordable care act. been, i think, a conversation that has moved forward because of people, their voices and they are being heard today. that, to also recognize who is leading this effort for house democrats, they are for ranking members who have jurisdiction over the affordable care act. three are here.
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we have frank pallone, john yarmouth and bobby scott. i will year of -- yield to frank pallone. thank you chairman, thank you for convening this hearing. i have to say that three witnesses are wonderful. just because you are so practically oriented looking at what happens out there, which often times we do not hear those kinds of voices, all of you talked about the uncertainty in the market. we would like to see is the republican effort to repeal the effort to sabotage the aca, which i guess the president has and working to cease with us to make improvements. i think you both specifically mentioned how the uncertainty is playing out with rate increases. i say that in my home state, the rate increase, which has 70% of is almost proposed
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25%. only 8% is health cost. the rest is uncertainty over the mandate. if you could explain what would happen if the president decided to unilaterally cut off funds, how would this impact the individual market across the country? >> cutting off payments to insurers would wreak havoc in the individual health insurance market. insurers would lose a lot of money. inwould lower income rowley's, they would not get the payments. they would lose a lot of money. he would hike up premiums and flee the market. we see some of that happening already, just over the anxiety and uncertainty. if it came to pass, a lot of people would lose health insurance. is happening in
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new jersey, that is why we need to make sure it does not happen. miss miller, could you explain how this reinsurance works and republican say it is a bailout. if you would describe that briefly and why it is not a bailout? >> thank you for the question. there were three premium stabilization programs part of the affordable care act. risk quarters, and risk adjustment. two of those three were temporary programs. reinsurance programs was a temporary program. it was designed to help insurers cover the high cost enrollees. it helps reimburse companies when they are covering someone that has a lot of health care costs. that lowers everybody's premiums and helps keep companies in the market that may not stay in the market otherwise. in the first year of the program, the academy of actuaries put out a document
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that was included in your materials, it talked about the impact of the premiums in year one. i think it was between 10 and 14%. betweenremium impacts 4% and 7% recently. that is a program that can impact premiums. that is one of the things on the regularly side -- on the regular side -- regulator side agree with. it is an area that has gotten bipartisan support. >> i should mention that, as the four ranking members and our leader pelosi had a press theerence, we stressed initiative and reinsurance as ways that we could improve work on a bipartisan basis to make a difference with the affordable care act. number --ou ranking ranking member. we will go to bobby scott.
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me gonk you for letting of a hearing at 2:00 that i am convening. the affordable care act made a lot of progress but it did not solve all the problems. whatever anybody thinks about the affordable care act, we ought to recognize that, if we do something, it ought to be an improvement and not making things worse. ,e should be lower in cost insuring people and improving the quality of insurance. we can do that if we work together. we will not do that if we are taking money off the table and reducing medicaid. money are spending less on subsidies, you cannot cover more people with less money. we want to make sure we are going forward. thateader has indicated the democratic numbers in the in the houseers and senate are willing to work
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together, but we will not work together to help things go backwards. toould like any witnesses come in on the stability of the program. the cbo indicated that the insurance is stable if you do not mess it up. you mentioned the havoc that with be reeked -- wreaked a cost-sharing reductions and what that would do. you mentioned the failure to enforce the mandate and what it would do. the association plans have also been mentioned as a possibility and could you mention how they are problematic and what they said if the repeal without a replacement would live in an area where no insurance company wanted to participate in the marketplace. >> the congressional budget office and a number of other
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organizations about the marketplaces have concluded that under the policies in place the marketplaces would be stable in years to come. the problem now is coming from the uncertainty created by this administration's aks and by the legislation moving through the congress. insurers will not lead to the benefit of the american people. >> so california, we have been fortunate we have a state exchak. it has been functioning well. we do have a come pettive market. no one likes to see rate
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increases. it has been in line with increased cost of medical care. we have been directed to submit two sets of rates for 2018. we have a lit it less than a month to inform our customers what they will be paying for 2018. as of now they will be paying more. so you end up in one of those spirals. they would return us to a time when many small employers could not get coverage.
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if they had bone sick person wh worked for them they would be charged more. with these associations, as it is now you cannot do that. you could put together groups of healthy young people and it would result in those that have older workers being charged more. >> can i just make one statement? when you think about the premium stabilization programs, two of those were three-year temporary programs. i think the people who drafted the aca understood there would be some market instability because everything was new in 2014. we are now in that fourth year.
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last year i had to convince some of them to stay in the market. the interesting thing was what changed in 2017. they indicated their 2017 early experience was getting better and that they were feeling very much like the market was stabilizing but only concern that all of them said over and over was the biggest concern we have is what's happening in washington d.c. if you could take that uncertainty off the plate we feel really good about our market. it's heading in the right direction. all of what's happening here is
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a caveat of that. >> thanks to leader pelosi. i appreciate this. this is something many of us have been involved in now going on eight years. we often have a lot of discuss saying that the problem with much of the aca is that we don't have enough competition in many of the counties and paul ryan often says they only have one insurer. a few counties have none. i come from a state with counties like robertson county
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which has 2,300 people. you may have a county that has potential customers of 500 or a thousand people. the idea that there's a way to create competition among insurers is basically unrealistic. isn't that the experience that you have in pennsylvania? >> what i have specioused -- i was regulator in oregon before i was in pennsylvania. both states have fairly competitive health insurance
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markets. if you look at premiums, provider competition has more to do with premiums. the areas where we have fewer -- like the areas covered by one insurance company, those are some of the lowest prices in the state. some of the areas where we have more insurance companies, those are actually the higher premium air wrea areas. my biggest thing is competition. >> and in the aca there was kind of a government option for competition which was the co-op program which kentucky
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established and was having a very successful run at it. the house bills admit there is no way to create a viable individual market without government involvement either through tax subsidies, reinsurance, high risk pools in the case of house bill. that's something that i think they had never been willing to admit. they admitted it in their legislation. the other question i have is -- i have been saying it so i'm asking particularly, you know, he studied the other bills.
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> >> i think you're right to say it requires a set of rules that insurers and families have to abide by. i think you're right to say it for tens of millions of americans. there was no health insurance market for the millions and millions of people who have preexisting condition. there was no market at all.
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when we talk about wanting to have a competitive market we have created a market for the affordable care act. >> thank you. i appreciate that. >> thank you. we'll turn now to jim of south carolina. >> thank you for convening this hearing. i'm extremely impressed. i'm used to hearing from him having been part of that super committee and other things that sort of -- i get it. it's a great deal. i thank you so much for your testimony today. i am particularly interested in this whole issue of certainty in the marketplace in peoples homes, in peoples lives. it seems to me that that's becoming a watch word for all of
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us in many many different areas. >> so last year after we finalized rates for our companies i had phone calls from a couple of them indicating even though we thought we had gotten to an agreement they called and said they are not sure they want to continue in the market. that's a big problem for
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regulato regulators. one was enforcement of enrollment periods. it would have been helpful. but the second one was the litigation. at the time this was back in september. it was before the election. even having that case out there, they had dollar figures they could put on that case and what it meant to them. those two issues in particular, enforcement of the special enrollment periods, those were two of the reasons why they were really struggling to figure out if they wanted to stay in the market. i had to bring folks from the obama administration at the time up to pennsylvania and we sat down together with some of our carriers to say what can we do from the state side and federal side to make it a more attractive market.
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>> they went to court. they won. do an appropriation. it is very simple. we have to provide this benefit. it is worth billions of dollars nationwide. they won their case. they made their point. now it's their obligation to appropriate the money. >> i would add that the consequences of uncertainty show why a strategy would be such a disaster for the country. there is a lot of uncertainty created by the federal government's policies. if it's on top of that they said we'll take the whole thing away and do spomething, we don't kno what, that would have a damaging effect. >> so you're saying if the
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senate were to come up with -- that is to pass something to repeal, delay imply men station of 2019, you're saying this would have even greater adverse impact? >> yes. absolutely. >> thank you. >> we will recognize four at a time. the first go around we want representative ruiz, mike thompson and january shakowski. >> it is a treat to have all of
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you three on the panel. i'm personally connected to all of you. i'm an alumni in the harvard school of government. i trained at the university of pittsburgh in emergency medicine and i grew up and live and my heart is always in california. thank you all for being here. i'm an emergency medicine doctor. i take care of patients with different urgencies. we always have a method of approaching all of these complex situations. first would be do no harm to stabilize the and stabilize the patients. you talked about there are active decisions the trump administration is doing that is harming the marketplace and harming patients. that's an outrage and a shame.
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the people that are suffering are the people that need health care. second is we need to stabilize the market. i introduced a bill that will permanently fund csr's and it will increase tell jiblt to receive those copays and deductible subsidies up to 400% federal poverty level. so the quote of letting obamacare fail is very misleading. it's one of the more frustrating things. you all hit it right on the head of the nail. it is a way to hurt people in order to force people to want to swallow their placebo or actually their poison. i want to ask mr. cohen. you highlight the difference
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they make for your members. can you explain more what they have to lose and i also want you to emphasize the time urgency that we have here. i don't think a lot of people understand that right now insurance companies are deciding whether they are going stay in the market or they are going to leave the market. what's the price all of them are going to hold? can you elaborate on that time frame and urgency of needing to act right now? >> thank you. i can. so on our time line once we get to the middle of august that's when our rates get locked dow down. it takes a little bit of time to get that done. when i was in the obama administration i had the painful experience of knowing what happens when you haven't got your data locked down and have your i.t. working properly.
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you have to get that done. we need to inform our current members what their rates are going to be for the future. they will be renewing abdomen and they may have an opportunity to get different plans. we have to get those rates locked down. we are dealing with a situation where we have to look at are we getting that cost sharg or are we not? we are hearing about statements from the president and others that the funding may not be there. we have to take into consideration we may not get that funding. if we don't we have to increase rates for everybody. it's not just for the people that bet that benefit. everybody will pay more to spread that cost among our members. nobody should want people to have to pay more. when the question of what that benefit is worth to people it is the ability to go to a doctor
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and get care or not. if you have a plan with a deductible of $3,000 that might as well be a million. the whole point of that is that it reduces the cost of the deductible. it reduces it to a point that they can give care. >> if you could pick one thing, would it be cost sharing deduction in. >> yes. >> it is to stop the bleeding in a fracture that will save the patient's life, right? >> yes. >> thanks to all of the witnesses for being here. you're fantastic testimony, i have some questions i had planned to ask. i sat down when we first convened. i got two messages that came in. one said if the atordable care
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act is -- and second they would eliminate the mandate and device tax. i know you have got a great experience and cbo already said if they do some of the things they are talking about it will cost us between 22,000,032 million jobs. if they do this skinny bill, what would cbo estimates look like if you consider that in the million job loss? >> well, congressman, as you know, former cbo directors do not carry around the ability -- >> i had confidence to give us a rough idea of how many million people would lose health care. >> the mandate to buy health insurance is extremely important
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we can pay the average cost. it is by which care exists those of us with employer sponsored health insurance are in a pool automatically. the genius was to create a pooling mechanism. as he pointed out. we need more portable benefits, not less. >> thank you. my colleague and i have that would apply a deduction depending on the cost of living. beth of us represent a high cost
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of living area. a lot of folks are squeezed out of market because of that. would that be a help in. >> i think it would be. i think the premium tax credit reflecting what it costs in a particular location. i think it would be a helpful thing to look at. >> thank you. >> mr. peters. >> i'm discouraged in the house process they didn't have hearings. it's nice to have a hearing where you you can ask questions and get responses.
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wanted to ask you, do you see a second option? one is how effective is advertising for the ability of health insurance? you spent more on advertising all of the federal exchange rates. two, what about young people in a plan that would allow insurance companies to get them. if we had to move off would those be effective? >> i think it's a conversation we need to have if we are going move up the mandate.
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>> i agreed very much with that. auto enrollment is very important. >> and i hope they don't cut it so much they can't do the calculation. >> i must say if i can that i think the tax ton congressional
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budget office on the integrity and potentially on its budget are terribly shortsighted by any member of the united states congress. the cdo was created to give the congress a source of information of its own in making policy, to take that away, what everyone thinks of particular estimate is very damaging to make informed policy. that's why i and all of the other former directors reminding the leaders of the congress about the value of cdo. >> thank you for your leadership. >> so what percent of the
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problems that you're seeing are in that market? >> thanks for that question. i think it's a good one. i think from where i sit really all of the people i hear from that are not 100% excited about the affordable care act, they are in the individual market. i think it's really helpful to understand what we are talking about there. i think it's similar across states is about 5% of the population. >> it is only about 3% in illinois actually. >> it is an important market because these are families but it is also important to remember thr is where most people in this market are getting financial assistance at least in pennsylvania. in pennsylvania on our exchange, which is not our entire individual market 80% of the
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people in the exchange are getting subsidies. over 50% are getting cost sharing reductions so that policy that allows us to pay less. >> so 80% of the 5% are getting -- >> not entirely because part of our market is outside the exchange. of course no one outside the exchange is getting access to subsidies. the numbers always change, over 500,000 and about 400,000 are on the exchange. >> so when we are talking about improvements now in insurance are we mainly focusing on relatively small percentage of people who actually have had trouble with obamacare? >> yes. that's right. >> so i think that's missing to
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a lot of people. we line up our stories about people who have been helped and they line up people who have been hurt by it and i think donald trump had some of those people behind him yesterday or the day before. yet there's no perspective on who we are really talking about and the people that are actually helping. i think it's really important. the sabotage issue is really worrisome to me. the most important is it needs to continue. it needs to be made clear to
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insurers immediately, i mean yesterday or the day before, not tomorrow, not next month or next year. that is where the biggest immediate danger to the market is because insurers don't get benefits they are required to provide. >> and will the insurance companies, you know, join them and will we get their support if we do that, if they understand the difference that it would make to them? >> absolutely. i think speaking for our company the mission is to serve the people in the states that we are. that's what those companies have been doing. it is because of uncertainty people are finding it and asking them themselves, is this a market we can be successful in?
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>> is our insurance company going to be our ally? >> i believe so, yes. >> thank you. i yield back. >> thank you. we'll go to doris and matt cartright. >> thank you very much. i really appreciate the panelists being here today. you have all been very articula articulate. i want to focus in on california. we have been working with ensuring it be as successful as possible in california and really planning ahead to figure out how we go through this rough weather in a sense too. mr. cohen, i know that it has been a leader in this. you have been a wonderful player in this especially in transforming in paying from volume and paying for value. can you describe as you move
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forward a specific effort that you have been doing? blueshield has been doing this in a state to achief these goals and how we might be able to ensure or bring in other insurance companies to understand this is a way to move along and save some money too. >> thank you congresswoman. as you pointed out blueshield has been a leader in creating deep partnerships with hospitals and doctors to provide care to work to a budget and to share risks both upside risks and downside risks so we all have the same incentive and to provide good outcomes at lower costs. that's something we are committed to and trying to grow. you know, the more you all can do here to encourage that and encourage that happening in public programs as well as in
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the employer market would be helpful. >> and i was also wondering too that there are -- you look up costs to consumers, what projects have you worked onto implement to have the most impact on reducing costs. i think you're looking at the costs we have moving forward but also as we look at the cost of healthcare itself. how do we do some of these costs and reduce the impacts on the consumers? >> so i think that there's ban lot of discussion about the high cost of expensive prescription drugs. it's been an increasing share in the country. there are a number of bills that have been promoted here and in the states. we have a bill moving forward
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for transparency on pricing. it would go a long way right now. it could raise costs without providing any information on what the basis for those increases are or why they are happening. it would be helpful. >> i would lieke to bring this up. we have to deal with reinsurance and marketing and all those types of things. we can't stop there. we know we have to move forward. part of this is ensuring these are the first things we have to think about to ensure that the market kpiexists, right? we can be t't forget we have to at this. i thank you very much. i yield back. >> thank you. now judy chu. >> one way would be to deal with the issue of prescription drugs.
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medicare spending ton part d benefit increased from 46 billion in 2007 to 80 billion in 2015. studies found there is overwhelming support for allowing the federal government negotiate to get a lower price for people on medicare and also they support making it easier for generic drugs to come to mark and requiring to release information on how they set drug prices. despite all of the republicans talk of lowering health care costs consumers have not seen any proposal on the skyrocketing cost of prescription drugs. could you describe how it could help to fix the aca? >> so congresswoman, you raised an important and challenging
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question. i'm skeptical as some other people are that negotiations by the federal government are the key part of the solution here. my skepticism comes from the narcotic t -- we will not pay for that drug or not pay very much nar drug. but that can then lock people out of debting access to that drug. it's a hard one for all of you to watch happen. so my own view rngs it is all about the rules, drugs coming to market, about what has to happen for the research that leads to some of these and so on. i would focus more in that area. >> i think what i would add is this is the conversation we should be having. we should be talking about how
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we actually get at the cost of care. i think when some of the republicans who are pushing some of the proposals out there today talk about reducing premiums all they are talking about is shifting the costs onto consumers. they are not talking about reducing the costs at all. it's really just instead of having insurance companies pay it we'll have insurance companies pay it. this is the conversation we should be having going forward. >> i agree with that. there are ideas out there which would enable patients to have access to drugs when patents expire that congress should be taking up. >> great. thank you. >> thank you. >> now we'll taurn to matt cartwright. thank you to the panelists for coming. i'm particularly proud of
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commissioner miller. you blew my cover. my fellow members up here were saying wow, she is so impressive and knowledgeable and i said well, we are all like that in pennsylvania. then you said you're from oregon and congressman welch turned to me and said busted. i want to continue this about the cost of care. i mean we can talk about 3 to 5% or individual market. we can talk about 150 million americans are covered by employer sponsored coverage. i'm hearing from the employers their premiums are going up. you have talked and said outloud we have to have the c conversation. i want to talk about health care in general. let's not just have a conversation about how we have to have a conversation.
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you all have been thinking about this. i want to push you on that. you have been thinking about what steps can be taken in the health care community to reduce the astro no, ma'amically rising level of costs. >> thank you nar question. i feel like i planted that. governor wolf in pennsylvania has had a health innovation plan we have been working on for the last few years. we brought together all of the stake holders and asked what can d we do to address the cost of care. we have a subgroup that is meeting with all of the stake holders to say how do we make sure they have so they can get care for the right places, the most cost effective places with
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the highest quality. we have struggled legislatively to get that through but we are continuing to work on that. that's starting point. ultimately we have also had subgroups looking at price transparency. how do we get better information out there as consumers. now that we have a deductible saying i need to get a shot that costs me $150 a month. when they are not it saves the
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system money. we have to do -- and we do not do a very good job with that today. we are trying to get it out there so they can make informed decisions. there is a lot of things they can do there. this is the con vaer sags we need to be having and this should be a focus going forward. >> thank you. yield back. >> thank you. next is sherry from illinois. >> thank you. i represent a district that is mostly rural. so i'm just wond erlg, when you think about rural areas in these bare counties, what are the answers? i would like to hear from each
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one of you. it's a really big concern of mine. i want to figure out how to help throughout the country. >> well -- and that may sound really simple but in many ways it is the result of not having companies that want to participate in the market. so at the end of the day i think some of the things we have been talking about today really are the answer to that question. if we can make it a market companies want to participate in i don't think we have to worry about the bear counties. one of the things is this conversation has been happening in d.c. we don't have any counties in pennsylvania but i fear as these conversations continue and insurance companies here are getting very close to dates where they have to make decisions about staying in the
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market. this uncertain the i is what's killing that. if we can kind of stop the bleeding like we talked about and make it is a market companies want to participate in, i think they will be there. i'm sure there are other things we can do but first and foremost we have to stop doing damage. we have to stop not paying risk corridors and not committing to paying csr's and committing to make it a market insurance companies say okay. i can't be here anymore. >> and i would just add access to care in rural areas is a problem. it was a problem before the affordable care act and what's taking place here. what can we coto improve that situation. one is we should be making more
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use of telehealth and tele medici medicine. it is what people want. people would rather not drive 100 miles to get to the doctor if they could have a video visit that could take care of a lot of their problems. technology is not an issue all of our injuries but there are a lot of things you can do particularly in mental health where access has been extremely difficult. >> thank you. >> i agree with my fellow panelist comments, making sure people want to be in those markets. i think vigorous actions are crucial to that. you told the story about sitting down with insurers that are thinking about backing out of the market and finding out what could be done to keep them in.
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we continue to work on ways to address that! thanks very much. i yield back. >> thank you. >> a lot going on today but i don't think anything is going on more important than your testimony other than what's going on in the united states senate. hopefully we will prevail in there. if that a agree. it it's working. . that's what doug said some
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months ago. thank you for dg hoar and mad dam thank you for your work. you know, pelosi pointed out in the bill they set forth how to stabilize the market for the next two years. all of the things they mentioned, they know full well what they are doing and they know full well how to stabilize the market. the aca is not working in some places. you just pointed out it wasn't working before the aca. we know how to fix that. it would be costly. one of the things is we pretend health care market -- we don't
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buy our elt care to think this loubing that. it would give the insurance company a better ability to price its product and more confidence and it would give the marketplace more stability. i thank you for your testimony here today. i was are late and apologize for that. i really do appreciate you're spending your time here. doug, thank you very much for the service you made to the cbo. hopefully it will exist next year. if it doesn't the country will suffer. it is such a wonderful group of people who give such honest advice. i talked to you as i talk to every director. give us the honest answer.
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we may not like it. it may not be in our political rest. almost all of your predecessors did that as well. i don't have an exception in mind. i think your successors have done that as well. >> thank you very much. >> thank you. >> no. i'm fine. >> thank you to all of our colleagues for being here and and what we are trying to do is look at stabilizing that
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insurance insurance market. what has struck me is that there is that you have. it is outreach. you agree that prescription drugs have to be dealt with. that is powerful testimony in this time where it's fake news about how the affordable care act has failed. it's interesting i noted earlier we did some looking how republicans rng senate come cats all for dealing it with reinsurance and make that. csr, again, house republicans,
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senate republicans, senate democrats believe the csr payments should be made. when secretary price testified he would not answer any questions with regard to the much of csr i know payments have been made for june. it was so enlightening and i will tell you, our colleagues on the other side do not want to
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stabilize the insurance market. you don't have to attest to that. essentially what they are engaged in is a self--fulfillin care act is a failure, it will implode and the hypocrisy that they can afford and that is quality and everyone is going to be able to share in that effort. we thank you so much for your professionalism and understanding that nuts and bolts of this issue we want to get your word out there because you have such standing in this area. thanks so much for today. thank you very much.
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>> yes, ms. jackson lee? >> i told her i was coming back, i apologize, thank you very much, let me try to use the very, very skinny time i have that to thank all of you for being here. i come from houston, texas, the texas medical center which i'm trying to convince -- well, not convince but to have them be more energetic and vocal about what is right for them not what is right for democrats and republicans so let me do a question across the board and that is, particularly, mr. cohen, i know you may have stated all that is going on that pours out of washington, the word "repeal" skinny bill, numbers that frightens the
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market. if we were to continue the subsidies or the elements of the affordable care act which mr. am amendorf gave us good numbers to work with, subsidies, work with rule hospitals, make sure medicaid is strong. i just heard today we are a $22 trillion economy. there's no reason why we can't find a way to strengthen medicaid. anyhow, would we not be in a place where we would not look at numbers like 32 million or 22 million but we could stabilize this system, work with this health system. we have something called harris health and if the three of you could just add on our way of stabilizing, the messages here are right messages and we're doing the right thing. >> thank you, congresswoman jackson lee. in california, the affordable care act is working well. we have reduced our uninsured
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rate by more than half, from 17% in 2013 to 7.1% this year. a lot of that is due to the medicaid expansion and in addition to health care that's being provided by the subsidies. so while there are things that could be done to improve the way it's working today, it's working well. if we can avoid any big obstacles put in our path i believe it will continue to work well and will continue to cervical foreignians well. >> i agree with very much the marketplaces can be sustained in a stable way if only the trump administration would carry through with specifications of payments and other actions under the affordable care act.
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they have gained political support for their opposition to the affordable care act but that is very shortsighted because millions of americans will be hurt if they push the marketplaces into a destabilized state and more over, americans' confidence in the private health insurance system will be diminishes if the marketplaces falter which if anything is an outcome that the republicans who generally support private insurance should be worried about themselves. so i think this is a damaging and short-sighted policy by the administration ain't hope they change course along the lines we've discussed. i hope the congress tries to force them to carry through with the provisions of the affordable care act. >> and from moi perspective, you know, i think as we talked about today, number one, if we can stop undermining the market and actually work towards stability i think as the co-chair said, we're on the same page on so many things that need to be
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done. this is not a partisan issue if we focus on just stabilizing the market. i think one of my biggest frustrations and a lot of us who have been working on the issue with the proposals out there is they don't solve a health care or health insurance problem. the president has promised that we were going to have better coverage, it was going to be more affordable and more people would be covered and the proposals out there don't do those things. that i take a step back in those areas so if we were trying to solve this problem and understood the problem, which is really in the individual market, there are ways to do that we that we talked about today if we focused on that. >> let me thank the co-chairs and the leader for this very astute very important hearing and i would only say there's a vote coming up in a couple hours on the other side of the congress or maybe going on now, the leaders saying, and i just want to quote senator al franken. this will be probably one of the most or the most significant vote they will cast in reframing
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the life saving truck which you are that we've given and that they will take it away. i hope that vote goes in the way you have articulated. let us help the system as we as democrats have said and it's not partisan. let's work to strengthen it so we can have more opportunities for americans to be covered. thank you very much. i yield back. >> i thank our co-chairs and i'm going to yield to mr. swalwell to close. i want to thank our three guests, mr. cohen, mr. elmendorfcan, commissioner miller for your excellent testimon your objectivity of where we can do better is helpful. i started the meeting by talking about cost. cost to individuals, cost to
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business, cost to the public seconder, the private sector and many manifestations and what this will do in terms of cost to individuals and any other elements of this is just horrific. as i said earlier, what is it, $1400, $1700 if you're in your 60s and make $56,000 a year, you pay $11,000 more under the republican plan. this is a person making $56,000. so i think we have to focus on cost and all of the discussions we have and what it means if people's lives. some of it prevents them from even having access to care but i will say this, about this is what i was pleased to hear, we know the mandate was important, the individual mandate, but there are other ways to skin that cat and i would hope the trump administration would come in and say i'm not for a mandate but i know that we can't have free riders, how do we solve
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that? you've suggested we can work together to do that and i think democrats are open to do that. all of the things that congresswoman delauro and others that have pointed out that are in the republicans' bill that relate to stabilization, short term and long term and cost-sharing. let's embrace that and do that right away. the court case was an intervention, unfortunately. we thought the case was clear in terms of it's already called for in the bill. the judge thought not, now it's up to the president to give us more certainty but certainly congress can at this. mr. elmendorf mentioned. thank you. what do i call you, mr. president of the kennedy school? what is the title? chairman? >> dean, but delegate is just
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fine. doesn't matter. >> thank you for the letter from all of the cbo, directors of the congressional budget office in support of objectivity evidence, fact, and data and thank you all for the evidence, facts and data that you gave us today to make our decisions. we consider you an intellectual resource, we're blessed by your presentation today but hope we can count on you further in the future. thank you. >> thank you, madam leader. [ muted ] repeal is being considered and what it would mean in their lives and you have giv given to us ideas that we can put into action and i think ideas our republican colleagues have acknowledged would be fixes to strengthen and not take away the affordable care act. i have a particular interest being a 36-year-old myself and having constituents in a
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district that is quite young, we do everything we can to look out for the next generation of americans as hay go into a much different work force and have health care needs of their own so thank you for making this an ideas factory, for making this a place where we can collaborate and we were watching you probably observed the senate vote as it takes place right now. it will come down to the vice president if they have enough votes and we just hope that whatever happens going forward your ideas are, i would hope, debated at the very least and at best put into practice. thank you. >> hearing is add jeb bujouadjo. thank you. [ indistinct audio ]
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we are live this morning as justice department officials are here on capitol hill to testify at a senate judiciary committee hearing on form agent registration requirements. recently, senate judiciary chair chuck grassley wrote to deputy attorney general rod rosenstein over concerns about the foreign agents registration act as it relates to last year's election. the foreign agents registration act requires u.s. agents representing the interests of foreign powers to disclose their relationships with the foreign governments and information about related activities and finances. it should start in just a moment, live coverage here on c-span three.
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[ indistinct audio ] [ indistinct audio ] today the committee will examine the justice department's enforcement

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