Maximizing Health Coverage Enrollment Amidst Administration Sabotage

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yes we are ready can you count down one more time just so they know and we got everybody or should we wait a minute oh i you killed me no we're good to go thank you uh good afternoon and welcome i want to call to order subcommittee on oversight thank everyone for joining us today uh

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we are we are holding this hearing virtually if you didn't realize it in compliance with the regulations for uh remote committee proceedings pursuant to house resolution 965. before we turn to today's important topic i want to remind members of a few procedures to help you navigate this virtual hearing first consistent with regulations

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the committee will keep microphones included muted to limit background noise members are responsible for unmuting themselves when they seek recognition or when recognized within five minutes second members and witnesses must have their cameras on at all times you need to step away from the proceedings please leave your camera on rather than logging out third

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we will dispense with our practice of observing the givens rule and instead go in order of seniority for questioning alternating between minority and majority beginning with members of the oversight subcommittee first finally without objection representative chu is authorized to serve as chair in the event that i have some technical difficulties or or whatever i thank you all for your

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continued patience as we navigate this technology in order to continue serving our country together in this great time of me and with that i'll now turn to the important topic of today's hearing maximizing health coverage enrollment amidst administration sabotage it sounds like a movie so good morning everyone or good afternoon rather our hearing today will focus on access to health coverage

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and the trump administration continued continued unconscionable sabotage of america's care since its passage over a decade ago republican leaders have treated destruction of the affordable care act like captain ahab treated the white whale since 2011 the other side has voted more than 70 times to eliminate the aca

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in 2017 they even held an outdoor party at the white house after passing a plan that would cause millions to lose their health care coverage that same year one of the greatest abuses of power in this era in the dead of night republicans came within one vote of ending the aca and remaking one-sixth of the american economy on a bill it introduced hours earlier

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the president recently bragged about his health care of course he has great coverage coverage paid for by all of us by the same taxpayers who stand to lose their protection if the administration succeeds in the courts they've never let up i just want to remind everyone administration is in court right now demanding to destroy the aca the administration is fighting to remove health care

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programs and protections from millions during a pandemic they're using virtually every tool to dismantle the health care system they have greenlit scam junk plans without any protections they have imposed the gag rule to prevent women from having access to reproductive health care they have gutted funding for navigators and assisters while failing to crush the aca

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they are destabilizing the american health care system to a breaking point mr has gone out of its way to prevent americans from getting and maintaining coverage between february and may of this year 21.9 million workers lost their jobs of these workers 5.4 5.4 million became uninsured due to their job loss in march i joined my colleague health

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subcommittee chairman lloyd doggett and nearly 100 house members calling for a special enrollment period for people to seek aca marketplace coverage during the colder 19th pandemic even during the pandemic hhs refused likely dooming many americans to suffer no other word that i could think of except sabotage we keep seeing the administration and my friends across the

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aisle swear up and down they support protections for pre-existing conditions they assert with a straight face while spending 10 years attacking the aca let's repeat republicans have sought to terminate pre-existing protections over and over and over again it's on the record in welcome contrast some states are working hard to expand

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access to coverage one of them is the great state of new jersey we have witnesses today from new jersey colorado who will discuss how they are making the aca work best for their citizens as senate republicans race to confirm a new justice they are downplaying their challenge to the aca if the republicans have changed their minds on the aca why would they join us in defending the law

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when we voted in june to protect the aca 177 of 179 republicans opposed it if you don't have a calculator handy that's 99 when given a chance 99 of our colleagues across the aisle voted against protecting pre-existing conditions we know why in just a few short weeks the supreme court will hear the aca case the future of our health care system

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hangs in the balance and i want to yield now to my good friend the ranking member mr kelly of pennsylvania and i'm going to keep it to five minutes because we should show what happened last time people went over republicans we talked too much mike okay so michael michael thank you william and thanks for hearing uh holding the this is really a tough time so i think all our thoughts and prayers go out to anyone who's lost a family member or eleven during this virus

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there's nothing been more devastating in our time than the china flu and during this time the cost of healthcare is on the minds of almost every american so i appreciate the opportunity to really discuss the issues today now while far from being perfect our health care system is the best in the world and with a hearing like this i'm also reminded of how fortunate we are to live in a country with access to the most innovative health care on the planet i hope we can use this hearing to put things in perspective and correct some of the myths about the american health care we have

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been hearing out uh we're having a hearing on on the campaign trail today i want to talk about two things first i want to talk about some successful health care policy developments we've achieved over the last couple years and second i want to correct the record on some of the rhetoric we've been hearing about american health care a lot of this rhetoric seems designed to scare the american people in advance of an election and i think that effort has been both unfortunate and very misleading the idea that this administration has sabotage sabotaged our health care system if

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that's the truth this is the worst sabotage the world's ever seen it has been i i i can't look i can't actually look at this and say come on if we're really going to fix this let's fix it let's not talk about things that sound good on the campaign trail but ring hollow when it comes to truth uh we've made some very positive progress on stabilizing the aca's exchanges insurance premiums are down coverage choices are up and enrollment is stable so in addition this administration has made many strides towards being more affordable health

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care options to americans who may not want need or be able to afford some of the aca's coverage plans so i'm pleased that we have chris pope here with us today he can speak further to some of these successes including the restoration of short-term health care plans and major enhancements to health reimbursement accounts now these crucial events uh or reforms have actually provided options to family options letting them choose what's best for them again emphasizing letting them choose what's best for them and not having something

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shoved down their throat that they don't have a choice in now let's also remember that by getting rid of the individual mandate we've saved lower and middle income taxpayers at least 695 dollars a year and that's huge when you look at that group of people now democrats have been trying to block these efforts and i understand why and also using scare tactics to stop the progress of this administration or what time what tactics am i saying are talking about well like saying that republicans would eliminate coverage for people with pre-existing conditions which

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couldn't be further from the truth on protecting pre-existing conditions democrats won't take yes for an answer makes no sense to me but that's where we're at now let's remember the first legislation offered by republicans in this new the 616th congress said no one and i mean no one should be charged more or denied coverage based on their pre-existing conditions democrats rejected that offer apparently to try to preserve it as a as a as an election issue so any suggestions that republicans won't fight to protect americans with pre-existing

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conditions is just flat out wrong and a great miscarriage of the truth meanwhile instead of working together on bipartisan efforts to improve our health care system 118 democrats have co-sponsored medicare for all this new and enormous program would destroy our current health care system starting with the repeal of the affordable care act sadly many democrats simply want an unpopular and partisan government takeover of healthcare when we should be working together to low cost and coverage uh for everybody and get

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get more options for the american people now this one-size-fits-all approach is absolutely wrong it doesn't make sense to anybody other than somebody trying to push an agenda the wrong way now the plans that will take away choice from hard-working americans in my district would also destroy their health care options the affordable care act is 10 years old much of that law has changed over the last 10 years on a bipartisan basis yet democrats keep looking to pat to the past rather than working

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together to improve the future for our american people but we can build on recent successes in healthcare policy by continuing to bring down premium prices and by increasing coverage choices for all americans the key the key is increasing the number of options available and people can actually buy something that fits their needs and something they can afford now i hope we can stop all the fear monitoring on this issue and come together in the near future to work on bipartisan reforms that will improve the lives of our constituents mr mr chairman i want to

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thank you for holding this this uh this hearing and also want to thank all our panelists for taking time out of their lives to come and talk with us so thank you so much and i yield back sir and uh say uh to you and to all the democrats and republicans who were on last week with our last hearing not this hearing i thought going over everything after the hearing tremendous questions from both sides of the aisle on the subject of taxation tax fairness

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i i think that you know it's tough to get people together before an election but i want to compliment both sides for doing expect what i think was a spectacular job we're next going to hear from our panel and thank you to our distinguished witnesses for taking the time to appear before us today to discuss this very important issue i'll introduce our witnesses and then turn to each of them for their testimony our first witness is commissioner

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marlene karidi greeted credey she is the commissioner currently leading new jersey's department of banking and insurance previously she was a member of the new jersey general assembly representing the 36th legislative district our next witness is kevin patterson mr patterson has served as the chief executive officer of connect for health colorado

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since april of 2015 he has a long history of public service including as interim chief of staff to governor john hickenlooper our third witness is andy slavitt mr slavic currently serves as the board chair for united states of care previously he was the former acting administrator for the cms and our final witness is chris pope mr pope currently serves as a senior fellow at the manhattan institute his research

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focuses on health care payment policy and insurance market reform each of your statements will be made a part of the record in its entirety i would ask that you summarize your testimony in five minutes or less to help you at this time please keep an eye on the clock that should already be pinned to your screen if you go over your your time i will notify you with the tap of my gavel uh commissioner pretty

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you may begin thank you and good afternoon everyone uh thank you chairman pascarelle ranking member kelly and members of the committee um as mentioned by the chairman my name is marlene caridi and i am the commissioner of the new jersey department of banking and insurance and we regulate the banking insurance and real estate industries and now operate get covered new jersey the state's official health insurance marketplace which launched this month under the leadership of

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governor murphy new jersey has led in protecting the affordable care act stabilizing its insurance market and increasing access to coverage based on the guiding principle that health care is a right the state has moved in a deliberate way towards where we are today opening our state-based exchange making coverage more accessible and affordable for our residents and providing more financial help than ever before for those purchasing coverage on our marketplace starting this open enrollment

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in 2018 the state enacted two major policies we took first in the nation action to continue a requirement to have coverage after its elimination from the federal level and we implemented a reinsurance program beginning with plan year 2019 to cover high cost claims reduces rates in the individual market the two laws resulted in health insurance rates in the individual market that were 22 percent lower than they would have otherwise

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been the state decided to establish its own marketplace in order to better secure access to affordable quality coverage for our residents the fact is that while we have been sending funds to washington for the use of the federal marketplace we continue to see policies enacted that threaten the progress made by the affordable care act and made our work more challenging from 2017 to 2018 enrollment in the individual market dropped for the first time since 2014

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and continued to drop the following year when new jersey took control of outreach and enrollment assistance in 2020 as a state-based exchange on the federal platform we began to reverse that trend get covered new jersey will open for enrollment on november 1st and will keep more than 50 million dollars in our state to strengthen the marketplace residents will see benefits that include new state subsidies on top of premium tax credits the estimated average subsidy for an

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individual would be at least 578 dollars a year and at least 2 313 a year for a family of four the average net monthly premium for those eligible for financial help is estimated at 117 a month for 2021 compared to 164 dollars a month in 2020 increased navigators to provide free enrollment uh assistance with 3.5 million dollars in funding

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16 navigators up from one navigator under the federal government in 2019 three months to enroll compared to its six-week window under the federal government and residents will also benefit from our ability to respond to the needs of the state with a special enrollment period such as for covet 19 and quality uh qualifying life events including pregnancy which improves maternal health which has been a focus of this committee as well as the focus of the first lady of new jersey

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we have taken deliberate progressive steps to stabilize our market and improve access to coverage all leading to the establishment of our marketplace for this open enrollment period beginning november 1st with the public health emergency we are facing we believe there is no better time than now to make this transition chairman thank you for the opportunity to speak before you and your panel hey commissioner carrita i am very honored to see you again

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uh you happen to live in my district right how to get that commercial in our next witness is kevin patterson mr patterson has served as the chief executive officer of connect for health colorado since april of 2015 uh and of course he was a interim chief of staff to governor hickenlooper uh mr patterson please thank you mr chairman chairman jerome pasquale ranking member kelly and sub

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subcommittee members thank you for the opportunity to submit testimony on behalf of the insurance exchange in colorado and the people who rely on getting their coverage through the individual market here again my name is kevin patterson i'm the ceo for connect for health colorado our mission is to increase access affordability and choice for individuals families and small employers purchasing health insurance i am proud of the innovation and collaboration in our state to steadily reduce the uninsured rate and increase enrollments i'm pleased to share more with you today about our achievements as a state-based

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marketplace and how this unique position allows us to expand healthcare coverage to the people of colorado since we opened for business in 2013 we have helped hundreds of thousands of coloradans get the coverage they need to protect their health and livelihood however colorado's path to increasing access to affordable health care and choice started years before the passage of the affordable care act in 2006 a bipartisan group of state lawmakers created commission to study models for comprehensive reform under then republican governor bill owens with the passage of the aca in march of 2010

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our state legislature passed a bill creating the colorado health benefit exchange as a public nonprofit entity that has a bipartisan legislative oversight committee board members are appointed by the governor and both democratic and republican members of the legislature i joined connect for health colorado's ceo in april of 2015 when the state's uninsured rate reached a record 6.7 one of the lowest in the country charged with further increasing access affordability and choice for our residents i knew we had to prioritize meeting

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people where they are so whether i'm having a conversation with a single mom in denver or a farmer on the eastern plains i and the rest of my marketplace team are listening and learning from coloradans about viable solutions for accessing healthcare in their community generally every fall i visit many rural communities around the state to hear from them and share the upcoming open enrollment period this year these challenges of face-to-face visits are leading me to have these conversations virtually i'm thankful for the opportunity to still see our partners community leaders and local policy makers outside of

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denver since our inception we have funded our navigator program or what we call our assistance network at approximately two million dollars a year in about 45 sites they are integral to our success enrolling customers and providing health insurance literacy our assistance sites have also built relationships with small businesses regional hospitals and surrounding communities their work is vital to our ability to reach especially vulnerable populations including families with low income disabled population immigrants and folks in rural corners

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of the state the ongoing public health emergency has also underscored the value of our relationships with local counties and flexibility we wield as a state-based marketplace in mid-march we made the decision to open a special emergency enrollment period in response to coven 19. in early april the adams county commissioners informed me that their constituents were still experiencing hardships a result of efforts to combat the coronavirus we listened and we decided to extend our emergency special enrollment period through the end of the month our assistance network and brokers were

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ready to field questions from those unexpectedly without coverage and help them enroll as a result over fourteen thousand individuals enrolled in coverage during this emergency special enrollment period we continually explore ways to expand coverage with policy makers and advocates we will be integral in the implementation of two new programs that passed the colorado legislature this year the health insurance coverage easy enrollment program and the health insurance affordability enterprise i'm excited that we can extend access to affordable health coverage for colorado's with a simple act of checking a box i'm

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also looking forward to greater stability and cost due to the reinsurance program especially for consumers who do not qualify for financial help and are still struggling to access coverage with job loss and income instability and all-time high in our state is more important than ever that we remove barriers to health care by providing portable and affordable health care options like those that are offered through our marketplace i miss the challenges we face every year as a state-based marketplace i'm encouraged by the fact that we have flexibility crucial relationships and proven capability to ensure our residents have and access

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the coverage that they need thank you thank you very much mr patterson for summarizing your remarks i deeply appreciate that our third witness is andy slavitt mr savile slavic currently serves as the board chair for the united states of care previously he was the former acting administrator for the cms mr slavic chairman pascal ranking member kelly members of the committee i'm andy slavitt the former head of the centers for medicare

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and medicaid services and board chair of united states of care founded in 2018 us of care represents a movement of nonpartisan citizens former policymakers and experts who are committed to working so that every single american has quality affordable health care regardless of health status social need or income before i continue i want to please recognize the late chairman lewis for the great service to this nation thank you for inviting me to testify in the status of the affordable care act

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we sit at a perilous moment in our nation's history and for millions of american families the global coronavirus pandemic has taken hundreds of thousands of american families in a matter of mere months as many as 14.6 million people have lost their health insurance coverage along with their jobs at a time when the health of each american is more connected than ever before unfortunately covet 19 is not the only threat americans are facing right now rather than support americans through these

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trying times the trump administration has added to the uncertainty facing americans by attacking the very existence of the affordable care act dca serves two main functions patient protections and affordable care the law provides every single american a guaranteed set of protections including prohibiting insurance companies from discriminating against them on the basis of a preexisting condition and outlaws insurance companies from stopping coverage due to arbitrary annual or lifetime limits

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the aca has provided coverage to tens of millions of americans through expanded medicaid and the aca exchanges this quite simply has been life-changing the aca is saving americans four thousand dollars per family and many now can afford their prescriptions and to see their doctor for the first time and the aca saves 12 million seniors an average of 2 200 on their prescription medication and eliminates the age tax they made insurance unaffordable to americans 50 and older

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rather than implement the law as congress intended over the last four years this administration has undermined the law with a clinical callousness these actions have included cutting funding for navigators who assist people enrolling in coverage as well as other outreach and advertising by 90 shortening the open enrollment period illegally attempting to end payments owed to insurers to discourage them from participating in exchanges promoting insurance plans which have substandard or limited benefits

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which raises the price of insurance and brings back the fine print gotcha policies that kept so many people from getting the health insurance coverage they thought they purchased when i served in the obama administration i had responsibility for administering the laws passed by both democratic and republican-controlled congresses i understood that i had a duty to implement the laws based passed on by congress to the best of my ability that the executive branch did not get to choose which laws we liked and which we didn't but not so with this

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trump administration they have taken this to a new level now by refusing to defend the people in a case brought by republican attorneys general to invalidate the affordable care act and take their health insurance the public now faces great uncertainty into the future of this law just as a deadly and serious virus is making its way almost completely unchecked through the country the effect of the lawsuit were to be successful would put 130 million americans in a situation where they

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could be uninsurable for prior illness and with the copic 19 this is even more troubling it is the ultimate pre-existing condition the virus attacks multiple organ systems our clotting system our immune systems rendering our entire body a pre-existing condition in 12 days the eighth open enrollment period for the aca exchanges will commence despite the efforts of repeal despite the refusal of congress to build on the law despite continued negligence and sabotage millions of americans

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will get health insurance coverage for their families and americans do not understand why protecting their families is controversial and has been opposed at every turn by this administration americans would like nothing more than for by the bipartisan fighting over their health to stop at times like these people expect the support of their government not making their lives more challenging all people ask is to be able to care for their families keep them healthy and not fear bankruptcy at the first sight of illness they certainly would like to stop

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fearing the very government they elect in this country that should not be too much to ask thank you mr slavitt we appreciate your presentation today now i'm going to call on our last witness uh mr pope and mr pope got five minutes try to summarize and we're honored to have you here thank you sir chairman past girl ranking member kelly thank you for the opportunity to appear before the ways and means oversight subcommittee hearing on expanding health insurance coverage to more americans as the american people prepared ahead of

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the polls the committee is doing them an important service by taking time to review the arguments made over the past four years the claims made over against them and the evidence regarding how they've worked out now it's clear that the affordable care act subsidies expand as necessary to guarantee coverage to individuals with pre-existing conditions but the affordable care act wasn't just subsidies to protect people with pre-existing conditions but also a dysfunctional change in insurance market rules the affordable care act required

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insurance to be priced the same for people who waited until they got sick before purchasing insurance as it was for people who signed up before they got sick this had the obvious consequence the premiums spiraled up deductible sores insurers panics tried to restrict their networks many dropped out of the insurance industry or at least the individual market altogether and we've been left with a situation when four years ago the average premium uh plus deductibles the amount of money that an individual

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or sorry a family would pay to get coverage would be twenty two thousand dollars before they had any medical care paid for that's not a that's not an attractive insurance market it's not saying it's going to be appealing it's least of all success it was it was an urgent necessity to establish an alternative source of coverage and a source of appropriately priced insurance which give people value if they signed up before they get sick saying this price and proportion of their risk and in proportion to their needs and the basically rewards them for signing up

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prudently in a time in a timely manner the short-term limited duration market was not perfect but it was the best opportunity to do this and for this individuals who enroll in the sdlvi market are able to get better benefits at the same price for the same price as they would of the affordable care act and achieve a much cheaper price for the cheapest available plans at the same price for equivalent aca plans they will find better networks and these plans have higher satisfaction ratings

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so the administration was right to try and make sdldi plans more available congress is also right in repealing the mandate or at least zeroing it out the mandated proven ineffective and it because so many exemptions have been created under the obama's administration what remained of it was really just an unfair and inequitable tax a lot of claims were made that the sky was going to fall if the mandate was zeroed out and if sdldi plans were allowed to be made available to americans

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none of these predictions came true at all we were told the premiums were sold we would soar in fact they saw it before the mandate was repealed and since the mandate has has been eliminated premiums have been stable in fact slightly reducing enrollment itself has also been stable in the aca market since the premiums have been sorry since the mandate has been uh zeroed out so has um so it has been the effects with the stldi deregulation scldi

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uh deregulation if you look at the states where plans have been uh made available premiums on the aca market haven't soared or increased and enrollment hasn't plummeted in sdl the ui states any more than has in non-sdldi states there's been no discernible harm whatsoever to the aca market from the provision of sdldi plans all that has happened is that millions of americans have been able to buy affordable insurance the majority of which would have otherwise been uninsured there are flaws with stldi plants this

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was nobody's idea of a perfect insurance market it was the best that could be done in a regulatory framework that had been established by the affordable care act restricting planned term lengths to three months as had been done under the obama administration creates a huge uh incentive for short-termism and for plans to restrict uh long-term coverage of chronic conditions these are real problems they are best solved by uh guaranteeing renewability for plans over

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the long run eliminating restrictions on guaranteed renewability of short-term plans so that if an individual develops a major chronic condition while enrolled in the short-term plan the insurer has to cover it this year next year and into the future under proposals to restrict short-term plan renewability as prevailed under the obama administration if an individual enrolled in stl bi plan got cancer the insurer would be able to would actually be forced to drop them from coverage and will be banned essentially from covering them again

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this is that's exactly the wrong way to proceed we should protect consumers not eliminate options from them mr pope thank you so much for your presentation we appreciate it at this time i will open the hearing for questions without objection each member will be recognized for five minutes to question our witnesses if the witnesses will respond with short and concise answers all members should be able to ask questions as mentioned earlier we will not observe the gibbons rule

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in this remote setting we'll instead go to the order of seniority for questioning alternating between minority and majority beginning with members of the oversight committee members are reminded to unmute yourselves when you are recognized for your five minutes i'll begin by recognizing myself and mr pope let me just have a quick question before i start uh my questions which i had prepared do you

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advocate that we eliminate or that the courts eliminate the aca is that where you're advocating yeah that's not what i'm advocating now you're not advocating that that's interesting thank you uh i have a question the question is for the entire panel please answer with a simple yes or no the nation continues to battle the coronavirus pandemic with over 8 million cases and more than 220 000 deaths

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too many families are struggling to make ends meet do you agree that access to health insurance is more important than ever amidst the ongoing coronavirus pandemic and i'll start with the commissioner yes or no mr patterson uh for mr patterson in colorado the answer is yes yes chairman the answer for new jersey is yes

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mr slavitt yes mr trump mr pope yes mr chairman thank you commissioner why did new jersey decide to establish a state-based marketplace rather than relying on the federally facilitated marketplace thank you chairman for that question as i mentioned previously we were sending funds to washington and the money that we were sending

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um we weren't being able to utilize it properly um and on top of that we were seeing policies that were coming out of washington that was just creating confusion and making our job much more challenging by keeping those funds in new jersey we're able to tailor it specifically to our residents we've been able to use that money to improve and expand our navigators program outreach education um just explain

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just explain the navigators yes chairman the navigators are individuals organizations in the communities that help our residents to enroll them on the exchange to educate them about the exchange to explain the exchange we had one navigator in 2019 while under the government uh under the federal platform and we have managed to invest much more money now 3.5 million dollars and expanded to 16 navigators for this coming open

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enrollment thank you very much uh mr slavic how destructive would it be for the supreme court to overturn the affordable care act during a pandemic mr chairman there's never a good time to take people's health care coverage away from them uh but at a time when they are getting a mysterious illness that we don't even understand when many indeed children and college

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students are getting an illness that appears to be asymptomatic decades from now they could develop things as like heart arrhythmia or asthma insurance companies will be able to deny coverage on the basis of pre-existing conditions if the affordable care act is eliminated a vast majority of americans do not want to see the aca eliminated and i think it would be a significant mistake but it might also add that in into pandemic it's important that people are able to report their illnesses so that we can contact trace and

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prohibit the spread once people start to worry about insurance coverage again they will not disclose their illnesses and the virus will spread even more rapidly is this a a mr mr slammit is this a an exaggeration on my part that during the pandemic millions of people lost their jobs and many many of them lost their insurance

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is that an exaggeration is that hyperbole no in fact press reports and uh data analysis suggests you're exactly right mr chairman well what's going to happen to these folks if the supreme court says that's enough no more of this i think americans will will go into bankruptcy they'll avoid getting medical care we'll be back to where we were in the early 2000s but worse with a disease spreading around the country nearly unchecked

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and finally have you seen the republican plan to replace the aca i have not thank you mr slavitt i appreciate that i want to recognize my friend mr kelly for five minutes to ask his questions thanks chairman appreciate it uh first of all i'm a small employer myself and we do provide uh insurance for the people that are on our team and i would just suggest that you most small employers really look at their workforce

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as family not not as as as some uh unimaginable group of people they are the people we work at today with for mutual success i just want to go over one thing now mister and mr sabbath uh written testimony he says that there's 14.6 uh million americans that that and here's the key may have lost employer-sponsored insurance since the pandemic began but and according to the cpo about 3.9 million people are dealing with

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permanent job loss and had an offer of employment-based insurance so of those 3.9 million americans that may have permanently lost your job i'm saying may have uh 1.3 million are estimated to be uninsured so a third of those are estimated to be uninsured while others have obtained new coverage so i mean listen there's no question this pandemic's been a strain on all of us but i want to address one of the myths that they had the administration is trying to sabotage the aca the trump administration and house republicans have committed to providing

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the health insurance options that americans want need now any indication that this administration is sabotaging the affordable care act is simply not supported by the facts health care premiums are down right choices are up competition between insurance and tourism and republicans have confirmed time and time again our support for protections but for those with pre-existing conditions so i wish would quit saying that's not the republican plan it absolutely is now despite that there's still a lot of issues plaguing our system and making it unaffordable for many so

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mr pope as an expert do you think this is an issue that should be solved by washington and if not what can our congress be doing today to bring down the rising cost throughout the entire health care sector well that's a great question the um the big problem with the affordable care act is it essentially said you can have any health plan you want so long as it's obamacare um and that's no real choice um there has to be a broader array of choices and it can't just be that there are

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plate plans that are out there that are priced the same if you sign up after you get sick as before you get sick people need to be able to have a reward for signing up early get a good value plan that is priced appropriately for someone who's doing the prudent thing and if we make available options to individuals who are who are prudently signing up early for coverage then as they develop a condition it won't even have become a pre-existing condition because they will only have had they will always have had insurance coverage

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well thanks you know one of the things i want to point out that as part of the health association plan act of 2019 both house republicans and senate republicans were talking about allowing people to actually become part of of association health plans that means they could spread the risk of the health insurance loss across a larger number of people and and access the same lower cost and high quality health coverage as large employers have and unions have now democrats in several states have actually sued to block this rule change so mr pope

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can you tell us about why association health plans are a potential benefit to small businesses and self assault proprietors and the self-employed it's a huge issue yeah so if you look at where where has traditionally been the strongest health insurance coverage in america it's recently been large employers and that's in large part because large employers are exempt from a lot of state regulation under orissa so association health plans allow smaller employers to bundle together and basically set up associations as the

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name would suggest basically benefits from some of the same regulatory freedom and flexibility and pooling how health insurance costs that large employers have always been able to benefit from so it really levels the playing field allow small employers to do what big businesses have always been able to do yeah i appreciate that again as a small employer myself there's nothing more valuable to us than the people that come to work every day that we can have mutual success so i thank you for being here and all the panelists thank you for being here today one thing i want to point out the supreme court

01:02:57

future action it really is about the constitutionality of the affordable affordable care act let's make sure that we we actually put that in the right light so mr chairman thank you for the opportunity to uh have a an exchange with our panel and i yield back thank you mr kelly and now uh the chair recognizes ms delmany for five minutes thank you mr chairman thanks for convening this very important hearing and i want to thank all of our witnesses for joining us today during a global pandemic of such

01:03:28

devastation it's critical that we turn our attention to maximizing health care coverage throughout the country through opportunities that were created by the affordable care act mr patterson like colorado the washington state health exchange has been quite successful in fact earlier this month washington health plan finder announced that the proposed rates for next year are expected on average a decrease by of 2.3 percent if everything goes as expected this would be the second year in a row

01:04:00

that rates have gone down washington state took several steps to counteract the administration's efforts to destabilize the aca individual marketplace the best way to lower insurance premiums is to bring in more folks and expand the risk unfortunately in 2018 the administration slash funding for aca navigators and marketing less marketing means fewer people signing up for coverage a smaller risk pool and higher premiums but watching the state chose to fund marketing and sign up assistance

01:04:31

mr patterson did colorado take similar steps and were you successful thank you congressman i we work very closely with our partners in in the evergreen state so i think pam does a great job with her folks and uh we've had a an exchange of ideas we we do a lot in colorado very similarly we have a very diverse state an urban corridor uh eastern plains uh and a lot on the western slope so we actually just go out and meet with people and we try to make sure that we have navigators literally in every

01:05:03

corner and so our assistant site we've been funding it at about 2 million as i said per year first it was a grant we've committed those funds out of our own revenue so that's been really important to make sure that we are able to work with communities that are being missed or that have language barriers and so we have a lot of support from brokers and assisters in uh different languages in in not just along the front range where a lot of the population is but in all all corners of the state so i hope that answers your question congresswoman

01:05:32

thank you in 2018 the administration allowed short-term limited duration plans to be extended for up to three years these plans are intended uh to serve as a bridge between coverage um because they don't have the protections that qualified aca plans have they don't cover all essential health benefits like maternity mental health or prescription drugs they don't have out-of-pocket limits they don't have to cover pre-existing conditions so allowing customers to sign up for these plans for extended periods of time fractures the individual market

01:06:04

and drives up prices in the aca marketplaces in washington we're fortunate that our insurance commissioner limited short-term plans to only three months preserving a robust individual market again mr patterson has colorado been able to help short-term limited duration plans thank you congresswoman in uh january i believe of 2019 our division of insurance and our insurance commissioner michael conway did put some different restrictions and regulations that they've updated around short-term limited duration plans

01:06:37

a lot of them around making sure they had an essential health benefit as colorado law covers you know preventative services prescription drugs hospitalization uh maternity and newborn care so all of those pieces were in there they also looked at some of the age ratings a lot of the components that i think the commissioner would probably be a lot better in answering your question but i i do know that that has been an effort that we have uh have seen in colorado and partner

01:07:07

with our division of insurance to to help implement and then lastly just collectively um have the actions that you take the impacted premiums and ultimately enrollment in the aca marketplace in colorado uh thank you congresswoman uh so we have like i said we've done a lot around reinsurance and last year we saw about a 20 reduction in rates uh we're also looking at large reductions in some of the more high cost areas in that same vicinity

01:07:38

but an overall rate reduction in colorado of about 1.46 if my memory serves me correctly uh and we've actually added carriers and so we've gone from you know we've got now we used to have seven carries last year we've got eight going into this open enrollment and about 160 almost 160 plan standard plans for people to choose from so we've been able i think with a lot of our outreach a lot of the work that we've been doing on the ground talking and listening more importantly listening to our our citizens in every

01:08:09

corner as i say about what they're needing and trying to facilitate the right kind of approach that that has given us the success we're proud of thank you so much um thank you mr chairman i yield back thank i you to meant to mention this before based on the members in attendance and consistent with the committee practice we will move to two to one questioning after representative wallarsky now i'd like to please call on our friend my friend from

01:08:41

indiana miss wallarsky thank you for being here thank you mr chairman thanks so much and thanks to our panel appreciate you being here today as well well here we go again instead of having a hearing on how we can work together and find bipartisan solutions in health care we're back to the only thing that we've seen so far which is political messaging and we all know that americans have been faced with rising costs fewer options and a chaotic health care system fortunately under this administration we have made

01:09:13

progress in these areas but these are still ongoing issues that need to be improved in my district so that's what i think we should be focused on the only thing we get from the other side is finger-pointing and accusations that republicans and administrations have undermined the aca i think if we put politics aside work on this in a bipartisan way i think if we had all the rank and file members together i have no doubt we could build some kind of a better patient-centered system that would lower costs maintain protections

01:09:44

for patients with pre-existing and no lifetime caps give states more flexibility give families and individuals more choices and greater control over their own health care this committee was able to pass a bill to in surprise medical billing so americans wouldn't have to worry about unexpected health care bills even though the bill hasn't become law at least we are able to come together in an agreement on fixing the problem i still think we can work together we could expand access to coverage and while lowering costs increasing choice

01:10:15

giving individuals more control maintaining important patient protections mr pope we've watched the majority try everything they could to entice people into aca plans going so far as to outlaw other insurance plans speaker pelosi's latest coveted package attempted to throw more money at the aca's problems even allowing millionaires to receive thousands of dollars in subsidies can you walk us through some of the reasons why in 2019 two-thirds of aca eligible americans

01:10:47

opted for a different option well that that's a a very good way of putting the context of this um i think the the affordable care act problems in terms of the individual market come down to one thing it's pretty simple it's the price um the the these plans they're they're far too expensive for what they are um the benefit the deductibles are very high but if the premium was low the deductibles would be okay the networks

01:11:18

aren't very good but if the premiums were low the networks would be okay um the covered benefits are fine premiums are far too high relative to what people are getting especially if they sign up before they get sick so if you're a cancer patient as a safety net if you're someone who never bought insurance before and all of a sudden you need a safety net source of care the the obamacare plans are fine as a safety net as a last resort but as a as a good quality source of insurance coverage

01:11:49

that gives people a reason to sign up while they're reasonably healthy before they have a major medical condition is just not good enough let me ask you this how would you characterize the current state of our health care system across these three areas first what happened to premium costs in the four years following the establishment of the aca's reg reforms and in the two years since the individual mandate was repealed and short-term limited duration plans were expanded and then second on the number of options available to the public and then third on the number of enrollees in the aca

01:12:20

right so the the premiums increased by 105 percent from 2013 to 2017 as the aca's insurance regulations were changed uh that's more than doubling really and we've seen that a lot of a lot was said that this was uh going to be outweighed by the impacts of rolling back short-time insurance repealing the mandate eliminating the mandate um but those two policies that have recently happened have had essentially no impact on premiums

01:12:52

premiums have gradually leveled off in fact slightly fallen we've seen again yesterday news came out the day slightly declined enrollment is as stable as it has been in years and in terms of options we're starting to see insurers that have fled the marketplace because it was in chaos starting to come back in some of the major insurers starting to realize there's now some stability they know what they're dealing with and it's not great insurance coverage that someone will buy before they get sick but as a safety net it's workable

01:13:23

thank you mr chairman i yield back thank you very much my friend from uh indiana next i'd like to call on the gentle lady from california miss sanchez thank you mr chairman and thank you for holding today's important hearing i also want to thank each of the witnesses for taking the time to be here for the last decade we've been so busy working to protect patients we know more work needs to be done and this pandemic has magnified for us that we must do more to eliminate

01:13:55

the systemic health disparities affecting our communities that's why i'm so tired of the president and his administration's blatant attacks to make health care harder to access they are making people fear for their health care during a pandemic where over 8 million americans have contracted the virus and 220 000 have lost their lives it's an absolute disgrace an executive order saying that you protect patients with pre-existing conditions

01:14:26

does not negate the fact that the administration is in court right now trying to overturn the aca overturning the aca means removing the protections for over 300 000 people under 65 with pre-existing conditions in the district that i represent the protections help our neighbors with cancer diabetes asthma mental illness and many other conditions apart from pre-existing conditions i want to talk about another provision of the aca in 2009 i was one of the authors of the

01:14:58

provision that stopped health insurance companies from engaging in gender writing simply put the aca does not allow a woman to be charged more than a man for the same health care plan simply because of her gender mr slavitt i want to start my questions with you do you imagine that this gender gender rating provision would be protected if the aca was overturned in court and what would that mean for women in this country uh thank you congresswoman uh no and in

01:15:30

fact one way to tell that is these short-term limited duration plans and these association health plans that we've talked about are able to charge women more uh for their coverage and also to deny them essential things uh that are that are important to everyone's health insurance coverage uh the even even provisions that affect both genders like mental health excluding those from from coverage as these policies often do is an incredible disservice

01:15:59

americans don't know when they're going to need a particular service so discriminating against them and leaving out things that they expect to find in their policies do them in an important disservice so would it be fair to say that women would probably pay more for their health insurance if they say were taken away and that they probably wouldn't get the services that they need they did before the aca and they would after thank you i also want to discuss specifically how communities of color are impacted by the aca mr slavic could you talk a little bit more about why the aca

01:16:30

is important in reducing health inequities and how has the administration's constant attacks on healthcare navigators and advertising for the marketplace impacted communities of color well there's terrific news from the epa the first five years of the aca saw reductions in disparities in cancer care in cardi and cardiology and maternity and infant health and in things like homeownership and in things like reduction of bad debt so that's been great news

01:17:01

unfortunately um without the outreach with the aca and the congress and its wisdom included in the package um there's no ability to reach communities that are on the margins and help them enroll for coverage whether it's a language issue or a cultural issue and that's why we've seen reductions in coverage that's why we've seen increases in the uninsured rate since the trump administration has begun overseeing the affordable care act so would it be fair to say that they've been trying to undermine or sabotage the coverage that the aca could provide well they have in fact

01:17:32

undermined and sabotaged the affordable care act thank you uh for being for being so forthright on that um commission commissioner carradine and mr patterson i'm also interested in briefly learning about how your states are helping communities of color and why the administration's sabotage and confusing messaging is so detrimental and you'll need to be brief because we've got about a minute um thank you uh thank you congresswoman in new jersey we went from one navigator

01:18:03

in 2019 while we were under the federal platform since taking back control we have now increased it to 16 navigators that will be able to blanket our state reaching communities that are uninsured as a latina it it kills me to see that my community is double in percentage of uninsured when compared to the rest of the uninsured uh market here in new jersey and if you look at the latino company throughout the country

01:18:34

it's one of the highest uninsured rate the population with the highest uninsured rate so we have invested in our community as well as in our navigators to make sure that we are able to reach all of the underrepresented communities here in the state of new jersey thank you i believe my time is up but before i yield back to the chairman i would ask that mr patterson be allowed to uh respond in writing at a later time thank you very much the gentlelitty from california now the gentlelady from california miss chow

01:19:06

miss true thank you thank you mr chair first let me say to those on the other side of the aisle who use the term china virus in this hearing the scientific term is novel coronavirus or covid 19. by not using the scientific term as established by the world health organization you are stoking the flames of xenophobia which has resulted in 2 900 anti-asian hate crimes and incidents

01:19:37

well pivoting to mr slavitt thank you for joining us today i'd like to focus on what is at stake for 135 million americans with pre-existing conditions should the aca be struck down when we wrote the affordable care act democrats created a multi-pronged approach to protect those with pre-existing conditions under the aca you cannot be denied coverage for having a pre-existing condition but you also can't be charged more for it and you can't be subject to a

01:20:08

lifetime cap and you're required to offer minimum essential health benefits like hospital stays and prescription drugs although the president and republican proposals have paid lip service to protecting americans with pre-existing conditions their proposals all fall short of actually doing so last month president trump issued an executive order that he claimed would protect those with pre-existing conditions mr slavic would you say mr trump's executive order

01:20:39

protects those vulnerable americans and if not why not and why have republican proposals to replace the aca falling short of its protections for americans with pre-existing conditions my parents taught me to watch what people do not what people say and unfortunately what the continued actions of the trump administration to eliminate the aca to sue to get rid of it um to propose laws that do not cover pre-existing conditions like short-term

01:21:11

uh duration plans uh all of which uh show me what they want to do not just what he says unfortunately if any american was to print out an executive order from the president of the united states saying that they would have their their pre-existing condition covered and brought it to an insurance company the insurance company would laugh at them because an executive order like that does not have the power of law and so i would urge americans to look at his actions not at his statements thank you mr patterson i wanted to ask

01:21:43

you about the wonderful work colorado's done to expand its family planning program thanks to a massive investment from a private grant and the implementation of the aca colorado was able to expand access to contraceptives for young people including the long-lasting iud thanks to this investment the teen birth rate for girls ages 15 to 19 dropped by more than half falling 59 from 2009 to 2017

01:22:13

and similarly the abortion rate amongst colorado teens fell by 60 during those years these are remarkable statistics however if the affordable care act were to be struck down patients would once again be required uh to pay for the cost for their contraceptive and family planning care and that could be thousands of dollars for young people the cost can be the barriers uh to accessing the the health care that they need so mr patterson how would losing the preventive services

01:22:46

benefit of the aca impact family planning in colorado would losing this benefit increase costs for patients in the state thank you congresswoman uh yes you're going back to my time with the governor's office but i think that was one of the things we were proud of back then is the long-acting uh contraceptives and so i think that would we've seen like you showed great strides in reducing those and i think those costs and those outcomes would be the opposite if those

01:23:16

resources weren't there thank you uh mr slavitt i'm so proud that my state of california is one of five states that has prohibited the sale of short-term limited duration plans or junk plans on the marketplace um so mr slavic can you expand on how these junk plans will undermine the aca marketplace and put patients at risk are these junk plans a sufficient replacement for the aca yeah i think it's important and it's an important point that mr pope

01:23:48

brought up uh earlier which is to say what kind of choice should americans have and do americans want i think everybody believes that there should be some amount of choice but there should be certain guard rails that exist the aca builds in those guardrails to suggest that there are 10 essential benefits that americans really are in no position to say i don't want to have hospital coverage i don't want to have my prescription drug coverage those are good ideas until that until that occurs those are not expensive provisions by the way

01:24:18

um mental health coverage is about one to two percent of overall premiums so people think they're getting a good deal if they save premiums but it's it's as if we got a fire insurance policy and we come to read the fine print to find that it doesn't cover the kitchen it only covers the living room so there's certain basics that i think americans want and should agree to and and for a three-month period um in transitional period it's probably acceptable for people um to to to be in that kind of circumstance but

01:24:49

to buy insurance coverage for their family and to find out that they can't use it which is what happened routinely prior to the aca would be an enormous issue thank you mr sarah and i want to thank the general lady and i want to say that using that term china virus congresswoman chu is unacceptable in this committee period and now i'm going to call on uh mr wenstrup

01:25:22

from ohio doctor well thank you mr chairman and thank you all for being here today and contributing to this conversation i just want to start out by echoing what my republican colleagues have said about pre-existing condition the pre-existing condition component of the aca was not something that we were against we stand with patients with pre-existing conditions we'll continue to ensure that those protections become the law of the land and remain the law there's a difference between challenging

01:25:54

the existence of the aca versus the constitutionality of a component of it and i would never want to take the right of any american away to challenge the constitutionality of a bill that we pass bigger than that republicans want to put patients back in the driver's seat especially when it comes to their health care you know the word sabotage keeps being used and i'm sorry but i can't help but think of a line from the princess bride

01:26:24

where he says you keep using that word i do not think it means what you think it means because while the affordable care act did help some patients were sabotaged and you know i'm reminded of what mr gruber said uh when working with the obama administration he said about the cadillac tax he said they proposed it and that passed because the american people are too stupid to understand the difference maybe mr slavic worked with mr gruber and uh i think that uh that to me is sabotage but the affordable care act did not give

01:26:56

people choices and we have advanced policies to give patients health care options instead of leaving them with a one-size-fits-all approach families can now take advantage of health reimbursement arrangements short-term limits limited duration plans and hopefully in the future better association plans another way we put patients back in the driver's seat is by advancing policies to increase healthcare price transparency and i can tell you as a physician that is a big deal and that has to take place at a time in our nation when americans

01:27:28

want to see their elected leaders coming together to restore our way of life i'm disappointed we've gathered today for yet another partisan hearing predicated on half truths and manufactured fear we do a lot of impactful bipartisan work on this committee and our bipartisan rural and underserved health care task force which i'm a co-chair of with representative sewell and davis i think is a great example of how we can work together to advance our shared goal of improving the health outcomes of americans and i hope we can move past

01:27:59

the fallacy that republicans don't support pre-existing conditions because we do and work together in a bipartisan fashion to improve choice access and quality health care for the american people there is no part about me as a doctor that doesn't want all americans to have access to health care it's too important as the only one here who has uh served patients i can tell you that the burdensome regulations the government has put in place over time has taken the joy out of taking care of people and now democrats want to go even

01:28:30

further 180 118 house democrats have determined to end the current employment-based health care system as we know it by supporting medicare for all another one-size-fits-all washington approved plan it's dangerous republicans want to expand the plan options available to all americans so they can decide what is best for their family mr pope quickly i know we know much time could you talk about the administration's rule change on short-term coverage and why allowing folks to choose the coverage that is right for them is important and with that

01:29:02

if obamacare's coverage is so great then why is the market for a lower cost alternative growing so fast lifelines that democrats want to eliminate mr pope the affordable care act's plans were designed around the needs of people with pre-existing conditions which is important there needs to be a safety net for them not everybody has a pre-existing condition having an insurance plan that's tailor-made to someone who already has cancer is important but it's not going to offer value for somebody who wants

01:29:36

who's trying to sign up and buy coverage a long time before they develop cancer or a heart major heart condition and so you need to entice people to buy coverage with insurance that is priced in proportion of their risk and that is what short-term insurance the short-term insurance option does um it basically creates an opportunity for people to buy insurances pricing proportion for their risk without really having any negative impact on the protections for people with pre-existing conditions that the exchange provides

01:30:07

it exists alongside it it coexists it provides a better alternative and a more appropriately priced alternative which is really the core problem with the affordable care act it all comes down to price so you would say that it has helped many americans yes data's sketchy we don't know how many exactly but millions surely thank you i yield back i want to thank my friend from ohio i appreciate his questions and mr pope we thank you also now i'd like to ask

01:30:38

the gentlelady from wisconsin miss moore thank you for being here today well thank you so much mr chairman and i have really enjoyed uh this hearing and really appreciated the comments of all of all of them and so it's so frustrating not to be able to ask questions of each of them i guess i i really want to since we have had a lot of discussion on the uh we're talking about the affordable care act i just want uh i think uh

01:31:09

mr um mr andrew i can't see it right here mr slavitt please i just want you to clear clear some things up for me um it was the theory of the case around the affordable care act uh that by requiring the individual mandate we're going to draw in healthy people like young people and therefore reduce the cost of uh reduce the cost of care for everyone such that it could be affordable to everyone wasn't that the theory of

01:31:43

the case i believe that was congress's intent at the time okay so wasn't the theory of the case um also um that really the government would provide things like um uh the uh cost sharing reductions to make it more affordable and also the risk corridors so that as the we started uh as we provided enrollment to these younger people that the amounts of monies that they lost we would share

01:32:14

in the coverage the lost uh that these companies um endured wasn't that also part of the theory of the case yes those were intended to keep okay and where i'm going with this is that when we talk about uh there being no intention of getting rid of coverage for pre-existing conditions wasn't the theory of the case that we'd be able to support people like me who've had who have cancer uh because we're getting premiums and getting the mix and so therefore the

01:32:45

math really doesn't work at all when you take out the mix of younger people so notions that mr pope was sharing with us that there aren't more uninsured people or or you know we had you know the court just just five years later said that the united states has to pay those uh risk sharing costs because we had insurance companies all over the country just go out of business and leave people stranded as a result of that particular sabotage of the of uh

01:33:17

obamacare wouldn't you agree with that i would agree with that right so tell me help me with the math while i still have time help me with the math of how insurance works tell me a little bit about the short-term limited duration insurance plans and i'll give you an example i have a nephew 20 years old he was 20 years old 10 years ago playing basketball having a good time fainted fell out my sister-in-law seeing something was wrong rushed him off to the hospital

01:33:49

long story made short he was on a waiting list for two years for a new heart never smoked anything like that what would a short-term limited duration insurance plan uh for a 20-year-old like he was have done once that happened he would have no idea because he doesn't have to cover it so there's no minimum coverage right and so it's you know he would have an affordable plan he would have had a choice of a plan but

01:34:20

once that basketball game was over and what would have happened to him uh and we've sabotaged the affordable care act the math does not work i'm sorry about that you know without the protections for pre-existing conditions you can make all kind of speeches about it or resolutions to protect people but if you don't have the incentive that we gave the insurance companies that we have this broad

01:34:51

base of people paying uh then the math doesn't work do you agree with that mr uh slavic yes all right and i have 49 seconds left so i guess i'll give mr pope um an opportunity to respond i i just don't understand your your assertion that the uninsured rate has gone down um according to the all the data i've seen that the uninsurance rate has gone up i am very sympathetic with your notion

01:35:22

that it costs too much but you never mentioned stuff like the risk sharing um the other kinds of sabotage that this administration did including not marketing it or anything would you stipulate that that also had something to do with the affordable care not being as good as it could have been so the census bureau found that the uninsured rate went down this year in one of its surveys um the key thing with uh

01:35:52

they took these skinny plants yeah and i agree that there there are flaws with them i think the co-problem is that their renewability has been limited and remains limited so exactly your nephew's problem is exactly a problem i think needs still needs to be fixed is the the short-term plans can't be renewed for more than three years and in some states not more than six months and so that's why these people aren't able to have good protection from the short-term plans

01:36:23

because the insurance is just banned from renewing them and from continuing those protections over the long haul that should be allowed that that i think is effects that congress should should do thank you i want to thank the gentleman and uh for some excellent questions and mr pope from your response and all the witnesses so far the chair now recognizes five minutes the gentleman from pennsylvania mr boyle well thank you uh thank you mr chairman for holding this

01:36:55

important hearing uh healthcare would be an important topic at any time but especially as we're now eight months though it seems like eight years into this covid crisis and we are unfortunately the country that is leading the world in most coveted cases and most coveted deaths that's not just because of our population we are four percent of the world's population and yet still account for more than twenty percent of the coveted cases and tragically more than twenty percent

01:37:27

of the covet deaths uh speaking of cove i would like to thank all the witnesses but i wanna especially thank you uh thank andy slavitt i personally follow your twitter and throughout this covid crisis i've found the information that you provide very helpful and a real service so i want to uh thank you for for that i'll also direct my first question to you uh as you know and as has come up exactly one week after election day three weeks from now

01:37:57

the supreme court will hear oral arguments in yet another case about the constitutionality of the affordable care act given that it was only found to be constitutional by a five to four vote in 2012 if the aca were to be struck down by the supreme court could you help me bring it home to to my constituents in my home state of pennsylvania and are you able to to direct what the consequences would be i know they would be nationwide but specifically for my state what would be

01:38:28

some of the the consequences if the aca were to disappear thank you uh congressman and uh i appreciate the question and uh and i know that the people of pennsylvania and in your district um millions of whom in pennsylvania hundreds of thousands of whom in the philadelphia area um receive coverage for the first time and and i know what that means because i was while i was not part of the law i was part of the turnaround process as the law was implemented

01:39:00

and i received and read many many letters from constituents including uh in your area one i recall from a woman who said that for when she got insurance was the first time after the affordable care act that she allowed her daughter to play high school volleyball uh because she was before then she was concerned that nobody that if she got injured she would not be able to afford her medical care i've received so many letters like that and when you when you add them all up you think about the law going away it not only puts americans who are already fearful

01:39:31

of this global pandemic into a more fearful state it puts them in a state where they're not sure they're able to pay for their health care if someone is to get sick and if they do get sick whether they'll ever ever be insurable again so um the court the court decision to strike down the affordable care act would be calamitous at any time it would be especially calamitous today in this environment and i can't imagine how people would be able to recover from that this is a time when

01:40:02

we look to our government for help and we hope that the government will help us not undermine us yeah thank you uh for that i would just further point out that um specific to to my state it wouldn't just be the people on the uh in exchanges that would lose out it would also be all those who benefited from the medicaid expansion which happened several years later because of the aca and those are people in particular who are the working poor people who are working full-time yet aren't covered uh by their employer for

01:40:34

for health insurance seniors as well yes your prescription drug benefit correct yes right i'm glad you pointed that out i just in in the minute i've left moving ahead to mr patterson if optimistically from my view the aca is again found to be constitutional we still have long term the issue of ensuring that the exchanges are uh vibrant and that there's plenty of competition on them i know especially early on when the exchanges were rolled out in some

01:41:06

states in some marketplaces there was a challenge of a lack of competition what are things that congress could do at the federal level to ensure that we have as much competition on the exchanges as possible and as much choice for the consumer in terms of what congress will do i have to be careful on my answer but i actually think just giving us the flexibility that we need i think all states have a little bit different you know we're about 104 000 square miles in colorado it's it's it's a lot to try to figure out

01:41:42

how do we help leverage the right networks and and the right choices that people have and i think just allowing states to have the right amount of flexibility to fit the needs the geography and the demographics of their own states is really really important i think a gentleman's time is up and i would now uh want to ask mr smith and nebraska the gentleman to start his five-minute question thank you mr smith for being here thank

01:42:14

you mr chairman i appreciate the opportunity to have an exchange here i i do regret that you know the entire health care issue has become so political the mere title of this hearing is evidence of that it's interesting to hear one of our witnesses say that he participated in the turnaround of of the aca or obamacare i don't want to take the time to get into the so-called turnaround uh i wish that there were room on the

01:42:47

panel to hear from some of my constituents who have faced such high premiums that some are opting not to buy it and and that's that contributes to some of the uninsured because it has become so expensive now i don't see the solution as just throwing more money at it that's not sustainable i don't think we can carry that on for a long time but i i am just absolutely

01:43:17

puzzled as to uh the the numbers and the premiums now before the aca we had the high risk pools that i will tell you had some offensively high premiums but now when folks in the individual market face a similarly high premium that we used to found used to find offensive i don't hear the concern for those folks paying such high premiums now and i i realized that many of my

01:43:48

colleagues say here today they think that the aca is just fantastic and has been performing so well but it hasn't and i'm just going on what i what i hear from from uh my own constituents now there was some relief offered with some association health plans of course the the opponents to these consumer-driven choices um have been

01:44:18

sabotaging by all means sabotaging these consumer choices and i think that's unfortunate because i think it's based on politics i i long for a day when we can have a thoughtful discussion about how we can get more people covered uh with affordable health insurance through affordable health care let's face it you know the aca was not health care reform it just kind of shifted around who pays for what and and now the net result is more

01:44:51

americans paying more of their income for high premiums for health insurance i i just think we can do so much better it's interesting i i just heard that mr patterson say we need more flexibility i can't agree more and he he noted that he had to be careful with how he worded that uh i can imagine but but clearly we need more flexibility we need consumers to feel the empowerment to be able to

01:45:21

decide for themselves what is best for their household for them as individuals in exercising the the freedom to choose among plans hopefully more plans rather than fewer plans there were so many promises made about the aca i think about the health insurance co-ops and how much of a disaster that was where we had a hearing after more than half of the co-ops had

01:45:52

collapsed and we had a hearing from the previous administration is saying that everything's just fine i don't know what metrics should be used in making that analysis but man we can do so much better we as elected officials i think oh the american people a better discussion than what has been taking place and i'm certainly willing to participate in that mr pope can you tell me you know with association health plans

01:46:24

um you know we we know there are antagonists out there who are opposed to consumers deciding for themselves to enroll in a plan of their choosing can you tell me what would be necessary to uh revive these association health plans that so many consumers uh found found benefits in so the the association health plans are first small businesses really that group together so it is an employer offered health care

01:46:56

option um traditionally that large employers have been the ones that have been given a lot of flexibility in in terms of what health insurance can be offered to their staff and so this the association health plan expands option expands that uh that right to small employers that have that they can get together uh to offer essentially exempt from a lot of state regulation the same plans that that large employers can yeah

01:47:30

mr smith your time is up thank you very much thank you mr pope for responding thank you now i want to call on the chair recognize the gentleman from illinois representative davis thank you for being here thank you very much mr chairman for holding this very informative hearing and i also want to thank you for giving me the opportunity to wave onto it although i am not a member of the committee but i think that

01:47:59

health policy and health care is so important that it touches everybody in our country and so this has been a very delightful discussion and i want to thank all of the witnesses for participating representative boyle mentioned the fact earlier that the united states supreme court

01:48:30

has health care on its agenda in a couple of weeks and they're going to be discussing the same issues that we're talking about today and i'm a big fan i make no bones about it of the affordable care act i think it's one of the best things that's happened to healthcare since the indians discovered cornflakes that the affordable care act itself

01:49:03

is the best thing that we've had in modern years since medicare and medicaid because it gave low-income people poor people an opportunity to have care paid for which they previously did not have i think all of the witnesses but mr slavitt let me commend you for your tenure when you ran

01:49:35

cms it's a complex agency with complex issues and questions before it and i think you did an outstanding job so i commend you for that while there are many components of the affordable care act and we've heard about it and we've heard about them but let me just ask specifically in terms of the disparities

01:50:07

that we've learned about as we have discussed and dealt with kovic 19. african americans have tremendous disparities in terms of health status gaps in health care followed by latin x communities if the affordable care act did not continue always dismantled

01:50:40

what would be the impact of that action on the health status in health care for african-american and other minorities in this country thank you um you know i think anybody who is a disadvantage of this country whether it's african-american whether they're latinx whether they live in a rural community where they don't have much access whether whether they're poor

01:51:12

uh and of any color whether they're women or whether they're older they were disadvantaged under the system we had before the affordable care act and indeed disparities shrunk quite significantly over the five-year period for african americans i'll give you one example cancer care um [Music] disparities and outcomes were reduced after a five-year period of the affordable care act

01:51:42

so it would be a shame given as i think as we know right now the difficulty many african-americans and other minorities are having accessing the health care system during coven 19 to take away that one lifeline that has been showing some improvement the way that you have handled the situation what has made it possible for the state of colorado to enact the policies and implement them

01:52:19

that you've discussed thank you congressman i don't think i heard the first part of your questions i wasn't sure i got that i just had to do what environment existed in colorado that has enabled you to do what you've done okay my apologies congressman i think we have a way that we reach out we have a great set network brokers and assisters as i've spoken to um and i think just listening to folks and actually hearing

01:52:52

where they're struggling i've heard the business owner say that his insurance was more than his mortgage and we've been able to find people and help them find more affordable options having a lot having a lot of options is is key thank you very much the state for your efforts and i yield back mr chairman thank you mr davis appreciate your questions and now uh just before i call on representative civil

01:53:25

to ask her questions the general lady from alabama i would ask uh congresswoman chu to take over the chair just for a few moments are you able to do that congresswoman true yes absolutely you're in charge and next speaker after uh miss sewell uh will be mr kilby i believe from michigan okay yes thank you mr chair i want to thank you for hosting

01:54:02

today's hearing i'm glad we are able to be joined by andy slavitt and officials from new jersey in colorado two states that have made great strides in expanding coverage and access holding our states accountable for their health coverage choices i believe is an imperative and we would start and we should start by focusing on the damage that republican governors have done to their citizens that did not expand medicaid both of your states have expanded their medicaid programs

01:54:33

neither state has had a rural hospital closure since the affordable care act was enacted unfortunately my home state of alabama has had seven hospitals to go under alabama has high has some of the highest uninsured rates and a low percentage of folks covered by employer-sponsored coverage mr chairman no one wins when states like alabama don't expand medicaid today there are nearly six million americans who fall into the medicaid gap

01:55:04

in the 14 states that did not expand medicaid they are our hairdressers our maintenance workers our fast food workers our servers our cashiers these are working americans who make too little to qualify for subsidies or to afford coverage in the private market but too much to meet the their state's uh requirements to qualify for medicaid even with alabama's bare bone minimum medicaid plan what this means is that a single parent of two in alabama

01:55:34

cannot qualify for medicaid if she makes uh more than four thousand dollars annually not monthly annually four thousand dollars to make matters worse as these americans work to earn at least the poverty line so that they can afford health care insurance with sympathy subsidies the republican attorney generals across the states uh have of the same states are also currently denying them coverage in courts as has been said earlier one of the greatest injustices is that

01:56:06

people who live in the poorest states are left with the worst health care access and coverage options because of failed leadership on the state level the um the consequences are cyclical and compounding especially when combined with the global pandemic that has really left people suffering with chronic illnesses and especially those of racial minorities i think about a third generation farmer in the rural part of my district named hank he was able to afford insurance for

01:56:35

the first time in his life in 2014 thanks to the affordable care act's cost-sharing subsidies he signed up for a great plan months before he was in a terrible farming accident which would have lost he would have lost his arm had he not been able to rush be airlifted to a birmingham hospital which literally saved his life and also saved his family from being bankrupt hank admitted that if he knew that it was called obamacare when he was uh signed up when he signed up he probably would not have

01:57:06

uh signed up when the when the navigator that knocked on his door uh told him about the chance to get health insurance to the affordable care act just months before he needed it my question is twofold to administrator side um andy slavitt first why is uh protecting and strengthening the affordable care act important for those who help whose health care who cares about health care inequities particularly in rural communities and underserved black communities can you also talk about the advantages of

01:57:36

extending medicaid secondly if these republican attorney generals are successful before the supreme court november 10 would alabamians like hank lose their marketplace subsidies and again thank you sir for all that you've done regarding the affordable care act thank you congresswoman i think the message that people get around the country when the state doesn't expand medicaid or if they are not offered affordable coverage is you don't matter enough to earn

01:58:06

health care coverage that you have to either be of a certain social status you have to be of a certain income level you have to be of a certain race you have to live in a certain zip code and then healthcare coverage is for you the affordable care act far from perfect made an effort to say insurance co is no longer about the insurance companies who get to make whatever rules they want and exclude whoever they want but it is in fact about us as individuals as families as americans

01:58:37

as alabamians so it is a vital part of our message that health care in this country is not something to be earned it's something that we that is our ultimate source of freedom because it allows us to live a better more prosperous healthy life now if the court case or uh anything else were to take away the affordable care act your constituent and all of your constituents would be back to a situation where they would be uninsured now that

01:59:08

wouldn't mean that they wouldn't need medical care they would they would just be going to emergency rooms they would be waiting until their cancer had progressed to stage three or four instead of getting mammograms we saw that all over um that was the norm before the aca and unfortunately it would be the norm again thank you so much uh once again i truly believe that health care in this great country that we live in should be a right and not a privilege thanks again for all that you've done to help shore up uh healthcare in america

01:59:39

i yield back okay the gentlelady's time has expired the chair now recognizes uh mr kelty from michigan for five minutes thank you madam chair uh and obviously thank you to chairman pasquale for organizing this very important hearing which comes at a very important time i have a couple of questions that i want to get into but before that i want to just give mr patterson an opportunity to clarify i think the way his statement around flexibility may have been interpreted

02:00:10

i assume mr patterson you would agree with the um with the notion that flexibility granted to states would be flexibility that builds upon the existing guard rails and architectural foundation of the aca not flexibility to get away from those is that would that be a more fair characterization of the position that you articulate mr patterson

02:00:50

i don't see or i don't hear mr i'm sorry i'm sorry i didn't have myself off from you congressman uh the flexibility is within the context of uh the implementation of the affordable care act the best of our ability as a state right not flexibility to undermine those foundational characteristics of the aca i mean i think flexibility it can be interpreted in different ways and i took from one member that you may have interpreted your your point to be flexibility to move

02:01:22

away from the guardrails that the aca provides and i would want to be careful that that not be a position that i don't believe that comports with the way you have articulated yourself so far today i would agree with your characterization of that congressman yes that's cute uh i wonder you know if i could just uh turn to mr slavitt for a moment on the issue of pre-existing conditions in michigan uh before the implementation of aca about 11 of our state's population had no health insurance whatsoever and by

02:01:54

2018 due to aca we'd cut that number by more than half and i'm worried that despite lots of rhetoric and promises that what some of our colleagues on the other side say that they want to protect people with pre-existing conditions they have to accept the fact that they're suing right now to take away all of the provisions of the aca including those important provisions so i wonder if you might talk about some of the damage that would be done number one to people with pre-existing

02:02:26

conditions like my daughter who has diabetes my wife who has multiple sclerosis and i would i wonder if you might couch some of your comments in these terms even if somehow the reported promise of ensuring coverage for people with pre-existing conditions is a genuine one would overturning the aca also allow insurers to return to annual or lifetime caps for example would they allow those premiums paid by people with pre-existing conditions

02:02:58

to be so onerous that they only have the right to coverage in name only but can't afford it i wonder if you might just comment on that in my remaining time yeah thank you congressman uh the uh the truth is that uh if in fact the the aca is overturned americans would once again find themselves in a position that they found themselves in 2007 2008 2009 where insurance companies would not be required to cover them for their pre-existing condition they may cover them but they may say

02:03:29

your asthma or your cancer or your mental health condition or your heart arrhythmia is excluded or they may say you could take you can have those things but we're going to charge you an unlimited amount of money more that's what the discrimination is and it would affect michiganders quite directly in the midst of the pandemic the situation would be even worse because no one knows no one knows what covet 19 brings in terms of conditions that will come from it we just don't know yet and so it is a

02:04:00

blanket pass to insurance companies to say i don't want to cover you again so for people like your daughter once again it would be hazardous for her to change jobs it would be hazardous for her to disclose to people that she had diabetes because if she did she might be the coverage might be excluded imagine trying to manage a pandemic with everybody in the country with an incentive to not disclose that they have covered 19. imagine trying to contact trace or again people to agree to testing

02:04:30

we would be in even worse shape than we are today thank you mr but i think it also if you could just comment on the lifetime in the annual caps what what would happen on that score well a lifetime an annual cap let's think about what that is typically if you have a 500 000 or a million dollar lifetime annual cap if a baby is born a few weeks or or so early or if there is a bad case of cancer that that's it so those are arbitrary lines those are lines that the aca does not allow

02:05:01

insurance companies to cross it is we're able to eliminate that it's much more freedom for people and it's not much additional premium so it's uh that would go away of course uh if the affordable care act is overturned thank you mr chair i appreciate that i you're back thank you mr chairman just thank you mr kelly for your questions and now i call on mr schneider a gentleman from illinois uh thank you mr chairman and uh i i appreciate you having us here hearing we're so deluged with many crises that

02:05:33

it's hard to know where to turn our energies but this hearing importantly maintains this issue on the front burner especially as we fight cover 19 the copa 19 pandemic and consider the long-term impacts that it's likely to have the trump administration has taken unprecedented steps to undermine what has been the law of the land for a decade the affordable care act not only before but during this global health crisis we've lost more than 220 000 american lives eight and a quarter million people are already confirmed to have the infection

02:06:04

and most many if not most are likely to have lifetime related effects in other words other words cover 19 is likely to be a pre-existing condition mr slavic is slavic as you noted early evidence indicates covet impacts on quote our heart lungs pancreas kidneys brain and our clotting and immune systems mr lava you also noted that when you work in the obama administration you were duty bound to implement the laws as congress intended administration should not pick and choose to enforce the laws they do or do

02:06:36

not like this is true with all laws but especially problematic for the long question has proven beneficial to so many million americans millions of americans there is no doubt our country's health care system is stronger because the ac aca more than 130 million americans have pre-existing condition protections and has already noted that number will only grow because of coping lifetime and annual caps on coverage are banned for more than 100 million americans free preventive care expanded medicaid

02:07:05

eligibility the list goes on and on these benefits are valuable in normal times but have proven absolutely critical during the covic pandemic where getting care when and where you need it is at a premium but those critical improvements will be of no value if we have an administration that tries to sabotage the law at every turn trump has promoted junk plans that don't cover pre-existing conditions he's gutted funding and support for enrollment assistance and as we convene here today his

02:07:36

administration is looking to invalidate the law through the courts however less eye-catching but just as disappointing as partisan refusal to work across the aisle to improve the aca any law as large and complex as the aca is bound to need changes and improvements but for a decade any significant effort to build on the aca successes fix its shortcomings and explore ways to improve healthcare for all americans have only been met with disdain and derision by our republican counterparts improving existing law for the

02:08:08

betterment of our constituents should not be controversial but that has been the political reality for too long so mr slav like others before me i follow you on twitter i appreciate your insights my question for you is if you were still serving in the administration what would be the top improvements you would immediately make to aca recommend to us in congress to improve it for all americans thank you congressman um look i think i think the first uh thing is to absolutely reach out to the

02:08:38

communities that are in need of coverage um and assure them that this coverage is available to them in most cases for under 75 to reach out to young people um and to continue to expand the aca we we had four we had uh you know four or five years in a row where we reduced the uninsured rate from something like 17 down to eight or nine percent depending on which measure you use that's gone up over the last few years if you believe government should be about results not about actions then those are the kinds of results that

02:09:10

we would have to commit ourselves to deliver again and also work with congress to correct some of the things that i think mr pope and others have pointed out will improve the law there are absolutely opportunities for us to make the law better it was passed 10 years ago it was not intended to be the final word it was intended to be a great start and there are plenty of opportunities if the congress would work together in a bipartisan way to build on what we have not not eliminated or reduce it so i would say that um this is what americans want americans

02:09:42

don't want both parties fighting over their health care they want the support in times of need thank you i couldn't agree more we do need to find a way to come together and improve health care for all americans that they have it as a right not a privilege that they can get the care they need from doctors they trust all of those things are are so important and uh as my time inspires mr chairman i will ask unanimous consent to enter into the record the most recent census report showing an increase in the number of uninsured not a decrease as was mentioned earlier

02:10:11

in this year okay thank you very much i appreciate that enter into the record without any objections thank you thank you questions and our last congressman today is mr horsford from nevada you have five minutes and thank you for being here well thank you mr chairman uh for holding this hearing today and the reason that i came to congress and the reason that i worked so hard to join

02:10:45

this committee was to increase access to health care and to bring down out-of-pocket cost of prescription drugs for nevadans and people all across the country um and i agree with my colleague and those who've spoken today that you know that that we need to improve on the affordable care act make it work for all people and address the weaknesses that may exist in order to improve on it well instead of doing that

02:11:17

president trump has time and time again made it his number one goal to strip health care away from americans with no plan to replace it and it is surely one thing when the trump administration and some of my colleagues on the other side repeatedly sought to repeal the affordable care act but now in the middle of a global health pandemic that has taken the lives of more than 220 000 americans the likes we have never seen before this administration is

02:11:48

running running racing literally to undermine our health care system one that has already been stretched too thin so instead of focusing on cutting health care to americans we ought to be improving access and coverage because now is the time that americans need that the most that also means strengthening our health systems by expanding telehealth for rural communities protecting our frontline medical workers

02:12:19

and implementing real testing tracing and treatment strategies for covert 19 so no more american lives are lost yet here we are again discussing the full onslaught assault of the affordable care act which would dismantle nevada's medicaid expansion for 371 000 nevadans now when this bill was passed i was serving in the state senate i worked with our republican governor at the time

02:12:51

he was the first republican governor in the country to enact the medicaid expansion it was bipartisan because we knew it was important to put nevada's health above any party now this administration is now looking to strip away protections for over 1.2 million nevadans with pre-existing conditions which now include even the coronavirus so i would like to just underscore

02:13:22

that right now in nevada because of the ongoing effects of covet 19 and its impact on the economy we have nearly 200 000 individuals who are out of work many are furloughed or laid off currently they have the opportunity through some of their employers to maintain their health insurance but some are relying on cobra coverage until they're able to return to work that's why i introduced with the help of this committee the worker health

02:13:53

coverage protection act to provide financial assistance to workers and families by covering the full cost of cobra premiums for people who lost their jobs or had their hours reduced so mr slavitt in your testimony you shared that there are an estimated 14.6 million people who may have lost their employer-sponsored health coverage the commonwealth fund recently found that in the last three quarters of 2020 one-third of those who lost

02:14:24

employer-sponsored insurance coverage through pandemic related job loss will become uninsured so mr slabid if the trump aca lawsuit succeeds what will happen to these americans and why do we need to protect the aca for individuals like those who are covered through their employer-sponsored plans thank you congressman i think two things happen the first is that more and more people will lose coverage and not have a place to get it

02:14:56

and secondly um as they continue they will those with pre-existing conditions including anybody who had contacted covet uh will be in a situation where they may not be able to get coverage again so we will be back to a situation that is uh worse than we were um even uh 10 years ago and i suspect the uninsured rates will go back from where they came down to eight nine or ten percent up to you know fifteen sixteen percent again uh which would be a tragedy for millions of american families

02:15:28

well thank you and that's why i'll continue to work to make sure we safeguard the aca and nevada and across the country uh so that they can have access to their employer-sponsored health plan to protect the hard-earned benefits for which workers and families have fought and sacrificed i thank you mr chairman for this very important and timely hearing the gentleman's time has expired and all members have completed questioning so i'd like to thank our witnesses for joining us today please be advised

02:16:04

that members have two weeks to submit written questions to be answered later in writing those questions and your answers will be made part of the formal hearing record with that the subcommittee stands adjourned you

Maximizing Health Coverage Enrollment Amidst Administration Sabotage | Subcommittee on Oversight

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