[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
PROTECTING AMERICANS WITH
PREEXISTING CONDITIONS
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON WAYS AND MEANS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
FIRST SESSION
__________
JANUARY 29, 2019
__________
Serial No. 116-1
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Printed for the use of the Committee on Ways and Means
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
__________
U.S. GOVERNMENT PUBLISHING OFFICE
35-633 WASHINGTON : 2020
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COMMITTEE ON WAYS AND MEANS
RICHARD E. NEAL, Massachusetts, Chairman
JOHN LEWIS, Georgia KEVIN BRADY, Texas
LLOYD DOGGETT, Texas DEVIN NUNES, California
MIKE THOMPSON, California VERN BUCHANAN, Florida
JOHN B. LARSON, Connecticut ADRIAN SMITH, Nebraska
EARL BLUMENAUER, Oregon KENNY MARCHANT, Texas
RON KIND, Wisconsin TOM REED, New York
BILL PASCRELL, JR., New Jersey MIKE KELLY, Pennsylvania
DANNY K. DAVIS, Illinois GEORGE HOLDING, North Carolina
LINDA SANCHEZ, California JASON SMITH, Missouri
BRIAN HIGGINS, New York TOM RICE, South Carolina
TERRI A. SEWELL, Alabama DAVID SCHWEIKERT, Arizona
SUZAN DELBENE, Washington JACKIE WALORSKI, Indiana
JUDY CHU, California DARIN LAHOOD, Illinois
GWEN MOORE, Wisconsin BRAD R. WENSTRUP, Ohio
DAN KILDEE, Michigan JODEY ARRINGTON, Texas
BRENDAN BOYLE, Pennsylvania DREW FERGUSON, Georgia
DON BEYER, Virginia RON ESTES, Kansas
DWIGHT EVANS, Pennsylvania
BRAD SCHNEIDER, Illinois
TOM SUOZZI, New York
JIMMY PANETTA, California
STEPHANIE MURPHY, Florida
JIMMY GOMEZ, California
STEVEN HORSFORD, Nevada
Brandon Casey, Staff Director
Gary J. Andres, Minority Chief Counsel
C O N T E N T S
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Page
Advisory of January 22, 2019, announcing the hearing............. 2
WITNESSES
Karen Pollitz, Senior Fellow, Kaiser Family Foundation........... 6
Andrew R. Stolfi, Insurance Commissioner and Administrator of the
Division of Financial Regulation, Oregon Division of Financial
Regulation..................................................... 17
Rob Robertson, Chief Administrator/Secretary-Treasurer, Nebraska
Farm Bureau Federation......................................... 27
Keysha Brooks-Coley, Vice President of Federal Advocacy, American
Cancer Society, Cancer Action Network (ACS CAN)................ 34
Andrew Blackshear, Patient and Volunteer, American Heart
Association.................................................... 47
SUBMISSIONS FOR THE RECORD
Kaiser Family.................................................... 164
American Speech-Language-Hearing Association (ASHA).............. 170
Michael G. Bindner, Center for Fiscal Equity..................... 173
Association for Community Affiliated Plans (ACAP)................ 177
PROTECTING AMERICANS WITH
PREEXISTING CONDITIONS
----------
TUESDAY, JANUARY 29, 2019
U.S. House of Representatives,
Committee on Ways and Means,
Washington, DC.
The Committee met, pursuant to call, at 10:00 a.m., in Room
1100, Longworth House Office Building, Hon. Richard E. Neal
[Chairman of the Committee] presiding.
[The advisory announcing the hearing follows:]
ADVISORY FROM THE COMMITTEE ON WAYS AND MEANS
CONTACT: (202) 225-3625
FOR IMMEDIATE RELEASE Tuesday, January 22, 2019
FC-1
Chairman Neal Announces a Hearing on
Protecting Americans with
Preexisting Conditions
House Ways and Means Committee Chairman Richard E. Neal today
announced that the Committee will hold a hearing on Protecting
Americans with Preexisting Conditions. The hearing will take place on
Tuesday, January 29, 2019, in the main Committee hearing room, 1100
Longworth House Office Building, beginning at 10:00 a.m.
In view of the limited time available to hear witnesses, oral
testimony at this hearing will be from invited witnesses only. However,
any individual or organization not scheduled for an oral appearance may
submit a written statement for consideration by the Committee and for
inclusion in the printed record of the hearing.
DETAILS FOR SUBMISSION OF WRITTEN COMMENTS:
Please Note: Any person(s) and/or organization(s) wishing to submit
written comments for the hearing record must follow the appropriate
link on the hearing page of the Committee website and complete the
informational forms. From the Committee homepage, http://
waysandmeans.house.gov, select ``Hearings.'' Select the hearing for
which you would like to make a submission, and click on the link
entitled, ``Click here to provide a submission for the record.'' Once
you have followed the online instructions, submit all requested
information. ATTACH your submission as a Word document, in compliance
with the formatting requirements listed below, by the close of business
on Tuesday, February 12, 2019. For questions, or if you encounter
technical problems, please call (202) 225-3625.
FORMATTING REQUIREMENTS:
The Committee relies on electronic submissions for printing the
official hearing record. As always, submissions will be included in the
record according to the discretion of the Committee. The Committee will
not alter the content of your submission, but reserves the right to
format it according to guidelines. Any submission provided to the
Committee by a witness, any materials submitted for the printed record,
and any written comments in response to a request for written comments
must conform to the guidelines listed below. Any submission not in
compliance with these guidelines will not be printed, but will be
maintained in the Committee files for review and use by the Committee.
All submissions and supplementary materials must be submitted in a
single document via email, provided in Word format and must not exceed
a total of 10 pages. Witnesses and submitters are advised that the
Committee relies on electronic submissions for printing the official
hearing record.
All submissions must include a list of all clients, persons and/or
organizations on whose behalf the witness appears. The name, company,
address, telephone, and fax numbers of each witness must be included in
the body of the email. Please exclude any personal identifiable
information in the attached submission.
Failure to follow the formatting requirements may result in the
exclusion of a submission. All submissions for the record are final.
The Committee seeks to make its facilities accessible to persons
with disabilities. If you require special accommodations, please call
(202) 225-3625 in advance of the event (four business days' notice is
requested). Questions regarding special accommodation needs in general
(including availability of Committee materials in alternative formats)
may be directed to the Committee as noted above.
Note: All Committee advisories and news releases are available at
http://www.waysandmeans.house.gov/
Chairman NEAL. The Ways and Means Committee will now come
to order. I want to thank everyone for their presence here
today for the Ways and Means Committee's first policy hearing
in the 116th Congress. A warm welcome to the new Members of the
Committee on both sides of the aisle. I am honored this morning
to be the 67th Chairman of the House Ways and Means Committee.
We take this position, history, and prestige of the Committee
all quite seriously.
I look forward to considering policies that will have a
positive impact on the future of our Nation and all American
families. Today we will discuss an issue that affects nearly
every American family: Preexisting conditions and their impact
on healthcare coverage. Over 130,000 Americans have a
preexisting condition, and protecting them goes to the core of
safeguarding healthcare for all Americans.
What insurance companies consider to be preexisting
conditions can be anything from asthma to cancer to even
pregnancy. Before the Affordable Care Act, which is the current
law of the land, Americans faced significant hardship when
trying to purchase adequate healthcare coverage. Insurance
companies could refuse coverage altogether, charge excessive
fees, and place dollar limits on the amount of care that
Americans might receive. Insurers could even discriminate
against patients with common healthcare issues such as diabetes
or high blood pressure.
When the ACA became law, new safeguards went into place to
put a stop to these practices. Our healthcare system's
protections really matter for American families' peace of mind,
and certainly for their pocketbooks.
My colleagues on the other side from time to time have
offered a different view. Despite their repeated claims to
support the protections for healthcare for people with
preexisting conditions, their actions have directly
contradicted the statements. They are currently leading ongoing
efforts to undermine or eliminate the current law's protections
for Americans with preexisting conditions. This is the wrong
course of action.
The Trump administration's efforts to chip away at the law
and 18 Republican attorneys general who are actively trying to
sabotage the law through the courts understand what they can't
do legislatively they will attempt to do judicially. As one of
the first actions in the 116th Congress, my colleagues and I
are moved to intervene in the GOP lawsuit and defend the
current law's preexisting conditions safeguards.
I am pleased to join attorneys general from Massachusetts
and other Democratic attorneys general who are defending
consumers in fighting for Americans with preexisting
conditions. Let me be clear: The ongoing effort to sabotage the
healthcare system is having a direct impact on the finances of
Americans across the country, and it is creating uncertainty
for one-fifth of the U.S. economy. Four million Americans have
lost health insurance since President Trump took office. That
is 4 million Americans who previously had insurance and now
must pay their medical costs fully out-of-pocket or delay
needed medical care. And earlier this month, this
Administration took action to reduce the tax credits by $900
million while raising the out-of-pocket maximums by an
additional $400 per family.
I want to take a minute to share a story about one of my
constituents who has been personally impacted by the
preexisting condition protection. Michael Finn is 48 years old
and a State representative from West Springfield,
Massachusetts. He was diagnosed with type 2 diabetes 2 years
ago when he was 46. He was a borderline diabetic for at least
10 years before that, even though his condition went
undiagnosed.
Mike is married with three children under the age of 10,
and he is grateful to the ACA for allowing him to keep
receiving treatment, medication, and care, even though he has a
preexisting condition. His wife is a stay-at-home mother, and
Mike is the sole breadwinner in the household. If he were
unable to work or unable to receive insurance assistance to
help cover healthcare costs, he and his family don't know what
they would do.
We need to embrace policies that protect people like Mike.
The law is currently clear. But there is an opportunity to
build upon it and stop the ongoing sabotage. I have seen in
Massachusetts that we can work together across party lines to
make sure Americans have coverage and to protect families from
financial ruin. Recall that 100 percent of the children in
Massachusetts are covered and 97 percent of the adults. We need
more of that reflection here in Congress, and I hope this
hearing will be the beginning of that process.
I am pleased our witnesses could join us today to share
their professional and personal experiences and thoughts on how
protections for people with preexisting conditions are
essential. Our witnesses know that these safeguards can be the
difference between getting needed medical assistance and
foregoing necessary treatments or the difference between
accessing affordable care and losing a lifetime of savings just
to stay alive.
These protections mean the world to people, and they are
the law of the land. I am glad we will have an opportunity this
morning to discuss them.
And, with that, let me recognize the Ranking Member, Mr.
Brady, for his opening statement. Mr. Brady for 5 minutes.
Mr. BRADY. Thank you, Chairman Neal, for convening this
important hearing today.
Without question, while America's health system boasts
remarkable innovation and highly trained professionals, it
faces many challenges, the greatest among them: The high cost.
Americans agree. In a recent Gallup Poll, almost 70 percent
of Americans say healthcare has major problems, and nearly that
many say rising insurance premiums are their biggest concern.
It is clear the status quo of America's healthcare isn't
working. When Democrats pushed through a healthcare bill,
written behind a closed door, filled with special interest
provisions, and with no Republican support, President Obama
made many unkept promises to the American people, including the
reform we are proposing will provide you more stability and
more security. When it comes to healthcare costs, the words
``stability'' and ``security'' are the last to come to mind.
It has been 10 years since the ACA was passed by Democrats
only, and yet healthcare still remains the top worry of
American workers and businesses. We have to do better. For
Republicans, what we hope will happen today is an honest
conversation, one on how we can create a healthcare system that
is more compassionate, more convenient, and less costly.
And to begin, there are a few things that I would like to
make clear. First is this: Of course, Republicans support
protections for people with preexisting conditions. We included
these protections in our House-approved alternative to the ACA.
Section 137 of the American Healthcare Act said clearly:
Nothing in this Act shall be construed as permitting healthcare
insurance issuers to limit access to health coverage for
individuals with preexisting conditions.
Furthermore, Republicans guaranteed there can be no
lifetime limits on healthcare costs. It is important if you
have a child with an expensive disease or you face one
yourself. We make sure young people can stay on their parents
plan until they are age 26. And then again, on day one of this
Congress, Republicans offered and unanimously supported an
amendment on the House floor stating our unwavering support for
protecting patients with preexisting conditions. This means
guaranteeing no American purchasing healthcare as an individual
can be denied coverage, denied renewal, or charged more because
they have a preexisting condition.
These protections, by the way, have long been guaranteed
for 93 percent of the Americans who get their healthcare at
work or through the government. They should be guaranteed for
individuals as well. And if you remember only one thing we say
today, remember this: We have to do more than protect
healthcare; we have to work together to make it affordable. The
ACA is failing too many Americans who face soaring costs,
skyrocketing deductibles, and few choices of local doctors and
hospitals. It really is time for a fresh start, this time with
both parties working together creating truly affordable
healthcare focused on patients, not on Washington.
This Committee advanced many bipartisan healthcare reforms
last Congress that expanded health savings vehicles for
families, protected the most fragile among us in Medicare,
rolled back some of ObamaCare's most egregious taxes, and
looked for ways to increase innovation. So let's work together
this Congress to build on these initiatives.
I think there are many commonsense areas where we can work
together, Mr. Chairman, from price transparency, to spurring
innovation, lowering drug prices, addressing surprise billings,
and removing the regulatory barriers to improve patient care.
The final point I would like to make is this: What
Republicans don't support, as well as the majority of
Americans, is the status quo. I know many of my Democrat
colleagues may want to relitigate the past today; we will be
glad to because the ACA has become too expensive to use for so
many Americans and so many Texans. So expensive, in fact, twice
as many Americans have found a way to get out of ObamaCare than
those who chose it. Twice as many got out of it--out from under
it because they couldn't afford it and they couldn't use it.
So what will benefit us is to focus on the future. Today
let's turn a new leaf, beginning the work folks back home sent
us here to do: Work together to help make healthcare less
expensive and easier to use. We owe that to our families and to
our businesses.
With that, thank you, Chairman Neal.
Chairman NEAL. Thank you, Mr. Brady.
And, without objection, all Members' opening statements
will be made part of the record.
Let me now introduce our distinguished panel of witnesses
for the opportunity to discuss many of the important questions
for protecting coverage for preexisting conditions.
First, I would like to welcome Karen Pollitz, a Senior
Fellow at the Kaiser Family Foundation and, for those of you
with long memories, a former staffer for our longtime colleague
Mr. Levin of Michigan, who recently retired from Congress.
Next is Andrew Stolfi. He is the Insurance Commissioner and
Administrator from my friend Earl Blumenauer's State, Oregon.
He is in the Oregon Division of Financial Regulation.
Rob Robertson from the State of Adrian Smith's, Nebraska.
He is the Chief Administrator/Secretary-Treasurer of the
Nebraska Farm Bureau Federation.
Keysha Brooks-Coley, Vice President of Federal Advocacy at
the American Cancer Society, Cancer Action Network, will share
with us why these protections are so critical for Americans
living with cancer and cancer survivors.
And, finally, Andrew Blackshear, a constituent of Mr.
Thompson and one of the 133 million Americans with a
preexisting condition. His story highlights the dangers of
short-term limited-duration healthcare plans that have been
promoted by the Trump administration.
Each of your statements will be made part of the record in
its entirety. I would ask that you summarize your testimony in
5 minutes or less. And to help you with that time, there is a
timing light that you might take note of at your table. When
you have 1 minute left, the light will switch from green to
yellow and then finally to red when the 5 minutes are up.
Ms. Pollitz, please begin.
STATEMENT OF KAREN POLLITZ, SENIOR FELLOW,
KAISER FAMILY FOUNDATION
Ms. POLLITZ. Thank you, Mr. Chairman, and Ranking Member
Brady, and Members of the Committee. Good morning.
Mr. Chairman, most people are healthy most of the time, but
when we need care, it can get expensive. Figure 1 in my
statement shows that each year about 20 percent of people
account for 80 percent of all health spending, while the
healthiest half accounts for just 3 percent of health spending.
That chart is just a snapshot, though. Over time, our health
status changes, and eventually, at some point, we will all get
sick or hurt or pregnant and need costly care at least for a
while. So we buy health insurance in case we get sick, not in
case we stay healthy.
Before the Affordable Care Act, the individual insurance
market didn't always work for people once they got sick. People
with preexisting conditions could be turned down or charged
more. About 27 percent of nonelderly adults each year have a
condition, such as cancer, diabetes, or pregnancy, that would
have made them uninsurable in this market.
Also, people healthy enough to get nongroup coverage
couldn't be sure it would work for them once they got sick.
Policies typically didn't cover key benefits, such as
prescription drugs, mental health, or maternity care. And if
people made large claims, they could find it hard to stay
covered. Renewal premiums could skyrocket. Insurers also
engaged in post claims underwriting, investigating a condition
to see if it existed even undiagnosed before the policy, and if
so, denying claims for the preexisting condition.
Premiums on average were cheaper before the ACA. But there
was a lot of variation around that average. And the cheapest
premiums were only available to people while they were young
and healthy. The ACA made a lot of changes. It required
insurers to take everybody and offer policies that cover
essential health benefits at premiums that don't vary based on
health status. To make that affordable, the ACA added
subsidies. Last year, more than 9 million people bought
nongroup policies with the help of premium tax credits.
Subsidies also stabilize the market, helping people buy
regardless of health status, and they effectively absorb
premium increases from year to year for people who are
eligible. Of course, nearly 4 million other unsubsidized
individuals were enrolled in ACA policies last year, mostly
bought outside of the marketplace. And, for them, rising
premiums are harder to afford and enrollment by unsubsidized
individuals has been declining.
Why are premiums rising? Uncertainty is the key underlying
reason. Insurers didn't know how to price for this in market
when it opened. Most set premiums low and lost money in the
first 3 years. Rates then increased substantially in 2017, a
one-time correction, according to insurer rate filings, but
then new sources of uncertainty arose.
The Trump administration ended payments to insurers for
cost-sharing subsidies they are required to provide through the
marketplace. Insurers responded with so-called silver loading,
raising the premiums for silver plans twice as much in 2018 as
for bronze and gold plans. For 2019, for the first time we saw
national average premiums for the benchmark marketplace plan
decline by about 1 percent. Even so, premiums this year are
higher than they would have been by about 6 percent due to two
new factors: Repeal of the ACA individual mandate penalty and
competition from short-term policies.
Short-term policies are exempt from ACA market rules. They
will deny coverage to people who are sick. They will terminate
coverage for people when they get sick. And typically they
covered fewer benefits. They are also cheaper, but only for
healthy people. Competition by short-term plans threatens
stability of the ACA risk pool. Initially that threat was
limited because regulations required the term of short-term
policies to be short, less than 3 months; they weren't eligible
for subsidies; and they didn't satisfy my mandate, so people
who bought these to save money were at risk owing a tax
penalty.
But now the mandate penalty is gone. The new Trump
administration regulations allow short-term policies to last up
to 12 months. And other guidance on ACA waivers now give States
a path to promote the sale of these policies and even shift
some Federal subsidy dollars to them.
How markets might evolve under these and other changes
remains to be seen. Further steps to divide the risk pool can
make cheaper options available to some people while they are
healthy, but that strategy won't increase choices for people
who have health conditions, and it will increase premiums for
the ACA-compliant plans on which they rely.
Protections for people with preexisting conditions have
become a defining feature of the ACA, and they enjoy strong
public support, our polling shows, by Democrats and
Republicans, and by people with preexisting conditions, and
those who haven't developed them yet. Most Americans want
health insurance to work for people when they get sick.
Thank you, and I am happy to take your questions.
[The prepared statement of Ms. Pollitz follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman NEAL. Thank you, Ms. Pollitz.
Now we would like to recognize Mr. Stolfi. Would you please
begin?
STATEMENT OF ANDREW R. STOLFI, INSURANCE COMMISSIONER AND
ADMINISTRATOR OF THE DIVISION OF FINANCIAL REGULATION, OREGON
DIVISION OF FINANCIAL REGULATION
Mr. STOLFI. Chairman Neal, Ranking Member Brady, Members of
the Committee, thank you for inviting me today for this
important discussion. My name is Andrew Stolfi, and I am the
Insurance Commissioner and Administrator of the Oregon Division
of Financial Regulation.
Since Oregon implemented the major provisions of the
Affordable Care Act, more than 340,000 Oregonians have gained
health insurance, and our uninsured rate has dropped from a
high of more than 17 percent to about 6 percent. Today more
than 3.7 million Oregonians, 94 percent of the State, are
covered by health insurance, and our goal is to maintain
coverage for 99 percent of adults and 100 percent of children.
Governor Brown's vision and our goal is not just a number;
it is for all Oregonians to have quality, affordable
healthcare, regardless of who they are or where they live. The
ACA has greatly advanced this goal, and we urge this Congress
to protect the gains that have been made while continuing to
work toward bending the cost curve for consumers.
Oregon's health insurance market has traditionally been
competitive and offered choice. We have also been a leader in
implementing progressive consumer-focused health reforms.
However, despite our best efforts, our uninsured rate in 2009
was higher than the national average at more than 17 percent.
Oregonians seeking insurance in the individual market also
experienced high rates of denials based on preexisting
conditions. In 2007, the denial rate was about 30 percent.
And when an individual policy was issued, it could exclude
or limit coverage in a myriad of ways. The ACA helped change
all of this, particularly for those with preexisting
conditions. More than 1.6 million American Oregonians with
preexisting medical conditions are protected from coverage
denials or limitations. Pregnant mothers know they can get the
care they and their babies need. And children with
developmental disabilities can get all the essential therapy
they need to grow to their fullest potential.
We have individual health policies offered by at least two
carriers in each of our counties and are one of the first
States to implement our reinsurance program that has kept
individual insurance rates about 6 percent lower than they
would be without. These numbers reflect the work that has been
done in Oregon to provide stability to the State's health
insurance market. Unfortunately, other numbers demonstrate the
harm recent Federal actions have caused.
Federal rule changes to short-term limited-duration plans
and association health plans, along with zeroing out of the
individual mandate penalty have raised 2019's individual health
insurance rates about 7 percent. Cutting off funding for cost-
sharing reductions has added another 7 percent to 2019 silver
rate plans, meaning that rates in Oregon in 2019 are between 7
and 14 percent higher than they could have been without
unnecessary and avoidable Federal uncertainty.
The true harm, however, would come if challenges to the ACA
were successful and we lost the consumer protections it created
for people with preexisting conditions. These protections
require a comprehensive set of interlocking laws that work
together like spokes in a wheel. For an individual with a
preexisting condition, these spokes fit together like this:
Guaranteed issue lets you buy a policy you need. Community
rating prevents you from being charged more just because of
your condition. Guaranteed renewability prevents an insurer
from canceling your policy if you use its benefits. A ban on
preexisting condition exclusions ensures that your policy
covers the treatment you need. Preventive services can keep
your problem from getting worse. Essential health benefits
ensure that all the treatments you need are covered, and a ban
on annual and lifetime dollar limits protects you from
crippling out-of-pocket expenses when you use your essential
benefits.
Oregon's experience pre-ACA shows why each of these
elements are essential and work together to protect individuals
with preexisting conditions. In 2009, we technically had some
protections for individuals with preexisting conditions,
however, within these meager protections, insurers had ample
room to limit their risk exposure and control costs.
A pregnant woman could be denied coverage. Treatment for a
preexisting condition could be limited. Miniscule benefit
limitations could be imposed, and necessary prescription drugs
were not required to be covered. For those with preexisting
conditions, you were lucky if you were even given the choice to
take an insurer's limited terms.
In conclusion, the ACA has helped to provide Oregonians and
their families with access to comprehensive healthcare. It has
greatly reduced our uninsured population, created tens of
thousands of new jobs, and saved hospitals hundreds of millions
a year in uncompensated care. More people are healthier than
they would be without it.
Unfortunately, uncertainty at the Federal level has
threatened our work and unnecessarily added cost to the system.
Access to affordable healthcare is important for everyone, and
it is time we stop dismantling the gains we have made and focus
more on innovative solutions to control cost and maintain a
stable health insurance market.
Under Governor Brown's leadership, we will continue to
protect consumer's access to healthcare through the ACA. We
will continue to build on our successes, fight to increase
access, and search for ways to make insurance affordable for
everyone.
[The prepared statement of Mr. Stolfi follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman NEAL. Thank you.
Now I would like to recognize Mr. Robertson. Please, begin.
STATEMENT OF ROB ROBERTSON, CHIEF ADMINISTRATOR/SECRETARY-
TREASURER, NEBRASKA FARM BUREAU FEDERATION
Mr. ROBERTSON. Yes, good morning, Congressman Neal,
Congressman Brady, and Members of the Ways and Means Committee.
I am Rob Robertson, Chief Administrator for the Nebraska Farm
Bureau. We are pleased today to share with you some challenges
we see in the individual health insurance markets and also some
steps that Nebraska Farm Bureau took to protect those Americans
with preexisting conditions.
I have dedicated my entire life to helping farmers and
ranchers, and I just honestly couldn't believe what I saw
during the summer of 2018. We held listening sessions with our
farmer and rancher members, and they, literally, got up in
tears talking about their challenges of how they are coping
with the health insurance markets and the individual market.
And the emotional stories were many. I mean, farmers and
ranchers and spouses got up and said, you know, I am forced to
work off the farm because of the high cost of health insurance.
We heard about farm and ranch families not taking out any
health insurance and then having major medical bills during the
year. We heard that the highest living expense for the farm is
health insurance. The stories were all over the board. We heard
common reports of annual premiums being $30,000 to $35,000 to
$36,000 a year. That is $3,000 a month. And I am sure
Congressman Adrian Smith heard similar stories throughout his
travels in Nebraska as well.
But what makes matters worse is farmers and ranchers, more
than any other sector or occupation in the country, are more
affected by the high cost of the individual health insurance
markets than any other sector because the lion's share of
farmers and ranchers are self-employed. And if you are self-
employed, you generally buy on the individual market where the
costs are high and you are not able to be a part of a large
group. This is not a partisan issue. This is not a political
issue. This is an issue of hardship. And we need to fix these
individual markets and try to find some ways to protect
preexisting conditions at the same time.
Because of these issues with our members, the Nebraska Farm
Bureau took matters into our own hands. In 2017, we began to
establish an association health plan with our organization. By
the fall of 2018, we implemented and started enrollment. It
never would have happened without the wonderful partnership we
had with the insurance carrier Medica, based out of
Minneapolis, Minnesota. They partnered with us, and the plan
offered a more affordable health insurance product, which on
average was 25 percent less than the individual marketplace for
members of our large group in our association health plan. It
covers preexisting conditions. And let me repeat that: It
covers all members regardless of their health status in our
association health plan. And it was ACA compliant.
The plan is what our members wanted and is what we
delivered. In creating the association health plan, we deeply
believed it was imperative to cover preexisting conditions, and
that is what we did. Let me be clear: That is not an attack on
the ACA; that is a companion to the ACA by providing our
members with another insurance option.
And our results: Coming out of the first year, we had
almost 700 members sign up for the association health plan;
they saved millions of dollars in premium costs; and then we
continue to hear a lot of interest this coming year for sign-up
for the next enrollment period, starting in 2019 for the 2020
year. From a policy standpoint, one of the best ways we can
protect Americans with preexisting conditions is to enhance the
ability of individuals to ban together, pool their risk, and
form large groups that are fully insured. That is what the AHP,
our association health plan, did.
In our case, many of our members are self-employed. The
only way we were going to be able to form this association
health plan was because of the new association health plan
regulation issued by the Department of Labor last summer. If it
wasn't for those new regulations, we would not have an
association health plan for our members.
Let me share a quick example with you on the impact this
association health plan had on members. Our first enrollees out
of the gate, a husband and wife who farm together near
Fairbury, Nebraska, in 2018, their annual cost on the
individual market was $25,000. They are told in 2019 it was
going to be $26,000 a year. Under our plan in which they signed
up, it was $19,000. They saved $7,000, and that is real money.
How do we get this discounted rate? You know, farmers and
ranchers are now a part of a large group, rated as a large
group. And when you rate as a large group, you can spread the
risk out, you can lower administrative costs, and you can do a
little bit more with pricing in terms of risk-adjustment
factors.
My testimony provides a lot of eligibility criteria on how
to be a part of our association health plan. In general, you
have to be in a similar line of business to be a part of that,
so we designated and targeted farmers and ranchers and
agribusinesses, and it is ACA-compliant on what it covers.
Our organization represents farmers and ranchers with an
average age approaching 60. We strongly support the
continuation of health plans that cover preexisting conditions.
The key is to provide innovative policy solutions to allow for
those types of things like the association health plans to be a
part of how we cover preexisting conditions. Hopefully, our
plan works. And I appreciate the time from the Committee today,
and I will be happy to answer any questions.
[The prepared statement of Mr. Robertson follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman NEAL. Thank you, Mr. Robertson.
Let the Chair recognize Ms. Brooks-Coley. Please, begin.
STATEMENT OF KEYSHA BROOKS-COLEY, VICE PRESIDENT OF FEDERAL
ADVOCACY, AMERICAN CANCER SOCIETY, CANCER ACTION NETWORK (ACS
CAN)
Ms. BROOKS-COLEY. Good morning, Chairman Neal, Ranking
Member Brady, and Members of the Committee. I am Keysha Brooks-
Coley, Vice President of Federal Advocacy for the American
Cancer Society, Cancer Action Network, the nonpartisan,
nonprofit advocacy affiliate of the American Cancer Society.
We appreciate the Committee holding today's hearing to
examine how policymakers can build on critical patient
protections in the ACA and make sure people continue to have
access to quality, affordable health insurance. Nearly 16
million Americans have a history of cancer and another 1.8
million will be diagnosed with the disease this year. For these
individuals, your family, friends, and many of your
constituents, access to affordable health insurance is a matter
of life and death.
The American Cancer Society research shows that uninsured
Americans are less likely to get screened for cancer and more
likely to be diagnosed at an advanced stage. Yet, prior to the
ACA, a cancer diagnosis or other serious illness was often the
exact reason why these individuals were uninsured. Insurance
companies could deny coverage to someone simply because they
had or had survived cancer. They could abruptly revoke health
coverage after someone was diagnosed. They could charge
exorbitantly high premiums to purchase coverage. In other
words, people who needed health coverage the most could not get
it.
Before the enactment of the ACA, the American Cancer
Society's national call center heard from recently diagnosed
cancer patients daily who were unable to get coverage because
of their disease or who had lost coverage as a result of their
diagnosis. It was stories like these about cancer patients from
across the country that moved ACS CAN and other advocacy
organizations to engage in the policy debate about access to
care. Passage of the ACA significantly helped cancer patients
and others with serious conditions.
People can no longer be denied coverage because of a
preexisting condition. They no longer face arbitrary lifetime
or annual caps on their cancer care. And more Americans are
able to access meaningful health coverage, either through
marketplace plans, which currently serve 10 million people, or
through Medicaid expansion, which currently provides coverage
to 17 million people.
These patient protections are at the core of the ACA and
must be maintained. Unfortunately, recent policy changes are
putting many of these most essential protections at risk,
specifically the expansion of short-term health plans and the
drastic reduction in navigator funding. Last year, the
Administration issued a final rule to expand access to short-
term limited-duration health insurance. These plans do not have
to abide by key consumer protections, they can discriminate
based on preexisting conditions, charge higher premiums to sick
people, and exclude certain benefits based on health history.
This means they could cover everything except cancer care.
Expansion of these plans does not help consumers; it puts
them at increased risk. While these plans are often touted as
lower cost alternatives, they are only less expensive upfront
because they don't cover necessary care.
Finally, ACS CAN is concerned about the drastic reductions
that had been made to navigator and enrollment education
funding. Shortened enrollment periods, fewer resources for
outreach and education, and less funding for consumer
navigators directly impacts the number of individuals who
enroll in marketplace coverage.
Beyond shoring up existing patient protections, there are
also ways Congress can strengthen the ACA, many of which I
detail in my written testimony, but a few I will mention now.
Fixing the so-called family glitch would allow more families
the opportunity to access affordable comprehensive healthcare.
Eliminating the so-called subsidy cliff by creating partial
subsidies for individuals with incomes above 400 percent of the
Federal poverty level would also go a long way to improve
affordability of coverage.
Mr. Chairman, thank you again for the opportunity to
testify today. We urge the Committee to find bipartisan
solutions that ensure individuals with preexisting conditions
are protected from discrimination, that essential health
benefits are maintained, and that coverage is made affordable
for individuals.
We look forward to working with you to build upon the
foundation of the ACA and strengthen healthcare coverage for
millions of Americans living with a serious illness such as
cancer. Thank you.
[The prepared statement of Ms. Brooks-Coley follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman NEAL. Thank you, Ms. Brooks-Coley.
Mr. Blackshear, you are recognized, would you please begin.
STATEMENT OF ANDREW BLACKSHEAR, PATIENT AND VOLUNTEER, AMERICAN
HEART ASSOCIATION
Mr. BLACKSHEAR. Chairman Neal, Ranking Member Brady,
Members of the Committee, my name is Andrew Blackshear. I have
been a volunteer with the American Heart Association since
2017. Thank you for the opportunity to testify today about the
lifesaving importance of quality, affordable insurance coverage
for people with preexisting conditions.
I was a healthy 27-year-old in 2015 when my health took a
turn for the worse. I was at home after a long night of
restaurant work, and as I leaned over to untie my shoes, I felt
some chest pain. The pain continued the next day, and I came
down with a severe fever. My fever kept climbing over the next
few days, eventually going above 103 degrees, all the way up to
103.6.
I was worried I would lose my job if I didn't get back to
work. So, on my first night back, I collapsed on the floor of
the restaurant in response to a fluid buildup between my heart
and the pericardium, the sac that surrounds the heart, a
condition that I later learned was called cardiac tamponade.
The fluid buildup was making it much harder for my heart to do
its job. I didn't know it at the time, but I learned later that
I had contracted an infectious fungal disease while driving
through California's San Joaquin Valley in August weeks before
this.
The condition, known as valley fever, was caused by
inhaling fungal spores that are released from the dry soil. It
was likely that just by breathing the air coming through my car
vents my lungs had become infected. When the spores
disseminated through my lung tissue, I developed fungal
pericarditis, and it almost took my life.
Treating my condition was a huge challenge. Over the next
few weeks, my blood tests and symptoms only got worse. Soon I
needed emergency open heart surgery to remove the fluid around
my heart. While fighting for my health, I was also fighting for
the care that I needed. I had purchased a short-term health
insurance plan after aging out of my parents' plan when I
turned 27.
Shortly after the fungal infection was diagnosed, medical
bills started piling up. I knew my short-term plan had a high
deductible, so during the time of my echocardiogram, I paid the
$5,000 deductible. But then I started receiving letters from
the insurance company asking me for more information and
demanding that I prove my heart problems weren't caused by a
preexisting condition. I kept getting the same letter over and
over saying the insurance company wouldn't pay my nearly
$200,000 in medical bills until I could show them that I didn't
have a preexisting condition.
Still recovering from my first operation, I had to go to
every doctor I had ever seen, all the way back to a
pediatrician, to collect the information my insurer was
demanding. The company finally agreed to pay for my care after
I requested the State of California help me take them to court.
When open enrollment began in November of that year, it was
amazing. I enrolled in a plan, started paying my premiums, and
continued to see my same doctors, but there was a big
difference. My ACA plan did what it was supposed to do: It paid
for my doctors' bills instead of punishing me for being sick.
No more calling around to my old doctors' offices. No more
collecting and sending in paperwork to this company. And no
more anxiety for my family over whether I could afford to get
better.
Weeks after my first operation, I then had a tender
stomach, extreme fatigue, swollen ankles, and trouble
breathing. I flew to Minnesota to be seen at the Mayo Clinic
and was diagnosed with constrictive pericarditis and heart
failure. My left and right ventricles were failing. I underwent
my second open heart surgery to remove the sac around my heart
completely. This is called a pericardiectomy.
I felt so much better after the second surgery. And with
comprehensive coverage, I knew I wouldn't be bankrupted because
I had gotten sick. Thanks to the Affordable Care Act, today I
have no medical debt and I am healthy. But I will always be
without a pericardium, so having health insurance that covers a
preexisting condition remains a necessity to me.
As a heart disease patient and volunteer with the Heart
Association, I urge lawmakers to make sure preexisting
conditions are covered. No one should face the prospect of
being unable to afford the care that they need to stay alive.
Thank you again for focusing on this critical issue.
[The prepared statement of Mr. Blackshear follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman NEAL. Thank you for that very important and
powerful testimony, Mr. Blackshear.
We will now proceed under the 5-minute rule with questions
for our witnesses. I will begin by recognizing myself for 5
minutes. But before asking the witnesses my questions, I would
like at this time to yield 2 minutes to our colleague,
Representative Gwen Moore, for the purpose of outlining her own
experience, but most importantly, for the first time having
done this publicly, for her constituency.
Ms. Moore, you are recognized for 2 minutes.
Ms. MOORE. Thank you so much, Mr. Chairman. And I am so
glad to be here. And when I say that I am glad to be here, I
mean I am glad to be here. Literally, instead of yielding me
time, you could be delivering kind words at my memorial
service.
In the spring of 2018, I joined an exclusive club of
millions of Americans with the cursed C-disease: Cancer. A
disaster that guarantees discrimination in the insurance
marketplace; for many, a death sentence. Specifically, I have
been diagnosed with small cell lymphocytic lymphoma, a
manageable cancer with proper surveillance and treatment.
Right now I am in great health with an excellent prognosis
of living with this disease, but throughout the spring and
summer of 2018, I spent a lot of time on a gratitude tour of
being grateful for medical research, having insurance, and,
most importantly, thanking God for the ACA provisions. No, I am
not one of the 20 million low-income people that we are going
to lay down our lives to protect, but I am one of the people
that, before the ACA provisions, could have been subject to
medical underwriting instead of community rating, making it
unaffordable, with no coverage of essential health benefits.
And with all the labs that I went to and all the visits to try
to pin down this diagnosis depending on early intervention,
none of that could have happened if they had imposed lifetime
limits on my care and imposed caps on the out-of-pocket costs,
if the ACA had imposed caps on that. Worse, they could have
just denied me completely because of my preexisting condition.
We have talked a lot about this costing too much or being
too expensive. What does a life cost? Let me just say that I
pay $15,000 a month for medicine. Who can afford that? And what
am I worth?
I yield back.
Chairman NEAL. Thank you very much for that important
testimony. I think your story highlights how, in considering
how to strengthen and protect consumer protections for
Americans with preexisting conditions, we must stand in the
shoes of those facing hard decisions about their healthcare and
work to make sure that they know their health insurance will be
there when they need it and for what they need.
Now, let me return to the start of our questioning to the
story I shared in my opening statement because each of us knows
someone who had delayed getting healthcare only to be diagnosed
with a chronic condition. Mike and his family benefit every day
from the ACA.
Ms. Pollitz, before the ACA, what would have happened to
the likelihood of Mike Finn and his family being able to get
and keep an insurance plan that meets the needs of a diabetic
as well as three young children? What kind of obstacles would
they have faced in trying to get meaningful affordable care?
Ms. POLLITZ. Mr. Chairman, diabetes is one of the
conditions that, through our research, we demonstrated was a
declinable preexisting condition. So the individual market
would not have been an option for that family or at least for
the child with diabetes, with the exception of a few States
before the ACA, including Massachusetts, which required
coverage to be offered on a guarantee issue basis. And so that
was the largest barrier to getting coverage in a nongroup
market.
In other plans, before the ACA, there could be temporary
preexisting condition exclusion periods. So if you took a new
job with a new health plan, there might be a waiting period as
long as a year before the diabetes would be covered. Under a
prior Federal law, HIPAA, people did have to get credit for
prior coverage under other plans, so that when they switched
jobs, they wouldn't continuously incur new preexisting waiting
periods, but any break in coverage of 2 months or longer would
end that protection, and then people might again face job lock
or difficulty getting private insurance coverage for a
preexisting condition.
Chairman NEAL. Thank you, Ms. Pollitz.
Ms. Brooks-Coley, I am sure that patients that you have
represented have experience with high-risk pools, can you
please share your thoughts about patient experiences with high-
risk pools?
Ms. BROOKS-COLEY. Thank you, Mr. Chairman.
An individual who has cancer has--they have experienced
issues with high-risk pools. Some of the concerns that patients
have experienced is not having access to actual services that
they need, making sure they have access to preventable
screenings that we know are lifesaving. Making sure that
individuals have access to actually real coverage they need
that is not too expensive, and is available when they need it.
We know that high-risk pools are not always the most
comprehensive coverage, especially if you have a serious
illness, such as cancer, and need access to very costly
treatments as well as therapies.
Chairman NEAL. Thank you.
And, with that, let me recognize the Ranking Member, Mr.
Brady, for 5 minutes.
Mr. BRADY. Mr. Chairman, thank you.
And thank you to each of the witnesses for your compelling
testimony. Your belief and support for preexisting conditions
is one of the reasons why Republicans fully support these
preexisting conditions and no lifetime caps and making sure you
can't be denied coverage and making sure young people can stay
on their parents' plans. All that is critical.
But we have to do more than just protect preexisting
conditions; we have to make healthcare more affordable. In
Texas, I cannot tell you how many of my constituents tell me
they can't afford the ACA. The monthly costs are far too high.
And, secondly, the out-of-pocket cost--it can be $10,000. Who
can use that healthcare insurance? And then often they can't
even see their local doctor or go to the local hospital.
I am so glad that the Cancer Society is here because, in
Houston, you know, maybe this is one of the reasons, you know,
three Texans eligible for ObamaCare got out from under it,
rejected it, for everyone that uses it. We have very few
choices. Cost went down. That is the good news. But in the
Houston region, for example, if you are a mom in Conroe, Texas,
struck with breast cancer, if you are a father with prostate
cancer, if you are someone with a blood cancer in Huntsville,
we have MD Anderson Cancer Center, one of the finest cancer
centers in the world. You can't go there if you're on ACA--if
you have a private plan, you can. If you are on the ACA, you
have to settle for less. Even if you can see MD Anderson, the
best cancer doctors in the world for you, you are denied
coverage under the ACA.
I am convinced we can do better to make healthcare more
affordable and have access that patients need. I do believe
that the Trump administration made some key moves over the last
year, that have been almost a lifeline for some Americans who
can't afford the Affordable Care Act. One is, for the first
time, the average benchmark premium for the nearly 40 States
that use Healthcare.gov, instead of doubling since ObamaCare
came into place, for the first time ever, those rates
decreased, including those in our State of Texas, where rates
are down 2 percent. They decreased.
Second, we now have, and I am pleased to say, we are
actually starting to see more insurers and more choices in our
State than before because, in too many counties in America, it
was take it or leave it. You take that ACA plan or nothing at
all, and that is not fair.
And then, when the individual mandate penalty was repealed,
I think Speaker Pelosi predicted millions of Americans would
face lifesaving choices, but in truth, nearly 97 percent of
those on the ACA have re-enrolled. The biggest challenge we
face--one of the reasons in Oregon two out of three people
eligible for ObamaCare aren't signing up--is the cost, and that
is what I worry about the most.
Mr. Robertson, you were very careful in not criticizing the
Affordable Care Act, and I think that is a great approach here.
But what I heard you say was that these association plans and
what you have developed for your members is because you can't
afford the other ACA options available, and you had to find a
better approach. As we think about the future of healthcare for
the 7 percent of Americans we are focused on here that don't
get it at work or from the government, do you consider this,
what you have for your members, to be junk plans or something
inferior, or something that really meets the needs of your
members?
Mr. ROBERTSON. It is the latter. It really meets the needs
of our members. And think about it: Everybody--most people in
this room probably are part of an employer group, but if you
are an individual self-employed farmer or rancher, you are not.
So the association health plans allow you to form a bona fide
large group, which allows you to spread out the risk. We are in
this for the long term because we want to reduce costs because
the cost from the ACA in the individual market, when you are
there solely, is very, very high.
Mr. BRADY. You know, if I recall, was Nebraska one of the
States that the ACA also created co-ops, you know, in
healthcare to try to lower costs by sort of taking the public
option? But if I recall, in many States, those co-ops failed
and left a lot of Nebraskans and others in a real lurch. Did
that contribute to the need to find something that actually
works for your members?
Mr. ROBERTSON. Yeah, absolutely. Just 2 or 3 years ago
there were a lot of co-ops that formed. A couple of them, they
all were going great guns the first year out, and then year 2
and 3, they all went belly-up, and that left many of our
Nebraskans, particularly farmers and ranchers, searching for
the right policies and affordable policies, which there are
hardly any.
Mr. BRADY. Thank you, Mr. Robertson.
Chairman NEAL. Thank you, Mr. Robertson.
With that, let me recognize the gentleman from Georgia, Mr.
Lewis, for 5 minutes.
Mr. LEWIS. Thank you, Mr. Chairman, for holding this
hearing. As I said to you, I think this is a good place to
start. Healthcare is a right; it is not a privilege. And all of
us--all Americans have a right to quality healthcare. I want to
thank our colleague and friend, Gwen Moore, for sharing her
story. It is not easy.
Mr. Blackshear, thank you for sharing your story with us.
It must be difficult to come and testify in public about such a
difficult and personal experience. I think you are very brave.
Please, would you share more about how you felt when you
learned that your insurance would not protect you?
Mr. BLACKSHEAR. Yes. Thank you for the compliments, as
well. I was very worried. My whole family was worried. You
know, these bills were stacking up. I knew I never had a heart
problem. Everybody in my family knew I never had a heart
problem. So I knew their attack wasn't justified at all, but I
continued to jump through hoops until I found a way out by
finding someone from the State to fight for me. Just a lot of
anxiety built up in my family while I was sick over these
bills.
Mr. LEWIS. But it is good that you didn't give up.
Mr. BLACKSHEAR. No, I would never give up.
Mr. LEWIS. You didn't give in.
Mr. BLACKSHEAR. No, never.
Mr. LEWIS. You kept the faith.
Mr. BLACKSHEAR. Uh-huh.
Mr. LEWIS. You kept fighting.
Mr. BLACKSHEAR. I kept fighting.
Mr. LEWIS. What would you say to others that may share your
concern and conditions?
Mr. BLACKSHEAR. Yeah, to them personally, I would say: You
know, if you are in that type of situation, keep fighting for
what you deserve. And another thing, I don't even think we
should be in a position where we have to fight in those
situations.
Mr. LEWIS. Thank you, Mr. Chairman.
I yield back.
Chairman NEAL. Thank you, Mr. Lewis.
With that, let me recognize the gentleman from California
for 5 minutes, Mr. Nunes.
Mr. NUNES. Thank you, Mr. Chairman.
I want to thank all the witnesses here for testifying. And
I want to make sure that everyone knows that everyone up here
supports protections for preexisting conditions, always have,
always will. Nobody up here believes that insurance companies
should be able to jerk customers around, drop their coverage,
and charge more when they get sick.
It is really this long debate on ObamaCare that Democrats
have consistently used protections for people with preexisting
conditions as a justification for the law and the creation of
two new entitlement programs. They have $750 billion in
Medicare cuts with ObamaCare, and a trillion dollars in tax
increases.
ObamaCare was supposed to solve these problems but, in
fact, has, in most cases, made them worse. So I understand we
have a political theater here in Washington and have hearings
like this, but I think we should be careful so that we are not
stoking fear that someone is going to lose their insurance. We
really have a responsibility to come up with a better
healthcare system because ObamaCare wasn't the solution.
Republicans have put solutions on the table in the past,
and we will continue to do that. I would love to work with my
colleagues on finding ways to fix our healthcare system. For
example, we know that the Medicare trust fund begins to go
broke just after 2020. The year 2024 is what they say today; it
could be even sooner than that. So we have a lot of challenges
ahead of us, and hopefully we can work together. And I think
what it takes first is to admit that ObamaCare was not the
solution. Maybe there is a better solution, but right now, it
is not the solution.
Mr. Robertson, one of the things that you have done very
successfully with the Nebraska Farm Bureau is you have thought
outside of the box. You have created a new program that is
working in your State. Do you have some examples, without
naming names, of course, but maybe give some examples of folks
who have enrolled in your plan that maybe weren't able to get
on the ACA, who are now getting healthcare coverage? Do you
have some personal examples of this?
Mr. ROBERTSON. Yeah, I sure do. We have a member of our
board of directors that did not participate in the ACA last
year and signed up for the association plan this year and saved
$7,000, $8,000, and so that is a question--they had an
alternative plan, but it wasn't near ACA-compliant and didn't
cover preexisting conditions. But now they are covering all of
those conditions at a lower cost than what it would have been
on the individual market with ACA.
So, in my mind, that is a win. Not a week went by without--
or a day go by during signup where we heard stories of our
members saving thousands of dollars by joining our association
health plan.
Mr. NUNES. And, roughly, how many folks do you have in your
plan now?
Mr. ROBERTSON. Nearly 700 members.
Mr. NUNES. Nearly 700. And they have to be Farm Bureau
members.
Mr. ROBERTSON. They have to be Farm Bureau members by July
1 of that preceding year because we wanted a 6-month waiting
period because we didn't want the next hundred Farm Bureau
members to need knee replacements. So that was important.
Mr. NUNES. Uh-huh. And what is the average age? You
mentioned the average age in your testimony, but could you
repeat that again. What is the average age of the folks that
are in your plan?
Mr. ROBERTSON. We were seeking that information out from
our insurance partner yesterday. I think because of some HIPAA
laws, we don't have that, but we are guessing it is in the low
50s. Typically the younger producers might have been eligible
for more subsidies on ACA, and so they took the subsidy ACA
route rather than our association health plan route. So we
think it is a little bit weighted toward the older end.
Mr. NUNES. Do you have an average price for the plan, and
can you walk us through the different types of plans that you
are offering?
Mr. ROBERTSON. Yeah. Prices vary for age and geography. And
we had six products that were offered underneath the plan that
we sponsored. And the average prices are anywhere from, we
think, $18,000 to $25,000 a year, and, again, that sounds like
a lot, but when you are paying $36,000 a year, that is a
savings. That is real-time savings.
Mr. NUNES. Well, congratulations on thinking outside of the
box and coming up with plans, and I think we can learn a lot
from your work, and I appreciate you being here today.
Mr. ROBERTSON. Thank you.
Mr. NUNES. Thank you, Mr. Chairman.
Chairman NEAL. I thank the gentleman. The gentleman from
Texas, Mr. Doggett, is recognized for 5 minutes.
Mr. DOGGETT. Thank you. How appropriate and important it is
that we are focusing on healthcare and preexisting conditions
as the first formal hearing of this new and much-improved
Congress. In understanding where we go forward, it is important
to understand the path that has led us to today. And that path
is 8 years of Republican persistence in trying to destroy the
Affordable Care Act and its protection for preexisting
conditions. Trying again and again and again, dozens and dozens
of times, to repeal the Affordable Care Act and its protection
for preexisting conditions, and failing on those efforts. Then
moving to try to weaken and undermine the Affordable Care Act
in any way that they possibly could.
One thing that has been missing from that path is the
replace part of repeal and replace. Not once was any
comprehensive alternative to the Affordable Care Act and its
protection for preexisting conditions ever presented for a vote
in this Committee or any other one. It is great to hear that
they want to work with us, and I hope that they do, in moving
to a better place and correcting some of the obvious
deficiencies of the Affordable Care Act. But it would be even
better had they advanced a comprehensive replacement, if they
had one, for a vote and action over the course of the last 8
years.
On Inauguration Day, not even getting to the inaugural
dances, President Trump decided to join their effort to destroy
the Affordable Care Act, and he issued an Executive order on
that day to tell all Federal agencies to do everything they
could to undermine the Affordable Care Act. And the most recent
example of that is what is clearly collusion. It is collusion
between an indicted Texas attorney general who sought to
destroy protection in the court for preexisting conditions and
the Trump administration, which, instead of defending that
protection for the Affordable Care Act, decided they would just
lay down and play dead. And had it not been for the important
intervention of attorneys generals from States across the
country to defend the Affordable Care Act, there would have
been no contest over this total capitulation by the
Administration.
Republicans can tell us that they believe in preexisting
conditions, but this is more than passing some sense of
Congressional resolution, it is a matter of structuring a way
of accessing healthcare that does protect without exorbitant
premiums those many Americans, almost half of Texans, who have
preexisting conditions.
Perhaps the most troubling aspect, in fact, of preexisting
conditions, maybe the most overriding preexisting condition in
America today, is amnesia, the political amnesia of those who
have forgotten what it was like before the Affordable Care Act
and how it was that those who would get a diagnosis of a
serious disease would also be getting an effective diagnosis of
financial ruin if there was no protection for them before the
Affordable Care Act.
The Affordable Care Act is far from perfect. One of the
areas that I hope our Committee will focus on is how we get an
answer on the question of prescription price gouging, the need
for Medicare and negotiation, and the need for more competition
to reduce those costs.
But, Ms. Brooks-Coley, I would ask you one question. Across
my area, I have been to so many Relay for Life events where
cancer survivors come out and people from the community come
out to support the American Cancer Society, and one of the
statistics that I remember from those gatherings is the
indication that if you don't have insurance--and, of course, in
a State like mine in Texas with an indicted attorney general
who keeps fighting Medicaid expansion, we have more uninsured
than just about any place in the country, probably just about
any place in the industrialized world--that you have a 60-
percent greater chance of dying with cancer if you lack
insurance than if you have access, such as through the
Affordable Care Act. Is that still the case?
Ms. BROOKS-COLEY. Thank you for the question, Congressman.
That actually is a 2017 statistic from our Cancer Journal, and
it is a really important statistic that we actually cite
oftentimes when we are having conversations about why patients
with preexisting conditions have access to coverage.
American Cancer Society research has shown that access to
coverage and your ability to have health insurance is a
deciding factor, if you have a serious illness like cancer, of
what your diagnosis stage would be, as far as when your cancer
is found, what your treatment outcomes will be, the quality of
what those treatment options will be, as well as survival
rates. And speaking to your direct question, survival rates are
directly linked to an individual's ability to have access to
affordable, quality, and comprehensive healthcare.
Mr. DOGGETT. Thank you.
Chairman NEAL. I thank the gentleman. I thank the
gentleman. With that, I would like to recognize the gentleman
from Florida, Mr. Buchanan, for 5 minutes of inquiry.
Mr. BUCHANAN. Thank you, Mr. Chairman, for this hearing. I
also want to thank all of our witnesses.
First, I want to say that I, myself, and I know
Republicans, support preexisting conditions, but I wanted to
mention something else. Being someone that has been in business
for 30 years, this is always my favorite time of the year, the
beginning of the year. We have a new Congress. A lot of us are
new on this Committee. I would challenge all of us to find a
way that we can work together. These are big issues.
My big, most passionate thing I am passionate about is the
rising cost of healthcare. I read in the paper, USA Today--and
I have thrown this out before, but a year ago, it struck me so
much--that 62 percent of Americans don't have a thousand
dollars in the bank. They are living paycheck to paycheck. And
when I thought about that, for someone that has been in
business 40 years, many years before I got here, we paid for
everybody's healthcare for 20 years.
And then the next 20 years, the costs continue to go up,
not just in terms of ObamaCare, but in terms of the costs going
up. We have to find a way to bend the curve on costs because it
is bankrupting, in my mind, the middle class, and we talk a lot
about the middle class.
I would just tell you I met, you know, met with a lot of
people, over in Florida, anyway, about healthcare costs. One
gentleman said to me that he is paying--the company is paying
$700, he is paying $700 a month out of his pocket for a family
of five, a young family, and then he has an $8,000 deductible.
So as they have children, it cost $8,000 a year that is having
to come completely out of pocket.
Another gentleman, Roberto, has an Italian restaurant, that
he has had, and he was telling me that his healthcare cost is
something you mentioned, $3,000 a month. So it is clearly
affecting everybody.
And my point is that cost is getting pushed to the middle
class. That is why they don't have any money, you know, at the
end of every week, or at the end of every month, because they
are having to pay more themselves from that standpoint.
I think there has been probably some good ideas in terms of
Oregon and Massachusetts. We should look for the best
practices, the best ideas, and find a way to bend the cost of
healthcare costs. That is what we should be doing, not playing
the blame game. We are here today, let's find a way with a new
Congress, to move forward and start having an impact.
I think the spending last year or this year is $3.5
trillion that we spent on healthcare. There has to be ways we
can find more efficiencies by working together. So my focus is
on how do we bring the costs down?
Ms. Pollitz, let me ask you, what is your suggestion for
this Committee in terms of how we can work on a bipartisan
basis to start lowering the costs? What would be some of the
things that you might suggest?
Ms. POLLITZ. Well, Mr. Buchanan, I work for the Kaiser
Family Foundation, and we actually don't make policy
recommendations, but we do provide information. We have a lot
of information on our website and on our partner website, the
Kaiser-Peterson Health Tracking site, that provides a lot of
data on healthcare costs and where they are rising and why they
are rising. And I think we would be very happy to sit down with
you or any other Members and kind of review that information
for you and suggest other things.
Mr. BUCHANAN. My thought is, how do we start vetting the
curve on the costs?
Mr. Robertson, you mentioned--and I chaired our chamber in
our area, in Sarasota, Florida, there is 2,400 members in
there. Now, 80 percent of the members are 15 employees or less,
exactly what you are talking about. It looks like you have
about a 25 percent, 30 percent savings, through this
association concept, which we weren't able to put in place in
our chamber. We tried, but for whatever reasons, outside groups
had more influence, but is it your sense you are going to be
able to hold on to the savings that you have so far?
Mr. ROBERTSON. Yeah, we really do. I mean, it all depends
on how the history looks of the whole group, of the association
health plan in the first year out. We don't have experience on
this group yet, but we sense we will. And as the group gets
larger, which we are getting a lot of interest--more members
signing up this year--as the group gets larger, just because of
the fact it is larger, you can spread more of the risks and the
costs out with the whole group. And so we hope that 25 percent
becomes 30 percent, 35 percent reduction from the----
Mr. BUCHANAN. You mentioned that they all have preexisting
condition coverage, right, as a part of that package? So you
didn't drop any of that out to get to the savings?
Mr. ROBERTSON. No, no, the savings are just related to how
large groups are rated, basically.
Mr. BUCHANAN. Thank you, and I yield back.
Chairman NEAL. I thank the gentleman.
With that, let me recognize the gentleman from California,
Mr. Thompson, to inquire for 5 minutes.
Mr. THOMPSON. Thank you, Mr. Chairman, and thank you to all
the witnesses who took time to be here today for this very
important hearing.
I voted for the Affordable Care Act, a bill that was not
written in the back room, a bill that was written in full
public with hearings, amendments, hearing from witnesses, and I
did that because I believe every American should have access to
quality, affordable healthcare, including Americans with
preexisting conditions. And it has worked.
In my district alone, the uninsured rate dropped from a
full 10 percent, from 15.9 percent in 2013, to 5.9 percent in
2017. And that is, in large part, because folks with
preexisting conditions had access to a healthcare market that
they didn't before.
And you heard from my constituent, Mr. Blackshear; he was
one of those people who gave an outstanding explanation of his
personal situation. Every one of us have heard from
constituents in our district. Every one of us can talk about an
example to this. The last time we met, I shared with this
Committee the fact that my sister-in-law, who is a dental
hygienist married to a young minister, couldn't afford
healthcare in their State of Florida. Both were starting out in
their business, and it wasn't until the ACA was passed did she
have access to healthcare. And it was shortly after that, that
she was diagnosed with a very serious cancer. She has undergone
some pretty extreme procedures for that. She is home. She is
doing well.
And the number one concern that she has is, now that she
has a preexisting condition, will she be able to continue to
have healthcare. She is scared to death that somehow she is
going to lose that if the ACA goes away. And that is not what
we should be doing. We should make sure that this is, in fact,
the law of the land, because it is the ACA that made that
possible.
And, Mr. Robertson, I want to thank you for your testimony
and particularly the point that you made on a couple of
occasions, and that is that your Farm Bureau policy is ACA-
compliant. That is an important factor. Because if it weren't
for that, it could very easily be another junk policy, that
takes your members' premiums, and they are there for you every
step of the way, unless you become injured or you become ill.
So it was the ACA that provided that protection.
Mr. Blackshear, you purchased your short-term healthcare
policy a few months before you fell ill. The following November
you said that when open enrollment hit, you purchased a plan
through Covered California, our marketplace for the ACA. Can
you describe how the patient experience changed on a day-to-day
basis after you purchased a plan through Covered California?
Mr. BLACKSHEAR. Yes. Basically, just the anxiety, that was
the huge thing. Being sick, you know, and especially severely,
in heart failure, seeing bills that aren't being paid, and I am
having to run errands. It was pretty difficult. So I would say
the biggest thing is just the anxiety surrounding it, you know,
that wondering, I am paying my premiums, but are they going to
help me out, you know.
Mr. THOMPSON. And we have heard a lot from the dais today
from our colleagues on the other side who keep raising the
issue of the cost of healthcare through the Affordable Care
Act. Talk a little bit about what you pay and the difference
between what you pay for your ACA policy and your short-term
policy that didn't provide you the care that you needed.
Mr. BLACKSHEAR. With no income change, my short-term plan
was $160 to $180 premium per month. And then surprisingly, when
I got on the ACA, it went down to $70 a month.
Mr. THOMPSON. This was after you were diagnosed with a very
serious healthcare issue?
Mr. BLACKSHEAR. Yes, yes.
Mr. THOMPSON. Thank you very much.
Mr. Stolfi, you talked about your Oregon plans. In
California, we recently passed legislation prohibiting these
short-term, junk plans. Has Oregon done something similar?
Mr. STOLFI. Thank you, Representative, for the question. In
2017, our legislature passed a law limiting short-term plans to
what was then the Federal requirement of 3 months. It was a
policy decision made at the time, and we are very happy with
that decision.
Mr. THOMPSON. And all the plans that you sell are compliant
with the ACA?
Not that you sell, but the State--that's sold in the State?
Mr. STOLFI. Well, the short-term plans are not required to
be compliant, which is the problem with them.
Mr. THOMPSON. Thank you very much. I yield back.
Chairman NEAL. I thank the gentleman.
With that, let me recognize the gentleman from Nebraska,
Mr. Smith, for 5 minutes.
Mr. SMITH OF NEBRASKA. Thank you, Mr. Chairman. I
appreciate the opportunity to have this hearing and bring some
attention to the fact that there is a lot of common agreement
in terms of preexisting conditions. Actually, what we as
Republicans have proposed previously and actually voted on, and
I do want the record to reflect that we did vote on an
alternative that would have, I think, proven very effective to
consumers to be able to have options and actually to afford
health insurance.
It concerns me greatly when we see an increase in premiums
to levels that are--I never even thought imaginable before we
even had that vote back in 2009 and 2010.
And so, as we process this--and Mr. Buchanan certainly
pointed out how important it is that we work together to find a
way forward so that the American people will not be harmed,
because let me be very clear, many Nebraskans have been harmed
by the heavy hand of the Federal Government saying that they
have been helping them, and that the government has helped in
ways that many Nebraskans would tell me they have actually been
harmed. So I do have some questions.
Ms. Brooks-Coley, you referenced exorbitant premiums that
were paid before the ACA came about. What would you list as an
example of an exorbitant premium?
Ms. BROOKS-COLEY. From the cancer perspective, one of the
concerns that our patients had before the ACA, and before the
important patient protections included in the law, was the fact
that our patients had to oftentimes pay more for their care.
Sometimes they had insurance plans that did not actually cover
cancer treatment and had to pay exorbitant prices to actually
access lifesaving chemotherapy, radiation, and other
treatments.
So those exorbitant prices, that even if they had coverage,
may not have actually covered the actual care that they needed,
were extremely harmful.
If you look now at the Affordable Care Act and the patient
protections and the essential health benefit requirements that
are in the law, our patients don't have to worry about those
costs, and they are paying their premiums and paying for the
expenses that they have with the understanding, though, that
they won't be hit with exorbitant costs that could impact them
and their family members.
Mr. SMITH OF NEBRASKA. So a high-risk pool, you are telling
me, would pay a higher premium before the ACA. Is that correct?
Ms. BROOKS-COLEY. I am sorry, Congressman.
Mr. SMITH OF NEBRASKA. A high-risk pool that would have
covered preexisting conditions, even before the ACA, are you
saying that those premiums would have been higher than others?
Ms. BROOKS-COLEY. I was speaking specifically to the fact
that there may have been services they had to pay for out of
pocket that weren't covered by those plans.
Mr. SMITH OF NEBRASKA. Okay, all right. And thank you.
I am concerned that some of the high-risk pool premiums
that were around prior were higher, but now we see more people
paying similar premiums, as Mr. Robertson pointed out. Even the
roughly $19,000 premium per year, that is still a lot.
Ms. BROOKS-COLEY. Right.
Mr. SMITH OF NEBRASKA. And so that is why I hope we can
work together on a way forward to bring that down. Because even
if there are preexisting conditions that are covered in a
mandatory fashion, if the premium is out of reach for a rate-
payer and they can't afford it, there is not a lot to do about
that. And it is certainly unfortunate because it ultimately
reduces access. I mean, we see that even folks in California
who qualify for an ACA plan, only 40 percent opt for that plan.
And I think we need to get to the bottom of why and how that
has come to be the situation.
I think of Pam in my district, who liked her plan before
all of this came about. She had a plan that she liked. It
covered her preexisting condition. She was canceled and that is
unfortunate. She lost coverage through no fault of her own four
times because the government said they were trying to help her,
and that should be unacceptable to us as policymakers.
And certainly we want the American people to have more
choices for coverage. And I am glad that the Nebraska Farm
Bureau has at least given another choice to its members because
we have seen choices diminish, certainly in Nebraska, since the
ACA came about.
Thank you, I yield back.
Chairman NEAL. I thank the gentleman.
With that, let me recognize the gentleman from Connecticut
to inquire for 5 minutes, Mr. Larson.
Mr. LARSON. I thank you, Mr. Chairman, and I thank you most
of all for something that Mr. Buchanan said--this is the start
of a new Congress and a commitment to have public hearings and
to have them often and to go to regular order. And I would
point out to my colleagues on the other side, and I often
wonder when they say ``ObamaCare'' if they mean it in the same
way that we do in terms of Obama truly caring about the people
of this country. I will give them a pass and say that is what I
think they mean on this and not the derisive nature that
oftentimes--that it takes.
What we are going to need here on this Committee is the
kind of format that Mr. Neal has indicated this Committee is
going to be dedicated to, and that is to have public hearings
as we did during the Affordable Care Act, and make sure that
everybody has an opportunity to go back and forth.
Our colleagues on the other side, it doesn't seem that
there is much disagreement between us with preexisting
conditions. We should, therefore, all be able to reach a
conclusion rather quickly.
I want to ask the panelists real quickly. All of you as you
have sat here today, you all agree that there should be no
limit, that anyone who has a preexisting condition ought to be
able to get an insurance policy, correct? Is there anyone who
would disagree?
Does anyone disagree, of our panelists, with what Mr. Lewis
had to say, that because of the nature of health insurance--Mr.
Robertson, you have seen it up front with farmers. All of you
have experienced it in one form or another. Should it be a
right? Can I see a show of hands? Should it be a right, yes?
You all believe that it should be a right, as Mr. Lewis has
pointed out.
What we have here is an infrastructure problem, and what we
find in Congress when we have an infrastructure problem, even
though currently our national infrastructure, Mr. Blumenauer
would tell you, has a D-minus rating by engineers, et cetera; I
would say our overall health infrastructure--and by that, I
mean our own personal health and well-being--is an
infrastructure problem.
And in both cases, what Congress has to do is come together
and talk about what is necessary to improve that
infrastructure. And it is not roads and bridges in this case,
but it is arteries and disease and preexisting conditions. But
like all of these, they come at a cost. And so while Congress
may strongly agree about the need, when it comes to paying for
it, that is where the disagreements come in. And that is the
bottom line here.
Mr. Robertson, you have talked about pooling resources and
everybody coming together. What a great thing. A colleague of
ours here, Brian Higgins, has come up with an idea, and I want
to quickly ask you this. What about if we were to have 50-year-
olds be able to buy into a Medicare system? A Medicare system
that the Kaiser Family Foundation said that if a 60-year-old
bought into the plan, it would be 40 percent less than the
Affordable Care Act gold plan. Is that something you could
agree with?
Mr. ROBERTSON. Well, it depends. I mean, there is a lot of
value to pool individuals together.
Mr. LARSON. Precisely. And----
Mr. ROBERTSON. But if you don't address the cost side of
that equation----
Mr. LARSON. Sure. But let's say if it was age 50 years old,
again, and you could buy into a program which would make it
revenue neutral but would look at the older end of the people
that you cover from, say, 50 to 64, they would get a break, and
the Medicare group would be much younger, as well. Also, the
younger group would become 27 to 49, driving, as you know,
insurance down dramatically.
Mr. ROBERTSON. Right. Again, there is value with pooling
resources, but until you address the other side of the equation
on cost of providing healthcare, somebody has to pay for those
plans.
Mr. LARSON. Exactly. And so what would you suggest?
Mr. ROBERTSON. There are a lot of things that I think have
not been looked at yet by Congress and policymakers, but there
are some--I think, some market innovation programs that can be
looked at to make a health insurance system work.
Mr. LARSON. We are running out of time, but if you would
submit those to us we would be happy to take a look at them.
But thank you for your testimony. I want to thank all the
panelists. I yield back.
Chairman NEAL. I thank the gentleman, and let me recognize
the gentleman from Texas, Mr. Marchant, to inquire for 5
minutes.
Mr. MARCHANT. Thank you, Chairman Neal. Congratulations on
your Chairmanship. I am looking forward to working with you and
with our leader, Mr. Brady, on finding some solutions that will
positively affect my constituency. I want to echo Mr. Brady's
statements and make sure that my constituents back home know
that I support protecting access for all patients with
preexisting conditions.
We all agree that protecting these individuals is
necessary, and I will look forward to working on policy
solutions that address the uncertainty that surrounds these
individuals. Sadly, current law is riddled with problems that
make it a litigator's dream and a patient's nightmare.
So I will ask the panel--and I have heard each of your
stories and what you do. I would like to ask you a very
specific question, though, and if it doesn't apply to you, just
say, it doesn't apply to me and I don't have an answer for you.
But what law or laws would you propose Congress pass that the
President could sign, that would give individuals with
preexisting conditions the certainty that they need when it
comes time to utilize their coverage?
Ms. Pollitz.
Ms. POLLITZ. I am sorry? The certainty to utilize their
coverage?
Mr. MARCHANT. Yep.
Ms. POLLITZ. I am not sure what you mean by that.
Mr. MARCHANT. Make a claim, have it paid.
Ms. POLLITZ. Getting the claim paid?
Mr. MARCHANT. Yes, ma'am.
Ms. POLLITZ. I mean, the ACA does require that people have
access to insurance regardless of their preexisting conditions.
It does require that insurance provide essential benefits, at
least in the individual and small group market, and it provides
subsidies to make all of that work.
Mr. MARCHANT. So you would propose no new law to change
what is on the books now?
Ms. POLLITZ. I wouldn't propose laws one way or the other.
I am just saying there is that law. As I think the Members have
discussed today, not everybody gets coverage under the ACA.
Particularly, it is difficult for people who don't qualify for
subsidies.
There are other limits. We haven't talked too much today,
for example, about--well, actually, I think Mr. Brady brought
up network adequacy, and whether the plans that are there for
people then cover a sufficient number and distribution of
doctors and hospitals. I think it is fair to say implementation
of network adequacy standards under the ACA hasn't gotten very
far. The Obama administration, toward the end, began to ask----
Mr. MARCHANT. But my question was about preexisting----
Ms. POLLITZ. But now the Trump administration isn't even
looking at that anymore.
Mr. MARCHANT. My question is about preexisting conditions.
This is the purpose of the hearing.
Mr. Stolfi.
Mr. STOLFI. Thank you, Representative. I would say that a
prior Congress has already passed, and the President has
already signed, a piece of legislation that protects people
with preexisting conditions, the Affordable Care Act. And as
far as helping those individuals further when it comes to the
costs that they are faced with, and all individuals, actually,
with coverage, work can be done on, as one of the panelists has
mentioned, the cliff.
So individuals at and over 400 percent of the poverty
level, helping those individuals get more subsidies to help.
Cost-sharing reductions could be funded so that we could see
rates come back down----
Mr. MARCHANT. That would be addressing preexisting
conditions?
Mr. STOLFI. People with preexisting conditions and people
without. So every person with insurance would benefit.
Mr. MARCHANT. Okay, thank you.
Mr. Robertson.
Mr. ROBERTSON. Well, I am here talking about the
association health plans, and I think more laws and regulations
to improve and reform association health plans would be very
helpful to help cover preexisting conditions.
Mr. MARCHANT. Ms. Brooks-Coley.
Ms. BROOKS-COLEY. Thank you, Congressman. The American
Cancer Society, Cancer Action Network supported the Affordable
Care Act for that very reason, because of the patient
protections that are included in the law, that made sure that
patients who had serious illnesses such as cancer, and had
preexisting conditions, had access to the coverage that they
need.
Mr. MARCHANT. Thank you.
Mr. Blackshear.
Mr. BLACKSHEAR. With a policy question like this, I would
refer you to speak with the people that I work with in the AHA.
Mr. MARCHANT. Okay. Thank you.
One of the real-life situations that some parents in my
district face are children that are privately covered on their
parents' insurance plans now, but their disabilities and their
sickness will go much past the 27-year-old limit. And they fear
that eventually, when they pass away or their coverage goes
away, there is a retirement, that when they have to switch that
child to Medicaid, that the preexisting condition or the level
of care will not be adequate or compare to the level of care
that they are getting on the private insurance. Does anyone
have a comment about that?
Chairman NEAL. The gentleman's time has expired.
Mr. MARCHANT. Thank you.
Chairman NEAL. Let me recognize the gentleman from Oregon,
Mr. Blumenauer, to inquire for 5 minutes.
Mr. BLUMENAUER. Thank you, Mr. Chairman. I appreciate our
having this discussion today and I think it is appropriate to
start out. Although I must confess that I would think my good
friend from Texas, the Ranking Member, would be embarrassed to
critique the Affordable Care Act process, the dozens of
hearings, the work that went on, to the--I don't even know how
to describe jamming through the largest transfer of wealth in
American history without a hearing, with people not knowing
what was in it to this day.
When the history is written of what happened in the--in
this last decade, that claim will be laughable. And I hope we
can get past it.
Mr. Chairman, one of the things I think is important, two
of the witnesses, Ms. Pollitz and Mr. Stolfi, pointed out that
we have legislation now that reaches the requirement for
preexisting conditions. The only problem in terms of gaps is
that there is not adequate funding for subsidies and they are
chipping away at some of the things that are going on. We have
it now.
Now, notwithstanding legislation that my Republican friends
passed to try to give themselves a fig leaf before the last
election, what they did is not sufficient, is not as good as
the Affordable Care Act. They can say that they want to do
that, but it didn't speak to the interaction of all of the
pieces. That is why they never passed legislation and enacted
into law something to replace the Affordable Care Act. They
couldn't do it and meet those standards.
Or, as the President of the United States said, healthcare
is complicated. Who knew? Who knew? But the fact is, what you
came up with is not as good as what we had, and if we would
have been working together for the last 6 years to refine and
enhance the Affordable Care Act, coverage would be better,
costs would be lower, and we could move on to other areas that
we agree need help.
Now, Mr. Stolfi, you have, in your testimony, impacts of
what happened with the Republican Congress and the
Administration that have driven up costs, not reduced them but
driven them up. Do you want to point to your testimony? I think
people missed that, that the things the Republicans have done
and the Administration is pursuing, according to your
testimony, has harmed people in my State.
Mr. STOLFI. Thank you, Representative, for the question.
Yes. So we are calling it Federal uncertainty, but it is a
contribution of a number of factors. It is the short-term
limited duration plan changes, association health plan changes,
zeroing out of the Federal mandate, the Texas lawsuit, and the
loss in marketing dollars to promote open enrollment at the
exchanges. All of these things have a real-life impact on
people.
In Oregon, they have influenced the rates that people are
paying in 2019, by increasing those rates between 7 and 14
percent over what they otherwise could have been, without this
unavoidable Federal uncertainty.
Mr. BLUMENAUER. Thank you. The witnesses have pointed out,
there have been some problems earlier. Getting a massive
proposal in place, insurers made bids that weren't accurate,
and it took them a couple of years to be able to get it right.
That is not something that should be surprising for something
that is dealing with this much of the economy. It will take
time to get it right.
But what has happened is that, while they are working to
get it right, my Republican friends and the Administration have
created greater uncertainty, getting rid of the mandate and
having problems in terms of cost-sharing reductions. Things
that were envisioned in the bill that were part of making it
work properly, unnecessarily put this uncertainty in a business
that doesn't thrive on uncertainty. They are risk adverse. They
want good information.
Mr. Chairman, I appreciate our having a discussion like
this today. I think as we go through, we will find areas that
we don't need that make it worse. We ought to take a bill that,
as enacted, is providing what people want for preexisting
conditions, not chip away at it, but refine it.
Thank you, Mr. Chairman.
Chairman NEAL. I thank the gentleman for his inquiry. And
now let me recognize the gentleman from New York, Mr. Reed, for
5 minutes.
Mr. Reed not being here, let me recognize Mr. Kelly for 5
minutes.
Mr. KELLY. Thank you, Mr. Chairman, and thanks for having
this hearing. And to all the witnesses, thanks for taking time
out of your private lives to come here.
This hearing today is about preexisting conditions and what
is covered and what is not covered. But most importantly, while
it is called the Patient Protection Affordable Care Act, the
most obvious part of it is the ``Affordable'' Care Act.
I don't know how many Members sitting up at the dais today
actually buy health insurance. I am still in the private sector
and we do provide employer-sponsored healthcare and pensions,
by the way. I think one of the biggest challenges is how do you
afford to do that, especially if you are a small employer. And
I think that is where we come in with the association health
plans.
And I think, Mr. Robertson, that is the key to how even
small employers can offer a benefit to their associates that
lets them compete in an open market for talent, part of that
being benefit programs.
In Pennsylvania, by the way, there is a company in
Fairview, Pennsylvania, which is just outside Erie, and I
represent them--there is new ownership, 13 employees. The owner
wants to provide health insurance for his employees, but can't
afford the rates for them.
Now he wants to join an AHP through his business
association with the manufactured business association in Erie,
but the Governor of Pennsylvania says ``no, no, you can't join
an AHP; Pennsylvania isn't providing that.'' And I have to tell
you, we hear all this back-and-forth about what we do. We have
always supported preexisting conditions. It is just flat out
what we do because we believe in that.
Being an employer, I believe in that because of the people
that I work with every day for mutual success. And to try to
develop some type of a plan that says, ``no, they don't want
this,'' that is not true. I think what all of us want is
something that is truly affordable.
Ms. Brooks-Coley, you know I am a Hyundai dealer. Hyundai
Motor America Hyundai dealers have something called the Hyundai
Hope on Wheels. We just finished our 20th anniversary, and
through Hyundai dealers and Hyundai Motor America, have
contributed $125 million to the research for pediatric cancer.
So there is nobody in America that says, ``nah, they don't
deserve it'';'' nah, we can't go down''; ``too expensive.''
``Too expensive'' is true because sometimes your heart is
willing but your wallet is weak; you don't have the resources
to do it.
But, Mr. Robertson, I want to get to you because there is
an answer for people who want to provide healthcare. And they
want to provide it for their associates. But if you are
eliminated from doing that--and I think you covered it very
clearly. One of the ways we develop healthcare programs is
through what, age and geography, which is a little bit
different than the way I would think about it. But I would
think risk is probably something that should be figured in
there, too.
And I am not saying people with preexisting conditions
shouldn't be covered, but it has to be factored in.
Tell me, how else would a small employer be able to get the
same benefits as a large group for the rates that they need to
have, in order to remain competitive, and in their line of
business or their competition, to find talent out there, and
wanting to take care of those people?
Mr. ROBERTSON. Well, I think it is problematic for
individuals or small employers. Again, it is all economics.
Size matters. If you can pool a larger group, you can address
the preexisting conditions, but because you are in a larger
group, you can spread out the risk. And so if you are a small
employer, a farmer/rancher, and if you are only yourself, it is
hard to deal with the risk.
But we can address preexisting conditions if you allow the
individual and small markets to pool together all their
resources and risk. That is the way to do it. It is pretty
simple.
Mr. KELLY. It is pretty simple, and the reason that it can
be affordable is because you widen the universe of who is
paying premiums.
Mr. ROBERTSON. Correct. I mean, large employers do it
today. It is pretty simple. You widen the pool and you can
lower administrative costs. You can lower other associated fees
with that large group. Right now, we are trying to force the
small and individual group to cover preexisting conditions.
That is why the costs have gone up on the premiums, to where
they are $30- to $36,000 a year for farmers and ranchers of
Nebraska. We have to pool them up and----
Mr. KELLY. Let me ask you this, because we are all agreeing
on the same thing, right? We want preexisting conditions
covered. We want to make sure that employers can offer this.
Why would they want to exclude the association health
plans? For what reason? What would be the purpose of doing
that? Because basically with the Affordable Care Act, they
wanted more people paying in that were actually filing claims.
So it is the same principle. Why are AHPs under fire right now,
with no, you are not allowed to have those? For what reason?
Mr. ROBERTSON. I don't know. I think that is the best
reason to move forward, to cover preexisting conditions because
you are using market forces with insurance companies to spread
those risks to cover preexisting conditions. That is what needs
to happen.
Mr. KELLY. And I want to encourage you to keep going. I
know the farmers in Nebraska appreciate what you are doing. I
have to tell you, Manufacturers Associates in Erie have over a
thousand members in that plan. What a shame to have to tell
those people now, you can't participate on a level you can
afford; we are going to force you into some other market. That
is not what America is; that is not what we have ever been. We
are about innovation. So I thank you for your time here.
Mr. Chairman, thank you, and I yield back.
Chairman NEAL. Thank you, Mr. Kelly, and with that, let me
recognize the gentleman from Wisconsin, Mr. Kind, to inquire
for 5 minutes.
Mr. KIND. I thank you, Mr. Chairman. I want to thank you
for holding such an important hearing for our initial kickoff
as a Committee, and I want to thank the witnesses for your
testimony. And I am so happy to hear such wide, bipartisan
support for the need to protect individuals with preexisting
conditions. It is just fundamental in our healthcare system. I
am glad to see that consensus developing.
Mr. Robertson, let me ask you, and listen, I am an owner of
a family farm myself in a large, rural, Western Wisconsin
district. We rotate corn and beans, have some beef cattle, and
so I am operating in farm circles quite a bit. And I am glad to
hear that you are coming up with a solution in Nebraska with
these AHPs that are addressing one of the shortfalls, quite
frankly, that existed under the Affordable Care Act. That is
those individuals trapped in the individual marketplace that
are not qualifying for premium tax credits to lower their
healthcare costs. You are trying to address it right now with
the AHPs.
Clearly, it is not something that is prohibited under the
ACA, because the Nebraska AHP is ACA-compliant, which is all
that we have been asking. The concern with the AHPs, though, is
if it wasn't ACA-compliant, they would be offering junk plans
that wouldn't cover very much and, therefore, offering them
cheaper, and it would strip a lot of the younger, healthier
people and gravitate to those plans with the more comprehensive
coverage that virtually all of us ultimately need at some point
in our life.
But let me ask you a couple of questions, because I am
dealing with the same issue in Wisconsin. The average farmer's
age in Wisconsin is 60, 61, like you said it was in Nebraska.
Are you worried with the health pool that you have established
with the AHP, with the average age about 60 and the fact that
as we grow older, we consume more healthcare, healthcare gets
more expensive, and what that is going to do with your premiums
in the future, with that aging population within your health
plan?
Mr. ROBERTSON. No, no, we are not. I mean, we built this
plan to last for a long time, the next 5 or 10 years. And so we
built it to be ACA-compliant, and we think as we grow the pool,
we hope this thing becomes not just 700 members, but it becomes
3-, 4-, 5,000 Farm Bureau members.
Mr. KIND. Are you also worried about maybe the
extraordinary event that might happen with some of your
members, whether it is cancer or something else, with the
extraordinary costs that might come with one or two individuals
contracting cancer and having to deal with those expenses, what
that might do with the AHP premiums in the future?
Mr. ROBERTSON. Yeah, I mean, that is always a concern
because you have to have an association health plan that
remains solvent. And so there is that concern out there. But,
again, the track records will show, with all these large
employers, the larger the group, the more you can address those
types of large events.
Mr. KIND. And I think there is great agreement on that
point. It was just interesting, because I did encounter this
article of the World-Herald Bureau, written by Joseph Morton,
talking about the Nebraska AHP.
And, Mr. Chairman, I would ask unanimous consent to get the
article included in the record at this time.
[The information follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. KIND. But in it Mr. Jeff Bartsch, who is Medica's Vice
President, who is offering the health plan for you, was asked
how the initial premiums were established, and he was quoted as
saying, ``We had an opportunity to just assess who the
potential association members would be, and their health risk
is lower than the remaining individual market, and that is why
you are seeing some better premiums being offered.''
But he also pointed out there are over 90,000 people in
health insurance exchanges under the ACA in Nebraska who are
still in that pool, and the vast majority of them are receiving
premium tax credits to lower their costs.
I know in Wisconsin--I don't know what it is in Nebraska--
but 87 percent of the participants in the ACA health insurance
exchange in Wisconsin are qualifying for these premium tax
credits, substantially reducing their costs, and that is why so
many have signed up for it.
But Mr. Bartsch also went on to say that the association,
in our mind, is really targeting, again, either people who have
left the market already, or those people who are still in the
market but don't receive a premium tax credit. So that is the
issue, really, the roughly 5, 6 percent of the overall
population of the country. Mr. Bartsch, that is just a small
overall portion of the overall population that fits that
definition.
And that is one on which I hope that we could find some
bipartisan agreement. How do we address that small portion of
the American population stuck in the individual marketplace,
not qualifying for premium tax credits?
I know Mr. Neal and others of us have offered legislation
to address that by expanding these premium tax credits to cover
more individuals. That is another way of addressing it.
But I am just concerned that with demographics, with an
aging population, extraordinary health events, such a small
pool of 700 members--you are hoping to grow that--what that
might do to future premiums.
Let me finally ask you, do most of your members when they
hit 65 then transfer into Medicare?
Mr. ROBERTSON. Yeah. Yeah, they do.
Mr. KIND. And Medicare is a great program, and they have to
take all newcomers, whether you have a preexisting condition or
not. Medicare is able to spread that risk out.
Do you have a prediction that if there was an early buy-in
option to Medicare, that is budget neutral, that some of your
members might find that an attractive option?
Mr. ROBERTSON. I do not. No, I am just here on the
association health plans. I appreciate that----
Mr. KIND. Fair enough. Fair enough.
Mr. ROBERTSON. But on your point, on the Federal poverty
level, we even saw those members who are in the 250 to 400
percent Federal poverty level--actually, our Farm Bureau plan
competed with that tax credit, and we were able to pull some of
those away from that premium subsidy. So that was good news we
saw.
Mr. KIND. That is good. We will watch it very closely.
Thank you. Thank you all.
Chairman NEAL. I thank the gentleman, and with that I would
like to recognize the gentleman from Missouri, Mr. Smith. And
after Mr. Smith inquires, we will move to establish precedent
on the Committee, having two witnesses on our side for one on
the other side. With that, Mr. Smith is recognized for 5
minutes.
Mr. SMITH OF MISSOURI. Thank you, Mr. Chairman. I look
forward to working with you and the Republican leader on the
important business upcoming in this Committee.
We all agree that protecting access to coverage for
individuals with preexisting conditions is necessary. I look
forward to working with you, Mr. Chairman, on solutions that
offer certainty to our most vulnerable. That being said, the
status quo is full of problems that have made many patients'
nightmares become reality.
In 29 of the 30 counties I represent, Missourians only have
one insurance provider on healthcare exchanges. Lack of choice
has skyrocketed costs.
You know what fails to protect patients with preexisting
conditions? Deductibles so high that you might technically have
insurance, but it is effectively meaningless.
Lack of choice. A noncompetitive marketplace full of
options that don't meet your needs.
What will fail to protect patients with preexisting
conditions? Failing to address Medicare solvency before it
becomes insolvent in 7 years.
We have to address costs and increase choices in our
healthcare system to create a competitive marketplace, so
consumers can buy insurance that works for them and meets their
needs.
I want to share a letter I received from Marian and Greg
from Ozark County, Missouri, in my district: ``My husband Greg
and I recently moved to Ozark County from Tennessee. Greg had
to retire early because of a stroke that he suffered in 2015.
We are currently on COBRA and are paying a thousand dollars a
month for basically nothing. We discovered that our county in
Missouri has only one provider for ObamaCare, and that coverage
is even more expensive than our COBRA coverage.
When is Congress going to do something to correct the
damage of ObamaCare? Getting rid of the mandate was great, but
that is not enough. And why aren't there high-risk pools or
some other options for people with preexisting conditions like
my husband? We don't want to spend all of our savings on health
insurance premiums, especially if we don't receive any benefit.
Politicians say that people shouldn't go bankrupt from medical
bills. I say that people shouldn't go bankrupt from paying
ridiculously high insurance premiums.''
I couldn't agree with Marian more and I hope that the
Chairman will work with us to find policies to lower costs that
we can advance through, not only this Committee and the House,
but that can pass the Senate and earn the President's
signature. I yield back.
Chairman NEAL. I thank the gentleman. With that, let me
recognize the gentleman from New Jersey for 5 minutes to
inquire, Mr. Pascrell.
Mr. PASCRELL. Thank you, Mr. Chairman. Doing away with the
mandate and cutting subsidies, et cetera, et cetera, is just
the beginning of how you try to strangle the Affordable Care
Act. Let me hope you will write some of these things down,
because it seems like this is a redo of the last 6 years.
The ACA has substantially improved access to care and
financial security. Between 2010 and 2017, the share of
nonelderly adults with a problem paying a medical bill fell 21
percent; who didn't fill a prescription, fell 27 percent; who
skipped a test or a treatment, fell 28 percent; who didn't
visit a provider when they needed care, and that fell 23
percent.
Now, to bolster that, the marketplace consumers are
satisfied with their coverage. That has gone from 36 percent
all the way up, now it is at 82 percent in 2017. You have to
look at these numbers, instead of doing redo's.
Before the ACA, women could be charged more than men just
for being born female. Maternity, mental health, and substance
abuse were routinely not included in insurance coverage. What
are you talking about, you support preconditions? I must have
missed a lot of meetings over the last 3 years. And the
Administration must have missed it all.
Companies could bill consumers for every last dime with
virtually no oversight. Someone said before, look at what the
conditions were in 2010, which brought about this situation. If
we would have done nothing, if we would have done nothing--and
you are good at doing that--you criticized us and didn't come
up with another plan on preconditions. You have to be kidding
me.
The fact of the matter is, you voted more than 70 times to
repeal the protections and take us back to the days of
uncertain and discriminatory coverage. You did that.
After years of sabotaging the Affordable Care Act, your
efforts have served only to make protections afforded to
Americans and that law all the more popular today. Thank you.
But the repeated attempts at repealing, gutting, and
otherwise sabotaging the ACA, have left us with a lot of work
to do to pick up the slack. The Committee, in particular,
egregiously gutted provisions of the ACA in the 2017 tax bill
in December. Remember that? Remember that bill? You didn't even
have the guts to run on it. You ran away from the bill. A move
that is projected to cause 13 million people to lose insurance.
You did it. I didn't do it. No one on this side did it. You did
it.
A partisan lawsuit subsequently has tried to dismantle the
entire ACA, including its protection for preexisting
conditions, and taking away the few assurances we provide
Americans in the healthcare marketplace. We must stabilize. No
one said that the ACA was perfect. No one said that on this
side. In fact, everybody on this side in the last 6 years have
offered some kind of situation of amendment to make the ACA
better. Because we have never had perfect legislation in this
Committee or any other Committee.
I just want to ask you one quick question, Karen--Ms.
Pollitz. Republicans have put forward an expansion of a short-
term, limited duration plan for--it is called a junk plan--as a
new option to supposedly lower costs for consumers.
Can you describe the pitfalls of high-risk pools, and have
they ever worked in the past? And can you describe the problems
with these junk plans?
Ms. POLLITZ. I will start with high-risk pools if I could.
Mr. PASCRELL. Sure.
Ms. POLLITZ. I actually--yes?
Chairman NEAL. You will be allowed to finish your answer if
you make it succinct.
Ms. POLLITZ. Okay. So high-risk pools were a different way
of going about this before the ACA in many States, including in
Maryland where I live. I was actually on the board of our State
high-risk pool. Insurers were allowed to turn people down
because of their preexisting conditions and then the State
would provide a public program, a high-risk pool that would
offer alternative coverage.
That is a very expensive proposition, though. If you only
offer coverage for the people who are sick, who account for
most of the spending and the risk pool, that will be a very
expensive program. States that had these programs, by
definition, lost money on every person that they signed up.
They were very, very expensive.
So States, over time, started adopting features to limit
the cost of programs and to limit the number of people who
could enroll. So all but one of the high-risk pools excluded
coverage for the preexisting condition, which made you
eligible, for 6 to 12 months. They charge premiums higher than
standard rates, and even still they lost money on average,
about $5,000 a year per person. So it is another way to do it.
There are--Medicare, for example, covers people with end
stage renal disease, so there is a lot of tradition of having a
public plan take some of the expensive people and make that
sort of the main way of getting coverage. It is just very
expensive to do it that way, and without premium financing,
there has to be other taxpayer financing to make that work.
In terms of the short-term plans, that is an entirely
different approach. That is sort of undoing the risk pool and
saying, we can make cheaper coverage available to people while
they are healthy but only while they are healthy. And you heard
from Andrew what happens once you get sick in a short-term
plan.
So if you believe that you buy insurance in case you get
sick, then you want coverage that doesn't stop working once you
stop being healthy.
Mr. PASCRELL. Thank you. Thank you, Mr. Chairman.
Chairman NEAL. I thank the gentleman for his inquiry. With
that let me recognize the gentleman from Illinois, Mr. Davis,
for 5 minutes to inquire.
Mr. DAVIS. Thank you, Mr. Chairman, for calling this
hearing, and I also want to thank all of our witnesses for
coming to share with us.
Much of my focus is on children, because children are such
an important part of our population and represent so much of
the future. Children living with disabilities such as autism,
or ADHD, regularly need therapies or medication to ensure that
they can attain and retain their maximum functioning.
Under the ACA, even though children cannot be denied
coverage, they are charged higher premiums due to a preexisting
condition. Sometimes therapies and medications required to
address these conditions are not covered by insurance.
Ms. Pollitz, how do we ensure that treatments for children
with disabilities are covered by insurance, and how well are we
doing with it in the ACA?
Ms. POLLITZ. Mr. Davis, the--let's see. As you pointed out,
children with disabilities can't be discriminated against,
turned down, charged more, or have their preexisting condition
excluded. The ACA does prior to an acute care coverage benefit.
So depending on the disability and what it is, there are often
limits, I think, to what private insurance would cover, which
is why sometimes people end up turning to the Medicaid program
which provides a much more comprehensive set of services for
long-term services and supports.
And for children, because of the EPSDT benefit, the Early
Preventive Screening Diagnosis Testing--I forget--it covers
everything that children need, so that is the most
comprehensive benefit.
In terms of two of the conditions that you mentioned,
autism and ADHD--is that right?
Mr. DAVIS. Right.
Ms. POLLITZ. So that is then--the ACA is not so specific in
that. So there is a standard for essential health benefits that
applies in the individual and the small-group market, but those
essential health benefits are categories of services. They, by
and large, don't include a definition of specific services or
specific conditions. States are allowed to then add more detail
to the essential health benefits through the benchmark plan
that they adopt.
I think most States have adopted a standard--I don't know
about Oregon--to cover services and testing and diagnosis
relating to autism, for example.
In other plans, including large employer plans, and
particularly self-funded employer plans, at least with these
two conditions that you mentioned, there is another law, the
Mental Health Parity Act, which does require that plans have to
cover services related to mental health conditions at the same
level that they do for other medical conditions. I think----
Mr. DAVIS. Okay. Let me ask you----
Ms. POLLITZ [continuing]. Insurers can kind of have some
discretion, though, about determining what counts as a mental
disorder.
Mr. DAVIS. Good. Parents around the country regularly spend
anywhere between $2,000 and $5,000 out of pocket to determine
whether their child has a disability because insurance may not
cover the tests required to diagnose or assess these
conditions.
Is insurance required to cover the treatment associated
with preexisting conditions? Shouldn't it also cover the test
or evaluations required to determine whether a child has a
particular illness or situation?
Ms. POLLITZ. Again, in general, I believe insurance is
required to cover diagnostic services, but insurers have
discretion to determine what is medically necessary and what
falls within the scope of their covered services. I am not sure
if maybe in Oregon there is an example of some----
So some States are more specific, particularly with respect
to autism and do require private insurance to cover diagnostic
services, treatment services. But those State laws would not
reach large, self-funded, employer plans, and that may be where
your constituents are finding gaps in their private coverage.
Mr. DAVIS. Thank you so much for that kind of clarity.
Thank you, Mr. Chairman. And I yield back.
Chairman NEAL. I thank the gentleman. With that, let me
recognize the gentleman from South Carolina, Mr. Price, for 5
minutes.
Mr. RICE. That would be Mr. Rice, but you were close.
Chairman NEAL. Mr. Rice, I am sorry.
Mr. RICE. No problem, Mr. Chairman.
The theory of the Affordable Care Act was to provide
universal coverage for people, including those who had
preexisting conditions, and that we could keep the costs down
by adding to the risk pool because people were basically not
required to buy insurance but penalized if they didn't. And
also to bring down the health insurance cost.
As you will recall, the President said, you know, if you
like your plan, you can keep it, which is clearly a falsehood.
When he said, if you like your doctor, you can keep him, that
often proved not to be true. And when he said it would bring
down the cost of health insurance, in fact, the opposite has
been painfully true.
Expanding the insured base was one of the goals, and the
other goal was to bring the cost down. This first chart here is
of the insured base, and it clearly shows that before the
Affordable Care Act, 85 percent of America was covered, either
by private, employer-held insurance, which is the bottom of
each bar there. The first bar is 2010; the last is 2017. But at
the bottom in the blue there is employer insurance.
And then the--I am skipping the middle, the purple part is
Medicaid, and then the orange is Medicare, and then the yellow
is the uninsured population. So the uninsured population has
shrunk some. It was 85 percent, just before the Affordable Care
Act hit in 2013; now it is 91 percent.
So we have insured 6 percent more people. That is good.
That is a laudable goal. We want to insure as many people as we
can. But what is the cost of that? Next chart, please. So to
insure those 6 percent more people, we have--this is insurance
premiums. The first bar is 2013; the last is 2017. Individual
market insurance premiums in 2013 were about $225, and today
they are about $475, which, if you think about that, 85 percent
of people were covered before the Affordable Care Act.
We have succeeded in covering 6 percent more people. So the
cost of that, though, was those 85 percent, who were already
covered, have to pay more than twice as much to pick up that
incremental benefit of the 6 percent more people.
Now, there are different ways to cover those 6 percent more
people. Most of those people were picked up because we expanded
Medicaid in most States. And so we just basically said, here,
here is your free insurance, and we picked those up. We didn't
have to charge everybody else twice as much to get most of that
incremental benefit.
We could have just said, we are going to expand Medicaid,
forget about the rest of the Affordable Care Act, right?
Most States had other mechanisms for covering people who
had preexisting conditions. My State, South Carolina, had a
health insurance pool. I am curious about Oregon--and, Mr.
Stolfi, I am going to pick on you, because you are the only
Insurance Commissioner here. What was Oregon's mechanism for
covering people with preexisting conditions? Did they have one?
Did you have none?
Mr. STOLFI. Thank you, Representative. Oregon did have a
high-risk pool program.
Mr. RICE. And could people be excluded from the high-risk
pool?
Mr. STOLFI. There were waiting lists for the high-risk
pool. There were preexisting exclusions for the first--it could
be up to 6 months.
Mr. RICE. Okay. But we have open enrollment for a limited
period of time in ObamaCare, so if you want to sign up in May
you had a 6-month waiting period anyway, right? So that really
hadn't changed.
Now, how much more was the monthly premium in Oregon for a
high-risk pool, people with preexisting conditions, than for
other people? Was the premium a whole lot higher? In South
Carolina I know, because I had two kids that were in our high-
risk pool, I had one that had a heart defect and one that had a
brain defect, and the premium in South Carolina was about 30
percent higher. How much higher was it in Oregon?
Mr. STOLFI. It was capped at 125 percent of the cost.
Mr. RICE. So it was 25 percent higher, right?
Mr. STOLFI. Yes.
Mr. RICE. Okay. Well, today, I am telling you, there it is
right there, everybody has to pay 230 percent more because of
ObamaCare. Now, if before ObamaCare the most risky folks with
preexisting conditions had to pay 125 percent and their
deductibles had now gone up like five times, I mean, I looked
at your plan, you had a $750 deductible, a $500 deductible, and
a $1,500 deductible. Now your average deductible is $4,100.
So your people with preexisting conditions are now having
to pay 230 percent more or 130 percent more instead of 25
percent more, and their deductible is five times as much. Can
you really look at me with a straight face and tell me that
those people are better off with ObamaCare than they were
before ObamaCare? They had lower premiums. They had access to
coverage. And they had much lower deductibles. Are they really
better off? Do you really believe that?
Chairman NEAL. The gentleman will be allowed to finish his
answer, please.
Mr. STOLFI. Thank you, Mr. Chairman. Absolutely, the people
are better off now than they were before. And you touch on a
point of affordability, which is a very important concept. And
there is many different ways to look at affordability, and one
is, you know, for the people that don't have choice. The people
who have health conditions, how affordable is this coverage for
them? Before the ACA, this coverage was not affordable for
people. If they----
Mr. RICE. It cost half as much. It cost half as much.
Mr. STOLFI. So we have compared the price right now of an
average comprehensive healthcare plan that any individual can
get now to the price that someone would pay in OMEP, and those
prices are essentially the same. Actually, the OMEP policy is--
--
Mr. RICE. But the price you are comparing it to is 230
percent higher than it was before ObamaCare drove it up.
Mr. STOLFI. So the price differences have actually
happened, and I can't dispute that. But what is very important
is that we are not comparing apples to apples.
Chairman NEAL. The time of the gentleman has expired. We
move to Ms. Sanchez to be recognized for 5 minutes.
Ms. SANCHEZ. Thank you, Mr. Chairman. And I want to thank
all of our witnesses for joining us today.
I am extremely pleased that we are having this hearing on
preexisting conditions because it is a reminder of the
measurable improvements that have been made in the lives of
millions of Americans since the passage of the Affordable Care
Act.
And I have personal experience with this with staff members
that were employed in my district office. I know for a fact
that prior to the ACA, insurance companies could deny anyone
coverage for any reason, and they could also discriminate
against women and charge us higher premiums simply because of
our gender, because we are women. That is a practice known as
gender rating, which I was proud to have championed its demise
in the passage of the Affordable Care Act.
In 2009, a study by the Women's Law Center found that
young, healthy women were charged 84 percent more than
similarly aged males for plans that didn't even include
maternity benefits. Insurance companies treated being a woman
effectively as a preexisting condition. Before the ACA many
with health insurance who thought they had coverage often found
themselves denied coverage in their time of need. Many were
shocked to find that maternity care wasn't covered under their
plans or they were denied coverage entirely after a pregnancy.
But it is not just women who benefited from the Affordable
Care Act. More than 130 million Americans have a preexisting
condition and are now guaranteed access to coverage and quality
affordable care when they need it. I am proud to have worked on
and voted for the Affordable Care Act. And I am frustrated by
Republican efforts, namely, efforts by this Administration, to
increase costs and decrease quality. While they love to attack
the ACA, what they do in response to that is create more
uncertainty and drive up prices.
So I am interested, Ms. Pollitz, I have a few things that I
am interested in asking you whether or not doing these things
creates more certainty, and thus makes healthcare coverage more
affordable because these are things that we have seen. Refusing
to use appropriated money to do advertising, outreach, and hire
navigators to explain enrollment processes. Do you think that
creates more certainty and helps lower healthcare costs?
Ms. POLLITZ. I think that does make it harder for people to
know all of our polling that we have done every year. Open
enrollment shows that people don't understand the ACA still, or
when the dates are. So not having advertising and consumer
assistance can make it harder for people to sign up. The
healthiest people are the most likely to stay out.
Ms. SANCHEZ. Ms. Brooks-Coley, do you think that helps
create more certainty and lower healthcare costs by refusing to
use money for the outreach and to hire navigators?
Ms. BROOKS-COLEY. No. From our perspective, transparency
and education about plans and what type of coverage an
individual can purchase is extremely important. And not having
the funding used for that purpose can lead to patients not
actually purchasing insurance or understanding what they are
purchasing.
Ms. SANCHEZ. Okay. Ms. Pollitz--and Mr. Blackshear has
personal experience with this, perhaps you would care to chime
in--allowing these substandard junk plans to be sold on the
market, do you think that creates certainly and lowers costs?
Ms. POLLITZ. That has been shown to increase costs. Insurer
rate filings show that they expect this will cause adverse
selection, and so raise the average cost of the ACA compliant
plans.
Ms. SANCHEZ. Mr. Blackshear.
Mr. BLACKSHEAR. I just want to say, it literally does
increase uncertainty.
Ms. SANCHEZ. Thank you. What about challenging in court
critical provisions of the ACA such as penalties for those who
don't get coverage or striking down the individual mandate? Ms.
Pollitz.
Ms. POLLITZ. That is another source of uncertainty about
the future of the ACA.
Chairman NEAL. Mr. Stolfi, would you agree with that?
Mr. STOLFI. I would agree, yes.
Ms. SANCHEZ. Thank you. Finally, Ms. Pollitz, could you
explain what would happen if we rolled back the preexisting
condition protections and the gender rating provisions? What
would happen to those seeking coverage?
Ms. POLLITZ. Well, that would be kind of going back to what
the world looked like before 2010. So that women in--certainly
younger women would pay much more in premiums than younger men
due to gender rating, and people with preexisting conditions or
a history of them, would find it much more difficult to find
coverage in the nongroup market.
Ms. SANCHEZ. I just want to state for the record in the
limited time that I have, I had a staff member who worked in my
district office, the mother of four children, who got cancer,
and this was prior to the passage of the ACA, and they refused
her care at a certain point because she had hit her cap. And so
she was not able to get treatment, and sadly, she passed from
cancer. That is what will happen if we roll back the
protections in the Affordable Care Act.
And, again, I want to thank the Chairman, and I want to
thank our witnesses.
Chairman NEAL. I thank the gentlelady. With that, let me
recognize the gentleman from New York, Mr. Higgins, to inquire
for 5 minutes.
Mr. HIGGINS. Thank you, Mr. Chairman. Prior to the
enactment of Medicare in 1965, 56 percent of older Americans
could not get coverage because they had the preexisting
condition of old age. That is when the Medicare program was
established. Today, 97 percent of older Americans have access
to good quality healthcare through the Medicare program.
Preexisting conditions are basically good people that are
treated differently by private insurance because they were born
with a genetic mutation that causes or increases the risk of
disease. Those diseases include childhood cancer, juvenile
diabetes, kids born with Downs syndrome, and cystic fibrosis.
Before the Affordable Care Act, almost 50 percent of adults
between the ages of 50 and 64\1/2\ who tried to buy health
insurance for themselves and their families were denied because
of preexisting conditions.
You can't do that anymore. It is against the law because of
the Affordable Care Act. My colleagues on the other side keep
saying that everybody up here supports preexisting condition
protections. That is not true. Everybody up here does not
support preexisting condition protections. House Republicans
between March of 2010 and July of 2017, more than 7 years,
House Republicans voted 70 times--70 times to repeal and
replace the Affordable Care Act's preexisting condition
protections.
Everybody up here does not support people with preexisting
conditions. Having failed 70 times, Republicans then advance
their new plan. The insidious, malicious language in there said
that a health insurance company had to write a policy for
somebody with preexisting conditions, but that policy didn't
have to cover the treatment of a family member, a kid who is
struck with childhood cancer for that preexisting condition.
So, no, everybody up here does not support protecting people
with preexisting conditions.
Mr. BRADY. Will the gentleman yield?
Mr. HIGGINS. I will not yield. I will not yield.
Mr. BRADY. I yield back.
Mr. HIGGINS. So House Republicans couldn't pass legislation
to repeal and replace. They couldn't pass their own healthcare
plan because nobody supported it because nobody believed them.
So then they went to the States and they said they will do what
we were unable to do. Twenty States attorneys general joined a
lawsuit challenging the Affordable Care Act in the preexisting
condition protections in Federal court. Eleven of those States
have the highest population of preexisting conditions.
So the only hope left is the White House, and the White
House's Justice Department who can come in and save the day.
They filed an opinion saying that they would not defend the
Affordable Care Act, and that they opposed and characterized it
as unconstitutional. They opposed the preexisting condition
protections of the Affordable Care Act.
Nobody up here, not one person up here, supports
preexisting condition protections for the American people. Not
one person up here. And not one Republican out there either.
You go ask the States attorneys general in those States that
have joined together to fight this protection that people
fundamentally need.
Here is the bottom line. The Medicare program did what
private insurance companies had the opportunity to do and
decided not to, because they don't make a lot of money on
people who are sick. That is not who we are as a Nation. That
is why we should allow people to use the leverage of the
Medicare program to buy-in at their own expense so that they
can get the protection of preexisting conditions now.
The private sector has had all kinds of opportunity. And
the great irony in all of this is that Medicare was established
as a public program, and guess what, when it was so successful,
guess who wanted to get involved? Private insurance through
Medicare advantage.
Look, I think the choices are pretty clear here, and I
think that we will have legislation that will affirm that in
clear and unambiguous language.
Mr. BRADY. Mr. Chairman, regular order--stay on the time--
--
Chairman NEAL. I thank the gentleman. His time has expired.
Mr. HIGGINS. We have preexisting conditions. I yield back.
Chairman NEAL. With that, subscribing and adhering to what
is known as the Gibbons Rule, for some of us who have been here
for a bit, we will recognize the gentleman from New York. And
the Gibbons Rule simply says people are recognized in the order
in which the gavel came down if they were seated. Mr. Reed.
Mr. REED. Well, I thank the Chairman for the recognition.
And with great respect to my colleague from New York who just
articulated one of the greatest falsehoods I have ever heard
uttered in this chamber on the Ways and Means Committee,
Republicans, and the gentleman, I would hope, would remind
themselves that they are Members of Congress. And, as a Member
of Congress, I stand here to articulate as a Republican, and as
a Member of this dais on the Republican side, that we take yes
for an answer.
We support the provision. The provision. Remember, the
Affordable Care Act was 3,000-plus pages. And the provision
that we are talking about, the protection of preexisting
conditions, is something where I say to the American people and
I say to this dais and I say to my colleagues on the other side
of the aisle, take yes for an answer. We agree with you. This
reform is good. This reform will stay as the law of the land.
And we heard the voice and the fear that was the result of
the 2018 election where this issue became centerpiece in that
vernacular and in that debate, that we listen to the American
people as Republicans. Preexisting conditions will remain the
law of the land. But we need to do better. And what I would
articulate to the American people today is that there is a
fundamental choice that is going to be on display for you for
the next 2 years.
The fundamental choice that is carried by my colleagues on
the other side of the aisle is known as something as simple as
Medicare for All, single payer healthcare. What that is is
government controlled, government run healthcare. We as
Republicans offer you a different vision. We offer you an
embrace of market pressure to bring healthcare costs down, that
will also bring health insurance premiums down.
So, Mr. Blackshear, I heard your story, I heard your
condition. And maybe if I could articulate something that I
have seen repeatedly as I have gone across my district and
across this country and talked to the American people, there is
a vast misunderstanding in regard to the connection of
healthcare cost and health insurance premiums.
I heard your testimony, and if I heard it correctly, you
said your premiums now are about $70 to $80 a month. Is that
correct?
Mr. BLACKSHEAR. That is correct.
Mr. REED. So that is approximately $1,000 a year. And your
horrific preexisting condition, your horrific heart condition,
I read your testimony, and it articulated that you had exposure
to medical costs of $200,000, and probably those medical costs
were triple that, quadruple that. It probably cost a million
dollars for the care that you received.
And so do you see the issue between $1,000 a year versus
the cost of care that your horrific condition of $200,000 plus
causes? And we in the healthcare arena have to have a vehicle
to take those costs, right, of $200,000 plus for your
condition, and if you are paying $1,000 a year in premiums, how
does that cover the two together?
And I think what Mr. Robertson is offering, from Nebraska,
is a way to do that. Are you not, sir?
Mr. ROBERTSON. Yes.
Mr. REED. And how do you do that?
Mr. ROBERTSON. Again, by forming an association health plan
you pool the individual small markets together so basically you
can cover people with preexisting conditions because your risk
pool is large enough to do that. That is what large employers
do today.
Mr. REED. And that is what employers do. So what it is
about is taking those costs, right, and trying to share them
amongst everyone. But most fundamentally, I think what is lost
in this debate is--did anyone here today testify to any
mechanisms to bring those healthcare costs of $200,000 down? I
did not see any of your testimony talking about how to bring
that $200,000 price tag that Mr. Blackshear was exposed to
down. Did I see any testimony offered by anyone in here about
bringing those costs down? Did I miss it?
And the silence of the dais speaks volumes to the issue
that we face. Because, Ms. Brooks-Coley, I heard your
testimony, and we talked about exorbitant prices, and my
colleagues question to you was about premiums. You didn't talk
about the premiums, you talked about the prices, and you kind
of mixed the two together. Did I hear your testimony correctly?
Ms. BROOKS-COLEY. You are referring specifically to high-
risk pool premiums?
Mr. REED. He asked you about exorbitant premiums and you
talked about exorbitant prices. So, to me, that was your
testimony. To bring prices down is where the focus should be.
And that is where agreement and common ground could be found.
With that, I yield back.
Chairman NEAL. With that, the gentlelady will be able to
answer.
Ms. BROOKS-COLEY. Well, the only thing I would say is from
the cancer perspective. We have concerns about the rising cost
of premiums as well as the out-of-pocket costs for patients.
And we agree that affordability is an issue, but you have to
look at ways to address affordability without addressing and
harming patient access to comprehensive coverage. You look at
plans such as short-term limited duration plans and other
products that aren't comprehensive, and that is where we become
very concerned.
Chairman NEAL. Thank you. With that, let me recognize the
gentlelady from Alabama, Ms. Sewell, to inquire for 5 minutes.
Ms. SEWELL. Thank you, Mr. Chairman. I want to commend you
for having our first hearing be about preexisting conditions.
As has been stated before, preexisting conditions affect over
half of Americans. And as my colleague, Ms. Sanchez, said, the
gender rating affected women and made being a woman a
preexisting condition. I can also tell you that the ACA has not
only helped us in making sure that insurance companies can no
longer discriminate against Americans for preexisting
conditions, but it also decreased the cost of being sick while
black.
So as a black woman, I have seen the ACA work both to
reduce the incidence of gender discrimination but also help to
reduce some of the barriers to access that often people of
color have.
My question really, I guess, is to Ms. Pollitz. Can you
talk a little bit about the barriers to access to healthcare
like, for example, not expanding Medicaid? There are lots of
States like mine, Alabama, that did not expand Medicaid, and
the premium costs have skyrocketed, not just because of, you
know, the fact that not as many people are signing up for the
healthcare insurance, but the fact that so many folks just
can't afford the premiums and the deductibles.
Can you talk a little bit about access to healthcare and
how the ACA has affected that?
Ms. POLLITZ. Sure. So about 2 million people live in--
adults, below poverty, live in States that have not expanded
Medicaid. So they don't have any affordable insurance options
available to them.
Ms. SEWELL. And isn't it true that by decreasing the
subsidies, which was one of the ways that my colleagues across
the aisle sabotaged the ACA, it only exacerbates the problem?
Ms. POLLITZ. There is actually a proposal the President
just released in the 2020 benefit and payment parameter rule
that actually would reduce subsidies under the ACA, just by
changing the formula that indexes what people have to pay and
how much in subsidies they get. That is expected to save the
Federal Government about a billion dollars a year, and----
Ms. SEWELL. Expanding Medicaid or creating----
Ms. POLLITZ. No, I am sorry, that is to reduce the ACA
subsidies. The Administration estimates about 100,000 people
would lose coverage as a result of that.
Ms. SEWELL. Well, I know that in my State we don't have--
our farmers struggle oftentimes with finding affordable
healthcare. In fact, there is a farmer in Nectar, Alabama, Hank
Adcock, whose story I have shared in this hearing before. He is
a third generation farmer, has never had health insurance until
a navigator knocked on his door back in 2015. And, you know,
had the navigator called it ObamaCare, he said that he probably
wouldn't have gotten the health insurance. But because they
said it was the Affordable Care Act and because it was an
affordable subsidy that he was offered, he took health
insurance.
Almost 6 months later, his hand got caught in one of those
hay bailers and, you know, not only did the Affordable Care Act
save his hand, it also saved his farm because he had health
insurance for the first time ever. And so, you know, unlike Mr.
Robertson, unlike the association plan that you discussed for
your farmers, we didn't have that option in Alabama. And
Alabama also did not expand Medicaid, and so, many low income
workers and hardworking families are struggling just to find
access. So I really wanted to talk about cutting down the
costs.
Wouldn't it be better if we expanded access to coverage
like you have done in Oregon through your own devices? I wanted
to talk to Mr. Stolfi about how we can decrease the costs,
because we have heard a lot about that. How has your State
decreased the costs and at the same time expanded access?
Mr. STOLFI. Thank you, Representative. Cost is definitely
one of the key issues and something that we all should be
focusing our time and attention on. In Oregon, we have taken a
couple of approaches--well, there are a couple of major drivers
of cost. Prescription drugs are a major driver of cost,
utilization is a major driver of cost. Uncoordinated care and
unhealthy behavior all contribute to cost. And----
Ms. SEWELL. I am going to reclaim my time because I only
have 7 seconds, just to say that your testimony--your written
testimony goes into detail about that, and I refer us all to
that.
I wanted to mention, Mr. Chairman, that the Black Lung
Disability Trust Fund, which was established 40 years ago and
pays benefits to coal miners who have had total disability, an
excise tax on coal that we supported for this fund has expired,
it expired last year.
And I just wanted, as a State, Alabama, who has lots of
coal miners, many of whom are out on disability because of
that, I would love for this Committee to have a hearing and
definitely hear from them as to why it is so important that we
reestablish this excise tax.
Chairman NEAL. I thank the gentlelady. I will make sure
that the staff follows up with you.
With that, let me recognize the gentlelady from Washington
State to inquire for 5 minutes. Ms. DelBene.
Ms. DELBENE. Thank you, Mr. Chairman. And thank you to all
of our witnesses for being with us today. Ms. Pollitz, I want
to make sure that it is clear what is covered by a qualified
health insurance plan that is sold on the Affordable Care Act
exchanges, and what could possibly be missing from a short-term
limited duration plan.
And I have a constituent, a nurse in my district. She has a
young son, Sammy, who has hemophilia, and her employer-
sponsored insurance is very critical. But if she lost her job
or could no longer work, first of all, would she qualify for a
special enrollment period?
Ms. POLLITZ. In the marketplace, yes, she would.
Ms. DELBENE. Yes. And if during that special enrollment
period she purchases a plan for her and her son, would all the
plans sold on the ACA exchanges guarantee coverage for
hemophilia?
Ms. POLLITZ. Yes.
Ms. DELBENE. And if she purchased a short-term limited
duration health plan, would she be guaranteed coverage for
hemophilia for her son?
Ms. POLLITZ. She would not be able to buy that policy for
her son. She would be turned down.
Ms. DELBENE. She would not have coverage?
Ms. POLLITZ. Correct.
Ms. DELBENE. Yes. If a young man in my district turns 26
and can no longer stay on his parents' plan, would he also then
qualify for a special enrollment period? If he has type 1
diabetes and he goes to buy coverage on the ACA exchange, would
he have coverage for his diabetes?
Ms. POLLITZ. Yes, he would.
Ms. DELBENE. Would he be guaranteed coverage for his
diabetes if he buys a short-term limited duration plan?
Ms. POLLITZ. He would not be able to buy one. He would be
turned down.
Ms. DELBENE. So another example, say, a graphic designer
who has lupus decides to quit her job and start her own small
business. If she buys on the ACA exchange, is she guaranteed
that her lupus would be covered by that plan?
Ms. POLLITZ. Yes.
Ms. DELBENE. And would she have that same guarantee for
coverage of her lupus if she acquired a short-term limited
duration plan?
Ms. POLLITZ. She would not be able to acquire a plan. She
would be turned down.
Ms. DELBENE. Finally, the ACA included a provision that
required all qualified health plans to spend 80 cents of every
premium dollar on healthcare. If the plan spends less than
that, they have to return some money to the beneficiary. Does
short-term plans have that same financial protection for
consumers?
Ms. POLLITZ. No, they do not, and they tend to have much
lower medical loss ratios.
Ms. DELBENE. Do you have examples of what those might be?
Ms. POLLITZ. Closer to 50 or 60 percent of premium dollars
are spent on claims as opposed to administration and profits
and other----
Ms. DELBENE. So there is quite a stark difference between
what qualified plans cover and what short-term limited duration
plans cover, isn't there?
Ms. POLLITZ. That is correct.
Ms. DELBENE. Thank you so much for your feedback.
And, Mr. Chairman, I yield back.
Ms. SEWELL [presiding]. The gentlelady yields back. And the
Chair recognizes Mr. Schweikert from Arizona.
Mr. SCHWEIKERT. Madam Chairwoman, you look good in that
seat. All right. Let's actually walk through a couple things.
First, to our witness from Kaiser, thanks to much of your
staff. They were incredibly helpful to my office over the last
couple of years, particularly as we worked on the invisible
risk pools, and the math. I know what you do datawise is very
difficult because you do a lot of your data out of survey
instead of getting actual hard data from insurers and others. I
am hoping over time we can find a way so you can have even
crisper data.
To the gentleman on the end who also has had valley fever,
you had an undifferentiated case. A couple of us actually chair
a valley fever task force. Be joyful, we think in 4 to 5 years
we will have a vaccine out for animals, and then a little while
after that, for humans. But it has been a fixation for many of
us from the desert southwest. Most people have no idea about
the orphan disease, which is this fungi, that affects so many
people. So I share that with you.
I am trying to find an eloquent way to say--I am frustrated
because I know everyone here is sort of speaking from their
heart and their knowledge-base. Much of my life has actually
been in the financing side on some of the healthcare, and how
do you do the actuarial math and how do you make it work.
A year ago, we actually--not only when you look at our
Republican legislation, we had in their guaranteed issue, and
we can all have a conversation on the mechanisms of what is
guaranteed issue and what is preexisting. They actually sort of
partially overlap, but there are some structural differences.
But we also added another $15 billion to buy down in the
individual risk pool some of the actuarial toxicity, because
let's face it, it is 5 percent of our population, that is a
little over 50 percent of all of our healthcare spending,
because there are brothers and sisters with chronic conditions.
So here is my argument to my friends on the left, the
right, and anyone that might be in between. We are having the
wrong conversation here. Think about what we are doing. We are
talking about, well, this is preexisting, well, this isn't.
Well, this is--we can do this with premiums, but we will
subsidize it more over here. The quick thought experiment, pre-
ACA, after ACA, Republican alternatives, this and that.
If you were to take all dollars we are spending in our
society, in our country, all dollars, whether it is coming
through government, whether it is coming through your insurance
premium, or out of your pocket, have we done anything to
actually change the cost curve? All we are really debating here
is who gets to pay.
And if you actually go back over the years, you know, going
back to 1986 when we had sort of guaranteed service at an
emergency room, or 1996, you know, when we actually did HIPAA,
which actually had lots of the guarantees and the protections
or the ACA. We have just been moving around the deck chairs on
the ship.
I will ask from my Democrat colleagues, from my Republican
colleagues, it is time for a radical rethinking of are you
willing to work with us to break down the barriers to have a
cost disruption? When this is about to become your primary care
physician. When the technology--when I can show you the thing
that looks like a large kazoo that you blow into, it tells you
if you have the flu, the handheld ultrasound. There is a
revolution rolling out right now and we have lots of statutory
barriers at our State levels, our Federal levels, even in the
original Social Security Act, that will keep technology from
rolling out, empowering us to take better care of ourselves and
crash the price of healthcare. And that is the more elegant
debate here.
If we can continue this sort of circular logic we are
having in these debates of well, you support preexisting
conditions, well, I support preexisting condition coverage.
Back and forth, and it is great politics. And we are doing
nothing to crash the price. It is basically your Blockbuster
video moment. Is there technology rolling out that should help
us crash the price?
Now, how many of the smart people sitting here at the dais
could start to design plans using that technology, using these
opportunities? And we are going to have to have some really
difficult conversations of do we have substantial overcapacity
in physical structures? Well, we have lots of reports. Kaiser
has actually done a couple of them of the number of hospital
beds in the Nation that are actually empty and the caring costs
of those. These are difficult conversations because we love our
hospitals, we love--but there is technology revolutions around
us, and unless this Committee and others around us start to
break down these barriers, we are going to continue in the
circular logic over and over. There is a chance to do a cost
disruption. Let's actually start to embrace it and do something
actually good.
Thank you, Madam Chairman.
Ms. SEWELL. The Chair recognizes Ms. Chu from California.
Ms. CHU. Well, I am particularly concerned about what would
happen to women's health if we did not have the ACA.
So, Ms. Pollitz, I am concerned that the actions taken by
the Trump administration will fundamentally undermine one of
the ACA's core tenants, the support of cost-free preventative
health services. And one of the most impactful is that of the
birth control benefit or the Affordable Care Act's requirement
that plans must offer no cost contraception coverage.
Since the ACA went into effect, about 63 million women have
access to this healthcare benefit. And I feel I must emphasize
this because it so often gets wrapped up in policy debates that
people don't consider birth control to be healthcare, but it is
healthcare plain and simple. But if the case in Texas prevails,
this benefit, like the rest of the ACA, will be eliminated.
So, Ms. Pollitz, can you discuss what the situation was for
contraception coverage prior to the ACA? Were there groups who
were more likely to not have access to contraception or be
unable to afford it?
Ms. POLLITZ. I believe our women's health team has a brief
on this, which I would be happy to look up and submit for the
record. In general, the big change with ACA was to require the
no-cost coverage, so no deductibles, no co-pays apply for FDA-
approved methods of contraception. So that has taken down a
cost barrier for many women.
Ms. CHU. Okay. Thank you for that.
Ms. Brooks-Coley, thank you for testifying today on behalf
of cancer patients amongst American women. Breast cancer is the
most commonly diagnosed cancer, and the second leading cause of
cancer death. In 2016, 3.5 million women in the United States
were living with a history of breast cancer.
So, Ms. Brooks-Coley, can you describe the provisions in
the Affordable Care Act that help women detect breast cancer
early when it can still be treated, and what would happen to
women with breast cancer if the ACA were repealed?
Ms. BROOKS-COLEY. Thank you, Congresswoman. The Affordable
Care Act made sure that women who actually are diagnosed with
breast cancer have access to comprehensive coverage. One of the
things that it also did for all Americans and all women was to
make sure that preventative services are available to
individuals for free or little cost.
We know that important preventative screenings, such as
mammography and colonoscopy, can be lifesaving tools that allow
an individual to actually have their cancer diagnosed early,
where we know then that the diagnosis and treatment can lead to
better survival rates and better survivorship.
Ms. CHU. Thank you. I am also concerned about what would
happen to low income women on Medicaid if the ACA were to end.
Ms. Pollitz, I am deeply concerned about the Medicaid
population. Medicaid provides 75 percent of the funding for all
family planning services, nearly half of all births, and half
of all long-term care funding, which many frail elderly women
on Medicaid rely on. Medicaid is a lifeline for millions of
American women, and Republican actions have put this lifeline
in jeopardy.
So, Ms. Pollitz, can you please discuss what the
implications would be for women in the Medicaid program if the
entirety of the ACA were to be struck down?
Ms. POLLITZ. Well, the Medicaid expansion covered adult
women who were not pregnant or mothers of dependent children,
and who had income up to 138 percent of poverty. So the
Medicaid expansion has been the engine of insurance expansion
in the ACA. And if that were to go away, then millions,
millions of low income women would lose coverage.
Ms. CHU. And, Mr. Stolfi, I want to ensure that women would
not be left unprotected through inadequate junk plans. My State
of California joined five others in limiting or prohibiting the
sale of short-term limited duration plans or the junk plans,
and while they may appear to have lower premiums, many
consumers find themselves stranded when they don't offer
coverage for some of the most expensive conditions like
pregnancy.
What is some of the additional actions that States like
California can do to protect consumers, especially women, from
efforts to undermine the ACA?
Mr. STOLFI. Well, yes, specifically in regard to short-term
plans, other States could do exactly what California has done
and prohibit them. What Oregon has done also is restrict the
amount of time that they can be sold. Other States have done
this through regulation. We would appreciate further guidance
at the Federal level reversing the Federal rule changes. Even
in States where we have not taken on those changes, it has
created uncertainty and added costs--unnecessary costs to our
folks. So we would appreciate more certainty there.
Ms. CHU. Thank you, I yield back.
Ms. SEWELL. The Chair recognizes the gentlelady from
Wisconsin, Ms. Moore.
Ms. MOORE. Thank you so much, Madam Chair. And, again, I am
just really glad to be here. I just want to say to our witness
from the Farm Bureau that I want to commend you for pooling
together the 700 people in the association to provide them with
affordable healthcare.
And while those 700 people can have some reassurances about
their healthcare, the Affordable Care Act sought to do that and
did do it for 20 million additional people. It was the very
same concept of pooling the risk, bringing in young people like
Mr. Blackshear, who were healthy at the time, having them pay a
premium so as to lower the cost for everybody.
And, as a matter of fact, before we started giving it names
like the Affordable Care Act and so on, and ObamaCare, it was
RomneyCare. It was the best of market ideas of the insurance
industry. Get a risk pool. And it was not Medicare for All, it
was the combination of a social goal of insuring as many people
as possible with a market driven pathway.
So for those people who are looking for ideas, let's just
go back to RomneyCare. Now, I guess the question that I have
for you, Ms. Pollitz, and keeping in mind the testimony that we
have heard from Mr. Robertson, if Nevada didn't have affordable
care, could it be because of some of the things that this body,
Congress, the Majority under the Republicans, did to undermine
the affordable healthcare? I am thinking back to the $12
billion in risk sharing that, you know, while we were trying to
stand up the Affordable Care Act, there was $12 billion that we
didn't give to the insurance companies to eliminate that
uncertainty.
I am thinking about not expanding Medicaid in places like
Nebraska, which raised the cost of healthcare to everybody. I
am thinking about reducing advertising to people. I am talking
about pushing out these short-term limited duration insurance
policies, which don't provide minimum care.
Cutting subsidies they did last year, how have these
impacted on people to the extent that folks that are in the
association health plans couldn't find good care, and what is
the difference between the association healthcare and the
affordable healthcare?
And I will yield to you.
Ms. POLLITZ. The changes that you--the actions that you
talked about in different ways contributed to kind of an
artificial increase in the cost of marketplace plans.
Ms. MOORE. And some insurers just disappearing from the
marketplace all together.
Ms. POLLITZ. Correct. That is correct. So the uncertainty,
as I mentioned in my oral statement, really has been kind of a
common theme of changes and actions taken that have driven up
marketplace premiums. Marketplace premiums in Nebraska were
driven up, for example, silver loading. The benchmark plan in
Nebraska is dramatic. The benchmark silver plan costs about 40
percent more than the cheapest gold plan in Nebraska, right?
That is just an artificial kind of price action that the
insurers had to take to back up.
So as long as people are eligible for subsidies, they don't
feel that, the taxpayer picks that up. And it sounds like many
of the members in Mr. Robertson's plan are not eligible for
subsidies, so they would feel the full brunt of this. Just one
other thing on pooling. It has just come up a couple of times,
and I kind of wanted to comment on it.
The pooling itself doesn't make insurance cheaper, it just
kind of spreads out the costs, it redistributes, so everybody
kind of pays the same share. If you pull out a small number of
people from the marketplace who are healthier than average,
then that also has an upward pressure on the average----
Ms. MOORE. Thank you so much. Reclaiming my time, I just
want to go back to the old axiom dating back to 1692, Gershom
Bulkeley, that says that actions speak louder than words. So
while we all say we are for protecting preexisting conditions,
I think that the sabotage we have seen does not hearken well.
Actions speak louder than words.
And if we were trying to provide healthcare to people, we
would not be undermining this market-driven proposal that we
have, the Affordable Care Act.
And I yield back.
Ms. SEWELL. The Chair acknowledges that votes have been
called to Members. There is only one vote. We are going to
continue to go. So the Chair recognizes Mr. Wenstrup from Ohio.
Mr. WENSTRUP. Thank you, Madam Chair, I appreciate it. It
has been an interesting morning, obviously, and I am glad that,
I think, deep down we all agree we want coverage for
preexisting conditions. We have had many little history lessons
today, true or otherwise. But the fact is that we as
Republicans have pledged support for coverage for preexisting
conditions included in our bill.
I have a family member that has a preexisting condition
that will need care her entire life. We all get it. There is no
part about me as a doctor--and, by the way, I came here for
many reasons. I ran for office for many reasons, but in part to
stand up for patients. There is no part about me as a doctor
that doesn't want our fellow Americans to have access to
quality affordable healthcare, all Americans.
I want Medicaid to be a better program than it is. I want
all of our plans to be able to take care of people and have a
way for people to get into care. And, frankly, I applaud the
Obama administration because they took the issue on. It should
have happened sooner. But I don't necessarily agree with the
direction that it went.
And, by the way, I heard President Obama one time say he
was very fond of it being called ObamaCare because it put his
name with the word care every time someone said it, and I don't
blame him. It is a pretty good marketing tool. And I hope the
Members of this Committee will come forward with more to offer
than just trying to scare Americans with the false claim that
we don't want people with preexisting conditions to be covered.
Is that what we are going to sit here and do for the next 2
years? I certainly hope not.
The Affordable Care Act has helped some people. That is a
fact. We get that. For many, it did not. That is also a fact. I
was in church in a small town in Ohio, the pastor was asking
for donations to help the poor, and a woman said, ``Pastor, you
don't know what it is like out here right now. What I am paying
for healthcare today is through the roof, and God forbid if I
get sick, because I can't afford that either.'' And that is in
part because of her deductible.
A primary care doctor in the same community quit taking
insurance because if he didn't have to go through the
rigamarole of insurance, he then could cut his cost. And since
people are paying out-of-pocket because of their high
deductible, he cut the price down and he eliminated the
paperwork. That is what is happening in reality, folks. And you
can talk about all this here today, but there are flaws in the
Affordable Care Act that is making it more difficult for
patients to get care. And at the same time, they are budgeting
with their healthcare. That is a problem when you put things
off because you can't afford it because of your high
deductible. And you can barely afford the premium, if you are
even getting it because the premium is so high.
So, yes, they do seek some of these plans where they
wouldn't take you with preexisting conditions, but then they
hope they have something just in case, in case there is an
unavoidable catastrophe. I would like to have all of you back
here sometime to talk about incentivizing health. What do we
have in our market today? What do we have in our plans today
that are incentivizing health, not only for the patient but for
the physician.
We talk about lifespan. We talk about how people live
longer in America, although because of our drug problem that is
going down, unfortunately, our lifespans. Let's focus on our
health span. Ms. Pollitz, you talked about treatments. We have
been great at treating things, but what have we prevented?
Think about this. Think about who gets rewarded in today's
system. You know if you are the open heart surgeon that saves
someone's life, yeah, we want that ability to be there, of
course, and we want people to have access to that. But do we
recognize any of the physicians that worked with the patient
that prevented him from needing the open heart surgery? That is
where we need to go, folks.
If you want to talk about a cost curve, start preventing.
So I hope that we can come back and have solutions for this
Committee so that maybe we can enhance things that will
incentivize health in America. That is where we are going to
save. That is where the cost will go down. And I want that so
that we will have a robust care system for those that have
something that can't be prevented. And I would hope that you
all agree with me on that. This is about patients, not
politics.
Let's cut the politics in this Committee and let's focus on
what is best for patients and people and their families. With
that, I yield back, and I hope to see you again to discuss that
issue.
Ms. SEWELL. To allow Members to vote and to allow the
witness to take a break, we will have a recess until 1 p.m.
[Recess.]
Chairman NEAL [presiding]. Let's reconvene the hearing. And
I believe that Mr. Boyle is next to inquire. I recognize the
gentleman for 5 minutes.
Mr. BOYLE. Thank you, Mr. Chairman. And just to briefly
follow up on what the gentlewoman from Wisconsin was talking
about in terms of the roots of the Affordable Care Act,
RomneyCare, I would just point out, the first time I ever heard
the concept was from a professor, he was a fellow at the
Heritage Foundation named Stewart Butler, who was one of the
founding fathers of this idea. The Heritage Foundation is not
exactly known for its bleeding heart liberalism. And then the
roots of the Affordable Care Act were originally introduced in
the Senate by Bob Dole and 17 Republican Senators.
Unfortunately, when President Obama and the Democratic
Congress championed it, suddenly the view on the other side
changed. But having just spent or endured the last 8 years of
an attempt to repeal the Affordable Care Act, and having seen
that defeated legislatively, I am very concerned that what
couldn't be achieved legislatively now might be achieved
judicially.
We had very recently an activist judge in Texas strike down
the Affordable Care Act, even though the Supreme Court had
affirmed the Affordable Care Act a number of years ago. So
could you talk to me, and I will turn to Ms. Pollitz, if you
could--if the 18 States attorneys general are successful
ultimately in their lawsuit and higher courts affirm the lower
courts' ruling and provisions of the Affordable Care Act are
scrapped, what would that mean for those who currently
absolutely need a policy that they have gotten from the
Affordable Care Act to live or have certain protections in
their already existing private plan that came about because of
the Affordable Care Act, such as the one on preexisting
conditions?
Ms. POLLITZ. Well, so that would roll the clock back to
pre-2010. The Federal law prohibition on discrimination against
preexisting conditions would go away. In a number of States
that prohibition has been enacted in State law, so at least for
people in State-regulated policies that would continue, but the
Federal subsidies would also go away, and that is what really
helps keep the market stable.
States that tried, before the ACA, to prohibit
discrimination based on preexisting conditions without
subsidies found that there were adverse selection and there
were rate spiral problems. And then other provisions covering
kids to 26, the Medicaid expansion for poor adults, and the
prevention trust fund, the FDA authority to license
biosimilars, the ACA ended up including a wide number of
provisions that really affect all Americans.
Mr. BOYLE. And I am glad that you point that out because
often coverage of the ACA just focuses on the marketplace and
doesn't focus on those other provisions. One that you spoke
about, I just wanted to key in on the Medicaid expansion. That
was one of the best bangs for our buck, so to speak, in terms
of expanding coverage to those who didn't have it.
Now, because of the U.S. Supreme Court decision, States had
the ability to opt-in or opt-out, so we haven't been able to
get Medicaid expansion throughout the country. If, ultimately,
the Affordable Care Act were done away with, what would happen
to those who got their healthcare through the Medicaid
expansion since that was one of the biggest boons for us?
Ms. POLLITZ. Right. So States--let's see. States--well,
first of all, States would lose the Federal money.
Mr. BOYLE. Which is currently 100 percent or has it dropped
to 90 percent?
Ms. POLLITZ. It is on its way to 90 percent. It is below
100 percent now and it will be at 90 percent next year. So
billions of dollars in Federal dollars would go away. But under
Federal law, Medicaid was a categorical program. And Federal
matching was only for poor people in certain categories, you
know, children, pregnant women and so forth. So millions of
people would lose coverage if that Federal law change were to
go away.
Mr. BOYLE. And when we talk about millions of people, it is
not just the overall number, we are talking primarily about the
working poor.
Ms. POLLITZ. Yes.
Mr. BOYLE. We are not talking about people who are sitting
at home and doing nothing. These are often people with full
time jobs that make a little bit too much money to qualify for
traditional Medicaid, but not nearly enough to afford
healthcare.
Ms. POLLITZ. Right. And actually for working poor adults,
even--well, if they weren't working and they didn't earn
anything, they weren't eligible for Medicaid before. But most
of the expansion population, as you pointed out, they are
working people. They are in minimum wage jobs and they are
earning less than 138 percent of the poverty level, and they
would lose coverage.
Mr. BOYLE. I yield back. Thank you, Mr. Chairman.
Chairman NEAL. I thank the gentleman. And, with that, I
would like to recognize Mr. Kildee for the purpose of inquiry
for 5 minutes.
Mr. KILDEE. Thank you, Mr. Chairman, for recognizing me and
for holding this very important hearing. This is obviously a
subject that is one of the subjects that drew me, and I know a
lot of the newer Members to this Committee. This is obviously
quite critical, and the decisions we make have real impacts on
real people.
Like a lot of families, like a lot of people, like a lot of
the people that I represent, preexisting conditions and their
impact on the ability to receive healthcare is really personal
to me. Like a lot of the families I represent, like a lot of
people around this country, I have close family members that
have pretty significant preexisting conditions.
Twenty-one years ago my wife was diagnosed with multiple
sclerosis. Thank God she has been able to receive good care,
but I can't tell you how many times we have had the
conversation about what our lives would be like if we were like
so many other people in this country that have had to try to
deal with these life-changing experiences, like Mr. Blackshear
has gone through, without having the benefit of health
insurance, and without having the assurance that condition will
not somehow prevent them from receiving important care.
Like my wife, I have a daughter who is 26 years old, who is
a type 1 diabetic, who was diagnosed when she was 7 years old.
I can't tell you again how many times my wife and I had this
conversation about what will happen when our daughter is gone
from the nest. Will she ever be able to have a future? It is
not just about being able to get healthcare.
So actually having the certainty that you can have
aspirations, you can dream about your own future, that you can
plan to be a productive and important part of society, that paw
that hangs over people without that assurance affects our
society in ways that I think we often don't even measure.
So any time there is a threat or an effort to undermine
that very elegant guarantee that is embedded in the Affordable
Care Act, we have to take notice. And assurances and pleading
from folks on the other side who, on one hand, assure us that
they want to protect those assurances, but support Federal
litigation that would essentially take that away, is a threat
to people like me and the people that I represent who have that
same set of circumstances.
So family members that are able to purchase healthcare at
an affordable price, regardless of their circumstances, is
pretty important. And I wonder, starting perhaps with Ms.
Pollitz, if you could tell us what options would exist for
people with preexisting conditions in terms of plan
availability and cost--I know this may be somewhat redundant,
but it is important to put this down--what options would be
available if the Administration's efforts to undermine the ACA
were to succeed? Where could they go?
Ms. POLLITZ. Before the ACA, Mr. Kildee, job lock was an
issue, so people would maybe take a job or stay in a job that
they would rather leave because of the health benefits. A
friend of mine jokingly coined the term ``slob lock'' to relate
to people who maybe stayed in marriages for the health
insurance or got married for health insurance.
For young adults--it sounds like our kids are about the
same age--young adults had the highest rate of uninsurance
before the ACA because their birthday gift or their graduation
gift was losing eligibility for their parents' policy, for
Medicaid. And if they couldn't afford coverage--often they
couldn't because they weren't making a lot of money yet--then
they would be uninsured. And certainly if they had a
preexisting condition, like the ones you talked about, they
would be uninsurable. So it is materially different now.
Mr. KILDEE. Thank you.
Mr. Stolfi, would you comment?
Mr. STOLFI. Thank you, Representative. I can add two points
to that. The first--and we saw this prior to the ACA--if you
were lucky enough to get an individual health plan, that pool
of people, as they got older, they got sicker; insurance
companies could decide that they no longer wanted to carry that
block of people, that pool of people, and could discontinue an
entire policy, therefore, presenting someone who might have
developed health conditions with the option of taking another
policy that insurer offered, which would surely have less
benefits and more cost, or taking their chances to go through
medical underwriting again, when, if they have developed a
condition, it would surely be denied.
And another thing that happened quite a bit before the ACA,
there was a lot of uncompensated care. Hospital systems in
Oregon had hundreds of millions of dollars more uncompensated
care, which drives up the cost for everyone else.
Mr. KILDEE. Again, I thank you for your presence here. I
thank the Chairman for arranging this hearing. It is an
important moment, and I yield back the balance of my time.
Chairman NEAL. I thank the gentleman.
The gentleman from Texas, Mr. Arrington, is recognized to
inquire for 5 minutes.
Mr. ARRINGTON. Thank you, Mr. Chairman.
And to the Ranking Member, it is an honor to serve with
you, and it is a great opportunity for rural America to have a
seat at the table where a lot of the big problems that we face
as a country are being worked out.
And in rural west Texas, I can tell you, the way we solve
things is we start by agreeing on a set of facts. And then we
agree on what success is; we define it so that we are all clear
when we have achieved it. Otherwise, we wander in the
wilderness. Because this issue is so highly charged and has
been politicized and demagogued on both sides, let's, Ms.
Pollitz, agree on some facts.
One fact may be that Kaiser is not bringing policy advice
and recommendations. You are, no doubt, an organization that
has expertise in healthcare policy information and analysis. Is
that----
Ms. POLLITZ. We try, yes.
Mr. ARRINGTON. Would that be a true statement?
Ms. POLLITZ. Yes.
Mr. ARRINGTON. Would you agree that in the implementation
and over the last several years of the ObamaCare ACA
implementation, that the cost of care has gone up
significantly? I use the word ``exponential,'' but--because
premiums have doubled across the country. Would you say that
because of the implementation and during the implementation,
costs have gone up significantly, yes or no? Just yes or no,
have costs gone up in healthcare since the implementation of
ObamaCare?
Ms. POLLITZ. Healthcare costs have gone up----
Mr. ARRINGTON. Yes. Okay.
Ms. POLLITZ [continuing]. Although----
Mr. ARRINGTON. Second, has choice been reduced? My
understanding is 50 percent of the counties where my fellow
Americans live only have one insurer. Has their choice in being
covered by an insurance company and with a certain plan, has
that been reduced since the implementation of ObamaCare, yes or
no?
Ms. POLLITZ. I don't believe so.
Mr. ARRINGTON. Okay. Now let's talk about this notion that
Republicans somehow don't support the provisions in the ACA
that protect people with preexisting conditions. Did your
organization review and analyze the American Health Care Act?
That is the Republican reform bill that passed last year out of
the House but failed in the Senate.
Ms. POLLITZ. Yes, we did.
Mr. ARRINGTON. And are you aware that we protected the
ObamaCare provision regarding people with preexisting
conditions and, in fact, sort of belted suspenders; we put a
rule of construction in play that says: Nothing in this Act
shall be construed as permitting health insurance insurers to
limit access to health coverage for individuals with
preexisting conditions. Were you aware of that?
Ms. POLLITZ. I was aware of that----
Mr. ARRINGTON. Okay, so, yes.
Were you aware of that, Mr. Stolfi, that Republicans
protected that provision of the ACA, because we believed it was
important?
Mr. STOLFI. I was aware of that language.
Mr. ARRINGTON. Yeah, were you aware of that, Mr. Robertson?
Mr. ROBERTSON. Yes.
Mr. ARRINGTON. Were you aware of that?
Ms. BROOKS-COLEY. Yes.
Mr. ARRINGTON. Were you aware of that?
You are all aware of it. So this could be a really short
hearing, Mr. Chairman. We are all in favor of preexisting
conditions.
Now let's get on to the real business of solving the
problem, and in order to do that, like I said, you have to
define what success is.
Mr. Stolfi, is there a difference between being covered by
health insurance and having access to affordable care? Is there
a difference?
Mr. STOLFI. There is a----
Mr. ARRINGTON. Yes or no?
Mr. STOLFI. Between having insurance and healthcare? Yes.
Mr. ARRINGTON. Okay. Does everybody on the panel agree with
that, that there is a difference between being covered, or
having a health insurance card and having access to affordable
care? So would the real definition of success for this
Committee and your sort of advice to us, as people representing
our fellow Americans, be that we focus on how we make
healthcare affordable for the American people, especially our
working and middle-income families? Would you agree? Just nod
yes if you do.
So, Commissioner Stolfi, let me ask you a few questions
about your State in particular. You said that there were
300,000 new, newly insured people since the ACA's
implementation, correct?
Mr. STOLFI. About 350,000.
Mr. ARRINGTON. How many of those got care through the
exchange, of the 300,000, versus Medicaid expansion?
Mr. STOLFI. The majority of the additional----
Mr. ARRINGTON. The Medicaid expansion. All right. I am not
going to try to play games with you here. I am just going to
state the fact--and you can confirm or deny--that 400,000
people in your State, citizens, fellow--what do you say?
Mr. STOLFI. Oregonians.
Mr. ARRINGTON [continuing]. Oregonians were qualified and
eligible for the exchange. And two-thirds of the 400,000
decided not to get ObamaCare through the exchange. They decided
to pay the fine rather than to get care on the exchange. Is
that correct?
Mr. STOLFI. I am not certain of those numbers, no, sir.
Mr. ARRINGTON. I yield back, Mr. Chairman.
Chairman NEAL. I thank the gentleman. I would say in
reference to the gentleman's point, the Chair never assumed
that this would be a short meeting.
With that, let me recognize the gentleman from Virginia to
inquire, Mr. Beyer.
Mr. BEYER. Mr. Chairman, thank you very much. Mr. Chairman,
I would like to point out that I have been running the family
business for 45 years, and our healthcare premiums were going
up 15 percent per year before ObamaCare. And if you do the
math, that means a doubling in 5 years. A part of what
ObamaCare was designed to address was the fact that premiums
were going up very quickly before. In fact, ours did not go up
any faster after ObamaCare than before, despite the fact that
coverage was so much greater.
Mr. Chairman, without objection, I have four letters I
would like to submit for the record and just briefly describe
them.
Chairman NEAL. Without objection.
[The information follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. BEYER. The first was--I was one of many Members of the
House that wrote Speaker Ryan on November 1, 2017, about the
President's decision to end cost-sharing reductions. We have
heard so much about the costs of healthcare. Ending the cost-
sharing reductions, which were an integral part of ObamaCare,
the Affordable Care Act, certainly increased the cost for
premiums.
The second was a letter on May 31, 2018, again, from many
Members of the House, to President Trump, about his signing
H.R. 1 that functionally eliminated the provision that required
Americans to purchase health insurance. I believe, Mr.
Robertson, in your explanation of how the association has
reduced costs, you said the larger the risk pool, the better.
Well, the very core of the Affordable Care Act is we have
the largest risk pool possible, and that is what the mandate
did. And when the Republican leadership and the President
eliminated that mandate, obviously we pushed costs up for
everyone. We took those low-cost young people out of the health
insurance pool. That is the way insurance works, going back a
thousand years.
The third letter, in two versions, October 30, 2018, both
to the Attorney General and to the President, was about the
Justice Department refusing to intervene in the lawsuit brought
by State attorneys general that would nullify preexisting
conditions protection.
If my friends on the other side are so committed to the
protection of the preexisting conditions waiver, the first
thing we should do is get the Department of Justice and our
President to stop the lawsuit that would make it irrelevant.
All of these, by the way, Mr. Chairman, contribute to the
uncertainty that pushes up premiums. Every time we mess with
the Affordable Care Act and do something yet again to undermine
it, we are making premiums go up.
But, Ms. Pollitz, I have a specific concern for you,
because I have heard a number of times the quote that nothing
in this Act shall override the ObamaCare protection for
preexisting conditions. Isn't there also a provision in the Act
that allows States to apply for a waiver to get rid of the
preexisting conditions?
Ms. POLLITZ. There was, yes, a provision to allow States to
waive the community rating requirements so that people could be
charged more based on health status.
Mr. BEYER. Isn't that functionally the same? When you don't
waive preexisting conditions, you just make it unaffordable; is
it not virtually the same thing?
Ms. POLLITZ. Well, that would have made it harder for
people with preexisting conditions to afford coverage.
Mr. BEYER. Like a Mr. Blackshear or like so many of our
family members that we talked about here today.
Ms. POLLITZ. Yes.
Mr. Beyer, that law also substantially changed the
subsidies, turning them into flat tax credits and smaller tax
credits so that they would not have had the same stabilizing
effect. And to the extent that people did drop out of coverage,
which CBO estimated tens of millions of people would lose
coverage, that would drive up premiums for people, to the
extent that people with preexisting conditions stayed, and the
tax credits would no longer protect them from that premium
increase.
Mr. BEYER. It seems like most of the adjustments made in
the last few years have been to increase the number of people
with adverse selection being part of the insurance pool and
reduce the ones that would bring the costs down.
So we talked about pregnancy as a preexisting condition.
Maybe someone would like to comment on the fact that because of
the Affordable Care Act and the pregnancy prevention coverage,
the contraception coverage, one of the few things we can agree
on here--the anti-choice versus pro-choice, a woman's
reproductive rights--is that our abortion rate is the lowest it
has been since Roe v. Wade, and that there are fewer teen
pregnancies and unintended pregnancies than there have been in
decades. Ms. Pollitz, as a researcher, would you agree?
Ms. POLLITZ. Yes. And access to contraceptive coverage has
helped. Actually, I was not able to answer the Congresswoman's
question before, but now only about 2 percent of young women
end up having to pay out-of-pocket costs for a contraceptive.
It was much higher before the ACA.
Mr. BEYER. And, Ms. Brooks-Coley, now that we have this
waiver of preexisting conditions, the protections, have you
seen any difference in cancer survival rates, when people are
not thrown off insurance because they have cancer or can't get
insurance?
Ms. BROOKS-COLEY. Congressman, thank you for the question.
We do have evidence to show that individuals who receive a
cancer diagnosis, their cancer is being detected earlier, and
we know that their survival rates and treatment outcomes are
better because they have access to coverage earlier than they
did pre the Affordable Care Act passing.
Mr. BEYER. Thank you very much.
Mr. Chair, I yield back.
Chairman NEAL. I thank the gentleman.
The gentleman from Pennsylvania, Mr. Evans, is recognized
for 5 minutes to inquire.
Mr. EVANS. Thank you, Mr. Chairman.
I would like to follow up with Mr. Arrington's statement
and allow you, Ms. Pollitz and Mr. Stolfi, to respond to what I
think you wanted to say, what you wanted to add in addition.
That is the impression I got. So you have your opportunity,
both of you, to kind of give some response in terms of
protecting people with preexisting conditions. So whoever wants
to start.
Ms. POLLITZ. Well, I guess in response to the question
about rising premiums versus rising costs, the national health
expenditure data show that, actually, healthcare costs per
capita have risen at a lower rate since the enactment of the
ACA.
In the 1990s, the average annual rate of increase in per-
capita healthcare costs was about 5 percent. In the 2000s, it
was 6 percent, and since the ACA, it has been 4 percent. So,
still rising, but at a slower rate, kind of a bend in the
curve. And we see similar changes in the rate of out-of-pocket
per-capita spending since the enactment of the ACA.
Mr. EVANS. Commissioner.
Mr. STOLFI. Thank you, Representative Evans. I could just
add to that to follow also what Representative Beyer said about
costs rising, this is not a new phenomenon. In the individual
market in Oregon before the Affordable Care Act, in 2008 and
2009, we saw rate increases that were greater than the rate
increases we saw in 2018 and 2019. There was 21 percent and 17
percent, if I have those numbers correct.
So this is not a new phenomenon, but also, as
Representative Beyer pointed out, the products are
fundamentally different. So the products that people have now,
the protections that individuals have now are much more
comprehensive and worth much more than they were before the
Affordable Care Act.
Mr. EVANS. So, in other words, they weren't protected then?
Mr. STOLFI. Much less so than they are now.
Mr. EVANS. Okay. Mr. Chairman, being that I am new to this
Committee but obviously not new to life, the President of the
United States came to Philadelphia August of 2016, and this is
the exact quote he said. He was specifically talking to the
black community. He said: ``What the hell do you have to
lose?''
The reason I asked the question is, in the past 2 years,
the Trump administration has drastically underfunded outreach
and education initiatives. What I am interested in, could you
please discuss the linkage between risk pools, outreach, and
health disparities? Can you respond to that aspect?
Ms. POLLITZ. I think--we still have a continuing health
disparities problem due to many factors. But it is also true
that extending coverage does help to address that because it
gives more people at least a ticket to healthcare. They may
encounter other barriers after that, but we have seen--we have
seen dramatic increases--or decreases, rather, in uninsured
rates, particularly among minorities, and so that has a
positive effect in improving access to care.
Mr. EVANS. So minorities have something to lose?
Ms. POLLITZ. Yes.
Mr. EVANS. Okay. Do you want to comment on that?
Mr. STOLFI. Representative Evans, I could just add that
every healthcare consumer is different. Every individual has
different healthcare needs, a different healthcare IQ,
different biases, as one Representative noted earlier. And the
best way to help each individual is to have one-on-one
counseling, one-on-one education, and that costs money. And
States like Oregon do spend quite a bit of money training
advocators, training people to educate and help consumers. It
is unfortunate when there are cuts to programs such as that.
Mr. EVANS. Mrs. Brooks-Coley, do you have any comment on
that?
Ms. BROOKS-COLEY. I do. Thank you, Congressman. I would
just make the comment that, from a cancer perspective, racial
and ethnic minorities continue to have higher cancer rates and
are less likely to be diagnosed early. So access to coverage
and access to comprehensive coverage is extremely important for
that population of individuals.
Mr. EVANS. I am going to go to Ms. Pollitz real quick.
There was a report in 2017 coming from your organization that
said changes in insurer participation in the Affordable Care
Act relating--was somewhat down. The question I want to ask
you, can you explain to us how premium tax credits assist in
keeping healthcare affordable and also help to stabilize the
insurance risk pool?
Ms. POLLITZ. Yeah. So premium tax credits are set on a
formula so that you, as an individual, pay only a certain
dollar amount toward the benchmark plan. If you are at the
poverty level, that is about $20 a month. If you are at 150
percent of the poverty level, that is about $60 a month. That
is what you pay, and the difference between that and whatever
the benchmark plan is, is the dollar value of your tax credit.
So, if premiums go up $100 next year and I am at 150
percent of poverty, I paid $60 for the benchmark plan last
year; I pay $60 for the benchmark plan this year.
The tax credits also help to really cure a lot of adverse
selection. Normally, especially a low-income person, I would
have to really ask some hard questions. Can I afford the $60? I
need a car payment. I am healthy. Maybe I will skip the
insurance because I need to spend the money somewhere else. So
the subsidies help people when they sort of evaluate the
expected cost of care and the cost of insurance. They help kind
of bring that calculation in line, so that people are much more
likely to sign up and stay signed up as long as they are
protected from the full cost of insurance.
Chairman NEAL. We thank the witness.
With that, let me recognize the gentleman from Georgia to
inquire, Mr. Ferguson, for 5 minutes.
Mr. FERGUSON. Thank you, Mr. Chairman, and I am very
grateful to be having this hearing. Let me say to each of you:
Thank you for taking time out of your busy schedules and your
personal lives to come here and talk about this important
topic.
I think it is important that we set that we are doing
exactly what we are doing today, which is to set the record
straight on preexisting conditions, our past positions, our
current positions, and our future positions. And one of the
things I think that--a Rubicon that we have crossed in this
country is that we all recognize--Republicans and Democrats,
Independents; it does not matter--we all believe that our
fellow Americans should be covered.
I don't think there is an argument there, and I think that
every one of us believes that in our heart. I think a lot of
the argument is about how do we do that. Okay? I think to
simply say that ``if you are against the Affordable Care Act,
that you are against preexisting conditions'' is not being
intellectually honest, particularly with the American people.
You can be for preexisting conditions and be against the
Affordable Care Act for other reasons, and that is pretty much
the position I am in.
Listen, as a former healthcare provider, I used to fight
this battle with insurance companies when I would have a
patient that would come in with a preexisting condition, that
they said would not be covered, yet they were willing to spend
countless dollars on another condition that was created by, in
fact, this existing condition. It made absolutely no sense. And
we had to go to battle for our patients on a regular basis. And
this is in the pre-ACA days.
So there have been a lot of comments about what we had
before didn't work. True. What we have now is not working
because one of the challenges that we have had is that we have
seen real costs rise to everyday Americans.
You know, you made the comment, Ms. Pollitz, that rates are
rising at a lower--at a slower rate. Healthcare----
Ms. POLLITZ. Healthcare costs, not premiums, yeah.
Mr. FERGUSON. So, you know, if you would like to come down
to the Third District of Georgia and stand on stage and make
that comment, I will let you do it by yourself. Because you
might have some stuff other than words thrown at you. And my
point in saying that is, I think that in many parts of the
country, that is not the case. I mean, we have constituents
that have seen premiums go from $600 a month with a $1,000
deductible to $2,400 a month with a $6,000 deductible.
I have a single mom, a former patient of mine, with two
teenage girls, that simply cannot afford to go to the doctor on
her insurance plan.
So I think the thing that we want to get out of all of this
today and I think the real honest conversation that we have is,
number one, recognize that we all believe that our fellow
Americans, and particularly those that are most vulnerable,
should have access to affordable care, and they should have
access to affordable insurance. I think it is wrong to state
otherwise.
I also think that we need to come together, as a Congress
and as a Nation, to discuss how to drive down the actual cost
of care. One of the things that I worry about greatly, in all
of this, and one of the unintended consequences, or maybe the
intended consequence, of the ACA is that you are now seeing a
very rapid, vertical integration of the healthcare delivery
space. You look at the different players that are in that
market, and they are all joining hands. And it is becoming
fewer and fewer players in the marketplace, and there is less
competition.
One of the things that I am excited that Mr. Robertson has
brought is a competitive idea that gives the consumer a
different choice. So to say that we can't have competition in
the marketplace or we won't be able to cover our most
vulnerable, I think, is wrong. I think we are a talented enough
group of Americans that we can figure out how to do that.
And let's be honest about the fact that we all believe in
care for our most vulnerable and those with preexisting
conditions. But we can all band together to fight to drive down
the rising costs of healthcare and health insurance so that
people can actually take better care of themselves and their
families.
And, with that, Mr. Chairman, I yield back.
Chairman NEAL. I thank the gentleman. I thank the gentleman
for his inquiry.
With that, let me recognize the gentleman from Illinois to
inquire for 5 minutes, my friend, Mr. Schneider.
Mr. SCHNEIDER. Thank you, Mr. Chairman, and I want to thank
the witnesses first for being here today and sharing your
perspectives and insights but also for your patience. I know it
has been a long day, but it is a critically important issue.
And I think what we have been talking about on this panel
and what others have said, but it is worth repeating, is we all
need to be striving--in the richest country in the world,
everyone in this country should have quality affordable care,
where they are, where they live, when they need it. And
healthcare is not something--I heard in a different meeting
this morning, someone made the comment about Congress, as we
try to tackle long-term problems, working in 2-year cycles, and
it is difficult.
Healthcare is not just a long-term issue; it is a lifetime
issue for each and every one of us. And it starts at birth, but
it is something we deal with our entire life.
And one of the things we have seen is that since the
Affordable Care Act--Ms. Pollitz, you touched on this--the cost
of healthcare, of delivery, has not risen at the same rate it
was before then.
And, with that, Mr. Chairman, I would like to submit for
the record a report from the Commonwealth Fund, highlighting
how ACA reforms have moved to paying for value and beginning to
address the healthcare costs.
Chairman NEAL. Without objection, so ordered.
[The information follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. SCHNEIDER. Thank you. And we are here today; it is a
critically important topic, talking about protection for people
with preexisting conditions. And as I have sat here today
listening, but also over the course of the year, meeting with
people, I am reminded of many young people I have met. I think
of Jared Cooper, who was diagnosed at a young age with type 1
diabetes and has become a champion, and all the other kids I
have met with diabetes, a lifetime condition, that, with
treatment, hopefully they will be able to have a full and
productive life.
A young woman, Kendall, who I met when she was in seventh
grade, was diagnosed when she was 2 years old with leukemia,
and--it was a burden on the family, but she survived, and will
always be a cancer survivor. But when I met her--and I saw her
recently. She is now in ninth grade. This is a young woman who
is on the soccer team, was a swimmer. She is living the life we
hope for all of our children, reaching her full potential.
I met a young woman yesterday, Brie, who was brave enough
to share with me her experience of dealing with learning
disabilities, combined with ADHD, which can be a preexisting
condition that would affect her outcomes, but with the proper
treatment, she is going to have all the opportunities we all
want for our children.
And it is not just young people. Mr. Blackshear, thank you
for sharing your story and bravely sharing your story. I can
only imagine what you went through, and it starts with just a
drive through the desert. You know, you wake up the next day,
and your life is changed forever. But that diagnosis shouldn't
be a sentence of financial challenge. It should be something
that you have the opportunity to consistently pursue--and it
looks like you might want to say something.
Mr. BLACKSHEAR. I was just going to say: I agree.
Mr. SCHNEIDER. But it is not just that, and these are
things, I think all of us have experience with preexisting
conditions. My sister is a thyroid cancer survivor, the mother
of three young children, and doing quite well, but she will be
dealing with healthcare issues her entire life. My cousin is a
breast cancer survivor. My great nephew was born 2 months
prematurely; he will soon celebrate his second birthday.
These are all things about our healthcare system that make
the world possible for us to appreciate. They should be open to
everybody. I didn't mean to give a speech. I really wanted to
get to a question, and, Ms. Pollitz, I will start with you. I
just gave a list of friends, neighbors, and family with
preexisting conditions. If we were to lose the protections for
these people, broadly speaking, what is the impact, not just on
these individuals but on our community?
Ms. POLLITZ. It would make it harder for people, as hard as
it was before the ACA, to get and stay affordably covered. It
would just make it harder for people. People, before the ACA,
sometimes hit bottom and did without, and--so they couldn't get
treatment for those conditions. Sometimes they had to rearrange
their lives in extraordinary ways, move or take a job or marry
or change their income or, you know, do something extraordinary
in order to be able to stay attached to some other coverage for
which they were eligible that wouldn't discriminate based on
their preexisting condition. So this makes other options
possible for people.
Mr. SCHNEIDER. Thank you, and I just have a few seconds
left. But, Mr. Blackshear, you were 27 when you were diagnosed
with valley fever----
Mr. BLACKSHEAR. Correct.
Mr. SCHNEIDER [continuing]. Right? And you said that was a
couple years ago. I think you shared with us, you have
healthcare now; it is not a worry. And as you look to your
future, is it something that you feel you can count on, or is
it something that still hangs over your head, saying, you know,
I don't know if I will have it a year or 5 years from now?
Mr. BLACKSHEAR. I really do hope I can count on it. I
really do. The conversations we are having, you know, I wish we
were past this, but they are very important, and I really do
hope so.
Mr. SCHNEIDER. Thank you. I hope so, too. I am out of time.
I will just say this: It has been 10 years we have been
litigating the Affordable Care Act while healthcare has moved
forward. Our job as policymakers, I would like to say--is we
don't get to be ahead of the curve; we have to do everything we
can to catch up and stay in pace with healthcare--but our job
is to make sure, Mr. Blackshear, that you don't have to worry
about this and you can achieve your dreams. Thank you and I
yield back.
Mr. BLACKSHEAR. I appreciate it. Thank you.
Chairman NEAL. I thank the gentleman.
And, with that, let me recognize the gentleman from
California, Mr. Panetta, to inquire for 5 minutes.
Mr. PANETTA. Thank you, Mr. Chairman. I appreciate this
opportunity and appreciate this type of hearing on such an
important topic as preexisting conditions. Let me also thank
all of the witnesses at this point for being here and for your
endurance this morning and this afternoon.
But I want to give four of you a break and actually focus
on Mr. Stolfi and have a conversation with you, if that is
okay. So the rest of you can either zone out or just take a
little break.
I want to talk about the connections between preexisting
condition protections and the ACA. Okay? I think what you are
hearing today is that most of us support the protections of
preexisting conditions. But I think what we need to highlight
is what exactly people are doing to support it, and that it is
not necessarily intellectually dishonest. What it is, is an
actual contradiction. What it is, is an actual inconsistency,
which I think is something that all of us, as representatives
of the people, try to avoid, being inconsistent. We want to be
consistent.
But it seems that in some of my colleagues' support for a
couple things, there is some inconsistency. And starting with
the Texas v. Azar case, a case that was filed to strike down
all of the ACA, in that you had 20 Republican attorneys general
who basically wanted to repeal the individual mandate as part
of the tax law, is what they were arguing because it was zeroed
out in such that the mandate was no longer constitutional.
And then, on top of that, you had our Administration, this
Administration, through the Department of Justice, file a
separate brief during that case in which they decided not to
defend the constitutionality of the individual mandate, and
they agreed that certain provisions of the ACA--guaranteed
issue, community rating, the ban on preexisting condition
exclusions, and discrimination based on health status--are
inseverable, are inseverable, from that mandate.
Now, to me, supporting the DOJ brief, supporting that case
by the 20 Republican AGs, seems inconsistent with saying you
are then for preexisting condition protections. Am I correct?
Mr. STOLFI. I would agree that it would be inconsistent to
support protecting people with preexisting conditions and the
Texas lawsuit at the same time.
Mr. PANETTA. And why is that?
Mr. STOLFI. Well, the Texas lawsuit itself is seeking to
invalidate and dismantle the entire Affordable Care Act.
Mr. PANETTA. And that includes protection of preexisting
conditions?
Mr. STOLFI. Absolutely.
Mr. PANETTA. Now, what we are also seeing recently is
certain States are trying to create their own laws, saying: We
protect preexisting conditions.
And I will use Wisconsin as an example. But what they are
doing, though, in trying to protect preexisting conditions, how
is that possible--how is that possible without the ACA? Can you
explain that?
Mr. STOLFI. Well, for one very big reason it would be
rather difficult without the ACA, because the ACA, one of the
essential elements of it are the subsidies it provides to
individuals to afford the insurance that they need to have.
Mr. PANETTA. Would it also create unbalanced risk pools?
Mr. STOLFI. Without the ACA, yes.
Mr. PANETTA. And would it also--I mean, it is basically--it
wouldn't ensure that certain procedures are covered as well,
correct?
Mr. STOLFI. That would be likely, yes.
Mr. PANETTA. And what about the exclusions on annual or
lifetime caps?
Mr. STOLFI. Those would go away in most States, yes.
Mr. PANETTA. Exactly. So it would be pretty hard to support
preexisting conditions without supporting the Affordable Care
Act, correct?
Mr. STOLFI. It would be difficult, yes.
Mr. PANETTA. Thank you, Mr. Stolfi.
I yield back. Thank you, Mr. Chairman.
Chairman NEAL. I thank the gentleman.
Once again acknowledging the Gibbons rule. When the gavel
came down, Mr. Suozzi had been seated, so we will move to him
for 5 minutes for inquiry.
Mr. Suozzi.
Mr. SUOZZI. Thank you, Mr. Chairman. I first want to thank
you for holding this hearing and thank you again for making
clear to the Ways and Means Committee that you are going to be
spending a lot of time on hearings looking at the facts of
different issues. I think it is a great practice that you are
making sure we return to. I saw Mr. Reed privately a few
moments ago. I was hoping he would be here so I could say
publicly that I want to congratulate him because he stated in
his very strong comments earlier, that he gets it now. He
finally gets the fact--and the Republicans that he associates
with--they get it, that preexisting conditions must be
protected. They heard the message. It only took years. It only
took 70 votes. It only took hundreds of millions of dollars of
campaign commercials. It only took billions of dollars of free
air time debating these issues. But they finally get the fact
that we must protect preexisting conditions. I think that is an
excellent, excellent result.
Ms. Pollitz, I know you said earlier that you don't
advocate for policy; you just focus on the facts and what is
out there, the data. So I wanted to just confirm some things
with you. Of the 330 million people in America, 160 million to
175 million are covered by their private employer for their
health insurance.
Ms. POLLITZ. Correct.
Mr. SUOZZI. And about 75 million by Medicaid; 45 million by
Medicare; and 30 million remain uninsured, 4 million people
more than it was before this Administration took office. Is
that correct?
Ms. POLLITZ. I don't know that the number of uninsured has
risen quite 4 million in the last 2 years, but it has started
to tick up again.
Mr. SUOZZI. Do you have any idea of what that number would
be, of how many it has gone up by? It is okay. You don't----
Ms. POLLITZ. I will have to submit a number for you.
Mr. SUOZZI. And there are about 23 million people that are
covered in the individual marketplace?
Ms. POLLITZ. Not that many. It is closer to 15 million that
are in the individual marketplace.
Mr. SUOZZI. Okay.
Ms. POLLITZ. I am sorry. In the individual market, most of
them in the marketplace.
Mr. SUOZZI. Is it 15 million?
Ms. POLLITZ. Total, for the individual market, yes.
Mr. SUOZZI. So most of the stories that we hear about
insurers pulling out of the market and about premiums going up
dramatically, are most of those stories specifically related to
the individual market?
Ms. POLLITZ. Yes.
Mr. SUOZZI. So most of the dissatisfaction with what is
going on in the marketplace is directly related to the
individual market?
Ms. POLLITZ. Correct. And that rise in premiums that was on
the chart before, that is just for the individual market. We
don't see that same volatility in the cost of employer plans.
Mr. SUOZZI. So you are referring to Mr. Rice's questioning
earlier when he had the charts up, about--he said only 6.6
percent more people were covered. That happens to be 20 million
people, which is an awful lot of people whose lives are much
more improved now that they have access to healthcare, and it
is a humongous number of people, especially if you are one of
those 20 million people.
Ms. POLLITZ. Yes.
Mr. SUOZZI. But when he talked about the rising of the
rates in the individual market, much of those rate increases
would have existed anyway because rates were going up before
the Affordable Care Act. Of course, they were affected by the
Affordable Care Act as well, but weren't rates going up anyway?
Ms. POLLITZ. They were, but the rates weren't the same for
everybody. So people, as long as they were healthy, could kind
of move to another plan, resubmit to medical underwriting,
maybe get another cheap rate. But as soon as you got sick,
either your rates would go through the roof or you would get
locked out of that market altogether.
Mr. SUOZZI. So one of the things that we have discussed
here today is that the Administration has been pushing these
short-term plans. And these short-term plans are, in fact,
cheaper for the people who are buying these short-term plans,
but one of the reasons they are cheaper is they don't cover
preexisting conditions. Is that correct?
Ms. POLLITZ. That is correct.
Mr. SUOZZI. So one of the points that we are trying to make
in this testimony today, or this hearing today, is that
preexisting conditions, when they are not covered, may provide
you with cheaper rates, but the people who have preexisting
conditions are very seriously hurt by that and can't afford
themselves those particular plans?
Ms. POLLITZ. That is right.
Mr. SUOZZI. And I just wanted to clarify one thing that
you--I think it was you that said it earlier. You said that we
have seen premiums increase over the past year, but we estimate
that about 6 percent of the increases are due to, one, the
repeal of the individual mandate, and, two, the okaying of
short-term plans.
Ms. POLLITZ. Actually, we saw the 2019 premiums go down a
little bit this year, by 1 percent, but if not for those two
other factors, the repeal of the mandate and the expansion of
short-term plans, we would have seen them go down another 6
percent. So insurers tell us in their rate filing that even
though they kind of overshot the mark last year when they
corrected and so they are kind of lowering their rates, they
are not going as low as they would have otherwise because they
are still worried about this other source of uncertainty.
Mr. SUOZZI. Thank you very much. I yield back my time.
Chairman NEAL. I thank the gentleman.
Let me recognize the gentlelady from the State of Florida,
Mrs. Murphy, to inquire for 5 minutes.
Mrs. MURPHY. Thank you, Mr. Chairman, and thank you to the
witnesses for your testimonies.
Along with Congressman Buchanan, I am one of the two
Members on this Committee who represents Florida, and according
to the Kaiser Family Foundation, there are an estimated 3.1
million people in Florida under the age of 65 who have a
preexisting health condition, such as cancer or diabetes or
heart disease. And I can sit here thinking to myself that I
know at least one family member or friend who has some kind of
preexisting condition, and I imagine that my constituents
probably could do that as well.
And, in fact, according to Kaiser, nearly 3 in 10
nonelderly adults in my Orlando-area district have a
preexisting condition. That is one of the most of any major
metropolitan area in all of Florida. It would have been very
difficult, and maybe even impossible, for these constituents of
mine to have obtained health insurance on the individual market
prior to the passage of the Affordable Care Act in 2010 because
of the way that the insurance companies screened applicants for
coverage.
And the ACA, in addition to empowering States to expand
Medicaid to more people and creating federally supported health
insurance marketplaces for individuals and families,
established robust protections for Americans with preexisting
conditions within those marketplaces. Specifically, the law
guaranteed access to insurance regardless of health status. It
prohibited insurance companies from varying premiums based on
people's health and required coverage of certain essential
benefits that are important to a healthy life.
And thanks to these consumer protections and to the
availability of the Federal financial assistance for lower
income individuals, there are now 1.7 million Floridians
enrolled in a marketplace plan. That is far more than any other
State.
And, in other words, you know, despite the misguided
decision not to expand Medicaid, Florida has benefited a great
deal from the Affordable Care Act. The State and its citizens
stand to lose a great deal if the law is repealed by Congress,
struck down by the Federal courts, or undermined by regulators
at the Department of Health and Human Services.
Nonelderly adults with preexisting conditions could once
again be denied coverage or charged an excessive amount for
coverage. And while my colleagues on the other side of the
aisle claim that they support protecting people with
preexisting conditions, it is my understanding that few, if
any, of the patient advocacy groups supported their various
efforts to repeal and replace the Affordable Care Act.
If their proposals were even adequate at providing patient
protections, why would the patient groups that purport to help,
oppose them? My colleagues on the other side can say they
support people with preexisting conditions all they want, but
the reality is that they continue to support efforts to
undermine these protections that Americans want. And I think it
is well past time that they matched their words with actions.
So my question is for Ms. Pollitz. At the risk of asking
you to repeat what you have already said many times today, can
you explain in just very simple terms what the recent
legislative, administrative, and judicial efforts to weaken the
Affordable Care Act would mean for people with preexisting
conditions in Florida and other States? And can you really
argue with a straight face that--or can anyone really argue
with a straight face that my constituents would be in a better
position now if these efforts were successful?
Ms. POLLITZ. The recent changes--I won't go through them
all--have had the effect of increasing premiums artificially,
for individual health insurance through the marketplace. When
people are eligible for subsidies, they are protected from
that. So it is the taxpayers of Florida who pay for that, not
the insurance enrollees. But there are millions of people
throughout the United States who aren't eligible for subsidies:
They earn too much. They are in the family glitch that Keysha
talked about. There are other reasons why they are not
eligible. And they bear the full burden. So to the extent that
they start to fall out of the marketplace, it is more likely
that the healthier people will let go first, that the people
who know they are using the coverage will hang on as hard as
they can, find ways to hang in there, and that kind of drives
up the cost more because it just means the average cost, the
morbidity of the risk pool, increases.
So far the subsidies are kind of the stabilizing factor.
They are kind of keeping it all together. They are keeping most
of the people kind of covered in the marketplace. But at the
margins, people with preexisting conditions are--they are
having to pay more for ACA coverage because they are not
protected by the subsidies, and at some point, they may not be
able to do that.
Mrs. MURPHY. Thank you. I yield back.
Chairman NEAL. I thank the gentle lady.
I recognize the gentleman from California to inquire for 5
minutes, Mr. Gomez.
Mr. GOMEZ. Mr. Chairman, thank you so much for organizing
this important hearing. Healthcare is a very personal issue.
For me, it was growing up without health insurance, spending 7
days in the hospital, when I was a kid, with pneumonia and
almost bankrupting my family. Preexisting conditions don't just
apply to seniors. They also apply to little kids.
This individual I want to talk about was about the same age
as me when I had pneumonia when she was diagnosed with a
congenital heart disease. Her name is Micah. And I had the
privilege of meeting her. She is amazing. She introduced
herself as, first, a Girl Scout--that is very important--a
figure skating aficionado, and a little lobbyist, because she
was making her voice heard about the Affordable Care Act and
what kind of impact it had on her life.
She might be just a kid, but her and her friends are really
fighting to make sure the Affordable Care Act is in place. She
has already had two open-heart surgeries and will need a third
in the future. And without the ACA, she could lose her
healthcare due to a serious preexisting condition.
And it doesn't only--although they might be young, they are
very aware of how their healthcare, their health, impacts their
entire family. Because from that moment on, I knew that if I
went outside to play, when I was a little kid, if I got hurt,
you know, it would have a big impact on my family because we
didn't have healthcare coverage.
Micah and 130 million people with preexisting conditions
deserve no less than to have an honest conversation about the
Affordable Care Act.
The other side of the aisle, I have been listening to them,
and I must admit, I have been getting kind of, a little bit
furious, a little hot under the collar here, because it is
just--all I could think about is whatever--they don't
understand that the Affordable Care Act works together, as all
of you know, right? Every piece of it. When it comes to the
subsidies, outreach, getting the risk pools, the marketplaces,
the expanding of Medicaid, it all works together.
And when you don't fight for all of it, but you are saying
you are for protecting people with preexisting conditions, it
is not--people who make that argument, I don't believe, are
sincere. You know, the words I come up with when I hear those
arguments are hogwash, rubbish, blarney, and just plain
nonsense.
You know, if you weren't at a hearing and somebody was
making that argument, let's say, at your kitchen table, right,
what would you say to them, that, ``Oh, yeah, I am for
preexisting conditions, but I am not for subsidies; I am not
for anything else in the Affordable Care Act''? I would love to
hear what you would say.
Ms. Brooks-Coley, what would you say?
Ms. BROOKS-COLEY. From the cancer perspective, we represent
a population of people who, before the Affordable Care Act,
could not access coverage. Oftentimes, they were individuals
who actually couldn't even get a plan even though they had a
serious illness such as cancer. So, from our perspective, the
entire ACA and that infrastructure is what has led to patients
with serious illness, like cancer, having access to coverage
and I agree with you that the patient protections, of course,
which are center of the law and important to us from the
serious illness perspective, but the entire law does work
together to make sure people have better access.
Mr. GOMEZ. Mr. Stolfi, what would you say?
Mr. STOLFI. Thank you, Representative Gomez. I mean, to be
honest, I think one of the most challenging things about this
is how complex the issues are. And it is one of the reasons why
this hearing is so important today, to talk in great detail and
to make sure everyone fully understands what it means and all
of the things that go into protecting people with preexisting
conditions.
I mean, I am going to walk away today with, you know, a
belief that there is a much greater understanding today, about
what that is. And I think if I were sitting around the table
with someone, I would spend quite a bit of time talking about
some rather intricate, somewhat boring, insurance concepts in
order to make sure they fully understood why every single part
of it is important.
Mr. GOMEZ. And I appreciate that. And sometimes in life you
just have to call out people for saying nonsense, right? And I
know that they are probably sincere that they want to cover
people with preexisting conditions, but we passed the
Affordable Care Act to work as an overall structure. And now
they are saying, after they basically ruined it, that the
prices are coming up. So our job in the next Congress and
moving forward is to fix what they broke.
Thank you, and I yield back.
Chairman NEAL. I thank the gentleman.
And now to recognize the gentleman from Nevada, Mr.
Horsford, to inquire for 5 minutes.
Mr. HORSFORD. Thank you very much, Mr. Chairman. Former
Congressman Mo Udall once said: Everything has been said, but
not everyone has said it.
So as the last Member today, I am extremely thankful for
this opportunity.
And thank you, Mr. Chairman. It says a lot that you made
this issue of preexisting conditions and the hearing today the
first priority of this Committee. So I want to thank you for
that.
There are 371,000 Nevadans who would lose coverage in 2019
if the Affordable Care Act were repealed. Approximately 1.2
million Nevadans with private health coverage would lose
guaranteed access to free preventative care like immunizations
and cancer screenings.
The impact of the Affordable Care Act is critical. About
one in two Nevadans, 51 percent, live with a preexisting
condition, including myself. Because of the ACA, insurance
companies can no longer deny coverage or charge more because of
a preexisting condition.
One of those Nevadans is Joe Molino, who lives in north Las
Vegas, Nevada. Joe was diagnosed with a rare cancer in 2011,
called chondrosarcoma of the larynx. On September 13, 2013, Joe
underwent a 12-hour surgery to remove much of the tumor. He
awoke with a tracheotomy, which he would have in for months.
The hole, his stoma, never healed, and he experienced a
complication called tracheal stenosis, which impacted his
ability to breathe. These complications kept him from going to
work, and in February 2014, he was notified by his employer
that his employee-sponsored healthcare would end. And he could
not afford a COBRA plan on his disability payment.
Luckily, he was able to get coverage under Nevada's
expanded Medicaid program, which I would note was actually
approved by former Governor Brian Sandoval, the first
Republican Governor in the country to adopt the Medicaid
expansion in the country.
In 2016, with the help of the Medicaid expansion and the
ACA health plan, he was finally able to get back to work and
live a fulfilling life.
So I am committed, as my colleagues are on this side of the
aisle, to do everything that I can to strengthen the Affordable
Care Act. This is the central issue that the constituents in my
district talked to me about over the last few years. So I am
hopeful now with this new Congress that we will look at ways to
build on the Affordable Care Act and make healthcare better for
all Americans.
But, Ms. Pollitz, I would like to ask you, what are some of
the improvements that Congress should be considering in order
to improve affordability and access?
Ms. POLLITZ. Well, again, Congressman, we don't make
recommendations. I think there are a number of proposals that
have been discussed in the course of today's session, including
expanding subsidies for some or all people who aren't eligible
for them today; expanding the cost-sharing subsidies so that
they are more generous; other changes to ensure that the
Medicaid expansion is available in every State, instead of, you
know, just the ones that have elected that so far.
So I think there have been--and, you know, there are
proposals to undo the Affordable Care Act and go in another
direction. You know, the Better Healthcare Act is one
direction. Others are talking about expanding public programs
in other ways: Medicare, Medicaid eligibility.
So I think there are a lot of options on the table, and I
am glad you are working on them.
Mr. HORSFORD. We will figure it out.
Ms. POLLITZ. Thank you.
Mr. HORSFORD. Can you discuss why the end to annual and
lifetime limits are important to cancer patients and other
Americans facing complex healthcare needs, please?
Ms. POLLITZ. Yeah. So there aren't that many people who
would reach lifetime limits, but actually an old friend of mine
who was on the board of the Nebraska high-risk pool reached it
because he had two daughters born prematurely with severe
congenital conditions, and he hit the million dollar lifetime
limit on his policy with those girls in less than a year. So it
does happen. They are the most severe conditions.
Cancer sometimes can get that high. My cancer treatment was
never that big, but over a lifetime, it could get there. So
that protection is there for the most extreme cases and the
most costly cases, and it is a lifeline for those people.
Mr. HORSFORD. Thank you very much.
Thank you, Mr. Chairman. I yield back.
Chairman NEAL. Mr. Gomez has asked for a brief interlude
here for a couple of seconds.
Mr. GOMEZ. Yeah. Mr. Chairman, I forgot to mention I would
like to submit for the record a statement from Ricardo Lara,
California's new Insurance Commissioner, on this issue. Thank
you so much.
Chairman NEAL. Without objection, so ordered.
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Chairman NEAL. Over the past decade, this dialogue has
been, from time to time, pretty contentious. But today I heard
a lot of Members on the other side of the aisle say they
support protecting people with preexisting conditions. And I
welcome this as an opportunity to move forward, and I hope that
we can work together to make sure that we preserve these
protections for all Americans, as they have come to rely upon
them.
The witnesses today, all of you, you were exceptional. And
I think that this is the sort of dialogue we could have going
forward, based upon the testimony you have all offered. It was
solution-based on how we can proceed in an area where people
expect us to. So, I want to thank you for your testimony.
Please be advised that Members have 2 weeks to submit
written questions to be answered later in writing. Those
questions and answers will be made part of the formal hearing
record.
And, with that, the Committee stands adjourned.
[Whereupon, at 2:14 p.m., the Committee was adjourned.]
[Submissions for the Record follow:]
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