[House Hearing, 118 Congress]
[From the U.S. Government Publishing Office]


                  ERISA'S 50TH ANNIVERSARY: THE VALUE
                 OF EMPLOYER-SPONSORED HEALTH BENEFITS

=======================================================================

                                HEARING

                               Before The

                         SUBCOMMITTEE ON HEALTH, 
                      EMPLOYMENT, LABOR, AND PENSIONS

                                 OF THE

                COMMITTEE ON EDUCATION AND THE WORKFORCE
                     U.S. HOUSE OF REPRESENTATIVES

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             SECOND SESSION

                               __________


           HEARING HELD IN WASHINGTON, DC, SEPTEMBER 10, 2024

                               __________

                           Serial No. 118-61

                               __________

  Printed for the use of the Committee on Education and the Workforce
  
[GRAPHIIC NOT AVAILABLE IN TIFF FORMAT]  


        Available via: edworkforce.house.gov or www.govinfo.gov
        
                               __________

                   U.S. GOVERNMENT PUBLISHING OFFICE                    
57-404 PDF                  WASHINGTON : 2024                    
          
-----------------------------------------------------------------------------------           
        
                COMMITTEE ON EDUCATION AND THE WORKFORCE

               VIRGINIA FOXX, North Carolina, Chairwoman

JOE WILSON, South Carolina           ROBERT C. ``BOBBY'' SCOTT, 
GLENN THOMPSON, Pennsylvania             Virginia,
TIM WALBERG, Michigan                  Ranking Member
GLENN GROTHMAN, Wisconsin            RAUL M. GRIJALVA, Arizona
ELISE M. STEFANIK, New York          JOE COURTNEY, Connecticut
RICK W. ALLEN, Georgia               GREGORIO KILILI CAMACHO SABLAN,
JIM BANKS, Indiana                     Northern Mariana Islands
JAMES COMER, Kentucky                FREDERICA S. WILSON, Florida
LLOYD SMUCKER, Pennsylvania          SUZANNE BONAMICI, Oregon
BURGESS OWENS, Utah                  MARK TAKANO, California
BOB GOOD, Virginia                   ALMA S. ADAMS, North Carolina
LISA McCLAIN, Michigan               MARK DeSAULNIER, California
MARY MILLER, Illinois                DONALD NORCROSS, New Jersey
MICHELLE STEEL, California           PRAMILA JAYAPAL, Washington
RON ESTES, Kansas                    SUSAN WILD, Pennsylvania
JULIA LETLOW, Louisiana              LUCY McBATH, Georgia
KEVIN KILEY, California              JAHANA HAYES, Connecticut
AARON BEAN, Florida                  ILHAN OMAR, Minnesota
ERIC BURLISON, Missouri              HALEY M. STEVENS, Michigan
NATHANIEL MORAN, Texas               TERESA LEGER FERNANDEZ, New Mexico
LORI CHAVEZ-DeREMER, Oregon          KATHY MANNING, North Carolina
BRANDON WILLIAMS, New York           FRANK J. MRVAN, Indiana
ERIN HOUCHIN, Indiana                JAMAAL BOWMAN, New York
MICHAEL A. RULLI, Ohio

                    Carson Middleton, Staff Director
              Veronique Pluviose, Minority Staff Director
                                 ------                                

        SUBCOMMITTEE ON HEALTH, EMPLOYMENT, LABOR, AND PENSIONS

                      BOB GOOD, Virginia, Chairman

JOE WILSON, South Carolina           MARK DeSAULNIER, California
TIM WALBERG, Michigan                  Ranking Member
RICK ALLEN, Georgia                  JOE COURTNEY, Connecticut
JIM BANKS, Indiana                   DONALD NORCROSS, New Jersey
JAMES COMER, Kentucky                SUSAN WILD, Pennsylvania
LLOYD SMUCKER, Pennsylvania          FRANK J. MRVAN, Indiana
MICHELLE STEEL, California           PRAMILA, JAYAPAL, Washington
AARON BEAN, Florida                  LUCY McBATH, Georgia
ERIC BURLISON, Missouri              JAHANA HAYES, Connecticut
LORI CHAVEZ-DeREMER, Oregon          ILHAN OMAR, Minnesota
ERIN HOUCHIN, Indiana                KATHY MANNING, North Carolina
                        
                        C  O  N  T  E  N  T  S

                              ----------                              
                                                                   Page

Hearing held on September 10, 2024...............................     1

                           OPENING STATEMENTS

    Good, Hon. Bob, Chairman, Subcommittee on Health, Employment, 
      Labor, and Pensions........................................     1
        Prepared statement of....................................     3
    DeSaulnier, Hon. Mark, Ranking Member, Subcommittee on 
      Health, Employment, Labor, and Pensions....................     4
        Prepared statement of....................................     6

                               WITNESSES

    Schuman, Ilyse, Senior Vice President, Health and Paid Leave 
      Policy, American Benefits Council..........................     8
        Prepared statement of....................................    11
    Wade, Holly, Executive Director, National Federation of 
      Independent Business Research Center (NFIB)................    23
        Prepared statement of....................................    25
    Wright, Anthony, Executive Director, Families USA............    31
        Prepared statement of....................................    33
    Fronstin, Dr. Paul, Director, Health Benefits Research, 
      Employee Benefit Research Institute (EBRI).................    52
        Prepared statement of....................................    54

                         ADDITIONAL SUBMISSIONS

    Allen, Hon. Rick W., a Representative in Congress from the 
      State of Georgia:
        Analysis dated September 28, 2024, by The AIDS Institute 
          entitled ``Health Insurance Issuers in Violation of 
          State Copay Accumulator Adjustor Laws''................    87
    Bean, Hon. Aaron, a Representative in Congress from the State 
      of Florida:
        Statement dated September 10, 2024, from the National 
          Association of Professional Employer Organizations 
          (NAPEO)................................................    89
    Foxx, Hon. Virginia, a Representative in Congress from the 
      State of North Carolina:
        Letter dated September 10, 2024, from the Associated 
          Builders and Contractors...............................    92
        Statement dated September 10, 2024, from AHIP............    93
        Statement dated September 10, 2024, from the Business 
          Group on Health........................................    97
        Statement dated September 10, 2024, from the Partnership 
          for Employer-Sponsored Coverage........................   102

                        QUESTIONS FOR THE RECORD

    Responses to questions submitted for the record by:
        Dr. Paul Fronstin........................................   105
        Ms. Ilyse Schuman........................................   112
        Mr. Anthony Wright.......................................   115

 
                  ERISA'S 50TH ANNIVERSARY: THE VALUE
                 OF EMPLOYER-SPONSORED HEALTH BENEFITS

                              ----------                              


                      Tuesday, September 10, 2024

                  House of Representatives,
    Subcommittee on Health, Employment, Labor, and 
                                          Pensions,
                  Committee on Education and the Workforce,
                                                    Washington, DC.
    The Subcommittee met, pursuant to notice, at 10:15 a.m., in 
Room 2175, Rayburn House Office Building, Hon. Bob Good 
(Chairman of the Subcommittee) presiding.
    Present: Representatives Good, Walberg, Allen, Bean, 
Burlison, Chavez-DeRemer, Foxx, DeSaulnier, Courtney, Norcross, 
Wild, Mrvan, McBath, Manning, and Scott.
    Staff present: Annmarie Graham, Deputy Communications 
Director, Mindy Barry, General Counsel; Sheila Havenner, 
Director of Information Technology, Alex Knorr, Legislative 
Assistant; Georgie Littlefair, Clerk; CJ Mahler, Professional 
Staff Member; Hannah Matesic, Deputy Staff Director; Audra 
McGeorge, Communications Director; Carson Middleton, Staff 
Director; Jacob Pletcher, Staff Assistant; Kelly Tyroler, 
Professional Staff Member; Seth Waugh, Director of Workforce 
Policy; Maura Williams, Operations Manager; Gavin Anderson, 
Intern; Illana Brunner, General Counsel; Ni'Aisha Banks, Staff 
Assistant; Nikita Chellani, Intern, Daniel Foster, Senior 
Health and Labor Counsel; Carrie Hughes, Director of Health & 
Human Services Policy; Cira Vera, CHCI Intern; Jessica 
Schieder, Economic Policy Advisor; Dhrtvan Sherman, Research 
Assistant; Raiyana Malone, Press Secretary; Madeline McBride, 
Grad Intern; Brashanda McCoy, CBCF Intern; Marie McGrew, Press 
Assistant; Veronique Pluviose, Staff Director; Isabella 
Sanchez, Intern and Banyon Vassar, Director of IT.
    Chairman Good. The hearing on the Subcommittee on Health, 
Employment, Labor and Pensions will come to order. I note that 
a quorum is present, and without objection, the Chair is 
authorized to call a recess at any time.
    I thank everyone for being here today. I hope our members 
enjoyed, and our staff a particularly long district work period 
over the last 6 weeks. I have heard a lot from my constituents 
about the issues that impact their everyday lives. High gas 
prices, housing, utility costs, food inflation, and fears of an 
economic downturn, all top of the list, and give working 
Americans a real concern about their economic insecurity.
    With costs for everything rising under the policies of the 
Biden Harris administration, it is important for Congress to 
look at ways to lower costs for American families. With 
constituent concerns top of mind, we meet today to discuss the 
bedrock law that helps provide economic security, stability and 
protection to a majority of the people we serve because it 
protects employee benefits.
    Specifically, we will discuss the value of employer 
sponsored healthcare benefits under the Employment Retirement 
and Income Security Act of 1974, or ERISA. In the 50 years that 
ERISA has been the law of the land, it has helped incentivize 
employers to offer healthcare benefits that cover over 153 
million Americans, or roughly half the population.
    ERISA works because of its preemption clause. As a 
conservative, you will not often hear me say I support Federal 
preemption of State law, but in this instance, ERISA's effect 
is to alleviate the burden of government on employers, which 
actually helps workers.
    Without ERISA preemption of State law, the patchwork of 
State regulations would hamper a business's ability to offer 
uniform coverage options. Imagine being relocated within the 
same company to a different State. It happened to me several 
times, and having to navigate an entire new system of 
healthcare regulation.
    Thanks to ERISA we can avoid that disaster. Employers can 
simply comply with the protections outlined in ERISA and 
provide healthcare to employees around the country. According 
to a Society for Human Resources Management Survey, 90 percent 
of workers consider healthcare to be an extremely important, or 
very important benefit.
    Another survey, by Protecting Americans Coverage Together 
found that 93 percent of Americans are satisfied with their 
employer sponsored coverage. With stats like that, it seems 
hard to believe that there are politicians who want to 
dismantle ERISA in favor of government run healthcare.
    Private health insurance is at risk due to the push of the 
left for Medicare for All. The Biden Harris administration 
wants to make private healthcare unaffordable and unattainable, 
so that Americans think that they have no choice but to support 
government run plans. They have saddled employer sponsored 
healthcare with more regulations and have removed viable 
coverage options like association health plans and short-term, 
limited-duration plans.
    The Democrats misnamed, Inflation Reduction Act, shifted 
billions of Medicare dollars to fund failing Obamacare plans. 
Now, Democrats plan to extend expanded premium tax credits 
beyond 2025 at a cost of 335 billion dollars. I do not think 
they understand that using tax dollars to pay for certain 
American's healthcare costs is robbing Peter to pay Paul, and 
actually makes healthcare less affordable for everyone.
    It costs the government over $1,000.00 more per patient per 
year to place someone on an Obamacare plan, than on employer 
sponsored insurance plan. Beyond Obamacare, the proposal from 
this administration Democrat nominee, Kamala Harris, are 
somehow even more radical.
    Vice President Harris has explicitly endorsed Medicare for 
All, a plan which calls for the elimination of private health 
insurance. This would prevent over half of America from keeping 
the plans they have now, and that they overwhelmingly prefer. A 
single payer system would mark the end of ERISA as we know it, 
and cost taxpayers an estimated 32 trillion dollars.
    Worse, her plan provides taxpayer funded healthcare for 
illegal immigrants. If the government has any legitimate 
responsibility in healthcare, it should at least be to benefit 
its own citizens. Before I close, I want to take a moment to 
play a video from the Washington Post that highlights just how 
real this threat to ERISA is.
    [Video playing]
    Mr. DeSaulnier. Mr. Chairman, a point of order here please. 
Mr. Chairman, point of order please.
    Chairman Good. Thank you to our staff. It is interesting--
we just had the Vice President in her own words without any 
commentary. For some reason, some members did not want anybody 
to hear that. It is very interesting. What she said----
    Mr. DeSaulnier. Okay, a point of order please.
    Chairman Good. The gentleman is not recognized. She says 
under my plan of Medicare for All, private insurance companies 
will be able to provide coverage if they play by our rules. 
Although she tries to moderate and disguise her position by 
acting like private insurance companies can keep functioning as 
normal, does anyone really think they will get better 
healthcare when they are playing by Kamala Harris' rules.
    The Democrat plan is to make private healthcare 
unaffordable, and ultimately non-existent. One way to do this 
is to provide artificially, and temporarily lower cost 
government provided healthcare to drive providers out of the 
market, but everything the government does ultimately costs 
more, especially with the initial costs of the exploding debt 
that causes higher taxes and higher inflation.
    Every government expenditure either causes higher taxes, 
higher inflation, or debt exploding to the taxpayers. At a time 
when many Americans are living paycheck to paycheck, and 
personal savings rates are near historic lows, rising 
healthcare costs are driven by government interventions are 
unmanageable. Permitting ERISA plans room to expand and 
innovate is the solution.
    Now it is time for Congress to work to strengthen ERISA and 
employer sponsored health benefits for the next 50 years and 
beyond. With that, I now yield to the Ranking Member for his 
opening statement.
    [The Statement of Chairman Good follows:]

     Statement of Hon. Bob Good, Chairman, Subcommittee on Health, 
                     Employment, Labor and Pensions

    Over the last six weeks, I heard a lot from my constituents about 
the issues that impact their everyday lives. High gas prices, housing 
and utility costs, food inflation, and fears of an economic downturn 
all top the list and give working Americans a real concern about their 
economic insecurity. With costs for everything rising under the 
policies of the Biden-Harris administration, it is important for 
Congress to look at ways to lower costs for American families.
    With constituent concerns top of mind, we meet today to discuss the 
bedrock law that helps provide economic security, stability, and 
protection to a majority of the people we serve, because it protects 
employee benefits. Specifically, we will discuss the value of employer-
sponsored health care benefits under the Employee Retirement Income 
Security Act of 1974 (ERISA).
    In the 50 years that ERISA has been the law of the land, it has 
helped incentivize employers to offer health care benefits that cover 
over 153 million Americans--roughly half the population. ERISA works 
because of its preemption clause. As a conservative, you will not often 
hear me say I support federal preemption of state law. In this 
instance, ERISA's effect is to alleviate the burden of government on 
employers, which actually helps workers. Without ERISA preemption of 
state law, the patchwork of state regulations would hamper a business's 
ability to offer uniform coverage options. Imagine being relocated 
within the same company to a different state and having to navigate an 
entire new system of health care regulations. Thanks to ERISA, we can 
avoid that disaster. Employers can simply comply with the protections 
outlined in ERISA, and provide health care to employees around the 
country.
    According to a Society for Human Resource Management survey, 90 
percent of workers consider health care to be an extremely or very 
important employee benefit. Another survey by Protecting Americans 
Coverage Together found that 93 percent of Americans are satisfied with 
their employer-sponsored coverage.
    With stats like that, it seems hard to believe that there are 
politicians who want to dismantle ERISA in favor of government-run 
health care. Private health insurance is at risk due to the push of the 
Left for Medicare-for-All.
    The Biden-Harris administration wants to make private health care 
unaffordable and unattainable, so that Americans think they have no 
choice but to support government-run plans. They have saddled employer-
sponsored health care with more regulations and have removed viable 
coverage options like Association Health Plans and short-term, limited-
duration plans. The Democrats' misnamed ``Inflation Reduction Act'' 
shifted billions of Medicare dollars to fund failing Obamacare plans.
    Now, Democrats plan to extend expanded premium tax credits beyond 
2025 at a cost of $335 billion. I do not think they understand that 
using tax dollars to pay for certain Americans' monthly health care 
costs is robbing Peter to pay Paul, and actually makes health care less 
affordable for everyone. It costs the government over $1,000 more per 
patient per year to place someone on an Obamacare plan, than on an 
employer-sponsored insurance plan.
    Beyond Obamacare, the proposals from this administration and 
Democrat nominee Kamala Harris are somehow even more radical. Vice 
President Harris has explicitly endorsed Medicare-for-All, a plan which 
calls for the elimination of private health insurance. This would 
prevent over half of America from keeping the plans they have now and 
overwhelmingly prefer. A single-payer system would mark the end of 
ERISA as we know it--and cost taxpayers an estimated $32 trillion.
    Worse, her plan provides taxpayer funded health care for illegal 
immigrants. If the government has any legitimate responsibility in 
health care, it should at least be to the benefit of its own citizens.
    Before I close, I want to take a moment to play a video from the 
Washington Post that highlights just how real this threat to ERISA is.
    She says: ``Under my plan of Medicare-for-All, private insurance 
companies will be able to provide coverage if they play by our rules.'' 
Although she tries to moderate and disguise her position by acting like 
private insurance companies can keep functioning as normal, does anyone 
really think they will get better health care when they are playing by 
Kamala Harris's rules?
    The Democrat plan is to make private health care unaffordable, and 
ultimately non-existent. One way to do this is to provide artificially 
and temporarily lower cost government-provided health care to drive 
private providers out of the market. Everything the government does 
ultimately costs more, especially with the initial hidden cost of the 
exploding debt that causes higher taxes and higher inflation.
    At a time when many Americans are living paycheck to paycheck, and 
personal savings rates are near historic lows, rising health care costs 
driven by government interventions are unmanageable. Permitting ERISA 
plans room to expand and innovate is the solution.
    Now, it is time for Congress to work to strengthen ERISA and 
employer-sponsored health benefits for the next fifty years and beyond.
                                 ______
                                 
    Mr. DeSaulnier. Just a question to the point of order is a 
question of the relevance of the video in particular. It is 
more of a political statement, and I know that there is some 
license here in Congress for that, but that was extreme in the 
10-years I have been here in Congress.
    Mr. Chairman, it is unfortunate there are--there is work we 
can do with ERISA, clearly, but being as partisan as you just 
introduced this, and using absolutes about every time there is 
a tax increase, every time the government spends money it leads 
to all of these horrible things.
    This is a mixed market economy, capitalistic economy, and 
it requires rules and guidance that we all come to agreement on 
to make it work, including unfortunately, some of the worst 
aspects of human nature's greed, and lack of ethics, and we are 
going to talk about that a little bit today, for instance with 
MultiPlan.
    In the spirit I think we have had for the last 4 years when 
we have been on this Committee, I appreciate our differences, 
but that was a rather extreme opening comment in my 
perspective.
    To the witnesses, thank you for being here. All of your 
perspectives are valuable. We appreciate it at this important 
hearing on ERISA. When ERISA was enacted in 1974, Congress made 
its intent clear. The law's primary purpose is to ``protect the 
interest of participants in employee benefit plans, and their 
beneficiaries.''
    To that end, ERISA established crucial consumer protection 
standards, provided remedies to workers whose claims are 
denied, or whose plans are mismanaged, and required fiduciaries 
to act solely in the best interest of the plan participants. As 
our Subcommittee discusses ERISA today, it's vital to keep this 
fundamental purpose at the forefront.
    It is about consumers. We must also keep in mind the urgent 
need to improve the efficiency of our health care system. Our 
country currently spends more than 17 percent of our gross 
domestic product, over 4.5 trillion on health care, far more 
than our peer countries.
    Workers and consumers are increasingly shouldering their 
costs through rising premiums and deductibles. Our health 
outcomes are among the worst in the developed world. In the 
other developed countries, they have a form of universal health 
care, so everyone can get quality health care. Different 
versions in different countries allow for the private sector to 
participate in it.
    They have better outcomes, longer lifespans. The healthcare 
system is plagued by numerous challenges and inefficiencies, 
including, excuse me, the lack of price transparency, the 
excessive fees charged by self-dealing third-party 
administrators and pharmacy benefit managers, and the 
escalating cost of medical care and prescription drugs.
    As the New York Times has documented, companies like 
MultiPlan and major third-party administrators make huge 
profits by charging high fees to employers, short-changing 
health care providers, and leaving workers on the hook for 
exorbitant medical bills, and yes, frequently their actions 
lead to death.
    This is not an efficient use of our health care dollars, 
which is why Ranking Member Scott and I have written to the 
Department of Labor in support of their oversight on these 
practices, and more funding for them so they can do a 
reasonable job.
    I sincerely hope my Republican colleagues will consider 
joining us to address these issues, including by supporting 
adequate funding for the vastly under-resourced Employee 
Benefit Security Administration and extending the bipartisan No 
Surprises Act implementation fund, which expires at the end of 
the year.
    Despite the challenges we continue to face, it is also 
important to acknowledge the significant progress we have made 
in recent years. The Affordable Care Act has provided 
preventative health services at no cost, protected tens of 
millions of Americans with pre-existing conditions, and 
allowing young people to remain on their parents' health plans 
until they turn 26.
    The American Rescue Plan Act, and the Inflation Reduction 
Act, strengthened ACA premium tax credits. The tax credits 
reduced monthly costs for low-income individuals and provided 
premium relief to millions affected by the subsidy cliff, 
particularly self-employed, small businesspeople.
    Just yesterday the Biden administration, Biden-Harris 
administration, finalized landmark new rules that will benefit 
compliance with the Mental Health Parity and Addiction Equality 
Act, and ensure that behavioral health needs are treated fairly 
by insurers and in health plans.
    While these reforms have strengthened workers' benefits, 
and improved the efficiency of our health care system, I am 
concerned by the proposals to take us backward. For instance, 
one of our biggest recent successes in that Biden-Harris 
administration, for the first time recently completed 
negotiations under the Inflation Reduction Act, to reduce drug 
prices for nearly 9 million Medicare beneficiaries, while 
slashing seniors' out of pocket costs by 1.5 billion dollars in 
2026 alone.
    Despite these historic savings, the Republicans' extreme 
Project 2025 policy agenda proposes to repeal this program, and 
instead put billions in the pocket of big pharma. I am a 
recipient of one of those ten drugs. When I first got it to 
save me from stage 4 cancer, it cost as much as $500.00 a day. 
Now, next, thanks to this, and the pressure we put on them, it 
is close to what the European Union charges of under $90.00 a 
day.
    In Australia it costs $37.00 a day. American taxpayers are 
subsidizing lower costs in other developed countries. Rather 
than roll back our historic progress, this Committee should 
move forward with House Democrats' legislation to extend drug 
price negotiations beyond Medicare and save billions for 
workers and businesses with private health insurance.
    While we may not agree on every issue, I hope that today 
will be a robust discussion of the future of employer-sponsored 
coverage, and how we can collaborate across the aisle to 
address the challenges we face and get rid of the 
inefficiencies and the greedy profit-taking by some of private 
sector entities. I yield back.
    [The Statement of Ranking Member DeSaulnier follows:]

  Statement of Hon. Mark DeSaulnier, Ranking Member, Subcommittee on 
                 Health, Employment, Labor and Pensions

    As a point of order, I question the relevance of that video in 
particular. It was more of a political statement. I know that there is 
some license here in Congress for that, but that was the most extreme 
in the ten years I have been here in Congress.
    Mr. Chairman, there is work we can do with ERISA, clearly. Being as 
partisan as you just introduced us, in using absolutes about ``every 
time there's a tax increase, every time the government spends money, it 
leads to all of these horrible things.'' This is a mixed market 
economy, a capitalist economy, and it requires rules and guidance that 
we all come to an agreement on to make it work--including, 
unfortunately, some of the worst aspects of human nature--greed and the 
lack of ethics. We will talk about that a little bit today, for 
instance, with MultiPlan.
    In the spirit that we have had for the last four years we have been 
on this committee, I appreciate our differences. That was a rather 
extreme opening comment from my perspective.
    To the witnesses, thank you for being here. All of your 
perspectives are valuable, and we appreciate it during this important 
hearing on ERISA.
    When ERISA was enacted in 1974, Congress made its intent clear: the 
law's primary purpose is to ``protect the interests of participants in 
employee benefit plans and their beneficiaries.'' To that end, ERISA 
established crucial consumer protection standards, provided remedies to 
workers whose claims were denied or whose plans were mismanaged, and 
required fiduciaries to act solely in the best interest of the plan 
participants.
    As our Subcommittee discusses ERISA today, it is vital to keep this 
fundamental purpose at the forefront. It is about consumers.
    In addition, we must also keep in mind the urgent need to improve 
the efficiency of our health care system.
    Our country currently spends more than 17 percent of our gross 
domestic product, over $4.5 trillion, on health care--far more than our 
peer countries. Workers and consumers are increasingly shouldering 
these costs through rising premiums and deductibles, yet our health 
outcomes are among the worst in the developed world. In other 
countries, they have a form of universal health care so everyone can 
get quality health care. Different versions in different countries 
allow for the private sector to participate in it. They have better 
outcomes and longer life spans.
    The health care system is plagued by numerous challenges and 
inefficiencies, including:

     the lack of price transparency;
     the excessive fees charged by self-dealing third-party 
administrators and pharmacy benefit managers; and
     the escalating costs of medical care and prescription 
drugs.

    As The New York Times has documented, companies like MultiPlan and 
major third-party administrators make huge profits by charging high 
fees to employers, shortchanging health care providers, and leaving 
workers on the hook for exorbitant medical bills--and yes, frequently, 
their actions lead to death. This is not an efficient use of our health 
care dollars, which is why Ranking Member Scott, and I have written to 
the Department of Labor to support their oversight on these practices 
and more funding for them so they can do a reasonable job.
    I sincerely hope my Republican colleagues will consider joining us 
to address these issues, including by supporting adequate funding for 
the vastly under-resourced Employee Benefits Security Administration 
and extending the bipartisan No Surprises Act Implementation Fund, 
which expires at the end of the year.
    Despite the challenges we continue to face, it is also important to 
acknowledge the significant progress we have made in recent years. The 
Affordable Care Act has provided preventive health services at no cost, 
protected tens of millions of Americans with preexisting conditions, 
and allowed young people to remain on their parent's health plans until 
they turn 26. The American Rescue Plan Act and the Inflation Reduction 
Act strengthen ACA premium tax credits. The tax credits reduced monthly 
costs for low-income individuals and provided premium relief to 
millions affected by the subsidy ``cliff,'' particularly self-employed 
small businesspeople. Just yesterday, the Biden-Harris Administration 
finalized landmark new rules that will benefit compliance with the 
Mental Health Parity and Addiction Equity Act and ensure that 
behavioral health needs are treated fairly by insurers and health 
plans.
    While these reforms have strengthened workers' benefits and 
improved the efficiency of our health care system, I am concerned by 
the proposals to take us backwards.
    For instance, one of our biggest recent successes--the Biden-Harris 
Administration, for the first time, recently completed negotiations 
under the Inflation Reduction Act to reduce drug prices for nearly 9 
million Medicare beneficiaries while slashing seniors' out-of-pocket 
costs by $1.5 billion in 2026 alone. Despite these historic savings, 
the Republicans' extreme ``Project 2025'' policy agenda proposes to 
repeal this program and put billions in the pockets of big pharma.
    I am a recipient of one of those ten drugs. When I first got it, it 
saved me from stage four cancer, and it cost me as much as 500 dollars 
a day. Now, thanks to this and the pressure we put on them, it is 
closer to what the European Union charges, 190 dollars a day. In 
Australia, it costs 37 dollars a day. American taxpayers are 
subsidizing lower costs in other developed countries.
    Rather than roll back our historic progress, this Committee should 
move forward with House Democrats' legislation to extend drug price 
negotiations beyond Medicare and save billions for workers and 
businesses with private health insurance coverage.
    While we may not agree on every issue, I hope that today will be a 
robust discussion on the future of employer-sponsored coverage and how 
to collaborate across the aisle to address the challenges we face and 
get rid of the inefficiencies and greedy profit-taking by some private 
sector entities.
    I yield back.
                                 ______
                                 
    Chairman Good. Pursuant to Committee Rule 8-C, all members 
who wish to insert written statements into the record may do so 
by submitting them to the Committee Clerk electronically, in 
Microsoft Word format by 5 o'clock p.m., 14 days after the date 
of this hearing, which is September 24, 2024.
    Without objection, the hearing record will remain open for 
14 days to allow such statements and other extraneous materials 
referenced during the hearing, to be submitted for the official 
hearing record. I note for the Subcommittee that some of our 
colleagues, who are not permanent members of this Subcommittee, 
may be waving on for the purpose of today's hearing.
    I will now turn to the introduction of our distinguished 
witnesses. Our first witness is Ms. Ilyse Schuman, who is 
Senior Vice President for Health and Paid Leave Policy, for the 
American Benefits Council in Washington, DC. Welcome, Ms. 
Schuman.
    Our next witness is Ms. Holly Wade, who is the Executive 
Director of the National Federation of Independent Business 
Research Center in Washington. Welcome, Ms. Wade.
    Our third witness is Mr. Anthony Wright, who is the 
Executive Director of Families USA in Washington, DC. Welcome, 
Mr. Wright.
    Our final witness is Dr. Paul Fronstin, who is the Director 
of Health Benefits Research for the Employee Benefit Research 
Institute, EBRI, am I saying that right, in Washington as well. 
Thank you, Dr. Fronstin.
    We thank the witnesses for being here today, and we look 
forward to your testimony. Pursuant to Committee Rules, I would 
ask that you limit your presentation to a 5-minute summary of 
your written statement. I would also like to remind the 
witnesses to be aware of their responsibility to provide 
accurate information to this Subcommittee, and we will now 
recognize Ms. Shuman for 5 minutes.

 STATEMENT OF MS. ILYSE SCHUMAN, SENIOR VICE PRESIDENT, HEALTH 
 AND PAID LEAVE POLICY, AMERICAN BENEFITS COUNCIL, WASHINGTON, 
                              D.C.

    Ms. Schuman. Chair Good, Ranking Member DeSaulnier, and 
distinguished Subcommittee members, thank you for the 
opportunity to testify on behalf of the American Benefits 
Council. Employers play a critical role in the healthcare 
system, providing health benefits to nearly 180 million 
Americans.
    In sponsoring these benefits, employers have made 
significant contributions not only to the health and well-being 
of working families, but to taxpayers, the economy, and the 
healthcare system as a whole. For 50 years ERISA, and ERISA 
preemptions specifically has been the cornerstone of the 
employer sponsored health benefits.
    America's employers recognize that their investment in 
health coverage is an investment in their workforce, and in 
their business success, and working families and voters 
recognize its value too. According to polling data from the 
Winston Group on behalf of the Alliance to Fight for 
Healthcare, more than three-quarters of registered voters 
expressed satisfaction with their employer-sponsored health 
coverage, far preferring it to a stipend to shop in the 
individual market, and in even more stark preference over a 
system where employers do not provide health benefits at all.
    Employer-sponsored health benefits yield a significant 
return on investment to the Federal Government and taxpayers. 
For every dollar of Federal expenditure for the tax exclusion 
of employer sponsored health benefits, employers pay more than 
$5.00 in benefits. It would cost said taxpayers substantially 
more to provide the same level of health benefits through a 
direct government program.
    With a vested interest in securing the health and well-
being of their employees, far from being mere payers that just 
sign checks for health benefits, our member companies employes 
have been innovators in market driven approaches to provide 
high value benefits. Our member companies also clearly 
understand that their innovation and ability to provide 
affordable, high-quality health coverage, are built on the 
foundation of ERISA, by enabling self-funded multi-State 
employers to offer uniform benefits to their employees 
nationwide.
    However, ERISA preemption is under assault, as states seek 
to impose their own requirements on self-funded group health 
plans. Without ERISA uniformity, these plans will be 
extraordinarily difficult to administer, forcing employers to 
offer different benefits to their employees based on their 
location.
    ERISA's 50th anniversary comes at a critical time to convey 
this important message. I also want to stress that employers 
are deeply concerned about overly burdensome Federal health 
plan regulations that add cost and complexity, but without 
commensurate value to either plan sponsors or employees.
    I also want to stress that employers are deeply concerned 
about rising healthcare costs, fueled by a lack of transparency 
and competition. While employers continue their innovative 
efforts to lower cost, Federal legislative solutions are needed 
to create a more competitive and transparent healthcare 
marketplace.
    90 percent of voters with employer sponsored coverage agree 
that it is important for Congress to take action this year to 
lower healthcare costs. There are solutions at hand. The 
Council strongly supports the lower cost, more transparency, 
including its PBM provisions, and more than 80 percent of 
voters agree that it should be a priority for Congress to pass 
price transparency legislation.
    The Healthy Competition for Better Care Act is critical 
that with growing market power, large hospital systems are able 
to demand higher and higher prices and impose anti-competitive 
contracting restrictions that stifle competition. The Council 
urges the Committee to pass the Healthy Competition for Better 
Care Act.
    Allowing hospital facility fees to be charged for 
telehealth appointments is precisely the type of payment 
distortion and obtuse billing practice that increases costs for 
patients and payers. Voters agree by an overwhelming margin of 
8 to 1, that patients should not be charged for this. The 
Council urges the Committee to approve the Transparent 
Telehealth Bill's Act to address the concern.
    On this 50th anniversary of ERISA, the message is strong 
and clear from employers, employees and voters about the 
significant value of employer sponsored health coverage, that 
is built on their foundation--is the call for Congress to take 
action this year to lower healthcare costs.
    These steps rely on and must be taken in concert with the 
uniformity ERISA preemption affords. 50 years after this 
landmark legislation was enacted, these provisions are even 
more important today. I appreciate the opportunity to testify.
    [The prepared statement of Ms. Schuman follows:]
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    Chairman Good. Thank you. I now recognize Ms. Wade for 5 
minutes.

   STATEMENT OF MS. HOLLY WADE, EXECUTIVE DIRECTOR, NATIONAL 
FEDERATION OF INDEPENDENT BUSINESS RESEARCH CENTER, WASHINGTON, 
                              D.C.

    Ms. Wade. Chairman Good, Ranking Member DeSaulnier, and 
distinguished members of the Subcommittee, on behalf of NFIB, I 
appreciate the opportunity to testify. Small businesses are the 
foundation of the U.S. economy, but unfortunately in recent 
years, the small business half of the U.S. economy has been 
significantly impacted by inflation, along with significant 
challenges in attracting qualified applicants for open 
positions.
    Operating a business in these conditions is particularly 
difficult for small business owners. Most small business owners 
compete for talent by offering competitive wages and attractive 
benefits. Health insurance is one of the most popular, but 
costly benefits offered by about 30 percent of small employers.
    However, escalating health insurance costs add to the 
inflation pressures many business owners face. These higher 
costs limit their ability to compete in the marketplace. The 
relationship between small businesses and health insurance has 
been a long-standing challenge for owners, whether they offer 
or do not offer the benefit to their employees.
    63 percent of all employers believe that providing health 
insurance to recruit and retain employees is very or moderately 
important to them. Almost all, 94 percent of small employers 
find it challenging to some degree to manage the costs of 
providing employer-sponsored health insurance.
    The cost of health insurance continues to rank as the most 
burdensome issue for small business owners, a ranking it has 
held since 1986. Currently, 41 percent of small business owners 
reported as a critical issue in operating their business. The 
average cost of individual health insurance plan has increased 
112 percent in the last 20 years for small employers.
    The average deductible for those policies has increased by 
194 percent. Small businesses are not only paying significantly 
more for their health insurance, but their deductibles are more 
costly as well. In response to these escalating costs, the 
offer rate among small businesses has declined from 42 percent 
in 2004 to 30 percent in 2023.
    Lack of insurance options, and affordability issues create 
significant headwinds for small business owners, and that most 
of them find the benefit important in retaining current 
employees and recruiting applicants. Broken down by employers 
who do and do not currently offer health insurance, 94 percent 
of owners who currently offer, believe that it is important, 
and 58, over half, percent of owners who do not currently 
provide health insurance find it important in those aspects of 
retaining and retention of employees.
    Almost two-thirds of non-offering small employers say that 
the health insurance is too expensive for them to offer it as a 
benefit. Most small business owners are offering health 
insurance purchase fully funded plans in the small group 
market. However, the small group market has experienced a sharp 
decline in issuer participation, and overall membership.
    Down 7.4 percent from 2022 to 2023, ending the year with 
8.5 million participants. This decline is driven primarily by 
the escalating cost of insurance. The coverage options in this 
market have declined. Alternatives, like those provided under 
ERISA framework become vital.
    Recent reports point to an increase in the percentage of 
small firms offering health benefits through a level funded 
plan, for instance. As we mark the 50th anniversary of ERISA, 
it is an opportune time to reflect on the rule that employer 
provider coverage has played in the U.S. and on small 
businesses. While most small firms remain fully insured, ERISA 
protections have been crucial in ensuring that even the 
smallest businesses can offer health benefits to their 
employees, while having the flexibility and predictability to 
design benefits in a way that works best for them.
    Moving forward, ERISA should be protected and strengthened 
to empower those small businesses with greater coverage choices 
under this framework, enabling them to offer valuable benefits 
that will contribute to their growth, stability and success in 
the U.S. economy.
    Some policy solutions to strengthen small firm's coverage 
choices; allowing small businesses and self-employed 
individuals to band together to achieve savings through 
economies of scale, protect small business's access to stop 
loss insurance, re-evaluate and right size mandates that drive 
up premium costs, and promote price transparency and price 
certainty.
    We thank the Committee for its vital work in the past year, 
expanding coverage choices for small businesses under ERISA, 
and look forward to partnering with you to continue building on 
this law's success. Thank you for allowing me the opportunity 
to testify for you today.
    [The prepared statement of Ms. Wade follows:]
   [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    

    Chairman Good. Thank you. I will now recognize Mr. Wright 
for 5 minutes.

 STATEMENT OF MR. ANTHONY WRIGHT, EXECUTIVE DIRECTOR, FAMILIES 
                     USA, WASHINGTON, D.C.

    Mr. Wright. Thank you. Good morning, Chairman Good, Ranking 
Member Scott, Ranking Member DeSaulnier, and members of this 
Committee. My name is Anthony Wright. I serve as the Executive 
Director of Families USA, a national health care consumer 
advocacy organization.
    I appreciate the opportunity to testify on behalf of 
consumers and workers on the 50th anniversary of ERISA, which 
is an excellent excuse to have some cake, but also to reflect 
on the employer-sponsored coverage, and its State, which is the 
pillar of our healthcare system that covers 60 percent of the 
Nation, 164 million Americans, including two-thirds of them in 
self-insured plans under ERISA.
    Workers with on-the-job benefits often consider themselves 
lucky to have group coverage, having a large employer share in 
the cost of coverage, and negotiate for the best quality and 
cost. They increasingly need help to access basic benefits, or 
key consumer protections, and most of all on affordability.
    Only Congress can provide that help. Since ERISA's broad 
State preemptions significantly diminish states' ability to 
innovate and improve healthcare quality, access, and 
affordability. Limiting states from even enacting modest 
efforts, like requirements to contribute to State health 
payment data bases for greater price transparency.
    Therefore, it is Congress that needs to be vigilant and 
proactive in updating ERISA, and other Federal laws, to improve 
health access and affordability. That is why Families USA, over 
the last many decades, has supported the many congressional 
actions to improve ERISA, such as COBRA, HIPAA, mental health 
parity and the Affordable Care Act. The most recent example is 
the No Surprises Act, which bans surprise bills.
    Prior to that, 33 states passed their own protections, but 
they did not apply to millions of their residents in self-
insured plans. Congress should continue to take steps that 
supplement State action, whether on the unfinished work on 
surprise ambulance bills, or on filling holes on ERISA's 
standards and patient protections.
    For example, should all large employers be required to 
provide the same essential health benefits that small employers 
give their workers? Some states are now working to update and 
improve their essential health benefit standards to better meet 
consumers' needs. The Federal Government should follow.
    Similarly, only Congress could provide relief to those in 
self-insured plans who need more comprehensive remedies for 
denials of medically necessary care. Another issue, when 
consumers have these or other problems, no one knows where to 
go for help. I mean no one. While 40 percent of the Nation are 
in these self-insured plans, in a recent KFF survey, zero 
percent of respondents guessed that their plan was regulated by 
the Federal Department of Labor.
    Congress should ensure that the Department has the adequate 
staffing and resources to ensure proper oversight of ERISA 
plans and their finances, to take complaints, and to support 
consumer assistance programs to help people navigate our 
complex health care system.
    Ultimately, the biggest issue for ERISA plans is the 
biggest issue in all of health care: affordability. No one is 
insulated from high health care costs, not even large employers 
and their workers. Inflated and irrational health care prices 
are putting Americans' health and financial security at risk.
    More than 100 million Americans are saddled with medical 
debt. Half of all Americans report foregoing medical care due 
to cost, and a third of Americans indicate that the costs of 
medical services interfere with securing basic needs, like 
groceries and rent.
    Over the past 25 years, the cost of family employer-based 
plan has increased from $6,500.00 to almost $24,000.00. The 
worker's share of premium and out-of-pocket costs has risen 
dramatically as well. In 2007, 60 percent of individuals in 
employer-based coverage had minimal deductibles under $500.00. 
Now 60 percent have deductibles over $1,000.00.
    For most low-wage workers, that means they have to pay more 
than what they have in the bank before most of their coverage 
even kicks in. For workers and employers alike, as we see 
today, rising healthcare costs have become unsustainable.
    Fortunately, Congress has the opportunity to take action to 
improve health care affordability, including addressing the 
underlying market failures that drive rising health care costs, 
ensuring price transparency, site-neutral payments, and other 
reforms advanced by this Committee in the Lower Costs, More 
Transparency Act. Broadening the prescription drug cost 
containment policies in the Inflation Reduction Act into the 
commercial market, so that we have more discounts for more 
drugs for more people.
    Taking timely access to extend enhanced tax credits to 
prevent dramatic premium spikes if they are allowed to expire 
next year and instituting and updating caps on out-of-pocket 
costs, both for prescription drugs and generally.
    Thank you again, for the opportunity to join in today's 
discussion on the ways to build on the foundation of ERISA to 
improve access to affordable coverage to everyone, including 
workers and their families. I yield back.
    [The prepared statement of Mr. Wright follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Chairman Good. Thank you. I will now recognize Dr. Fronstin 
for 5 minutes.

   STATEMENT OF DR. PAUL FRONSTIN, DIRECTOR, HEALTH BENEFITS 
RESEARCH, EMPLOYEE BENEFIT RESEARCH INSTITUTE, WASHINGTON, D.C.

    Mr. Fronstin. Chairman Good, Ranking Member DeSaulnier, and 
distinguished members of the Subcommittee, my name is Paul 
Fronstin. I am the Director of Health Benefits Research at the 
Employee Benefit Research Institute. Established in 1978, EBRI 
is committed to data dissemination, and policy research in 
education on financial security and employee benefits.
    Consistent with our mission, EBRI does not lobby or 
advocate specific policy recommendations. Thank you for the 
opportunity to appear before you today. Employers' commitment 
to worker health established its roots in the late 1800's. 
Examples of health programs include the mining, lumbering and 
railroad industries. Employers had a practical interest in 
their workers' health.
    During World War II, employers began to offer more formal 
health insurance. Because employer contributions to insurance 
did not count toward wage controls, health insurance became an 
attractive means to recruit and retain employees.
    Employers today offer health coverage because of their 
belief that offering has a positive impact on the overall 
success of the business, and ERISA's preemption of State law 
has created an environment of national uniform standards for 
employee benefit plans, thus giving employers the regulatory 
means to continue to offer health benefits as they do today, 
yet there have been questions along the way as to whether 
employers have reached the tipping point with health benefits.
    Predictions have been made that employers would stop 
offering coverage. In this testimony, I examine how the 
availability of employment-based health coverage has been 
changing, by examining employer sponsorship of coverage, as 
well as employee eligibility for coverage.
    There is no comprehensive dataset that allows us to go back 
to the days of ERISA. However, the percentage of the population 
with employment-based health benefits can be tracked. It was at 
or near 70 percent between 1970 and 1989, between 1989 and 2007 
it varied between 62 and 68 percent. Since then, it has varied 
between 58 and 62 percent, with 61 percent in 2022.
    The declines in coverage often coincided with relatively 
high increases in premiums, though there were years when the 
correlation was far from perfect. The more recent stability in 
premiums coincided with stability in the percentage to 
population with employment-based health coverage.
    In 2022, employment-based health coverage continued to be 
the most common source of health coverage. When examining data 
since 1996, the percentage of employers offering health 
benefits was at a near record low in 2023. However, it is 
important to put this in context. Small employers are in large 
part responsible for the decline in coverage, and most 
employers in the U.S. are small.
    Just about every employer with 100 or more employees offer 
health benefits today. Despite the overall decline and the 
percentage of employers offering health coverage, the 
percentage of workers eligible for health benefits has been 
mostly constant since 1996. The eligibility rate has not 
changed much because the majority of workers are employed by 
large firms.
    Workers have historically rated their health coverage as 
favorable and continue to do so. Just over one-half are 
extremely, or very satisfied with their current plan, and one-
third is somewhat satisfied. Only 12 percent say they are not 
at all satisfied, and these figures are essentially unchanged 
since the late 1990's.
    ERISA effectively preempts State and local regulation of 
self-funded health benefits. The scope of this has generated 
some degree of debate. Proponents of ERISA preemption point to 
the creation of a uniform and predictable regulatory 
environment for employers, while detractors believe that State 
and local governments ought to have a great role in pursuing 
healthcare reform, beyond their current ability to regulate 
health insurance.
    On Thursday, EBRI is releasing the findings from a series 
of focus groups, with benefits decisionmakers of large 
employers. Three main themes emerged from these discussions. 
First, under ERISA preemption, there is a uniform landscape of 
regulations, rather than a patchwork of different State level 
regulations, which makes it possible for an employer operating 
in more than one State to administer and offer benefits 
equitably to their employees.
    Second, ERISA preemption reduces administrative costs, thus 
enabling employers to deliver richer benefits and lower cost 
coverage to their workers. Third, ERISA preemption fosters 
innovation that would otherwise be stifled by different states 
requiring different coverages or administrative rules.
    Employers remain committed to providing health benefits to 
employees and their families. If ERISA preemption were eroded, 
however, benefits executives worry about higher costs for 
providing health benefits.
    Chairman Good, thank you again for the opportunity to 
appear before the Committee today. My colleagues and I look 
forward to working with you and members of the Committee in the 
future. Thank you.
    [The prepared statement of Dr. Fronstin follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Chairman Good. Thank you. Under Committee Rule 9, we will 
now question witnesses under the 5-minute rule, and I will wait 
to ask my questions at the end, and therefore, recognize Mr. 
Walberg from Michigan for 5 minutes.
    Mr. Walberg. Thank you, Mr. Chairman, and thanks to the 
panel for being here. The Employer Retirement Income Security 
Act, ERISA, enacted in 1974 is a cornerstone of American labor 
law that has profoundly shaped the landscape of employer 
sponsored insurances we have all mentioned today.
    ERISA has played a vital role in elevating the quality of 
employer sponsored insurance over the past 50 years. It has 
empowered workers, retirees, and others to make informed 
decisions about their health and retirement benefits, ensuring 
that their needs are met throughout their careers, and into 
retirement.
    ERISA has not only contributed significantly to the 
stability and security of millions of working families, but 
also brings tremendous values to taxpayers and the economy 
overall. Thank you to the witnesses for being here to help 
commemorate ERISA's 50th anniversary.
    Mr. Chairman, I do not see any balloons in the room, but we 
probably should have had some, though we do have some hot air, 
I guess, in the room. Ms. Schuman, thank you for being here. In 
what key ways has the healthcare industry changed since the 
passage of ERISA in 1974?
    Ms. Schuman. Thank you, Congressman, for that question. The 
healthcare industry has changed dramatically in the past 50 
years. It has certainly become more complex and consolidated, 
but it has also become more innovative, and a lot of this 
innovation has been enabled and fueled by ERISA, and the 
employer innovation that that enables and fuels.
    Mr. Walberg. Let me jump on that and ask you to suggest 
some top recommendations that you might give to Congress on how 
ERISA can continue to protect employer's ability to offer high-
quality and affordable health benefits.
    Ms. Schuman. Well, first of all let me thank you by 
recognizing the connection between ERISA and the ability of 
employers to offer affordable, high-quality coverage. That is 
predicated on ERISA and ERISA preemption, and the ability to 
offer affordable high-quality coverage to their employees 
nationwide.
    My top recommendation for you on how ERISA can continue to 
protect employer's ability to do so, is to protect ERISA 
preemption, mindful of expanding efforts at the State to erode 
that. Congress does need to do more to address the lack of 
transparency and competition in the healthcare marketplace that 
are driving higher costs for employer sponsored coverage, and 
those two can and must be taken in step, protecting ERISA and 
ERISA preemption, and at the same time taking action to lower 
healthcare costs. Thank you.
    Mr. Walberg. Thank you. Ms. Wade, could you discuss the 
challenges small employers face when they try to offer coverage 
to their employees, and what kinds of innovative coverage 
models would make it easier for small businesses to offer 
health coverage, and also if you would comment on how expanding 
access to association health plans would help small businesses 
to offer coverage?
    Ms. Wade. Certainly. Thank you for the question. For small 
firms, they are challenged in a whole myriad of ways, one of 
which is whether they offer health insurance at the beginning 
of operating their business as an employer firm. The challenge 
of costs and affordability is impacting their ability to 
construct competitive packages to attract talent, to retain 
their current employees.
    One of the key components for small business in the 
affordability aspect, is allowing a diverse array of plans and 
structures and the benefit to offer their employees that makes 
sense to them. More transparency in the cost part of it but 
offering more plan designs that makes sense for them to offer 
to their employees.
    Association health plans, the way it is constructed is very 
specific and confined, and restricted to a lot of small 
business owners currently. Expanding the availability of 
Association health plans to a larger population would allow 
them to purchase in economies of scale that are more afforded 
by large firms and will give them a competitive leg up from 
their current status right now in being able to afford.
    As I mentioned in my statement, those who are not able to 
afford health insurance and offering currently are looking to 
do that. They want to be able to compete for talent and retain 
current employees, so many of them are hoping that in the 
future the affordability will be more manageable, and that they 
will be able to offer the benefit to their employees because 
they know that that is the second most valuable, outside of 
wages, for competitive structure of that.
    Mr. Walberg. Thank you. My time has expired. I yield back.
    Chairman Good. Thank you. We will now recognize Mr. 
Courtney from Connecticut for 5 minutes.
    Mr. Courtney. Thank you, Mr. Chairman. To the witnesses, 
you know, Mr. Fronstin I think did a really nice job about 
going back to the origins of employer-sponsored insurance that 
the World War II decision to make the value of those plans tax-
exempt, really has been sort of foundational.
    Again, I would just like to ask all the other witnesses, 
the simple question yes or no, do you think Congress should 
reduce the tax-exempt status of health care--employer-sponsored 
health plans?
    Ms. Schuman. Absolutely not.
    Mr. Courtney. Ms. Wade.
    Ms. Wade. Absolutely not.
    Mr. Courtney. Mr. Wright.
    Mr. Wright. Given that it is a foundation for 60 percent of 
people to get coverage, no.
    Mr. Courtney. Again, the reason, and as a former employer, 
is that if Congress made that move, it basically would add to 
the taxable income of all the employees of Ms. Wade's 
membership, as well as Ms. Schuman's membership. Unfortunately, 
this is a very relevant issue in 2024.
    Project 2025, which is the document generated by the 
Heritage Foundation, with dozens of former Trump officials, 
Russell Vought, the former budget director of the Trump 
administration, also the Chair of the Republican National 
Committee's Platform Committee, again, in that package in 
Project 2025, it proposes to cap the tax exclusion below 100 
percent, which is a tax increase for workers of employee-based, 
employer-sponsored plans.
    The Republican Study Conference, which again is closer to 
home here in the House, about 70 percent of the membership of 
the majority caucus issued their 2025 budget document earlier 
this year, which proposed the same thing. Again, if you look at 
the history surrounding this issue, Milton Friedman, the 
Godfather of conservative economics, wrote an essay.
    Mr. Fronstin is probably familiar with it, How to Fix 
Health Care Costs, where he proposed eliminating the tax-exempt 
status of employer sponsored insurance. This year, in 2024, 
given the fact that we have Project 2025, which again, has got 
the fingerprints of the former President's former employees, as 
well as people working on his campaign, proposing to cap the 
tax exclusion, as well as the Republican Study Conference doing 
exactly the same thing.
    When we are talking about threats to employer-sponsored 
insurance in 2024, that is really the elephant in the room in 
terms of making sure that the foundational cornerstone that 
created employer-sponsored insurance, back during World War II 
remains intact. I can say this as somebody who when we passed 
the Affordable Care Act, and Ms. Schuman knows this, it 
included a Cadillac tax, which we furiously were succeeded in 
terms of delaying the impact of that for 10 years after the law 
passed.
    Then finally, in the House, with a bill that I was the lead 
sponsor, and had great bipartisan support, stripped that from 
the law by a vote of 419 to 6. There is strong bipartisan 
support for maintaining the tax-exempt status of employer-
sponsored insurance. However, that is very much, very, very 
much at risk in terms of just the positioning of different 
forces, think tanks and other groups, that really want to go at 
this.
    Which again, if you go back and read the Godfather, Milton 
Friedman's economic treatises on this, I mean that is a, you 
know, just a fundamental tenant of a lot of conservative 
economists in this country, which is that that's really the 
source of a lot of the problems for the costs of health care 
insurance.
    Mr. Wright, you mentioned the fact that the Inflation 
Reduction Act last August 15th during the recess, announced the 
first ten medications, in terms of the negotiated prices. 80 
percent cut in cost of some of those very high-cost, high-
utilized medications in Medicare.
    We have a bill, the Lowering Drug Costs for American 
Families Act, which would extend the benefits of that 
negotiation to employer-sponsored plans, or individual plans, 
optional. Do not have to do it if you do not want it, but can 
you, from Families USA, would that help small employers as well 
as individuals get the benefit of lower costs, which are 
driving higher premiums?
    Mr. Wright. The short answer is, yes, that individuals, 
businesses, insurers, other payers, are all struggling with the 
cost of high inflated and irrational health prescription drug 
prices. Using the authority of negotiation that is in the 
Inflation Reduction Act to extend those discounts, not just to 
the Medicare program, but more broadly in the commercial 
market, would be a big boon, and start to chip away at the 
affordability issues that people have at the pharmacy, and when 
paying premiums.
    Mr. Courtney. Thank you. I yield back.
    Chairman Good. Thank you. We will now recognize Mr. Allen 
from Georgia for 5 minutes.
    Mr. Allen. Thank you, Mr. Chairman, and first, just 
quickly, my position on employer health insurance or ERISA. We 
can always have a government program in this country, but we 
need to give the business community the flexibility to provide 
the best coverage at the best value for their employees. The 
business community will figure this out.
    My position is to give this coverage the same waivers that 
the Affordable Care Act gave to unions and the faith-based 
company--faith-based part of the healthcare industry, so that 
we can get totally away from Federal regulatory issues dealing 
with ERISA, as far as compliance, and all the costs, and 
everything that is being added to that.
    I also want self-employed people to be able to participate 
in ERISA. We do not have time to discuss that today, but I 
would like your written response to that idea as far as going 
forward and how to solve the tremendous cost increase in health 
insurance.
    In recent years, another matter is growing adoption of so-
called alternative funding programs and employer sponsored 
plans. Some stakeholders have suggested that AFP vendors divert 
employees into their programs, and push employers to adopt 
discriminatory benefit designs that single out medicines that 
treat specific conditions.
    They suggested this type of action could violate ERISA and 
HIPAA compliance. Representative McBath and I recently sent a 
letter urging the Department of Labor to investigate the 
prevalence of AFPs in the employer sponsored health coverage 
market, and asked the DOL to take action to prevent these 
predatory practices.
    Ms. Schuman, how well do you think employers are aware of 
potential ERISA compliance risks with AFPs? Have you provided 
any education about compliance risk to member companies?
    Ms. Schuman. Thank you for that question, Congressman. The 
Council's membership typically rely on traditional PBM and drug 
payment models, so members have not raised AFPs as an issue 
that I am aware of, and the Council has not actively addressed 
AFP with its members. It does sound like this is certainly a 
concerning practice, but I said it has not been brought to our 
attention by our membership.
    Certainly drug costs are a big concern for our members, and 
just want to take this opportunity to again offer my support 
for the great bipartisan work of this Committee already in the 
Lower Cost More Transparency Act, to bring more transparency 
and oversight of PMBs in an effort to do that.
    Mr. Allen. Well, it is a long and frustrating fight to get 
your medications approved through the PBM step therapy process. 
It often results in missed days of work, and a worsening of 
their condition. The lack of transparency, as you mentioned, 
PMB practices makes it difficult for employers to assess 
whether the administration of drug benefits aligns with their 
employees' best interest and well-being.
    Many people I represent in the Georgia's 12th District, 
experience these same frustrations, which is why I am proud to 
cosponsor the Safe Step Act, which would ensure employer health 
plans, including their contracted PBMs, offer an expedient and 
medically reasonable step therapy exceptions.
    Dr. Fronstin, how would legislation such as Safe Step Act 
help people with chronic conditions, who are covered by the 
ERISA plan?
    Mr. Fronstin. I have not studied the Safe Step Act, 
specifically, but it sounds like it would streamline prior 
authorization process, and speed up the process again for 
certain medications, when all the medications are not working 
as expected.
    Mr. Allen. What can be done to help employers navigate the 
complex benefit structures, pharmacy networks, and formularies 
that are obscured by the PBM incentives?
    Mr. Fronstin. PMB incentives are complex, and I think 
building an employee benefit program is complex as well for 
many employers, even large employers, and sometimes beyond the 
expertise of many benefit managers. That is why they use 
consultants, use ERISA attorneys.
    They often learn from each other at conferences. There are 
some purchasing coalitions that employers have joined to help 
them navigate a complex healthcare system, and provide them 
some leverage.
    Mr. Allen. Thank you. I am out of time. I have additional 
questions I would like to submit for the record. With that I 
yield back.
    Chairman Good. Thank you. Without objection.
    [The information of Mr. Allen follows:]
    Chairman Good. I now will recognize Ms. Manning from North 
Carolina for 5 minutes.
    Ms. Manning. Thank you. With regard to the antics at the 
top of this hearing, I did not realize we were playing campaign 
ads here. In fact, I thought there were ethics rules that 
separate our official acts from campaigning, and if I had 
known, I certainly would have brought a few campaign ads of my 
own to play.
    I would like to turn to the actual subject of this hearing, 
and I want to start by thanking our witnesses for being here, 
to celebrate the anniversary of ERISA. It is the essential 
cornerstone of our Nation's health care policy, and the 
consumer protections Congress has passed to strengthen it, such 
as the Affordable Care Act, have ensured better outcomes for 
millions of Americans.
    Sadly, for almost 15 years, the Republican Party has waged 
an all-out war on the ACA, and the landmark consumer 
protections it has enshrined into law for millions of working 
people in this country. These include protections for more than 
130 million Americans with pre-existing conditions, requiring 
coverage of contraceptives, prohibiting charging women higher 
premiums than men for the same coverage and so much more.
    In April of this year, 62 percent of the public had a 
favorable opinion of the ACA, and these protections are 
critical to my constituents and frankly, they are critical to 
my family. I have a daughter who has a serious pre-existing 
condition, a chronic illness that thankfully is successfully 
treated with a biologic that would cost her $23,000.00 every 
month, if not for the protections of the ACA.
    I am grateful that we passed the IRA, which will finally 
allow our government to negotiate over some of the most 
expensive prescription drugs available, and I am also 
astonished that the Republicans continue to push for the repeal 
of the ACA. In fact, Project 2025, Trump's Project 2025, lays 
out a plan for undermining and destroying the ACA.
    Project 2025 has a detailed plan from a right-wing think 
tank for the next Republican administration. Mr. Wright, let me 
ask you about this. One of the key policies of Project 2025 is 
to separate the subsidized ACA insurance market from the non-
subsidized insurance market.
    Can you explain what this would mean for Americans left out 
of the ACA's protections?
    Mr. Wright. I think the things that we would be concerned 
about is the loss of consumer protections and ultimately 
coverage for millions of Americans who depend on that coverage, 
that would have--losing those protections, and for some would 
be a problem. Losing the coverage would also have a 
destabilizing impact on the overall market because those who 
are no longer covered would be left in a smaller and sicker 
risk pool, and thus have ever increasing premiums as a result.
    The loss of consumer protection would be broader than that, 
and that would be the concern, whether it is access to basic 
essential health benefits, or as you mentioned, an issue with 
regard to being able to get the care that you need, regardless 
of pre-existing condition.
    Ms. Manning. For example, it could cause the loss of 
protections for people like my daughter, who have a pre-
existing condition, as do millions of Americans across the 
country. Is that correct?
    Mr. Wright. That is correct.
    Ms. Manning. Thank you. Overall, would this reduce 
American's health care costs, or increase them?
    Mr. Wright. As I mentioned, the destabilizing effect would 
not be just an impact on the people who would lose the subsidy, 
or lose the coverage, but also have a broader impact on the 
system as a whole, in terms of leaving people in a smaller and 
sicker risk pool, with higher premiums. Yes.
    Ms. Manning. To put it plainly, it could increase health 
care costs overall. Is that correct?
    Mr. Wright. Yes.
    Ms. Manning. Project 2025 also calls for keeping ``anti-
life benefits'' out of benefits plans, including coverage for 
abortion care, and I assume, including coverage for 
contraception or birth control, and this is actually written in 
the plan, including costs for surrogacy. Mr. Wright, could you 
speak to the benefits that reproductive care coverage has had 
for Americans?
    Mr. Wright. It is critical that people have the ability to 
plan and start families when and how they want them, but also 
to get the prenatal and postnatal care to have healthy babies, 
and children, and adults. This is critical, especially now that 
we are in a maternal--we have a maternal mortality crisis, and 
so those kinds of services are incredibly important to make 
sure that we deal with both disparities and the overall quality 
of care.
    Ms. Manning. Thank you. I have more questions. I will 
submit them in writing. Thank you very much.
    Mr. Wright. Thank you.
    Chairman Good. Thank you. We will now recognize Chairman 
Foxx from North Carolina for 5 minutes.
    Mrs. Foxx. Thank you, Mr. Chairman, and I want to thank our 
witnesses for being here today. It is a very important issue to 
the majority of people in this country, particularly those who 
are covered by employer sponsored healthcare.
    Ms. Schuman, your written testimony highlights anti-
competitive contracting terms, such as all or nothing, and 
anti-steering clauses, which prohibit a plan sponsor from 
contracting with a business associate's competitors or using 
providers outside of a business association's network.
    How did these restrictions affect plan benefit design and 
cost?
    Ms. Schuman. Well, thank you very much for that, for that 
question. As large hospital systems have increasingly acquired 
other hospitals and physician practices, these healthcare 
systems dominate the market, and they use their market power to 
push out lower priced, higher quality competitors. One of the 
ways that they can do that is through these anti-competitive 
contracting terms, that they demand are included in contracts 
with health plans, insurers and third-party administrators.
    These anti-competitive contracting terms come in several 
forms, anti-steering, or anti-tiering provisions, that prevent 
employers from utilizing value-based design to direct employees 
toward lower cost, higher quality providers, or all or nothing 
clauses, for example, that would require the health plan to 
contract with all affiliated facilities and providers, 
including lower quality ones.
    These contract provisions are designed to do one thing, to 
limit access to lower cost, high quality care, and to tie the 
hands of employers in their efforts to promote more value 
driven care. That is why the Council is so strongly supportive 
of the Healthy Competition for Better Care Act, that would 
restrict these anti-competitive provisions, and urges the 
Committee to approve it. Thank you.
    Mrs. Foxx. Thank you very much. You just answered my second 
question. Ms. Wade, the Affordable Care Act does not require 
employers with fewer than 50 employees to offer health coverage 
to their employees, and yet NFIB reports that many employers 
still choose to offer coverage. Can you discuss the benefits 
for small employers, and their employees of offering employer-
sponsored health benefits?
    Ms. Wade. Certainly. NFIB, we have surveyed our members 
periodically over the years, and with the tight labor market 
that they are experiencing now, but have been for years, the 
ability to offer health insurance as the primary benefit 
outside of wages is incredibly important to many of them in 
attracting talent and retaining current employees.
    The availability, the affordability, of this benefit for 
them being able to have a large choice of benefit structures to 
offer their employees is critical for them in those purposes of 
retaining talent and recruiting for open positions. This is one 
of the main hurdles that they face in offering the benefit, is 
cost.
    We survey our members, and they tell us that in the next 
five to 10 years, most of them are very concerned about their 
ability to keep the affordability aspect of offering the 
benefit to their employees, and so they are concerned whether 
they are going to be able to offer the benefit going forward.
    They are concerned about their ability to compete for 
talent in their workforce.
    Mrs. Foxx. Thank you. Dr. Fronstin, your written testimony 
states that ERISA's preemption of State law created an 
environment of national uniform standards for employee benefit 
plans and allows employers to continue to offer health 
benefits. What would health benefits look like today without 
ERISA?
    Mr. Fronstin. That is a really interesting question. I 
think if you go back before ERISA, employers offered coverage 
for business reasons, to be competitive in the labor force. 
Just about every large employer still does. Some small 
employers do, and if you ask the employers, small employers 
that do so, they are doing so for business reasons, to be 
competitive in the labor market.
    They are concerned about employee health and their 
productivity. I do not know that if we did not have ERISA it 
would look any different than that. I think ERISA certainly has 
enabled employers, perhaps large employers to--made it easier 
to offer benefits across State lines, but I still think they 
believe in the reasons why they offered benefits to begin with, 
which is to be competitive in the labor market, and to invest 
in worker health.
    Mrs. Foxx. Thank you very much. My time is expired. I yield 
back.
    Chairman Good. Thank you. Pursuant to previous order, the 
Chair declares the Subcommittee in recess, such to the call of 
the Chair. We will plan to reconvene promptly in 5 minutes at 
11:25. Thank you, so the Subcommittee stands in recess.
    [Recess]
    Chairman Good. The Subcommittee will now come to order 
following a recess. I will now recognize Ms. Hayes from 
Connecticut for 5 minutes.
    Ms. Hayes. Thank you. Thank you to our witnesses for being 
here today. I also want to just thank my colleague, Ms. 
Manning, who left, for bringing up the idea about the ethics 
separation on Committee. I was in the back and saw how this 
Committee opened, and that is not the way we should be doing 
our work, and she brought up the ethics guidelines, which I 
think would be a real issue, except that the people of 
Virginia's 5th have already worked that out for us.
    While hardworking American people are struggling to afford 
medications, drug companies are reporting billions in profits. 
According to Protect Our Care, in the first 3 months of 2024, 
15 of the biggest drug companies reported nearly 173 billion in 
revenue, and nearly 29 billion in net profits.
    In 2022, I voted to pass the Inflation Reduction Act, which 
empowered Medicare for the first time in history, to negotiate 
lower drug prices for millions of seniors. The ten drugs 
selected for the first round of negotiations accounted for over 
55 billion dollars in total Part D gross prescription drug 
costs in 2023.
    These negotiations resulted in a reduction of 38 to 79 
percent on the selected drugs. Mr. Wright, in Project 2025, and 
what we have heard from many Republicans on this Committee, 
there have been calls for repealing the Medicare drug price 
negotiation program. What consequences will seniors face if the 
Inflation Reduction--if that portion of the Inflation Reduction 
Act is repealed?
    Mr. Wright. Thank you for the question. I think there will 
be impacts to both the individual beneficiaries, and to the 
program as a whole. Individual beneficiaries are getting the 
benefits in the Inflation Reduction Act of an overall cap on 
prescription drugs of $2,000.00, access to free vaccines, a cap 
on $35.00 for insulin, but more they are getting the benefit of 
getting the negotiated discount rate when they go to the 
pharmacy, especially if they are under insured.
    If that was to be repealed, those benefits would--those 
direct-to-consumer benefits would go away, but also would be 
the savings to the Medicare program and would have a 
problematic impact on the solvency of Medicare and the trust 
fund.
    Ms. Hayes. Thank you. We are seeing that even with these 
negotiations, these companies are still putting up record 
profits. House Democrats are looking to expand the drug pricing 
negotiation program to private healthcare markets, like those 
covered under ERISA.
    Could you explain how applying the prices secured through 
the Medicare drug price negotiation program will reduce costs 
for millions of Americans with private health insurers?
    Mr. Wright. To the extent that the Medicare, and the 
government is using its purchasing power to negotiate 
discounts, it makes sense that those discounts should be 
applied to the broader public, whether through including in the 
commercial market that would help bring down the premiums that 
payers pay, whether employers, union trusts, or individuals who 
pay out of pocket for premiums.
    Ms. Hayes. Well, will this also have a benefit on the 
employer?
    Mr. Wright. As I said that it would be since the employer 
is often the one that is paying the main premium often with a 
shared cost by the worker, it would have a benefit for both, 
the employer and also the worker, whether the share of premium, 
or as the ability to have those wage increases in other ways.
    Ms. Hayes. Both the employer and the employees would 
benefit from negotiated drug prices, and lowering the cost of 
prescription drugs. Thank you so much for being here.
    Mr. Wright. Thank you.
    Ms. Hayes. The Inflation Reduction Act dramatically lowers 
costs by requiring drug companies to provide rebates when they 
raise list prices faster than inflation limits--then inflation. 
Limits total out of pocket costs through Medicare Part D at 
$2,000.00 annually, and caps insulin costs at $35.00 per month, 
but it is imperative that we pass legislation that would expand 
the drug price negotiation program, and the inflation rebate 
savings to ensure that individuals with private health coverage 
also benefit.
    Can you just speak in my last 40 seconds, about how we are 
talking a lot about Medicare Part D, and people who participate 
in these programs would benefit. How would this expand to 
everyone that would benefit from this type of work?
    Mr. Wright. I think the more we can do to expand these 
benefits broader than the Medicare program, that would be a 
direct benefit to consumers. At the pharmacy, this is one of 
those monthly costs people feel every time they go to the 
pharmacy, but also even for folks who do not use prescriptions 
because it is the premiums everybody pays.
    Ms. Hayes. Thank you. As we are talking about rising 
inflation, and the cost of living, the amount that families are 
paying should be considered as we are thinking about these 
things, and this is something that will definitely help. Thank 
you so much, I yield back.
    Chairman Good. Thank you. We will now recognize Mr. 
Burlison from Missouri for 5 minutes.
    Mr. Burlison. Thank you, Mr. Chairman. Dr. Fronstin, in 
your written testimony you said that small employers have been 
responsible for the decline in the number of employers that are 
offering health benefits. What has happened to cause that to 
occur?
    What steps can we take so that small employers are wanting 
to offer those health benefits?
    Mr. Fronstin. Yes. Keep in mind that small employers were 
never as likely to offer health benefits as large employers, 
and there is clearly an affordability issue there.
    Mr. Burlison. It is just a complexity--part of being a 
small business, right?
    Mr. Fronstin. I think the complexity part comes in because 
a small business, you do not have as many people that you could 
allocate these responsibilities to. You can certainly hire a 
broker to help you navigate the health insurance part of it, 
but that is just one more piece when you are potentially 
starting a business.
    I think the challenge with small businesses is that we have 
done surveys that are dated, right, about 20 years ago, where 
we asked small businesses that did not offer coverage why, and 
whether they thought it had a negative impact on their 
business.
    For the most part they did not. If you cannot convince 
them, and the NFIB was asked a similar question like that 
recently. If you cannot convince these businesses that not 
offering it has a negative impact, I think it is going to be 
very tough to convince them to offer, even if premiums were 
more affordable, they are just not focused on it.
    Mr. Burlison. I had a whole list of questions, and I am 
going to kind of go a little--I am going to wax philosophically 
here if that is okay. I am reflecting on the fact that in 
American at one point employers created pensions, right? They 
managed those pensions, and over time, decades, they became 
unsustainable, they became a liability. There was a lot of 
uncertainty with those, that sometimes you would have people 
that would lose out because their employer might go belly up 
and now their pension is gone.
    The result was this institution created a tax incentive for 
individuals, or created a mechanism so that employers can offer 
IRAs, can offer 401K's, that put the money in the hands of the 
individual. Let me choose where their investments are going, 
let them choose that.
    Could something like that be done with health insurance, 
where the Federal Government is giving the same tax benefits, 
but encouraging the employer to provide a benefit that the 
employee then takes, and takes control of?
    Mr. Fronstin. You could do that now by existing rules with 
individual coverage health reimbursement arrangements. 
Employers can give workers money, a tax-free basis, let them go 
buy insurance on their own. It is not a very popular benefit. I 
think at most there are different estimates, on how many people 
are in such an arrangement. They are all small, right, maybe--
--
    Mr. Burlison. It is not--I have not heard of it, so it is 
very under-utilized?
    Mr. Fronstin. Maybe a million people are in such an 
arrangement, but I do not think we know exactly. I have seen 
numbers of 200,000, maybe 400,000, you add in independents, you 
could double that number, so that is like where the million 
estimate comes from.
    We have asked large employers about it. Some of them we 
have asked about it to see if this is something they would be 
interested in, did not even know about it. I think the NFIB 
survey asked about it as well, and it was a lack of familiarity 
there. I do not remember the specific numbers.
    Mr. Burlison. Um-hmm. Being a former State legislator, I 
saw firsthand how a lot of employers were happy to move to an 
ERISA plan to escape all of the State regulations. The health 
and the mandates on what they have to provide care for, and I 
can only imagine how difficult that would be to go if you were 
occupying or had employees in multiple states.
    What--let me ask this, what else can we do, for example, to 
ramp up that individual program for small business owners. I 
know that we have got the association opportunities as well. Is 
there anything else that you can see?
    Mr. Fronstin. I am not--I do not know to what degree--small 
business. You have got two kinds of small businesses, both 
those that offer coverage, those that do not. I do not know 
that those that offer coverage are going to go in that 
direction, if they are already committed to offering coverage.
    While you have seen some erosion, it has not been very 
large erosion. I think this would be more appealing to 
employers, small employers that did not offer coverage as a way 
just to give their employees some tax-free benefit.
    Mr. Burlison. Has--Ms. Schuman, have these associated 
plans, these plans that where you are grouping people based on 
association, have they experienced any savings?
    Ms. Schuman. Well, you know our member companies are 
primarily large, multi-State employers that provide 
comprehensive healthcare coverage to their employees, so it is 
just not as----
    Mr. Burlison. This may be a question Ms. Wade can answer.
    Ms. Schuman. Yes. I think.
    Chairman Good. The gentleman's time has expired.
    Mr. Burlison. She can answer.
    Chairman Good. We would like her to submit that written for 
the record. Thank you, I apologize. I now recognize Ms. Wild 
from Pennsylvania for 5 minutes.
    Ms. Wild. Thank you. Mr. Wright, I have a particular 
interest and concern about the role of private equity in health 
care, and I do see in your written testimony that you mention 
the role of private equity in health care, and I want your 
opinion on a couple of things in a minute, but just for the 
benefit of people who might not understand what private equity 
is, and tell me if I am incorrect about anything that I say.
    Basically, this is private investors who contribute 
capital, but they leverage their investment with a whole lot of 
debt, and in the case of health care, they may use and likely 
do use physical assets, whether it is hospitals, buildings, or 
whatever, as collateral for that debt.
    Then they have to pay off the debt, which to my mind means 
they probably have to generate a whole lot of revenue in order 
to keep up with payment of that debt. Have I stated it 
correctly so far?
    Mr. Wright. Yes.
    Ms. Wild. Okay. Thank you. I have read that private equity 
has invested nearly a trillion dollars in the health care 
system in the United States since 2006. That means private 
equity collectively, and would it be a fair statement that when 
a consumer, a patient goes to a health care provider, goes to a 
hospital, that the chances are they do not know much about the 
ownership structure of the hospital, or the health care place?
    Mr. Wright. That is a fair statement.
    Ms. Wild. Okay. It is not like there is a big plaque on the 
side that says owned by private equity investors, so and so, 
and so and so. Okay. There has been a number of studies, 
including one by Harvard Medical School about the fact that 
private equity actually results in higher prices to consumers, 
that more profitable services are often performed, but do not 
match either the need for them, or the benefit that they would 
convey, surprise medical bills.
    Then, one study, the Harvard one in particular, found 
significantly worse outcomes for patients, particularly 
Medicare patients in private equity locations. My question to 
you after all that is, what can Congress do to manage this 
problematic role of private equity in our health care system?
    Mr. Wright. Thank you for the question. I think there is a 
number of things that Congress can do. It is an issue of 
concern. We have seen a lot of money come in from private 
equity. It has certain incentives that are not necessarily 
aligned with community health and more for short-term profit, 
even in some cases, stripping the assets of institutions to get 
the most value, or at least short-term value from them. I think 
there needs to be some transparency in this regard, just to 
even know when these transactions are happening.
    It has been actually surprising how quickly these ownership 
relationships have changed, even in the last five, 10 years, 
whether it is to medical groups, or in certain parts of our 
health system, and so having greater transparency of ownership, 
particularly with private equity would be important, and also 
oversight over the actual transactions themselves, whether by 
the FTC, the DOJ.
    I know states are introducing laws to have oversight by 
State Attorney Generals, multiple states had bills this year. I 
believe one is on the California Governor's desk, and I think 
it is a concern because the growing body of literature is that 
private equity is associated with higher costs--the growth and 
ownership of private equity is associated with higher costs, 
and in fact, a lower quality, and even closures, depending on 
the business model.
    Ms. Wild. My understanding is that so far at least, it is a 
relatively small percentage of health care systems in the 
United States that are owned by private equity, but would it be 
fair to say that struggling hospitals, for instance, in smaller 
communities might be more susceptible to a private equity 
buyout or takeover?
    Mr. Wright. I think that is certainly true, and it is 
becoming a big percentage in certain pockets of our system 
where those investors are seeing the opportunity to extract 
more dollars out of our health system.
    Ms. Wild. Can you elaborate on that? What do you mean?
    Mr. Wright. Whether it is on ambulances, whether it is in 
certain specialties, whether it is in certain areas.
    Ms. Wild. Okay.
    Mr. Wright. Like if you look at overall, it is a relatively 
small percentage, but in certain markets or certain areas that 
is a problem.
    Ms. Wild. Got it. You were not talking about geographic 
areas, you were talking about areas of medicine or services 
provided. One of the things I read was that the higher risk, 
more specialized areas of medicine are more susceptible to 
private equity takeovers.
    Mr. Wright. That is right.
    Ms. Wild. Is that fair to say. Thank you. I think it is a 
huge problem. I hope that we can address it in the coming years 
in Congress, and I think that it is a problem that is going to 
continue to grow unless we reign it in. Thank you for your 
information.
    Mr. Wright. Thank you.
    Ms. Wild. I yield back.
    Chairman Good. Thank you. I recognize now Mr. Bean from 
Florida for 5 minutes.
    Mr. Bean. Thank you very much, Mr. Chairman. Good morning 
to you, and good morning HELP Committee. What an honor to be 
here, and to our distinguished panelists, it is great to see 
you. Since the COVID pandemic the rise of telehealth has taken 
American by storm, and it is a popular option for many, many 
Americans, and there is a convenience factor, it is all kind of 
things.
    Now, we are seeing that it is not as affordable as you 
would think. You would think with innovation and with the 
efficiency of telehealth it would be a much less expensive 
option, one of which, one of the problems is different fees 
that providers and facilities are putting on telehealth visits 
to make it just not as affordable as it could be.
    Ms. Schuman, you have mentioned it in your testimony. I 
want you to talk about it. Is it a problem? I am considering, 
this is just between you and I, I am considering doing a bill 
to limit fees, and add-ons, which sometimes Americans are 
confused, and I would be confused if you get a bill from a 
doctor, but then get a bill from a hospital, then you will get 
a bill from somebody else facilitating it.
    Is it a problem? What do you think? Is there a need to fix? 
What say you, Ms. Schuman?
    Ms. Schuman. I say that it is a problem, and that it needs 
a fix. Allowing hospitals to charge a facility fee for 
telehealth appointment is a prime example of a payment 
distortion that is increasing healthcare costs for employers 
and patients. If these services are delivered via telehealth, 
but the facility is a phantom, but the fee is very real.
    We strongly support legislation that would protect group 
health plans from having to pay facility fees for telehealth 
services. It just does not make sense to pay a facility fee, a 
hospital facility fee when the facility involved is basically 
an internet connection, and voters see through this too.
    By an overwhelming margin of 82 percent to 9 percent, 8 to 
1, voters believe that patients should not be charged a 
hospital facility fee.
    Mr. Bean. Ms. Schuman, it sounds like that if you were a 
member, and I presume that you would vote yes. Is that correct?
    Ms. Schuman. That is correct.
    Mr. Bean. Yes. Fantastic. You think it is worthwhile to do 
this bill?
    Ms. Schuman. Absolutely.
    Mr. Bean. Fantastic. All right. I am very close to 
launching this bill. Ms. Wade, NFIB is the forefront, it is the 
freedom loving businesses that want to get government out of 
the way, and just provide a service, make money, and be the 
backbone of small business. I did a roundtable in--I partnered 
over the break with the Clay County, if they are listening, 
thank you the city of Orange Park gave us their facilities.
    It was town hall. We partnered with the Clay County Chamber 
of Commerce. They invited just a handful, a variety of 
businesses, and I sat there and listened to obstacle after 
obstacle of challenge, inflation, taxes, hiring practices, 
regulation, and we talked a little bit about healthcare, and 
many of these small businesses are just--they are challenged by 
the immense costs of offering health plans.
    What say you, Ms. Wade, and NFIB? What do we need to do to 
make healthcare more affordable in America? That is a big 
question, and welcome to the world we live in. It is such a 
little tight window, but is there some 50,000-foot view of what 
we need to do to get healthcare more affordable in America?
    Ms. Wade. Sure. Not surprisingly, our studies find similar 
to what you heard in the roundtable, that 41 percent say it is 
a critical issue in operating their business, the cost of 
health insurance, and their ability to afford it themselves as 
the owner, but also in offering it to their employees, or 
potentially offering it to their employees if they do not offer 
it already.
    Transparency, better design choices, more plans available 
to small business owners will help in having stabilized and 
lower costs for them to offer benefit, association health 
plans, expanding those opportunities.
    Mr. Bean. It sounds like you are saying if I could 
summarize it, choice and competition, that is what the American 
consumer and small businesses want. How devastating, if we went 
to a one size fits all, single-payer system, how devastating 
would that be to Americans and small businesses?
    Ms. Wade. Small business owners would be less able to 
compete for talent in retaining current employees, and 
attracting applicants for those positions, if not given the 
choice to offer the benefit.
    Mr. Bean. You nailed it. Devastating is what you are 
saying. It would be devastating to have single-payer, that 
would eliminate single plans, health plans, and wreak havoc 
across America. Thank you so much. Mr. Chairman, I yield back.
    Chairman Good. Thank you. I now recognize Mr. Scott from 
Virginia for 5 minutes.
    Mr. Scott. Thank you, Mr. Chairman. Mr. Wright, we have 
heard a lot about association health plans. It has always 
seemed to me that if you got a group of lower-cost healthier 
people, and make an association out of it, the association 
might save a little bit, but everybody left behind ends up 
paying more.
    Is there any evidence that eroding consumer protections 
promoting association health plans actually lowers health care 
prices in general, rather than shifts them to somebody else?
    Mr. Wright. I think a lot of the savings comes from the 
fact that they do not have to abide by certain consumer 
protections, and patient protections, which is a detriment 
obviously to the workers or employees, and also this issue of a 
risk shift, where if you are skimming off the healthiest 
populations, then you are shifting those costs onto the broader 
market for small businesses, and having an impact of increased 
premiums there.
    We would--I also just want to make sure that with regard to 
association health plans, that there is strong financial 
oversight because you do not want to have a situation of 
financial fraud or issues where because of lack of due 
diligence, you know, people are left high and dry without 
health care because the money went someplace else.
    Mr. Scott. You are talking about solvency of these plans?
    Mr. Wright. Yes.
    Mr. Scott. What happens when they go broke?
    Mr. Wright. Well, then that is a huge obstruction both to 
the health care for the workers, but also for the employer, 
issues of liability, issues of great concern. It is not good 
for anybody.
    Mr. Scott. What kind of--you talked about consumer 
protections before, you mentioned a protection if you have a 
pre-existing condition, what other kinds of consumer 
protections would you lose if you get into an association plan?
    Mr. Wright. Some of the consumer protections are just 
whether certain basic benefits are covered, whether 
preventative care, whether, you know, prescription drugs, 
equipment and services, et cetera.
    Mr. Scott. The American Rescue Plan Act and Inflation 
Reduction Act improved tax credits, Mr. Wright, and 
particularly for those earning over 400 percent of poverty, 
where there is a cliff, and you have got no benefits. Now you 
get benefits, you just pay a percentage of your income. At some 
point on the income scale, you will meet the sticker price.
    You would not be entitled to anything, but how have the 
premium tax credits helped both low-and middle-income 
individuals?
    Mr. Wright. They have been a lifesaver and a lifeline for 
millions of Americans. Over 5 million more Americans are 
covered, in part due to the enhanced tax credits that have been 
put in place in the last several years. People have gotten 
reduced costs at a time when people are screaming about 
affordability and have been screaming about health care 
affordability for decades.
    This is a direct form of assistance that says you do not 
have to pay more than a certain percentage of your income for 
coverage, and you are right, those folks just over 400 percent, 
for those under they will have the guarantee that they did not 
have to pay 8 and = percent of the income on coverage, but just 
those over, especially if they were older, would be paying 20-
30 percent of their income on coverage, having a huge impact on 
their ability to make ends meet for other needs.
    It is incredibly important that those tax credits get 
extended because they run out next year, and that needs to be 
done sooner, rather than later in order for them to take effect 
in 2026.
    Mr. Scott, Now, for small businesses where the owner may be 
just over the threshold, association plans start to look like a 
nice alternative. How does the elimination of the cliff affect 
the attractiveness of association health plans?
    Mr. Wright. In fact, the--if I had a chance to respond to 
the Representative here, I think the ACA Marketplace is an 
especially, with these enhanced tax credits, provide a real 
benefit for small business. A lot of the people in these 
Marketplaces are solo entrepreneurs, real eState agents, 
contractors, and people who are starting family businesses who 
are in the exchanges and marketplaces right now and getting 
this benefit.
    If these tax credits are not extended, that would be a 
premium spike of literally hundreds of dollars, and in many 
cases thousands of dollars to their bill. It would also have 
the impact of meaning that some of those 5 million people that 
got coverage, would lose coverage, and then have an impact on 
premiums overall in the overall marketplace.
    Mr. Scott. Now, if you are in an association plan, you are 
not getting a tax credit, right?
    Mr. Wright. No.
    Mr. Scott. The association plan would be competing with an 
ACA plan with a tax credit?
    Mr. Wright. That is right.
    Mr. Scott. That makes it virtually impossible for 
association plans to compete.
    Mr. Wright. I think that at this moment the ACA marketplace 
is a much better deal for people up and down the income 
spectrum.
    Mr. Scott. Thank you, Mr. Chairman.
    Chairman Good. Thank you. I will now recognize the Ranking 
Member DeSaulnier, for 5 minutes.
    Mr. DeSaulnier. Thank you, Mr. Chairman. Last spring the 
New York Times published the results of an investigation to 
MultiPlan, a private equity-backed data analytics company that 
works with many employer-sponsored health plans, and their 
third-party administrators, or TPAs.
    The investigation found that when MultiPlan lowered 
reimbursements to providers, consumers would be on the hook for 
exorbitant balance bills that employers were liable for huge 
fees. In many cases, the fees paid to MultiPlan and the TPAs 
were more than reimbursements being paid to health care 
providers.
    To me, this is a clear example of the inefficiencies, and 
unethical behavior plaguing our health care system. Mr. Wright, 
can you comment on MultiPlan and its inefficiencies for 
consumers?
    Mr. Wright. Yes. Thank you for the question. I think we are 
deeply concerned about the potential price fixing, and anti-
competitive behavior. I wish I could say I was shocked, but 
this is the kind of scheme that we have seen in the health care 
system with corporations trying to take a profit often to shift 
costs onto consumers.
    We are particularly concerned about the issue of a 
proprietary algorithm that is not public, that is making these 
decisions, and the issue of the shifting of costs onto 
consumers through balance billing. We do support the call for 
investigations by you, and others in the House and in the 
Senate, to look into this and deal with this appropriately.
    Mr. DeSaulnier. Ms. Schuman, much like PBA's, the 
inefficiencies of the system.
    Ms. Schuman. Okay. Well, thank you so much, and I think 
this just brings the light to need, the need to bring more 
light to healthcare system, and the need for transparency, to 
shine a light on these kind of payment distortions and 
practices that are driving higher costs for employers, and also 
for working families.
    Again, the important work that the Committee has already 
done to advance those transparency requirements in the Lower 
Costs, More Transparency Act.
    Mr. DeSaulnier. Thank you. The last hearing we had on ERISA 
we heard testimony about claim denials. Many of us have 
experienced at least one instance of a denied claim. We all 
know that claim denials can impose serious health and financial 
hardships. During our last hearing, the Democratic witness 
recounted the tragic death of Kyree, 27-year-old flight 
attendant who was denied prior authorization for a heart 
transplant, over criterion that never existed in the plan's 
documents.
    The denial would eventually be reversed, but the decision 
came almost a month after Kyree's death. Despite stories like 
Kyree's, we do not even collect adequate data to help us 
understand the extent of the problem. The Affordable Care Act 
required the Department of Labor to issue regulations to 
require group health plan reporting on claim denials, and in 
2016, the Department proposed to do just that.
    Unfortunately, the Trump administration ignored the ACA 
requirement and pulled the proposal in 2017. Mr. Wright, at 
least anecdotally, I am hearing the problem is getting worse 
from providers that claims that they regularly put in to 
providers, are being denied, denied, denied, and either they, 
or their clients give up. Do you have any comments about claim 
denials, and the possible effect of companies like MultiPlan?
    Mr. Wright. Thank you for the question. Claim denials is a 
big issue for both patients and providers who are trying to 
provide care to their patients, and you do not want a plan or 
an employer to be judged during an execution, you want 
independent review.
    You want the ability to appeal if your claim--if your care 
was denied, that was medically necessary. Right now, the relief 
under ERISA is very limited, and so I think we need to look 
into this, and right now we basically even just need the 
transparency to even know why the claim denials are happening, 
because right now we do not even have that.
    We need to be able to know that the timeliness of these 
claims, how many claims are filed, what is the rate of denial, 
and for what reasons. Then I do think we need to have a greater 
look at what kind of relief can be provided under ERISA.
    Mr. DeSaulnier. Ms. Schuman, claim denials?
    Ms. Schuman. Yes. Well certainly I could not agree more 
about the need to have more transparency again for these claim 
denials. I will say that there is an important service that 
appropriate medical management, and prior authorization plays 
without a doubt. Again, I think the need for greater 
transparency to understand where those distortions are.
    Mr. DeSaulnier. Thank you. I yield back.
    Chairman Good. Thank you. I will now recognize myself for 5 
minutes. Dr. Fronstin, President Biden and VP Harris have tried 
to expand even further, government's role in healthcare, 
including as we saw in the video, a Medicare for All, and 
lowering the age to qualify for Medicare.
    As government control of healthcare expands, like when 
Democrats increase subsidies for Obamacare plans, what happens 
to employer-sponsored health insurance?
    Mr. Fronstin. Yes. We have talked to large employers about 
expanded subsidies, and for the most part, it does not affect 
what they do. They are concerned about recruitment and 
retention. They recognize that their employees value health 
benefits more than any other benefit, something I remind my 
retirement colleagues of all the time at EBRI.
    Small employers--we have not polled them on how subsidies 
might affect their behavior, but I would point out to the 
degree offer rates have eroded in a small group market, that 
was happening before the ACA passed, so I think its premiums 
are driving that more so, and the ones that continue to offer 
coverage are doing so, I think because of business reasons.
    They are concerned about recruitment and retention, and 
even with enhanced subsidies, they are still going to be 
concerned about recruitment and retention.
    Chairman Good. No question about it. A CBO report estimates 
3 and a half million people would leave employment-based 
coverage if Democrats are successful in permanently expanding 
eligibility for enhanced Obamacare subsidies. Why do you think 
government wants to move more people--why do you think 
government wants to move more people from a quality private 
healthcare plan, to a more expensive one, fully paid for by the 
taxpayer? Why would the government want to do that?
    Mr. Fronstin. They are different markets, and they serve 
different purposes. The employment-based market is, you know, 
those are groups that are formed for reasons other than the 
provision of health insurance. They are considered a natural 
group, and the non-group market, it is different, right?
    It is people that cannot get coverage through their job, 
maybe they are in between jobs, subsidies are much higher in 
that market. I think they are temporary because of people 
moving in and out. I do not know that one--certainly one system 
has an advantage over the other, but there are purposes that 
they both serve.
    Chairman Good. Ms. Wade, more small businesses would like 
to offer health insurance to their employees, but many cannot 
afford it due to the cost of paying for the benefits, the 
reporting requirements, the bureaucratic burden of offering 
employer sponsored plans, but how can Congress make it easier 
for more small businesses to manage this bureaucracy that comes 
with operating a healthcare plan?
    Ms. Wade. First of all, businesses--16 percent are in the 
self-insured markets, so protecting ERISA, and allowing them to 
still have the flexibility and affordability of offering those 
sorts of plans to their employees is hugely important.
    Expanding the marketplace for the fully insured market and 
offering association health plans. Those sorts of tools that 
they can use to better access affordable plans that they can 
offer their employees. They are competing with larger 
businesses for talent that are better able to afford these 
benefits, and the labor market is still quite difficult for 
them, and a challenge in recruiting and retaining talent at 
their business.
    Because health insurance is the primary benefit that they 
are offering, or would like to offer, having that marketplace 
be affordable and flexible for them is important.
    Chairman Good. I am glad you mentioned it. I introduced, 
and this Committee passed, the Self-Insurance Protection Act, 
which prevents Federal regulators from redefining and 
regulating stop loss insurance, like a traditional health 
insurance. Many employers, as you know, choose to self-insure, 
and they purchase the stop loss insurance to protect themselves 
from the catastrophic claims.
    Why would some want to make it more difficult, some on the 
other side, for businesses to obtain stop loss insurance, 
unless it's just to prevent them from being able to provide 
private insurance?
    Ms. Wade. Without having that ability for the small 
business owners in the self-insured marketplace, it would be 
catastrophic for them in being able to offer the benefit to 
their employees and mitigating the catastrophic risk that they 
might incur with high costs associated with it.
    Protecting stop loss insurance, making it widely available 
to small business, is crucial in keeping that marketplace 
available to them.
    Chairman Good. Very good. Thank you. All right. We are 
going to go to Ranking Member DeSaulnier, for his closing 
remarks.
    Mr. DeSaulnier. Thank you, Mr. Chairman. Thank you to all 
the witnesses. I appreciate you being here. First, a comment 
just on this idea that universal health care versus a complete 
free market. I think what the Congress has tried to do over the 
years is balance, is to create an avenue for the private sector 
and employers.
    As a former employer, who provided healthcare for my 
employees, and some of the struggles we had when employees 
actually needed to use that, and how confused they were about 
their copays. I can remember instances where employees were 
crying because they could not afford their copays, and never 
understood the documentation.
    This balance between the private sector and creating 
employer/employee good relationship, and NFIB, I was once a 
member when I was a small business owner, having that balance 
of a good responsible employer to good, valued employees, 
healthcare benefits are really important.
    Healthcare benefits that are easy for the employer, and the 
employee to understand, and require value, good quality of 
care. Too much of this hearing has been about costs, costs, 
cost. Cost is only important if you get value in exchange for 
the cost. This idea, Mr. Chairman, with all due respect, that 
it is one way or the other, just is not the American model.
    It is a balance, and I grant you there are some people who 
would like to switch that balance on both sides. Preemption is 
important when it is a national issue, but there are states 
issues. There was another interesting debate today, take the 
other side of states' rights, I guess in this instance, which I 
do not regularly do, but maybe from California, as a Member of 
Congress, I have become more of a states' right person than I 
was before, Mr. Wright, because I knew you when we both worked 
in Sacramento.
    This balance is important. I do not think it is a choice of 
either/or. Then last, on universal health care. We already have 
a universal health care system in this country, it is just 
really bad. If you call 911, the ambulance will show up. If you 
go to the emergency room, you will get care. It is called 
indigent care, and basic adult care. It is required under law.
    It is just that it does not pay. The idea that somehow this 
free market is the heaven on earth that we could get, just is 
not reality. If we had an efficient delivery system of health 
care system that had a high quality of care, both in the 
employer/employee market, and also Medicare and Medicaid, 
people would live longer lives in this country.
    We would have a lower GDP ratio for health care, and we 
would have a better system. Maybe not perfect, but certainly 
better than it is right now. ERISA was enacted with a goal of 
protecting workers and their families. Given the dramatic 
changes since 1974 when ERISA was enacted, it is clearly 
evident that ERISA must evolve to effectively address new 
challenges and opportunities that improve the efficiency of our 
health care system.
    House Democrats' primary goal is to support and build our 
middle class from the bottom up, and the middle out. This 
involves not only addressing the immediate needs of workers and 
their families, but also creating an environment where middle 
class prosperity can thrive, and small businesses are a part of 
that middle class.
    Ensuring that ERISA has strong consumer protections reduces 
waste, inefficiencies, and excessive costs, and enhances 
transparency in this critical effort. Congressional Democrats 
are committed to fighting for working families, and we have 
made significant strides through recent legislative 
achievements to do just that, including passing the Affordable 
Care Act, the American Plan Rescue Act, and fighting the 
attempts by our Republican colleagues to overturn the 
Affordable Care Act, multiple attempts, including protections 
for consumers for pre-existing conditions.
    The Inflation Reduction Act, these historic pieces of 
legislation, all of them, have increased coverage, protected 
consumers from nefarious practices, and lowered costs for 
millions of working families and seniors. Notably, the 
Inflation Reduction Act capped out--of-pocket drug costs at 
$2,000.00 a year for Medicare.
    Capped insulin cost at $35.00 a month for seniors and 
secured significant price reductions through drug price 
negotiations. The negotiations alone will save an estimated 1 
and one-half billion dollars for nearly 9 million seniors. We 
must remain vigilant against proposals like those in the 
Republican's 2025 that seek to roll back these critical reforms 
and eliminate the protections in the Affordable Care Act.
    Our work is far from finished. We must continue to build on 
these successes, and focus on creating a fair, more efficient 
system, that benefits all workers, families, and businesses. 
Thank you, and I yield back.
    Chairman Good. Thank you. I now recognize myself for a 
closing statement. It was interesting to hear the minority 
members reaction to the video we saw today, with the unedited 
words of Vice President Harris, without commentary, presented 
by none other than CNN and the Washington Post. I guess this is 
because she has been trying to express different positions over 
the past few weeks, than she has expressed over her entire 
career prior to that time.
    As noted last week by none other than Bernie Sanders, whose 
Medicare for All bill she cosponsored. Democrats seem to know 
that Americans do not support their actual positions, whether 
it is open borders, non-citizens voting, electric vehicle 
mandates, appliance prohibitions, anti-police policies, pro-
criminal policies, higher taxes, more spending, and controlled 
by government, and yes, government mandated, government 
provided healthcare.
    This is a policy discussion, and the video revealed the 
Vice President's policy statements, relative to the topic at 
hand. The American healthcare system is far from perfect, but 
most Americans prefer their private health insurance offered by 
their employer. Naturally, Democrats do not want Americans to 
know that they want to eliminate that.
    On behalf of the 153 million Americans whose healthcare 
benefits rely on ERISA, I think we have learned a lot today. 
Government, especially the Biden Harris administration, 
continues to burden employer sponsored health insurance through 
over regulation. Meanwhile, they prop up the expensive 
Obamacare plans, and daydream about single payer Medicare for 
All.
    Government should actually though decrease intervention in 
healthcare markets, not increase it. Americans want flexible, 
innovative healthcare, not one size fits all. Employers have a 
strong incentive to keep healthcare costs low, to help their 
own bottom line, and they have an incentive to offer good 
benefits to keep their workers.
    Democrats never seem to understand that. For 50 years, 
ERISA has provided the guardrails to protect individuals, while 
allowing employers to develop robust benefit plans. We can 
amend ERISA while protecting it, because in doing so we defend 
private insurance and shield Americans from devolving into a 
single-payer system.
    We thank the witnesses today for your time and testimony, 
and without objection, there being no further business, this 
Subcommittee stands adjourned.
    [Whereupon, at 12:10 p.m., the Subcommittee was adjourned.]
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