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+
+ - EXAMINING THREATS TO WORKERS WITH PREEXISTING CONDITIONS
+
+[House Hearing, 116 Congress]
+[From the U.S. Government Publishing Office]
+
+
+ EXAMINING THREATS TO WORKERS
+ WITH PREEXISTING CONDITIONS
+
+=======================================================================
+
+ HEARING
+
+ BEFORE THE
+
+ COMMITTEE ON EDUCATION
+ AND LABOR
+ U.S. HOUSE OF REPRESENTATIVES
+
+ ONE HUNDRED SIXTEENTH CONGRESS
+
+ FIRST SESSION
+
+ __________
+
+ HEARING HELD IN WASHINGTON, DC, FEBRUARY 6, 2019
+
+ __________
+
+ Serial No. 116-1
+
+ __________
+
+ Printed for the use of the Committee on Education and Labor
+
+[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
+
+
+
+ Available via the World Wide Web: www.govinfo.gov
+ or
+ Committee address: https://edlabor.house.gov
+
+
+ __________
+
+
+ U.S. GOVERNMENT PUBLISHING OFFICE
+35-267 PDF WASHINGTON : 2019
+
+-----------------------------------------------------------------------------------
+For sale by the Superintendent of Documents, U.S. Government Publishing Office,
+http://bookstore.gpo.gov. For more information, contact the GPO Customer Contact Center,
+U.S. Government Publishing Office. Phone 202-512-1800, or 866-512-1800 (toll-free).E-mail,
+[email protected].
+
+
+
+ COMMITTEE ON EDUCATION AND LABOR
+
+ ROBERT C. ``BOBBY'' SCOTT, Virginia, Chairman
+
+Susan A. Davis, California Virginia Foxx, North Carolina,
+Raul M. Grijalva, Arizona Ranking Member
+Joe Courtney, Connecticut David P. Roe, Tennessee
+Marcia L. Fudge, Ohio Glenn Thompson, Pennsylvania
+Gregorio Kilili Camacho Sablan, Tim Walberg, Michigan
+ Northern Mariana Islands Brett Guthrie, Kentucky
+Frederica S. Wilson, Florida Bradley Byrne, Alabama
+Suzanne Bonamici, Oregon Glenn Grothman, Wisconsin
+Mark Takano, California Elise M. Stefanik, New York
+Alma S. Adams, North Carolina Rick W. Allen, Georgia
+Mark DeSaulnier, California Francis Rooney, Florida
+Donald Norcross, New Jersey Lloyd Smucker, Pennsylvania
+Pramila Jayapal, Washington Jim Banks, Indiana
+Joseph D. Morelle, New York Mark Walker, North Carolina
+Susan Wild, Pennsylvania James Comer, Kentucky
+Josh Harder, California Ben Cline, Virginia
+Lucy McBath, Georgia Russ Fulcher, Idaho
+Kim Schrier, Washington Van Taylor, Texas
+Lauren Underwood, Illinois Steve Watkins, Kansas
+Jahana Hayes, Connecticut Ron Wright, Texas
+Donna E. Shalala, Florida Daniel Meuser, Pennsylvania
+Andy Levin, Michigan* William R. Timmons, IV, South
+Ilhan Omar, Minnesota Carolina
+David J. Trone, Maryland Dusty Johnson, South Dakota
+Haley M. Stevens, Michigan
+Susie Lee, Nevada
+Lori Trahan, Massachusetts
+Joaquin Castro, Texas
+* Vice-Chair
+
+ Veronique Pluviose, Staff Director
+ Brandon Renz, Minority Staff Director
+
+
+ ------
+
+
+ C O N T E N T S
+
+ ----------
+ Page
+
+Hearing held on February 6, 2019................................. 1
+
+Statement of Members:
+ Scott, Hon. Robert C. ``Bobby'', Chairman, Committee on
+ Education and Labor........................................ 1
+ Prepared statement of.................................... 4
+ Foxx, Hon. Virginia, Ranking Member, Committee on Education
+ and Labor.................................................. 5
+ Prepared statement of.................................... 7
+
+Statement of Witnesses:
+ Corlette, Ms. Sabrina, Research Professor, Center on Health
+ Insurance Reforms, Georgetown University Health Policy
+ Institute.................................................. 9
+ Prepared statement of.................................... 11
+ Gupta, Dr. Rahul, Senior Vice President and Chief Medical and
+ Health Officer, March of Dimes............................. 42
+ Prepared statement of.................................... 44
+ Riedy, Mr. Chad, Resident, Alexandria, VA.................... 23
+ Prepared statement of.................................... 25
+ Turner, Ms. Grace-Marie, President, Galen Institute.......... 30
+ Prepared statement of.................................... 32
+
+Additional Submissions:
+ Adams, Hon. Alma S., a Representative in Congress from the
+ State of North Carolina:
+ Article: House Health Bill Would Lead To Less Coverage,
+ Higher Patient Costs................................... 108
+ Prepared statement from MomsRising....................... 110
+ Article: National Disability Rights Network Opposes
+ American Health Care Act............................... 112
+ Jayapal, Hon. Pramila, a Representative in Congress from the
+ State of Washington:
+ Prepared statement from Asian and Pacific Islander
+ American Health Forum (APIAHF)......................... 113
+ Underwood, Hon. Lauren, a Representative in Congress from the
+ State of Illinois:
+ Article: Final Rule on Short-term Insurance plans will
+ leave Patients With High costs, Less Coverage.......... 118
+ Questions submitted for the record by:
+ Guthrie, Hon. Brett, a Representative in Congress from
+ the State of Kentucky.................................. 121
+ Smucker, Hon. Lloyd K., a Representative in Congress from
+ the State of Pennsylvania.............................. 121
+ Ms. Turner's response to questions submitted for the record.. 122
+
+
+ EXAMINING THREATS TO WORKERS WITH PREEXISTING CONDITIONS
+
+ ----------
+
+
+ Wednesday, February 6, 2019
+
+ House of Representatives
+
+ Committee on Education and Labor,
+
+ Washington, DC.
+
+ ----------
+
+ The committee met, pursuant to notice, at 10:15 a.m., in
+room 2175, Rayburn House Office Building. Hon. Robert C.
+``Bobby'' Scott (chairman of the committee) presiding.
+ Present: Representatives Scott, Davis, Courtney, Sablan,
+Bonamici, Takano, Adams, Norcross, Jayapal, Morelle, Harder,
+McBath, Schrier, Underwood, Hayes, Shalala, Levin, Omar, Trone,
+Stevens, Lee, Trahan, Castro, Foxx, Roe, Thompson, Walberg,
+Guthrie, Byrne, Grothman, Stefanik, Allen, Smucker, Banks,
+Walker, Comer, Cline, Fulcher, Taylor, Watkins, Wright, Meuser,
+Timmons, and Johnson.
+ Staff present: Tylease Alli, Chief Clerk; Nekea Brown,
+Deputy Clerk; Ilana Brunner, General Counsel; David Dailey,
+Senior Counsel; Daniel Foster, Health and Labor Counsel;
+Mishawn Freeman, Staff Assistant; Alison Hart, Professional
+Staff; Carrie Hughes, Director of Health and Human Services;
+Eli Hovland, Staff Assistant; Eunice Ikene, Labor Policy
+Advisor; Ariel Jona, Staff Assistant; Kimberly Knackstedt,
+Disability Policy Advisor; Stephanie Lalle, Deputy
+Communications Director; Andre Lindsay, Staff Assistant; Max
+Moore, Office Aide; Merrick Nelson, Digital Manager; Udochi
+Onwubiko, Labor Policy Counsel; Veronique Pluviose, Staff
+Director; Banyon Vassar, Deputy Director of Information
+Technology; Joshua Weisz, Communications Director; Cyrus Artz,
+Minority Parliamentarian; Marty Boughton, Minority Press
+Secretary; Courtney Butcher, Minority Coalitions and Member
+Services Coordinator; Rob Green, Minority Director of Workforce
+Policy; John Martin, Minority Workforce Policy Counsel; Sarah
+Martin, Minority Professional Staff Member; Hannah Matesic,
+Minority Legislative Operations Manager; Kelley McNabb,
+Minority Communications Director; Alexis Murray, Minority
+Professional Staff Member; Brandon Renz, Minority Staff
+Director; Ben Ridder, Minority Legislative Assistant; Meredith
+Schellin, Minority Deputy Press Secretary and Digital Advisor;
+Heather Wadyka, Minority Staff Assistant; and Lauren Williams,
+Minority Professional Staff Member.
+ Chairman Scott. The Committee on Education and Labor will
+come to order, and I want to welcome everyone to the hearing. I
+note that a quorum is present. The Committee is meeting today
+to hear testimony on examining threats to workers with
+preexisting conditions.
+ Pursuant to committee rule 7(c) opening statements are
+limited to the chair and the ranking member. This allows us to
+hear from our witnesses a lot sooner and provides all members
+with adequate time to ask questions.
+ I recognize myself now for the purpose of making an opening
+Statement.
+ Today we are here to examine the threats to affordable
+healthcare for workers with preexisting conditions. I want to
+welcome our distinguished witnesses for agreeing to be here
+today and to testify on an issue that affects roughly 133
+million Americans across the country.
+ On March 23, 2010, President Barack Obama signed the
+Patient Protection and Affordable Care Act into law. Over the
+last 9 years, this historic legislation has improved the lives
+of countless Americans by making insurance more affordable and
+more accessible, while strengthening the quality of health
+coverage and enacting lifesaving consumer protections.
+ The Affordable Care Act's success is even more remarkable
+in the context of the persistent attempts to repeal and
+sabotage the law. Since it was passed the House Republicans
+called more than 70 votes to repeal all or parts of the ACA.
+Those efforts were punctuated by the American Health Care Act,
+a bill passed by House Republicans in 2017, which gutted
+protections for patients with preexisting conditions. According
+to the CBO, the repeal bill would have resulted in 23 million
+fewer Americans with health coverage, would have raised
+premiums by 20 percent the first year while providing less
+comprehensive benefits, and would have jeopardized many of the
+consumer protections found in the ACA.
+ The Trump Administration has taken an equally aggressive
+approach to undermining the law. For example, the
+Administration has expanded the use of junk plans that roll
+back consumer protections, raise the costs for most consumers,
+and have a troubling record of fraud and abuse.
+ On June 19, 2018, the Department of Labor finalized a rule
+to expand association health plans. Under the rule,
+associations can sell coverage to small businesses and self-
+employed individuals without meeting certain ACA standards that
+would otherwise apply, such as: the requirement to cover
+essential benefits, the prohibition against charging higher
+premiums based on factors such as gender or occupation, and the
+age rating limit, which prevents insurers from charging
+unaffordable premiums to older people.
+ Extensive research has shown that association health plans
+create a few winners and a lot of losers. A report published by
+the Government Accountability Office in 2000 found that they
+are likely to increase costs for most workers who are not in
+association plans and make it harder for older, sicker workers
+to get affordable care. The prevalence of fraud in these plans
+is equally concerning. A 2004 Congressional Budget Office
+report identified 144 ``unauthorized or bogus'' plans from 2000
+to 2002. Those plans covered at least 15,000 employers and more
+than 200,000 policyholders, and left unpaid medical bills over
+$252 million.
+ On August 3, 2018, the Departments of Health and Human
+Services, Labor, and Treasury jointly moved to expand the use
+of short-term health plans. The Departments issued a final rule
+to extend the allowable duration of short-term plans from 3
+months to up to 12 months, with renewability up to 36 months.
+Under the rule the short-term plans do not have include Federal
+consumer protections, including protections for patients with
+preexisting conditions. Because of the risk of confusion and
+overall lack of consumer safeguards, not one single group
+representing patients, physicians, nurses or hospitals voiced
+support for the rule expanding the use of short-term plans.
+ The Administration's final and most dangerous attack on the
+ACA is its unusual decision to side with a group of Republican
+attorneys general in a lawsuit against the Federal Government
+seeking to strike the ACA in court. So the Trump Administration
+is effectively arguing that the ACA's consumer protections
+should be invalidated, along with the rest of the law.
+ If this ultimately prevails, as it did in the district
+court in Texas, the result would be catastrophic. All
+Americans, whether insured through the ACA marketplace or
+through their employers, would lose the consumer protections we
+all take for granted, including elimination of lifetime and
+annual caps. The prohibition on lifetime and annual coverage
+limits, which protects workers from incurring unreasonable out-
+of-pocket expenses. Before the ACA, more than 90 percent of
+non-group plans had annual or lifetime caps on coverage, and a
+majority of the employer-provided plans imposed lifetime
+limits.
+ Cost-sharing protections, the requirement that plans offer
+to limit out-of-pocket costs to an affordable percentage of a
+worker's income, elimination of preexisting health condition
+exclusions, the requirement that all health plans cover
+patients with preexisting conditions at the standard rate. Last
+night I was pleased to hear the President's comment that he
+wants to protect patients with preexisting conditions and end
+the spread of AIDS. As I said, the actions of the
+Administration have jeopardized those protections and people
+with HIV or AIDS who would be excluded from coverage based on
+preexisting conditions if those initiatives succeed. Preventive
+services without cost-sharing, the protection that allows
+workers and families to access vital preventive care without
+paying out-of-pocket expenses. That protection would be
+eliminated.
+ While I appreciate that my Republican colleagues are now
+voicing support for many of these protections, their words have
+not translated into actions. On January 9, Democrats voted on a
+resolution to empower the House counsel to intervene in the
+Texas case to defend the ACA and protect people with
+preexisting conditions. Only three House Republicans voted to
+support the resolution.
+ There many different views within the Democratic Party and
+across the political spectrum regarding the best path forward
+to further expand affordable care. But we must all commit, both
+with our words and deeds, to maintaining the lifesaving
+consumer protections enacted in the ACA and we must refuse to
+go backward.
+ Until efforts to repeal and sabotage this historic
+legislation cease, workers with preexisting conditions will be
+at risk of losing access to the care they need to live healthy
+and fulfilling lives.
+ I now recognize the distinguished ranking member for the
+purpose of an opening statement.
+ [The statement of Chairman Scott follows:]
+
+ Prepared Statement of Hon. Robert C. ``Bobby'' Scott, Chairman,
+ Committee on Education and Labor
+
+ Today, we are here to examine the threats to affordable health care
+for workers with pre-existing conditions. I want to welcome and thank
+our distinguished witnesses for agreeing to be here and testify today
+on an issue that effects roughly 133 million Americans across this
+country.
+ On March 23, 2010, President Barack Obama signed the Patient
+Protection and Affordable Care Act into law. Over the past 9 years,
+this historic legislation has improved the lives of countless Americans
+by making insurance more affordable and more accessible, while also
+strengthening the quality of health coverage and enacting lifesaving
+consumer protections.
+ Prior to the ACA, Federal law allowed insurers to deny people
+coverage for certain pre-existing conditions, including recently
+treated substance use disorder, pregnancy, and cancer. Prior to the
+ACA, insurers in the individual market could exclude these individuals
+from coverage, charge higher premiums, or put annual or lifetime caps
+of health care coverage.
+ According to a 2007 Commonwealth Fund survey, 36 percent of adults
+who attempted to purchase coverage in the individual market reported
+being turned down or charged a higher price because of their medical
+history. The ACA guaranteed access to affordable care for the roughly
+133 million Americans with pre-existing conditions at the standard
+rate.
+ By any objective measure, the Affordable Care Act has been a
+success. The uninsured rate, which was 16.7 percent in 2009, fell to
+just 8.8 percent in 2017.
+ The ACA's success is even more remarkable in the context of the
+persistent attempts to repeal and sabotage the law. Since it was
+passed, House Republicans have voted more than 70 times to repeal all
+or parts of the ACA. Those efforts were punctuated by the American
+Health Care Act, a bill passed by House Republicans in 2017, which
+gutted protections for patients with pre-existing conditions. According
+to the CBO, the repeal bill would have resulted in 23 million fewer
+Americans with health coverage and would have raised premiums by 20
+percent in the first year while providing less comprehensive benefits.
+ The Trump Administration has taken an equally aggressive approach
+to undermining the law. For example, the Administration has expanded
+the use of junk health plans that rollback consumer protections, raise
+costs for all consumers, and have a troubling record of fraud and
+abuse.
+ On June 19th, 2018, the Department of Labor finalized a rule to
+expand association health plans. Under the rule, associations can sell
+coverage to small businesses and self-employed individuals without
+meeting certain ACA standards that would otherwise apply, such as: 1)
+the requirement to cover essential health benefits; 2) the prohibition
+against charging higher premiums based on factors such as gender or
+occupation; and 3) the age rating limit, which prevents insurers from
+charging unaffordable premiums to older people.
+ Extensive research has shown that association health plans create
+winners and losers. A report published by the Government Accountability
+Office in 2000, found that they are likely to increase costs to some
+workers and make it harder for older, sicker workers to get affordable
+care. The prevalence of fraud in these plans is equally concerning. A
+2004 Congressional Budget Office identified 144 ``unauthorized or
+bogus'' plans from 2000 to 2002, covering at least 15,000 employers and
+more than 200,000 policyholders, leaving $252 million in unpaid medical
+claims.
+ On August 3rd, 2018, the Departments of Health and Human Services,
+Labor, and the Treasury jointly moved to expand the use of short-term
+health plans. The Departments issued a final rule to extend the
+allowable duration of short-term health plans from 3 months to up to 12
+months, with plans renewable for up to 36 months. Under the rule,
+short-term plans do not have include Federal consumer protections,
+including protections for patients with pre-existing conditions.
+ Because of the risk of confusion and the overall lack of consumer
+safeguards, not one single group representing patients, physicians,
+nurses or hospitals voiced support for the rule expanding the use of
+short-term plans.
+ The Administration's final and most dangerous attack on the ACA is
+its unusual decision to side with a group of Republican Attorneys
+General in a lawsuit against the Federal Government seeking to strike
+down the law in court. Specifically, the Trump Administration is
+arguing that the ACA's consumer protections should be invalidated.
+ If it ultimately prevails, as it did in a District Court in Texas,
+the result would be catastrophic. All Americans, whether insured
+through an ACA marketplace or through their employer, would lose the
+consumer protections we all take for granted, including:
+ Elimination of Lifetime and Annual Caps: The prohibition on
+lifetime and annual coverage limits, which protects workers from
+incurring unreasonable out-of-pocket expenses. Before the ACA, more
+than 90 percent of nongroup plans had annual or lifetime caps on
+coverage, and a majority of employer-provided plans imposed lifetime
+limits.
+ Cost-Sharing Protections: The requirement that plans limit out-of-
+pocket costs to an affordable percentage of a worker's income.
+ Elimination of Preexisting Health Condition Exclusions: The
+requirement that all health plans cover patients' pre-existing
+conditions.
+ Preventive Services without Cost-sharing: The protection that
+allows workers and families to access vital preventive care without
+paying out-of-pocket.
+ While I appreciate that my Republican colleagues are now voicing
+support for many of these protections, their words have not translated
+into actions. On January 9, House Democrats voted on a resolution to
+empower the House counsel to intervene in the Texas case to defend the
+ACA and protect people with pre-existing conditions. Only three House
+Republicans votes to support the resolution.
+ There many different views both within the Democratic Party and
+across the political spectrum regarding the best path forward to
+further expand access to affordable care. But we must all commit both
+with our words and our actions to maintaining the lifesaving consumer
+protections enacted in the ACA and refusing to go backward.
+ Until efforts to repeal and sabotage this historic legislation
+cease, workers with pre-existing conditions will be at risk of losing
+access to the care they need to live healthy and fulfilling lives.
+ Thank you and I now yield to the Ranking Member, Dr. Foxx.
+ ______
+
+ Mrs. Foxx. Thank you, Mr. Chairman. Americans with
+preexisting conditions need health insurance. This is a fact
+and a value that Congress and the President have affirmed
+countless times. It is also the law. Insurance companies are
+prohibited from denying or not renewing health coverage due to
+a preexisting condition. Insurance companies are banned from
+rescinding coverage based on a preexisting condition. Insurance
+companies are banned from excluding benefits based on a
+preexisting condition. Insurance companies are prevented from
+raising premiums on individuals with preexisting conditions who
+maintain continuous coverage.
+ So it is perplexing why Committee Democrats are even
+holding this hearing. And by doing so, they are making it about
+threats. Instead, this hearing should focus on how the strong
+economy, with its extraordinary job growth, is increasing the
+number of workers with employer-sponsored health coverage.
+ This committee's work on--employer-based health care
+options dates back to when the cost of health care began to
+rise several decades ago. The status quo was not sustainable,
+then and in 2010, the tide took a radical turn for the worse
+with the Affordable Care Act, which decimated options for
+employers earnestly seeking to provide competitive benefits
+packages to recruit and retain workers and sent individual
+premium costs on an even faster upward trajectory. Workers paid
+the price, employers paid the price.
+ But, after 8 years of Republican leadership in the House of
+Representatives and the election of President Trump, the U.S.
+economy and job markets are thriving. With consistent wage
+growth and greater availability of highly competitive jobs,
+smart employers are continuing to ensure that they offer
+competitive benefits packages--including sponsored health care
+plans--to recruit and retain workers. And their efforts are
+working.
+ According to the Kaiser Family Foundation, 152 million
+Americans--including many who have preexisting conditions--are
+insured through plans offered by their employer. That is the
+majority of the American work force and more than the
+individual market, Medicare, or Medicaid. Since 2013, 7 million
+more Americans have gained employer-sponsored health care
+coverage, with 2.6 million gaining coverage since President
+Trump took office. The plans employers offer are on average
+higher quality and provide better value than what can be found
+on the individual market.
+ In 2017, the average premium for individual and family
+employer-sponsored coverage increased by a modest 3 and 5
+percent respectively. In contrast, the average exchange
+premium, Obamacare, went up by roughly 30 percent.
+ So, if we are going to have this hearing at all, we welcome
+it as an opportunity to talk once more about the importance of
+making sure American workers have more options, more
+flexibility, and more freedom.
+ Last Congress, the Republican-led House of Representatives
+passed the American Health Care Act. The legislation would
+restore stability to the health care marketplace and deliver
+lower costs to consumers. Ensuring protections for individuals
+with preexisting conditions was a central piece of the bill. It
+was Section 137 of the legislation stating: ``Nothing in this
+Act shall be construed as permitting health insurance insurers
+to limit access to health coverage for individuals with
+preexisting conditions.'' So, people may have an opinion, but
+they cannot argue with the facts. The facts are written in this
+legislation--Section 137.
+ Republicans on this committee also led the passage of the
+Small Business Health Fairness Act. That legislation would
+empower small businesses to band together through association
+health plans, AHPs, to negotiate for lower health insurance
+costs on behalf of their employees. And last summer, the
+Department of Labor finalized a rule expanding access to AHPs.
+ During the 115th Congress, House Republicans also passed
+the Competitive Health Insurance Reform Act and the Committee-
+led Self Insurance Protection Act. What all of these bills have
+in common is their goal to expand coverage, lower health care
+costs for all Americans, and again, give freedom to Americans.
+ Committee Republicans welcome this opportunity once again
+to assure Americans with preexisting conditions that their
+coverage is protected.
+ House Republicans will continue to champion legislative
+solutions to combat some of the most pressing problems facing
+our healthcare system, including skyrocketing costs, the high
+prices of certain drugs, the industry's lack of cost
+transparency, and the looming threat of a single payer system.
+These are the factors that pose the real threat to Americans
+having options to work for them.
+ I yield back, Mr. Chairman.
+ [The statement of Mrs. Foxx follows:]
+
+Prepared Statement of Hon. Virginia Foxx, Ranking Member, Committee on
+ Education and Labor
+
+ Americans with pre-existing conditions need health insurance. This
+is a fact, and a value that Congress and the President have affirmed
+countless times. It's also the law. Insurance companies are prohibited
+from denying or not renewing health coverage due to a pre-existing
+condition. Insurance companies are banned from rescinding coverage
+based on a pre-existing condition. Insurance companies are banned from
+excluding benefits based on a pre-existing condition. Insurance
+companies are prevented from raising premiums on individuals with pre-
+existing conditions who maintain continuous coverage.
+ So it's perplexing why Committee Democrats are even holding this
+hearing, and by doing so they are trying to make it about threats.
+Instead, this hearing should focus on how the strong economy with its
+extraordinary job growth is increasing the number of workers with
+employer-sponsored health coverage.
+ This committee's work on employer-based health care options dates
+back to when the costs of health care began to rise several decades
+ago. The status quo was not sustainable then, and in 2010 the tide took
+a radical turn for the worse with the Affordable Care Act, which
+decimated options for employers earnestly seeking to provide
+competitive benefits packages to recruit and retain workers and sent
+individual premium costs on an even faster upward trajectory.
+ Workers paid the price. Employers paid the price.
+ But, after 8 years of Republican leadership in the House of
+Representatives, and the election of President Trump, the U.S. economy
+and job markets are thriving. With consistent wage growth and greater
+availability of highly competitive jobs, smart employers are continuing
+to ensure that they offer competitive benefits packages including
+sponsored health care plans to recruit and retain workers.
+ And their efforts are working. According to the Kaiser Family
+Foundation,
+ 152 million Americans--including many who have pre-existing
+conditions--are insured through plans offered by their employer. That's
+the majority of the American work force, and more than the individual
+market, Medicare, or Medicaid.
+ Since 2013, 7 million more Americans have gained employer-sponsored
+health care coverage, with 2.6 million gaining coverage since President
+Trump took office. The plans employers offer are, on average, higher
+quality and provide better value than what can be found on the
+individual market.
+ In 2017, the average premium for individual and family employer-
+sponsored coverage increased by a modest 3 and 5 percent, respectively.
+In contrast, the average Exchange premium Obamacare went up by roughly
+30 percent.
+ So, if we are going to have this hearing at all, we welcome it as
+an opportunity to talk once more about the importance of making sure
+American workers have more options, more flexibility, and more freedom.
+ Last Congress, the Republican-led House of Representatives passed
+the American Health Care Act. The legislation would restore stability
+to the health care marketplace and deliver lower costs to consumers.
+Ensuring protections for individuals with pre-existing conditions was a
+central piece of the bill with Section 137 of the legislation stating:
+``Nothing in this Act shall be construed as permitting health insurance
+issuers to limit access to health coverage for individuals with
+preexisting conditions.''
+ So, people may have an opinion, but they cannot argue with the
+facts, and the facts are written in this legislation. Section 137.
+ Republicans on this committee also led the passage of the Small
+Business
+ Health Fairness Act. That legislation would empower small
+businesses to band together through association health plans (AHPs) to
+negotiate for lower health insurance costs on behalf of their
+employees, and last summer, the Department of Labor finalized a rule
+expanding access to AHPs.
+ During the 115th Congress, House Republicans also passed the
+Competitive Health Insurance Reform Act and the committee-led Self-
+Insurance Protection Act. What all of these bills have in common is
+their goal to expand coverage, lower health care costs for all
+Americans, and again, give freedom to Americans.
+ Committee Republicans welcome this opportunity once again to assure
+Americans with pre-existing conditions that their coverage is
+protected. House Republicans will continue to champion legislative
+solutions to combat some of the most pressing problems facing our
+health care system, including skyrocketing costs, the high prices of
+certain drugs, the industry's lack of cost transparency, and the
+looming threat of a single-payer system. These are the factors that
+pose the real threat to Americans having options that work for them.
+ ______
+
+ Chairman Scott. Thank you. Without objection, all the
+members who wish to insert written statements to the record
+should do so by submitting them to the committee clerk
+electronically in Microsoft Word format by 5 p.m. February 19,
+2019.
+ I will now introduce our witnesses.
+ Our first witness will be Sabrina Corlette, a research
+professor at the Center on Health Insurance Reforms at
+Georgetown University's McCourt School of Public Policy where
+she directs research on private health insurance and market
+research. Prior to joining Georgetown faculty she was the
+director of health policy programs at the National Partnership
+for Women and Families where she focused on insurance market
+reform, benefit design, and the quality and affordability of
+healthcare. She is a member of the Washington, DC Bar
+Association.
+ Chad Riedy is 37 years old, has cystic fibrosis. He lives
+in Alexandria, Virginia with his wife, Julie, and two sons. In
+addition to volunteering for the Cystic Fibrosis Foundation he
+has spent the last 13 year working in the real estate industry.
+ Grace-Marie Turner is president of Galen Institute, a
+public policy research organization she founded in 1995 to
+promote free market ideas for health reform. She has served as
+a member of the Long-term Care Commission, the Medicaid
+Commission, the National Advisory Board for the Agency for
+Healthcare Research and Quality. Prior to founding the Galen
+Institute she served as executive director for the National
+Commission on Economic Growth and Tax Reform.
+ Dr. Rahul Gupta is the senior vice president and chief
+medical and health officer for the March of Dimes. He is one of
+the world's leading health experts. In his role Dr. Gupta
+provides strategic oversight for the March of Dimes' medical
+and public health efforts to improve healthcare for moms and
+babies. Prior to joining the March of Dimes he served under two
+Governors as West Virginia's health commissioner, and as the
+chief health officer he led the State's opioid crisis response
+efforts and several public health initiatives.
+ We appreciate all of the witnesses for being here today and
+look forward to your testimony. Let me remind the witnesses
+that we have read your written statements and they will appear
+in full in the hearing record. Pursuant to committee rule 7(d),
+the committee, and committee practice, each of you will be
+asked to limit your oral presentation to a 5-minute summary of
+your written Statement.
+ Let me remind the witnesses that pursuant to Title 18 of
+the U.S. Code Section 1, it is illegal to knowingly and
+willfully falsify a Statement, representation, writing
+document, or material fact presented to Congress or otherwise
+conceal or cover up a material fact.
+ Before you begin your testimony please remember to press
+the button on your microphone in front of you so that it will
+be turned on and the members can hear you. As you begin to
+speak the light in front of you will turn green, after 4
+minutes the light will turn yellow to signal you have 1 minute
+remaining. When the light turns red we ask you to summarize and
+end your testimony.
+ We will then let the entire panel make their presentations
+before we move to member questions. When answering a question
+please remember once again to turn your microphone on.
+ I will first recognize Ms. Corlette.
+
+ TESTIMONY OF SABRINA CORLETTE, RESEARCH PROFESSOR, CENTER ON
+ HEALTH INSURANCE REFORMS, GEORGETOWN UNIVERSITY HEALTH POLICY
+ INSTITUTE
+
+ Ms. Corlette. Thank you, Mr. Chairman. Ranking Member Foxx,
+members of this committee, it is really an honor to be here
+with you today and to discuss the need for affordable, adequate
+insurance coverage, particularly for those with preexisting
+conditions.
+ In my testimony I will focus on some of the challenges
+faced by people with preexisting conditions before the ACA was
+enacted and how current threats to the ACA could have
+disproportionately harmful effects on these individuals and
+workers.
+ Before the ACA was enacted roughly 48 million people lacked
+health insurance and an estimated 22,000 died prematurely each
+year due to being uninsured. 60 percent of the uninsured
+reported having problems with medical debt. The high number of
+uninsured was costing providers an estimated $1,000 per person
+in uncompensated care costs. The lack of affordable adequate
+coverage also led to a phenomenon called ``job lock'', where
+workers are reluctant to leave the guarantee of subsidized
+employer-based coverage for the uncertainty of the individual
+market. And for many people with health issues job-based
+coverage could also be spotty or include barriers to enrolling.
+ Prior to the ACA, in most States, people seeking health
+insurance could be denied a policy or charged more because of
+their health status, age, or gender, or have the services
+needed to treat their condition excluded from their benefit
+package. Indeed, a 2011 GAO study found that insurance
+companies denied applicants a policy close to 20 percent of the
+time. Under the ACA these practices are prohibited.
+ Prior to the ACA coverage also could come with significant
+gaps, such as for prescription drugs, mental health, and
+substance use services and maternity care. Under the ACA
+insurers must cover a basic set of essential benefits.
+ Extremely high deductibles and annual or lifetime limits on
+benefits were also common before the ACA. The law protects
+people from both by capping the annual amount paid out-of-
+pocket each year and prohibiting insurers from placing
+arbitrary caps on coverage.
+ Members of this committee are aware that the ACA is now
+under threat of being overturned due to pending litigation in
+Federal court. If the plaintiffs' argument prevails it would be
+tantamount to repealing the ACA without any public policy to
+replace it. And this is a scenario that Congress rejected in
+multiple votes in 2017. Congress rejected it because repealing
+the ACA without replacing it would result in 32 million
+Americans losing insurance, double premiums for people in the
+individual insurance market, leave an estimated three-quarters
+of the Nation's population in areas without any insurer, cause
+a significant financial harm for hospitals and other providers
+due to uncompensated care costs, cause the loss of an estimated
+2.6 million jobs around the country, and importantly for this
+committee, result in harm to people with job-based covered,
+including the loss of coverage for preventative service without
+cost-sharing, such as vaccines, well visits, and contraception,
+the return to preexisting condition exclusions, young adults no
+longer allowed to stay on their parents health plans, and
+insecurity due to crippling out-of-pocket costs for people with
+high cost conditions.
+ This Administration has also instituted regulatory changes
+that have resulted in higher premiums for people in the
+individual market. These include the decision to cut off a key
+ACA subsidy, the dramatic reduction in outreach and consumer
+enrollment assistance, and the introduction of junk insurance
+policies that are permitted to discriminate against people with
+preexisting conditions. The zeroing out of the mandate penalty
+has also increased premiums.
+ While the bulk of the negative effects of these policies
+are felt by people in the individual market, these negative
+effects spill over into the job-based market. The ACA is by no
+means perfect. Even its most ardent supporters argue that more
+could be done to expand Medicaid and improve affordability for
+middle class families. There are a range of policy options that
+this committee and others can explore to strengthen the law's
+foundation while also building on its remarkable achievements.
+ Thank you for providing this forum and I look forward to
+the discussion.
+ [The statement of Ms. Corlette follows:]
+ [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
+
+
+ Chairman Scott. Thank you. Mr. Riedy?
+
+ TESTIMONY OF CHAD RIEDY, RESIDENT, ALEXANDRIA, VIRGINIA
+
+ Mr. Riedy. Good morning. Thank you, Chairman Scott, Ranking
+Member Foxx, and distinguished members of the committee for
+inviting me to testify today.
+ I would also like to thank my wife, Julie, and my parents
+for being here today and for their support.
+ My name is Chad Riedy and I have cystic fibrosis. I would
+like to share my story of what living with CF is like and what
+the protections in the ACA mean to me and millions of other
+Americans living with chronic health conditions. CF is a rare
+genetic disease that affects about 30,000 people in the U.S.
+and causes a thick, sticky mucus to buildup in the airways
+causing infections. There is no cure for CF.
+ When I was diagnosed in 1984 at 3 years old, my parents
+were told that they should not expect me to live to age 12.
+Today I sit here at 37. I have been married for 12 years and a
+father of our 2 boys, Liam, who is 8, and Tate, who just turned
+7.
+ Let me tell you what it is like to live with CF. Every day
+I take 30 pills to help me breathe, digest food, and reduce
+inflammation in my lungs. I also take inhaled medicines and use
+a vest that shakes loose mucus in my lungs. Four times a year I
+go through a lengthy evaluation process with a team of doctors
+at Johns Hopkins. I do this to keep my lungs well enough to
+keep me alive. But I will never have the lung capacity of any
+of you sitting here today.
+ When I was 26 I got really sick for the first time. My wife
+and I had just returned from our honeymoon when I started to
+notice that I was having a hard time breathing performing
+normal, routine activities, like walking up stairs or talking
+on the phone. After a visit to my care team I was admitted
+immediately to the hospital, where I stayed for 7 days
+receiving intravenous antibiotics, chest physical therapy, and
+other procedures to stabilize my health. While my healthcare
+was covered under my employer-based insurance plan, when I
+returned home I received constant reminders about how close I
+was to hitting my lifetime and annual caps. Before the ACA
+banned these practices I would stay awake wondering would I
+exceed my limits or be denied coverage, then what, how would I
+pay for these things?
+ The next time, in 2014, when I got very sick again, over 8
+months my lung function, which had been stable for 7 years,
+declined dramatically. I was so sick that not only was I
+missing work, I could not walk 10 feet across our living room
+floor without having to stop and catch my breath. I struggled
+to carry my kids, who at the time were four and one. Things
+progressed to the point where we started to have conversations
+about needing a lung transplant just to stay alive. Thankfully,
+because the ACA was in place, I could focus on making a strong
+recovery instead of the financial hardships from all these
+medical bills.
+ In January 2018 I started on a drug that has changed my
+life called SYMDEKO. It treats the underlying cause of my CF,
+not just the symptoms. It has brought more stability to my lung
+function, but most importantly it has allowed me to be a better
+husband, father, and friend. I no longer worry when carrying
+laundry up a couple flights of steps from the basement. And
+when my boys are tired and want a piggyback ride or need extra
+love, daddy is there for them.
+ My treatments and care help me breathe a little easier and
+stay healthy so that I can work to help provide for my family,
+but they are expensive. In 2018 the total cost of all my
+medicines was about $450,000. This does not include my care
+team, visits to them, or other procedures. While we spend a lot
+out of pocket, I am thankful that our insurance covers most of
+these.
+ This is my story and there are so many more like it across
+the country. For people battling rare and chronic disease, the
+policies we are discussing today are a matter of life and
+death. If the Judge's ruling against the ACA stands and
+insurance companies are allowed to implement annual and
+lifetime caps I would reach them in a matter of years and be on
+the hook for unimaginable financial costs. In addition, the cap
+on out-of-pocket sharing is vital for someone like me.
+ I am grateful that I have coverage that allows me to access
+a great team of doctors and cutting-edge medicines that help me
+fight this disease. Because of this I have hope, hope for a
+future where I grow old with my wife, see my kids grow up,
+graduate college, get married, and start families of their own.
+ I am not asking for you to take care of me, I do that
+myself. I also understand that the ACA is not perfect, but the
+protections it contains are critical to me and millions of
+other Americans with preexisting conditions.
+ I thank the committee for giving me the opportunity to
+share my story and I ask that you are to keep our hope alive as
+you consider legislation this Congress.
+ Thank you.
+ [The statement of Mr. Riedy follows:]
+ [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
+
+
+ Chairman Scott. Thank you, Mr. Riedy. Ms. Turner?
+
+ TESTIMONY OF GRACE-MARIE TURNER, PRESIDENT, GALEN INSTITUTE
+
+ Ms. Turner. Thank you, Chairman Scott, Ranking Member Foxx,
+and members of the Committee for inviting me to testify today.
+ At the Galen Institute we focus on ways to ensure
+affordable health coverage to all Americans, particularly
+protection for the most vulnerable. I am really pleased to be
+on the panel with Mr. Riedy, and thank you for so bravely
+sharing your story. I am thankful for the health care system
+that supports your care and for continued innovations so new
+treatments can be available.
+ Today in my testimony I am going to discuss the centralrole
+that the employer health insurance market plays in our health
+sector, new opportunities to reduce costs and expand access to
+coverage, and bipartisan support for preexisting condition
+protections, and the need for further improvements.
+ Nine out of ten workers are employed in the U.S. by
+companies that offer health insurance. These benefits are tax
+free, both to workers and companies, a generous benefit but one
+that leverages nearly $3 in private employer spending for every
+$1 in Federal tax revenue losses. Employers and employees want
+the best value for their health care dollar and often work very
+hard to balance cost and quality.
+ Long before the ACA, employers offered preventative
+services because they know that addressing health issues before
+they become a crisis can lead to better outcomes and minimize
+costs. These employers also play a vital role in supporting our
+health sector. Physicians and hospitals are paid much less
+under Medicare and Medicaid than under employer plans, and
+because private insurance pays more, they provide the margins
+that allow many hospitals and providers to stay in business.
+Leading proposals to expand Medicare coverage to all Americans
+would extend these public disbursement rates universally,
+diminishing quality and access to care.
+ The Trump administration is offering several options
+through its regulatory authority to help individuals and
+employees with more affordable coverage. The Chairman mentioned
+one of them, including association health plans. They allow
+small firms to group together to get some of the same benefits
+that large employers have. A Washington Post story just
+reported on a new study showing that AHP benefits are
+comparable to most workplace plans and plans are not
+discriminating on patients with preexisting conditions. They
+also have new flexibility under Section 1332 of the ACA to
+lower costs through risk mitigation programs. They separately
+subsidize patients with the highest cost, lowering premiums for
+others, and leading to increased enrollment. In Alaska,
+premiums for the lowest-cost bronze plan fell by 39 percent in
+2018 and Maryland is seeing an even larger drop this year.
+ Putting the sickest people in the same pool with others
+means that their premiums are higher. Virginia Senator Bryce
+Reeves talked with one of his constituents recently who said he
+makes a good living, provides for his family, but he said his
+health insurance premiums are $4,000 a month. And he said that
+is more than my mortgage, and really pleading for help.
+Unfortunately, many healthy people are dropping out of the
+market because costs are so high.
+ There is strong bipartisan support for preexisting
+condition protections. The ACA assures people cannot be turned
+down or have their policies canceled because of their health
+status, and these protections are still in place. Legislation
+passed by the House of Representatives maintained preexisting
+condition protection. But they do not work for everyone.
+Janet--did not use her last name--reported that she was
+diagnosed in 1999 with Hepatitis C. She lives in Colorado and
+applied for coverage in the State's high-risk pool. Her
+premiums in 2010 were $275 a month. Then her liver failed. She
+needed a transplant. The $600,000 bill was covered 100 percent
+with only $2,500 out-of-pocket. Colorado's high-risk pools
+closed when the ACA started in 2014. Her premiums rose to $450.
+By 2018 they were $1,100 a month. The deductible was $6,300.
+But her anti-rejection medications were not covered. She said
+almost everything I needed was denied, which threw me into a
+world of having to appeal to get the care I needed. She said
+those of us who are self-employed and are not eligible for tax
+credits wind up footing way too much of the bill. She said her
+costs are $19,000 a year before insurance pays and she has to
+pay extras for her medication. She keeps her insurance because
+if something else happened, and her liver failed and she needed
+another transplant, she said it would bankrupt my family.
+ I hope to work with you to achieve the goals of better
+access to more affordable coverage and better protection with
+those with preexisting conditions.
+ Thank you for the opportunity to testify today.
+ [The statement of Ms. Turner follows:]
+ [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
+
+
+ Chairman Scott. Thank you. Dr. Gupta, before you start I
+think I need to give full disclosure. I have been an active
+member of the--volunteer for the March of Dimes for several
+decades. So I appreciate your testimony.
+
+ TESTIMONY OF RAHUL GUPTA, SENIOR VICE PRESIDENT AND CHIEF
+ MEDICAL AND HEALTH OFFICER, MARCH OF DIMES
+
+ Dr. Gupta. Thank you for being an active member, Mr.
+Chairman, and thank you, along with Ranking Member Foxx and
+members of the committee, for the opportunity to testify today.
+ My name is Rahul Gupta, I am the senior vice president and
+chief medical and health officer at the March of Dimes. In
+addition to my role representing the March of Dimes I also
+bring perspective from my experience as a practicing physician
+and as a former State health commissioner and a local health
+officer.
+ As a primary care physician, it was not uncommon for me to
+treat women who were struggling with high costs of employer-
+based health insurance or priced out of coverage altogether due
+to their preexisting conditions. These women were in the
+impossible condition of having to make choices between getting
+the care they needed and affording their families' basic
+necessities, such as food and prescription medications.
+Preexisting conditions are common among Americans. Six in every
+ten American adults in the U.S. has a chronic disease, and four
+in ten have two or more.
+ Chronic conditions, such as high blood pressure, diabetes,
+heart disease, and obesity can have tragic consequences for
+women during pregnancy. Each day in the United States more than
+two women die of pregnancy-related causes, and more than 50,000
+have severe pregnancy complications. More American women are
+dying of pregnancy-related complications than any other
+developed country in the world, and it is not getting any
+better.
+ As pregnancy or childbirth are also widely considered
+preexisting conditions the prevalence of at least one
+preexisting condition in this population is almost universal.
+If conditions like preterm birth, birth defects, or neonatal
+abstinence syndrome, are considered tens of millions of
+children could be subject to insurance discrimination
+throughout their lives. The Affordable Care Act contains a
+range of provisions to help ensure comprehensive, meaningful,
+and affordable coverage for women, children, and their
+families. Amongst its most important popular provisions is the
+requirement that health plans cover all individuals regardless
+of preexisting conditions. The law ensures that all American
+can obtain coverage without worrying that they will be subject
+to discrimination, whether outright denial of coverage, or
+carve-outs of the benefits they need the most.
+ It is difficult for me to overstate the importance of ACA's
+requirements that all plans cover the 10 essential health
+benefits, including maternity care.
+ The ACA has also addressed a range of issues related to
+affordability of coverage. Cost has historically been and
+remains one of the greatest barriers to care. If people are
+unable to afford coverage, healthcare becomes all but
+inaccessible. Under the ACA, policies sold on the individual
+and small group markets are prohibited from charging women high
+premiums. Health plans can no longer impose annual or lifetime
+caps. In the case of maternal and childbirth and child health,
+these caps could be financially devastating.
+ A woman, for example, with a high-risk pregnancy and
+delivery could easily exceed an annual cap, leaving her unable
+to obtain needed care for the rest of the year. Worse, a baby
+born extremely preterm, who needs months of care in the
+neonatal ICU, could exhaust a lifetime cap before even coming
+home.
+ This triad of preexisting condition protections, essential
+health benefits, and affordability provisions represent a
+three-legged stool that supports access to comprehensive
+quality and affordable coverage for all Americans. All three of
+these legs must be maintained to protect and promote our
+Nation's health, especially the health of women, children, and
+families.
+ March of Dimes is deeply troubled by Texas v. U.S. This
+lawsuit appears to have been undertaken as a legal exercise
+divorced from any real appreciation of its ramification for
+millions of Americans and their health and wellbeing. With the
+recent decision of the Federal court judge to declare ACA
+unconstitutional in its entirety, the plaintiffs appear to be
+in a classic situation of the dog that caught the car. They
+were caught off guard by their own victory and now are unsure
+how to explain that they have argued for an action that will
+cost millions of Americans their health coverage and
+potentially even their lives.
+ In addition, we are deeply concerned about efforts by the
+Administration to promote access to short-term, limited
+duration insurance plans. These plans are not required to cover
+essential health benefits, including maternity care, mental
+health, and substance use treatment, and could again exclude or
+charge patients more based on their preexisting conditions.
+Whatever changes may be undertaken to our Nation's health laws
+and systems, they must be made with the express goal of
+improving access to coverage and care that is accessible,
+comprehensive, and affordable.
+ In essence, this concept is no different than when I am
+seeing a patient in my office. I endeavor to provide her with
+the highest quality care in a compassionate manner, keeping in
+mind that she should not have to sacrifice her next trip to the
+grocery store in exchange. I sincerely hope that we can provide
+the same guarantee to all Americans.
+ Thank you for holding this meeting, and I look forward to
+any questions.
+ [The statement of Dr. Gupta follows:]
+ [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
+
+
+ Chairman Scott. Thank you, thank you. And now we will have
+our members ask questions. First, I am going to defer on my
+side, and the gentleman from Connecticut, Mr. Courtney.
+ Mr. Courtney. Thank you, Mr. Chairman. And, again, I want
+to applaud the fact that we are holding this hearing in this
+committee. Back in 2009 and 2010, when the Affordable Care Act
+was crafted with three different committees, it was our
+committee which led the way in terms of preexisting conditions
+and all the patient protections, because we have jurisdiction
+over ERISA. So, again, we actually were the place where the law
+was written that was, in my opinion, you know, one of the great
+steps forward of our Nation in terms of social and civil
+rights.
+ You know, again, Ms. Corlette talked about what the
+landscape looked like back in 2009 and 2010. I brought along a
+flyer that was being sold to a lot of businesses, which again,
+brings back the bad old days. Again, it is a health plan where
+it is touted as great news for people who buy their own health
+insurance, a flexible health plan, affordable. However, if you
+flip to the back, it had sort of in the smaller print the fact
+that they may not be able to cover people who have ever had
+treatment for the following, AIDS, alcohol or drug dependence,
+cancer, COPD, connective tissue disorder, Crohn's disease,
+diabetes, emphysema, heart attack or stroke, hepatitis,
+inpatient emotional or mental illness, organ or tissue
+transplant, or colitis. So if you are like an episode of
+survivor and you are not in that category, however, you are
+still not out of the woods yet because it also says that other
+individuals who are obese, underweight, have undergone
+diagnostic tests for a whole variety of different illnesses, as
+well as expectant parents or children less than 2 months old
+are also not going not be able to take advantage of that
+policy. And, last, it says this list is not all inclusive.
+Other conditions may apply.
+ So, I mean that is what health insurance looked like until
+President Obama signed the Affordable Care Act in March 2010,
+which once and for all abolished this whole type of medical
+underwriting practice. And, again, it was also architecture
+that was built around it to make that meaningful, such as
+essential health benefits, the lifetime caps, which Mr. Riedy
+so powerfully testified to, adjusted community rating so that
+older people can't be charged more than three times a younger
+individual.
+ So, again, regarding the Texas case, as Dr. Gupta said, I
+mean there is absolutely no question that the Justice
+Department, which participated with the plaintiffs and did not
+defend the Department of Health and Human Services, if that
+ruling were to stand, again, that would just take a wrecking
+ball to the whole architecture, again, that was built. Is that
+correct, Ms. Corlette?
+ Ms. Corlette. That is correct. For the plaintiff States, if
+their position prevails the entire law would be invalidated.
+ Mr. Courtney. And in terms of some of the other changes
+that they have made through the regulatory process, the
+association health plans, which, again, on surface sounds
+great, that small businesses can team together in different
+sectors and go out and buy collectively. By the way, that was
+totally legal prior to the Trump Administration's ruling and
+there were about 600 association health plans across the
+country. What the ruling really did was it basically allowed
+those plans to avoid, again, a lot of these patient
+protections, such as essential health benefits, which were
+painstakingly designed with the Institute of Medicine in terms
+of what is healthcare and what should health insurance be, and
+lifetime caps, et cetera.
+ So, again, I just wonder if you could sort of focus on that
+point, that the Administration, again, is in fact undermining
+preexisting conditions and preexisting condition protections
+with those types of regulatory actions.
+ Ms. Corlette. That is absolutely correct. Groups of
+employers have always been able to join an association and
+offer benefits if they choose to do so. What the Administration
+is encouraging is arrangements that essentially are allowed to
+cherry pick the healthiest and youngest employer groups out of
+the regulated market and thereby gain a pricing advantage.
+ Mr. Courtney. And the short-term plans, Dr. Gupta, you
+mentioned, again, it is the same story, that it is really a
+device to avoid again the protections that were built into the
+Affordable Care Act.
+ Dr. Gupta. That is very true. And along with that, the
+other part of this is the medical loss ratio that was built
+into the ACA and that is not subject to in the short-term
+plans. So they can have as much as 50 percent medical loss
+ratio and actually profit disproportionately out of--
+ Mr. Courtney. And the short-terms plans are really not that
+short. Again, when the prior Administration allowed for a very
+short, short-term plan, these now almost are basically going to
+be sold for an entire year. Isn't that correct?
+ Dr. Gupta. Correct. They could be sold for about 364 days
+and then renewable afterwards.
+ Mr. Courtney. So, I mean it is basically a whole new
+product. And, again, we would see the bad old days in terms of,
+you know, this type of laundry list of fine print where people
+are going to have a rude awakening when they thought they had
+insurance and in fact it was totally useless and meaningless.
+ I yield back.
+ Chairman Scott. Dr. Foxx.
+ Mrs. Foxx. Thank you, Mr. Chairman. Ms. Turner, people
+living with preexisting conditions, such as cancer, diabetes,
+or other illnesses face an incredibly difficult battle each and
+every day. And, in particular, I commend Mr. Riedy for his
+strength and courage to share his story with us today. People
+should not worry about having their coverage denied because of
+a medical condition when they should be focused on getting well
+and managing their quality of life. That is why congressional
+Republicans have voted time and time again to protect
+preexisting condition protections.
+ Ms. Turner, are these protections under current law
+sufficient to protect access to coverage for the most
+vulnerable healthcare consumers, and do you agree that these
+protections should be maintained?
+ Ms. Turner. The protections absolutely should be
+maintained. But I do believe that we do have to address the
+issue of cost because many people who need coverage are not
+able to afford it and then are completely, completely exposed.
+So I believe that the preexisting conditions that are in law
+today and that the House of Representatives supported in the
+American Health Care Act were important, will continue to be
+important. I see the strong support, both in Congress and with
+the American people, to maintain those protections.
+ Mrs. Foxx. Thank you, Ms. Turner. Because of policies
+enacted by the previous House Republican majority and
+regulatory actions taken the by Trump administration our
+economy is thriving. As I mentioned, the economy added 304,000
+jobs last month, almost double what economists were expecting.
+As a result, the number of individuals with employer sponsored
+coverage has grown by nearly 7 million since 2013, with 2.6
+million gaining coverage since President Trump took office. How
+does strong economic growth contribute to more workers gaining
+health insurance from their employers?
+ Ms. Turner. Virtually all employers want to offer health
+insurance to their employees, but many smaller businesses, in
+particular, just can't afford it, both because of the
+regulatory burdens as well as the cost. The Trump
+administration is giving them some new options, both with
+association health plans and with health reimbursement
+arrangements. For those that have employer coverage, it is such
+a valued benefit and employers and employees work together to
+balance cost and quality and comprehensiveness of benefits. And
+as a result, employer-sponsored health insurance is certainly
+the most popular benefit offered by employers. And I am pleased
+to say that is not only continuing but being enhanced by the
+strong economy.
+ Mrs. Foxx. Thank you. Ms. Turner, when I travel around my
+district in North Carolina, I hear stories from so many people
+who struggle with the high and sometimes unpredictable costs
+that they face when taking care of themselves and their
+families. Out-of-control drug prices, surprise medical bills
+are two topics that President Trump has recently identified as
+places for reform and areas where I believe we can find
+bipartisan agreement.
+ In addition to these issues, what other areas do you think
+that Republicans and Democrats can move forward and work on
+together to find a solution that benefits patients, workers,
+and families?
+ Ms. Turner. I do work with a number of people in the policy
+community and it is surprising to see how much agreement there
+is on really trying to help people. I think we need to
+strengthen the system for the most vulnerable. I was on a panel
+yesterday--on Monday at the Academy of Health with several
+people from center-left and we talked about the importance of
+thinking of the whole person, of comprehensiveness of care, of
+allowing people to not only have coverage for health care, but
+housing support and food support and transportation support.
+Thinking of the whole person I think is really crucial and
+devolving more power and authority to the States and localities
+that have the understanding of their markets and resources I
+think is really crucial. But I also think addressing the cost
+of health coverage is so important.
+ Between 2017 and 2018 we lost 2 million people in the
+individual health insurance market. They dropped out because of
+cost. So we have got to address the cost for people who want
+health insurance, who currently are healthy, but know they need
+protection. And we need to make sure that we are strengthening
+the system for the most vulnerable.
+ Mrs. Foxx. Thank you, Ms. Turner. I yield back, Mr.
+Chairman.
+ Chairman Scott. Thank you. The gentlelady from Oregon, Ms.
+Bonamici.
+ Ms. Bonamici. Thank you, Mr. Chairman, and thank you to all
+of our witnesses.
+ Last week there was a hearing in the Ways and Means
+Committee here in the House about preexisting conditions and
+one of the witnesses was the insurance commissioner from my
+home State of Oregon, Andrew Stolfi. And he talked about how in
+Oregon since the ACA we now have more than 3.7 million
+Oregonians, which is about 94 percent of our population, with
+health insurance coverage. And since the ACA that has been a
+significant improvement, significantly reducing the number of
+people without insurance. And before the ACA insurers had
+offered limited coverage or excluded so many people who
+applied. In fact, before the ACA the denial rate was about 30
+percent, 30 percent of people who applied were denied. And in
+Commissioner Stolfi's words, he said the ACA has helped change
+all of this, pregnant mothers know they can get the care they
+need and their babies need, children with developmental
+disabilities can get all of the essential physician-recommended
+physical, occupational, and behavioral therapy they need to
+grow to their fullest potential.
+ So, the ACA is now protecting millions of people in Oregon
+who have preexisting medical conditions. Lisa from Beaverton is
+26 years old, she received a diagnosis when she was 23, stage 4
+lymphoma. I am happy to report that her cancer is now in
+remission and she is pursuing a master's degree, but she is
+pretty worried, frankly, when she hears all the conversations
+about repealing the ACA, this Texas lawsuit. She said ``I have
+hopefully a lot of life ahead of me and it frustrates me that
+my history of cancer could limit my access to healthcare.''
+ Mr. Riedy, thank you so much for sharing your story. I have
+an advocate in the district I represent, Ella, a young woman
+with CF, and she comes to the Capitol when she can to advocate
+for more research and funding. And her family shares your
+concern about lifetime caps.
+ How is the last couple of years--how have you personally
+felt when you hear all these conversations about repealing the
+Affordable Care Act? And when you hear about this lawsuit that
+might repeal the Act?
+ Mr. Riedy. Thank you. It is scary to think, especially like
+I testified earlier, with the cost of my care currently, having
+caps or potentially being able to be denied coverage is a scary
+thought. Knowing that there is access to drugs that are
+changing my life and that there is more medicine coming down
+the pike that will ultimately, I fully believe, one day cure
+cystic fibrosis. But that will come at a cost. And it is hard
+to think or sort of comprehend that those treatments may be
+there and because of a lifetime cap or because of being denied
+access, that I will not be able to get those medicines, or your
+constituent's daughter would not be able to get those medicines
+that could potentially save or prolong her life.
+ Ms. Bonamici. Thank you so much. And you made an excellent
+point, that access does not mean affordability. And if there is
+not the prohibition against discrimination for people with
+preexisting conditions, if the companies are saying well, we
+offer insurance to people with preexisting conditions, it just
+costs a fortune, it is not meaningful access.
+ I have another question to Dr. Corlette. I have another
+constituent, Diane, who is a small business owner and for a
+long time she--she has a son with autism and a small business--
+for a long time she could not afford insurance before the ACA.
+She almost lost her home and business during the financial
+collapse. She went several years without coverage and she was
+uninsurable because she had preexisting conditions.
+ So, she was not able to manage her arthritis, made it
+difficult for her to work. So, under the ACA she was able to
+get coverage, she could see a doctor, she eventually had hip
+replacement surgery, she is now able to work, has rebuilt her
+business. So, a really positive story largely because of that
+access to marketplace coverage.
+ So, Professor Corlette, if the ACA protections we have
+discussed are undermined, what might that mean for Diane and
+other small business owners who do look to provide coverage for
+themselves, their families, and their employees?
+ Ms. Corlette. Sure. So, if the ACA is invalidated in a
+Texas court it will wipe away some of the protections that your
+constituent has benefited from. So, for example, in the group
+market, if she is buying as a small business owner she could--
+her employees could face what are called preexisting condition
+exclusions where the insurance company excludes from your
+benefit package those services that would actually treat your
+condition, for which you actually need services, for up to a
+year. The insurance company would not be required to cover
+essential health benefits, which is a list of benefits that the
+Institute of Medicine and others have said should be in a basic
+benefit package, it could impose lifetime annual limits, there
+may not be a cap on the annual amount that she or her employees
+would pay out-of-pocket. So, there are a number of critical
+protections that people in job-based coverage would lose.
+ Ms. Bonamici. Thank you very much and I see my time has
+expired. I yield back. Thank you, Mr. Chairman.
+ Chairman Scott. Thank you. Dr. Roe.
+ Dr. Roe. Thank you, Mr. Chairman. And, Mr. Riedy, I want to
+start with you.
+ First of all, the easiest vote I have made here in the U.S.
+Congress was for the 21st Century Cures Act. To Dr. Collins,
+Francis Collins, the director of the NIH, it is very easy for
+me to vote to increase his budget to $39 billion. When I was a
+medical student, the first pediatric rotation I had in Memphis
+was St. Jude's Children's Hospital. Eighty percent of those
+children died in 1969 when I rotated there, today 80 percent of
+them live. If you have a rare condition, it is 100 percent for
+you. So I think there is a cure out there in the way and I
+think your future is very optimistic. And thank you for being
+here today.
+ Look, we could all agree that we want to increase coverage
+and access and lower costs. That is exactly what we wanted to
+do with the ACA. Everyone can agree to that. And we agreed that
+we wanted to discuss preexisting conditions. And I want to go
+over very quickly, so everybody understands, that if you have
+health-based insurance, which I provide in my office for my
+employees, everyone--you cannot discriminate based on a
+preexisting condition. No. 2, if you have Medicaid or Medicare,
+you cannot discriminate versus on a preexisting condition. It
+is only in the small group and individual market where this
+occurred. And people feared if they lost their job and they
+ended up in the small group or individual market that they
+couldn't do that.
+ I have a bill that I am dropping today, a very simple bill.
+It has one paragraph, it is three pages long, that essentially
+provides ERISA coverage to the small group and individual
+market. It treats them--me--as an individual--and I have been
+on the individual market--exactly like a large corporation. And
+that solves the problem and everyone in here--no matter what
+the Court does--if the Court rules whatever they rule. If they
+rule and it takes apart this, we have covered everybody and
+treated each individual exactly the same as a big company. This
+should be simple to do, it is one paragraph.
+ And let me also say, Dr. Gupta, to you, let me share some
+experiences in Tennessee. We were promised the costs were going
+to go down. Our costs went up 175 percent and we lowered the
+number of plans out there that we could have. In my district,
+where I live, three-fourths as many people paid the penalty as
+actually get a subsidy. And what is happening in the real world
+is with these out-of-pockets and co-pays, if the hospital were
+our practice for 30 years, over 60 percent of the uncollectible
+debt are people with the insurance, not without insurance, but
+with insurance. And what happens is a patient will come to my
+office and if they had a condition, one of the 10 essential
+health benefits, they got their screening procedure done, that
+was fine, that was ``free''. If I found anything wrong with
+them and I had to send them down to the hospital for a test,
+they then have to meet their out-of-pocket and co-pay, which
+can be $3-4-5,000--and my family is $10,000. And so what
+happens, the hospitals, the providers, end up eating that. That
+is what his happening in the real world. Or people don't get
+the second test that they need, and that is what we have to
+look at.
+ I also want to say to you all that I have a preexisting
+condition. I was treated 17-18 months ago for proState cancer.
+So I am in that pool of preexisting conditions and I don't want
+to be excluded either, nor do I want my patients excluded. And
+that is why I think we should all support this bill right here.
+ And, Miss Turner, if you would, I would like for you to
+comment a little bit about my suggestion, about just applying
+these ERISA rules to me or to any individual out there.
+ Ms. Turner. As we said, employers so highly value their
+employer coverage, and one of the reasons is because someone is
+negotiating on their behalf for a quality health plan. And
+health plans in the workplace are basically community rated.
+You may have different plan options, but everybody is basically
+paying the same amount for premiums. And HIPAA, of course,
+protections say that if you have group coverage through an
+employer and you move from one employer to another, that next
+employer must cover you at the same rate. So you can't then be
+basically underwritten. So there are a lot of existing
+protections in law.
+ And I am very intrigued with your very creative legislation
+to basically extend those protections. I think it is important
+to note that if the Supreme Court--and I don't know anyone who
+knows what the Supreme Court is going to do--were to strike
+down the law, Congress is absolutely determined to fix it and
+to maybe improve the ACA in the process.
+ Dr. Roe. I agree. And one of the things that I think is out
+there in the group market, in the self insured market--and we
+did this when I was on the City Commission in my hometown--is
+you can have disease management--Dr. Gupta knows this very
+well. And I have seen those cases where I have a friend of mine
+who has a large company with 15,000 employees, had a 1 percent
+increase in their premium per year for the last 5 years. And we
+can do that in the small group and individual market if we work
+together.
+ Mr. Chairman, thank you. I yield back.
+ Chairman Scott. Thank you. Gentleman from California, Mr.
+Takano.
+ Mr. Takano. Thank you, Mr. Chairman. Let me begin by saying
+that my home district in Riverside, California, we cut--the
+Affordable Care Act enabled us to cut our uninsured rate by
+more than half because of expanded Medicaid and because of
+Covered California, which is the name of our exchange. I have
+personally spoken to older people in my district who have not
+reached Medicare age, but at an age when if there were no ACA
+they would not get any cost-sharing subsidies and they could
+not have afforded the insurance. They were very grateful that
+they got the cost-sharing subsidies so that they could reduce
+their exposure to a major medical incident.
+ So, the majority offers these really false solutions of
+association plans and short-terms plans. Ms. Corlette, could
+you--you know, I think these plans are really evasions around
+minimum benefits. Is that correct?
+ Ms. Corlette. That is right. So short-term plans are exempt
+from all of the Affordable Care Act rules, so they don't have
+to enroll people who have health issues, they don't have to
+cover the essential health benefits, and quite commonly with
+these plans, if you do get diagnosed with something after you
+enroll, they will do what is called post-claims underwriting
+and drop you from the plan to avoid paying your medical bills.
+So, if you do have an unexpected medical event or diagnosis,
+you might find yourself uncovered.
+ The concern is that they will siphon away healthy people
+from the Affordable Care Act marketplaces and result in higher
+premiums for those who are not perfectly healthy and have to
+buy one of these ACA plans.
+ Mr. Takano. So, the same for association plans, which were
+available, but the way the Administration has structured them,
+a similar sort of result.
+ Ms. Corlette. Association health plans are similar but not
+exactly the same. They do have to comply with some of the ACA
+rules, but not all. And so they can use essentially the rating
+advantage they have, because they can charge higher rates based
+on age and other factors to cherry pick healthier employer
+groups from the ACA market.
+ Mr. Takano. And there goes, you know, any affordability
+gain by the ACA. So, these are really ways to undermine the ACA
+and to undermine by extension protections for people with
+preexisting conditions, is that right?
+ Ms. Corlette. That is right. If you have a preexisting
+condition or you simply want comprehensive coverage, like
+maternity care or other things that you feel are important, you
+would be buying in the ACA market, and if healthy people are
+siphoned away the ACA market risk pool will be smaller and it
+will be sicker, and insurers will price higher as a result.
+ Mr. Takano. So, I would say that attempts to undermine the
+pools, undermine enrollment periods--so if we look at slashing
+funding for outreach and enrollment activities, that means less
+people enroll and makes these insurance pools less viable. That
+is also hurting people with preexisting conditions.
+ Ms. Corlette. That is right. There is no question that
+research shows that advertising, marketing, outreach,
+education, consumer assistance, those all work to get healthy
+people into the pool.
+ Mr. Takano. And this Administration has, you know, really
+refused to spend the outreach to get people to sign up for
+insurance, which then creates the premium dollar pool to make
+insurance viable and actually keep the cost down.
+ Ms. Corlette. That is right. This Administration has
+slashed outreach and marketing by about 80 percent. So it is
+hard to bring healthy people in if they are not aware that the
+coverage opportunity exists.
+ Mr. Takano. It was hard for me to square this President
+wanting to protect people with preexisting conditions knowing
+that his Administration intentionally did that.
+ So also shortening the enrollment period, making it less--
+giving people less time to enroll into these insurance plans
+also has the same result.
+ Ms. Corlette. That is right. And a number of the State-
+based marketplaces that can choose their own open enrollment
+periods have extended them to give people more time to enroll,
+and that has been a successful strategy.
+ Mr. Takano. Well, and the Administration has also engaged
+in undermining the stability of the markets through ending the
+cost-sharing reduction payments for lower-income consumers.
+Would prevent people from being able to buy insurance because
+they don't have these subsidies.
+ Ms. Corlette. It is absolutely the case that the decision
+by this Administration to cut the cost-sharing reduction
+subsidy led to an increase in premiums in the individual market
+significantly. I think 20 percent.
+ Mr. Takano. Well, this intentional undermining in at least
+the three ways that I have spoken about, I mean certainly
+reduces the viability of these healthcare exchanges and also
+really makes meaningless any statement that this President
+wants to protect people with preexisting conditions and their
+ability to get insurance.
+ I yield back, Mr. Chairman.
+ Chairman Scott. Thank you. Gentleman from Pennsylvania, Mr.
+Thompson.
+ Mr. Thompson. Chairman, thank you for hosting this hearing.
+Incredibly important topic. As someone who practiced healthcare
+for 28 years as a therapist, rehabilitation services manager,
+licensed nursing home administrator, I mean this is an
+important topic and preexisting conditions is a serious issue,
+an incredibly important issue. I have been disappointed over
+the past couple of years where, you know, with preexisting
+conditions individuals living with preexisting conditions
+obviously need confidence in their lives that they are going to
+be able to purchase insurance that they need to cover that
+condition, for treatment, rehabilitation. But quite frankly,
+what I have been disappointed in is how--there are people with
+preexisting conditions--need that health care professionals who
+are compassionate and dedicated, they want to provide those
+service, they want to access--they want those patients to be
+able to access those services. Well, we have got a lot of
+politicians that have been weaponizing preexisting conditions
+for political purposes. And whenever we do that, you know, my
+experience--I have only been here--this is my 11th year. I was
+here in 2009-2010. It doesn't serve anyone well.
+ And so also my background, I used to get very frustrated
+advocating for my patients, whether it was in a nursing home,
+comprehensive inpatient, rehab, acute care, you know, going to
+battle with insurance companies. The people with some of the
+more chronic conditions are the ones that are facing those
+lifetime benefits. So I certainly support those improvements.
+ But that said, let us--you know, I really want to clarify
+here, Ms. Turner, you know, protections for individuals with
+preexisting conditions has been a consistent area of agreement
+for both Republicans and Democrats. You Stated that protections
+for people with preexisting conditions are currently the law of
+the land and under the American Health Care Act, passed by the
+House last Congress, would the current law's legal protections
+for individuals with preexisting conditions be retained?
+ Ms. Turner. If the Supreme Court were to invalidate the ACA
+and find the individual mandate unconstitutional and non-
+severable, which I think is unlikely, but if it would, it would
+certainly give several years of transition time before it went
+into effect to give Congress ample time to figure out how to
+back up these protections. And as you said, the Congress at
+the--whoever has been in control of the Congress has been a
+strong support of protection for preexisting conditions. Even
+if people don't have them now, they think they could get them
+in the future and they know someone has chronic conditions. So
+those protections need to be in place, but they need to be in a
+place in a way that actually allows the market to continue to
+work and doesn't drive out the healthy people because the costs
+are so high.
+ Mr. Thompson. I mean there are a lot of things that impact.
+I think people getting into the pool, so to speak, that was
+mentioned by my friend from California, but the folks that have
+gotten out of the pool, I think there is a significant number
+who have gotten out because of post ACA, the cost, the
+escalating cost. And people with preexisting conditions that
+have--that were pleased that they could get it, the insurance
+but their costs have escalated. So we can't be complacent with
+the law as it is now, whether--we have to take measures.
+ One final question for you, Ms. Turner. We constantly hear
+about the challenges that small employers face when dealing
+with costs and compliance burdens in providing health insurance
+coverage to their employees. While some small businesses are
+able to offer health coverage, many simply can't afford to do
+so. And one option, among others, which was passed by this
+committee, is for the small employers to band together to
+provide economies of scale for purchasing health insurance
+through association health plans.
+ Now, what are other alternatives that encourage and enable
+employers, both small and large, to preserve and expand quality
+health coverage for their employees?
+ Ms. Turner. Well, I do think it is important to focus on
+association health plans because this recent study by a very
+well respected analyst, Kev Coleman, said that he did not see
+that the plans that these new association health plans, which
+are offered in 13 States, just in the 7-months since the rule
+was finalized, and offering more than two dozen plans, that
+they really do provide an option for employers.
+ I have been in seminars with H.R. directors of Fortune 500
+companies and talked with innumerable small businesses. They
+want to negotiate benefits that their employees want and they
+listen to their employees. And they are as comprehensive of
+benefits as they can afford and offer that coverage. So I think
+that it is important to give respect to the people purchasing
+these policies, that they will find a way to make sure people
+have coverage that is as good as they can afford, rather than
+no coverage at all, which is where too many people are without
+these options.
+ Mr. Thompson. Thank you, Ms. Turner. Thank you, Chairman.
+ Chairman Scott. Thank you. The gentlelady from Washington,
+Ms. Jayapal.
+ Ms. Jayapal. Thank you, Mr. Chairman. On October 31 of last
+year, conveniently just a few days before the midterm election,
+President Trump tweeted, and I quote, ``Republicans will
+protect people with preexisting conditions far better than
+Democrats.'' That was a pretty big flip-flop given that the
+President and Republicans in Congress, including many on this
+very committee, spent most of last Congress voting to try to
+kill the Affordable Care Act and its protections for
+individuals with preexisting conditions. In fact, I think I am
+right about this, the only Republican members of this committee
+who did not vote for the horrible Trump Care bill last Congress
+were the eight new members who had not yet been elected.
+ Now, this Administration is backing a lawsuit that could
+strip coverage for more than 133 million Americans with
+preexisting conditions with absolutely no plan to replace that
+coverage. And if this ruling takes effect more than 17 million
+people would lose coverage in the first year alone.
+ So, to my Republican colleagues, which one is it? Do the
+American people deserve coverage for preexisting conditions or
+don't they?
+ Let me also point out that overturning preexisting
+conditions protections would disproportionately harm racial and
+ethnic minorities. And, Mr. Chairman, I seek unanimous consent
+to enter a written Statement from the Asian and Pacific
+Islander American Health Forum into the record.
+ Chairman Scott. Without objection. And I want to remind our
+colleagues that pursuant to committee practice, materials must
+be submitted to the committee clerk within 14 days following
+the last day of the hearing, preferably in a Microsoft Word
+format. The materials submitted must address the subject matter
+of the hearing. And only a member of the committee or an
+invited witness may submit the materials for inclusion in the
+record.
+ Documents are limited to 50 pages. Documents longer than 50
+pages will be incorporated into the record by way of an
+internet link, so that you must provide the committee clerk
+with that in the timeframe, but recognize that years from now
+that link may no longer work.
+ And I will give you a couple of seconds at the end.
+ Thank you.
+ Ms. Jayapal. Thank you, Mr. Chairman. And noted for the
+future.
+ So let me start with my first question for Ms. Corlette.
+Thank you for your testimony. In your professional opinion as a
+research professor at the Center on Health Insurance Reforms,
+let us go back a little bit, why did it take an act of Congress
+to require insurance companies to insure people with
+preexisting conditions?
+ Ms. Corlette. Well, before the ACA insurance companies, in
+order to make money, the business strategy was to enroll as
+many healthy people as you could, bring in their premiums, and
+pay out as little as possible in claims. So, to do that they
+engaged in what was called medical underwriting, which required
+people when they applied for coverage to submit health forms.
+They had lists of up to 400 different conditions that would
+cause you to be excluded from coverage. But, essentially that
+was the business strategy.
+ What the ACA tried to do was change the business strategy
+away from risk avoidance to risk management.
+ Ms. Jayapal. Thank you. So, just to be frank, insurance
+companies wouldn't cover people with preexisting conditions
+because they are too expensive, correct?
+ Ms. Corlette. Yes.
+ Ms. Jayapal. OK. So, Ms. Corlette, you also said in your
+testimony that the Affordable Care Act was enacted in part to
+correct serious deficiencies in health insurance markets that
+left millions uninsured and millions more with inadequate
+coverage. The reality is that the profit-seeking motives of
+insurance companies and big pharma are at odds with providing
+comprehensive care for everyone in this country. Do you believe
+that government should play a role in insuring that corporate
+greed doesn't allow insurance companies to deny coverage to
+people with preexisting conditions?
+ Ms. Corlette. I think absolutely government needs to play a
+role, both in terms of financing, and I think it is important--
+you know, this committee is as aware as anybody else that
+employer-sponsored coverage is the source of the biggest
+subsidy in the Federal tax code. So critical role in terms of
+financing, but also to set the rules of the road. So, to the
+extent that we have private market actors on the provider side
+or the payer side, that there are clear rules of the road to
+protect people who need help, which is individuals, consumers,
+small businesses.
+ Ms. Jayapal. So, thank you. In 2017--this is again a
+question for you--Aetena's CEO was paid nearly $59 million,
+Cigna's CEO took home almost $44 million, UnitedHealthcare's
+CEO $27 million. So, our healthcare system is underwritten by
+greed and health insurance companies and big pharma are
+profiting off of sick Americans. Without the protections
+ensured by the ACA, do you believe that insurance companies
+would continue to guarantee coverage for people with
+preexisting conditions?
+ Ms. Corlette. No, I think they would go back to the
+business practices they were engaged in before the ACA was
+passed.
+ Ms. Jayapal. Thank you. The Urban Institute estimates that
+17 million people will lose coverage in the first year alone if
+the Republican lawsuit stripping the ACA goes through. We have
+waited long enough for corporate executives to do the right
+thing, in my opinion. They simply aren't going to do so without
+government intervention. And that is why we passed the ACA.
+ And, Mr. Chairman, that is why we must go further.
+Ultimately, I believe we need to take the pure profit-seeking
+motives out of our healthcare system and ensure that the No. 1
+thing we do is protect every American's right to have
+healthcare. And so today we are united as Democrats in
+protecting the ACA, making it clear that we stand with millions
+of Americans who are at risk of losing coverage. But I am also
+determined to put forward a bold new vision for Medicare for
+all, something that the majority of all Americans support. As
+Members of Congress, we are ready to listen to them and put
+people over profits.
+ Thank you, Mr. Chairman, I yield back.
+ Chairman Scott. Thank you. Gentleman from Michigan, Mr.
+Walberg.
+ Mr. Walberg. Thank you, Mr. Chairman. Protections for
+individuals with preexisting conditions has been a consistent
+area of agreement for both Republicans and Democrats. We have
+to keep reiterating that.
+ I strongly believe that these protections need to remain in
+place and I voted and co-sponsored legislation to safeguard
+them and give peace of mind to patients, and that is a matter
+of record.
+ I am disheartened with my friends on the other side of the
+aisle's continued misinformation on our record on this issue.
+There was no Trumpcare, nothing got to his desk. There was the
+Affordable Health Care Act that dealt with all of the issues of
+concern that the ACA brought up because it didn't work for many
+people who did have a health care plan that they paid for, but
+when they went to use it, so many of them, so many of them did
+not have health care. So I hope that changes at some point in
+time, the rhetoric that continues on.
+ This committee has jurisdiction over employer-sponsored
+health insurance. I know there are some that believe we need to
+move beyond the employer-sponsored coverage, however, the
+employer sponsored system currently provides health insurance
+for over 181 million Americans. So instead of forcing Americans
+off their plans that they like, or in the cases of union
+employees, forcing them to give up health plans that they
+worked hard for and made salary sacrifices to negotiate, we
+should explore ways to strengthen our employer sponsored
+system, reduce costs, so more businesses can offer these good
+benefits to their employees.
+ I constantly hear from small employers in Michigan who are
+dealing with the cost and compliance burdens of providing
+health insurance coverage to their employees. While some small
+businesses are able to offer health coverage, many simply
+cannot afford to do so. One option among others, which was
+passed by this committee, is for small employers to band
+together to provide economies of scale for purchasing health
+insurance through an association health plan.
+ Ms. Turner, thank you for being here. As you know, in
+August the Department of Labor issued a final rule to expand
+access to AHPs. In your opinion, when finalized, will DOL's
+rule help or hinder efforts to increase coverage for small
+employers and their employees?
+ Ms. Turner. It absolutely will provide them an important
+new option to negotiate benefits on behalf of their employees.
+Talking with another H.R. director who has a work force of
+primarily medium and lower income workers, he said what happens
+is that as healthcare costs go up it eats up their wage
+increases. So employees see their wages as flat, but part of
+their compensation because too much of their compensation
+package is going to health benefits.
+ Some employers are very creative, helping to provide
+coordinated care for people that they have identified that have
+the greatest healthcare needs. So I think employers play an
+important role and I think association health plans also play
+an important role, as well as the new health reimbursement
+arrangement rule, which would allow employers who cannot afford
+and do not have the resources to actually provide coverage to
+give their employees a stipend to be able to purchase health
+insurance on their own. We recommended they be able to combine
+salaries from two spouses, for example. One spouse may be
+offered health insurance at work, the other one can get a
+stipend to help make that a family plan rather than just an
+individual plan.
+ Mr. Walberg. The beauty of more flexibility, creativity,
+and options that go on.
+ Ms. Turner. Yes. And also to recognize the competition out
+there.
+ Mr. Walberg. Right.
+ Ms. Turner. Plans are competing, companies are competing,
+everybody is trying to do the best job to get the best value.
+ Mr. Walberg. You mentioned in your testimony a study by Kev
+Coleman, a former analyst at the insurance information website
+HealthPocket. In his study, what type of plans did Mr. Coleman
+find that AHPs were offering? And let me ask this as well, are
+essential benefits covered in the plans that he discussed?
+ Ms. Turner. The study by Kev Coleman showed that these AHP
+plans are offering benefits comparable to the largest employers
+that have negotiated these benefits for years and that they are
+not discriminating against patients with preexisting
+conditions. Many of these employers may have someone on their
+staff, maybe even a family member, that has a preexisting
+condition.
+ Mr. Walberg. Or themselves.
+ Ms. Turner. Yes. And so they want those benefits and they
+are really pressing the market to figure out how do you do that
+in a price that they can afford to purchase that coverage.
+ Mr. Walberg. Thank you. I yield back.
+ Chairman Scott. Thank you. Mr. Morelle from New York.
+ Mr. Morelle. Yes, thank you, Mr. Chairman, for holding this
+very important hearing, and thank you to the panelists for
+being here and for answering the questions, particularly Mr.
+Riedy. Thank you for your courage in being here and sharing
+your story with us.
+ Back in 1993 I co-sponsored and helped pass a law in New
+York that provided community rating for all New Yorkers that
+were in small business, the individual marketplace, as well as
+ending the practice of--well, beginning the practice of having
+protections for preexisting conditions. Something I am very
+proud of. So I took it as an article of faith that everywhere
+was like that, and then I became chair of the insurance
+committee about 15 years ago and during the time of the
+implementation of the ACA. I learned a great deal about what
+happens in the rest of the country. So this is very, very
+helpful in terms of understanding all of this.
+ The first comment I would just make around coverage is we
+use the word coverage as though it means the same thing to
+everyone. The truth is, I remember as insurance chair, when
+people would come to me and say I had out-of-network benefits
+and it said out of network services were covered, yet it only
+covered 25 percent of my bill and I have this huge balance that
+I have to pay. You learn quickly that coverage doesn't mean
+coverage, that it means different things to different people.
+And cost avoidance is a big part of trying to provide coverage.
+ But I wanted to just talk a little bit about the definition
+if I might. My daughter, Lauren, was diagnosed with triple
+negative breast cancer just a few years ago and she passed away
+about 17 months ago. I had never heard of triple negative
+breast cancer, but it is part of the diagnosis. And when you
+begin to look at treatment, you look at genetic panels and what
+you can learn from the genome. And it turned out that in
+Lauren's case while it wasn't passed on genetically, she did
+have a mutation in one of her genes.
+ And so perhaps Ms. Corlette might be able to answer this,
+is there a concern that genetic predispositions will be defined
+more broadly as preexisting conditions in the way that some
+insurers view this or some people view it?
+ Ms. Corlette. Well, there is a Federal law that was enacted
+before the ACA, the acronym, is GINA, the Genetic Information
+Nondiscrimination Act, that does prohibit insurance companies
+from discriminating against people based purely on genetic
+information.
+ Mr. Morelle. And does that include then predispositions
+based on other things that would affect chronic conditions?
+ Ms. Corlette. With respect to the preexisting conditions
+that we are talking about today, most insurance companies
+require you actually be diagnosed with a specific condition
+before it would be underwritten. Although I will say for short-
+term plans, you know, they will look at your medical history
+and even if you were not given a formal diagnosis they might
+say that you had the condition, you know, the cancer cell was
+in your body before you enrolled and might disenroll you
+because of that.
+ Mr. Morelle. Yes, because it is certainly hard to tell when
+it manifests itself and--
+ Ms. Corlette. Exactly.
+ Mr. Morelle [continuing]. when it actually becomes disease
+state. Also to my colleague, Mr. Courtney, mentioned as he
+showed the pamphlet, in the description had obesity, which that
+would be a preexisting condition presumably?
+ Ms. Corlette. Yes. Yes.
+ Mr. Morelle. And that would be the case even if you had not
+exhibited or manifested any disease because of that condition,
+is that correct?
+ Ms. Corlette. Correct.
+ Mr. Morelle. And obviously that is not genetic in nature,
+but that is effectively underwriting which could lead
+ultimately to preexisting conditions?
+ Ms. Corlette. Right.
+ Mr. Morelle. And I did want to just mention coverage too
+because when you have community rating, and we don't even do an
+adjustment in New York for community rating, it is all the
+same. So that you have as you get older--as I am finding you
+have more medical conditions as you get older. Young, healthy
+people, obviously we want in the pools, and adverse selection
+often leads people to avoid coverage until they have a reason
+for it. But the larger the pool and the more that you
+essentially flatten the experience of the larger pool is really
+what insurance is all about. The avoidance of that with some of
+the plans that have either high deductibles or that in a sense
+sequesters the better risks is actually what causes the case of
+either uninsured or high premiums. Is that not right?
+ Ms. Corlette. That is exactly right. You said it better
+than I ever could.
+ Mr. Morelle. And that is my real concern here, Mr.
+Chairman, members, is that as we talk about coverage, as I
+said, it is not all the same, and you could be left with
+significant balance billing for procedures where you thought
+you had coverage, and this notion of sort of shifting risk to
+other groups of less well people is essentially what I
+understand the Administration policy to be.
+ Would you care to comment on that?
+ Ms. Corlette. Yes. I mean with respect to association
+health plans, short-term plans, it is really about shifting the
+risk from young, healthy people to older and sicker people. So,
+it is sort of rearranging the deck chairs without addressing
+some of the underlying issues about cost. Which is they are
+real. We have a cost problem in this country. But just creating
+new winners and losers is I don't believe the answer.
+ Mr. Morelle. Very good. Thank you. I yield back my time.
+ Chairman Scott. Thank you. The gentleman from Alabama, Mr.
+Byrne.
+ Mr. Byrne. Thank you, Mr. Chairman. I appreciate you
+holding this hearing.
+ Ms. Turner, I am sort of just the facts type person, and I
+didn't get here until I was elected in 2013, so I am having to
+go back and sort of make sure I understand how we got where we
+are.
+ When Congress passed Medicaid and Medicare, embedded in
+those programs was protection for people with preexisting
+conditions. I think that is correct. And when they created some
+other public programs, like TRICARE, they did the same thing.
+And then I think I was told that when HIPAA was passed in 1996,
+bipartisan bill, that we provided similar protection to people
+that are in-group plans, employer-provided plans. Have I got
+that right?
+ Ms. Turner. Absolutely.
+ Mr. Byrne. So I asked my staff to go back and look at the
+most recent numbers we could get, which was 2017. Forty-nine
+percent of the people in America are under an employer provided
+plan. When you add up all the people on the public plans, like
+Medicare and Medicaid, it is another 36 percent. So if I am
+doing my math right, since at least 1996, 85 percent of the
+people in America have had protections on preexisting
+conditions as a result of bipartisan acts of the U.S. Congress.
+Have I got that right?
+ Ms. Turner. Yes.
+ Mr. Byrne. OK. So that is another 15 percent and every one
+of those people in the 15 percent is important. I do not think
+any of us can gain say that, but sometimes we start talking
+about this, we forget that 85 percent of the people in America
+have got the protections that they need. So when we look at
+what happened in the Affordable Care Act--and I was not here
+when it was passed, so I was not a part of that debate--I have
+actually talked to people in my district who were in that 15
+percent. In fact, the very moment I was running for Congress is
+when those notices went out to people, who were told by the
+President of the United States that if they liked their health
+care plan they could keep it, they actually came up to me at a
+high school football game where I am passing out pamphlets, and
+showed me the notice they got from their insurance company that
+said we are canceling your health care plan. But here is our
+new one for you, and the cost was a multiple of what they were
+used to paying. And these people, while they were working
+people, they could not afford it. And ACA did not provide those
+type people with the sort of help they need financially to do
+it. So I have met those people across my district who now are
+uninsured because they can't pay their premiums.
+ So let me just ask you, are there individuals, including
+individuals with preexisting conditions, that the ACA might
+have actually materially hurt?
+ Ms. Turner. There are people who say that the coverage that
+they had before, even in the individual market, was better than
+the coverage they have now because it is more affordable. Some
+of them are facing deductibles of $10,000. And they say that I
+might as well not be insured because I can't meet that
+deductible.
+ Another friend who had a liver transplant needs significant
+anti rejection medications and he says that a health savings
+account actually is beneficial to him because he knows what his
+out-of-pockets costs are going to be, he can pay that on a tax
+free basis, and his catastrophic coverage actually was much
+better because it allowed him to wee any doctor without so many
+restrictions.
+ So, yes, there are people who preferred the coverage they
+had before, but I absolutely agree with you that preserving the
+preexisting condition protections is vital. And also not
+frightening people to think that they might lose it. I had a
+friend write to me saying that she was worried if the court
+case were to be successful that she would lose her preexisting
+condition protection and Medicare. And there is no reason for
+her to be so frightened.
+ Mr. Byrne. No, there have been scare tactics out there like
+that. It is unfortunate because even on Medicare you have got
+older people and they have got lots of other things that they
+are thinking about, and we don't need to be scaring them, we
+need to be helping them.
+ I have talked to many Members of Congress since I have been
+here. I have not met a single person in either party that
+doesn't want to protect people that have preexisting
+conditions. The question is how do you do it? What is the
+smartest way to do it? What is the most cost-effective way to
+do it? But when you get up and tell the people of the United
+States, if you like your healthcare plan, you can keep it, and
+then they get a notice that says no, I can't keep it, and the
+substitute is something I can't afford, you have materially
+hurt people in the United States. And everybody in this
+Congress, Democrat or Republican, we should all want to work
+together to make sure we help those people, because those are
+the good, hardworking people in America who depend on us to
+look after them.
+ I appreciate your testimony. And I yield back the balance
+of my time.
+ Chairman Scott. Thank you. The gentleman from California,
+Mr. Harder.
+ Mr. Harder. Thank you, Mr. Chairman, and thank you to all
+of our witnesses for being here on such an important issue.
+ Protecting folks with preexisting conditions is the entire
+reason I ran for this office. On my district in the California
+Central Valley this is my highest priority. Over 100,000 people
+in our district have health insurance only thanks to the
+Affordable Care Act. And those 100,000 folks were at risk of
+losing their coverage if the Affordable Care Act was repealed,
+and it was only after that vote a year and a half ago, almost 2
+years ago now, that I decided to get on in and see what I could
+do to fix that. And I think the reality is, is in a district
+like ours, where nearly 50 percent of our individuals have a
+condition that qualifies as a preexisting condition, this
+affects every single human being, every person in my community
+has a loved one who would be affected if the Affordable Care
+Act was threatened. Every single person, including me. In my
+case it is my little brother David. He was born 10 weeks
+premature, less than 2 pounds when he was first born, spent the
+first 2 years of his life in and out of a hospital, came out
+with a healthcare bill 104 pages long. And because of that he
+would be without insurance until he is 65 and on Medicare if we
+did not have protections for folks with preexisting conditions.
+ And, Mr. Riedy, I really was so touched to hear your story.
+I think your voice gives power to millions of folks. I think we
+need to be humanizing these statistics. And so when folks think
+about what life is really like with a preexisting condition,
+they are thinking about people like my little brother, they are
+thinking about people like you, and all of us, because the
+reality is each one of us has a loved one who would be affected
+by these changes.
+ And in your testimony you mentioned you had a cost of
+medical treatment $450,000 in 2018. Is that correct?
+ Mr. Riedy. That is correct. That was just for the cost of
+medicines.
+ Mr. Harder. One year, one year. And I think that, you know,
+in a district like ours, where we have a high rate of
+unemployment, we have a lot of folks that have real financial
+stress, there is a lot of folks that could be impacted by that.
+ I am very interested, based on your own experiences, Mr.
+Riedy, how do the annual lifetime caps affect patients with
+costly medical conditions?
+ Mr. Riedy. So with the passing of the ACA and the ban on
+lifetime caps, it has--and annual caps, it has allowed me
+personally, and others with preexisting conditions, to have a
+better frame of mind to be able to focus on our health versus
+if I go and see this doctor, or I get sick and I have to go
+into the hospital or I have to have some costly procedure, what
+is that going to do, how close is that going to get me toward
+that cap, and then potentially if I get to that cap, what
+happens then. So not only are you dealing with having to fight
+to stay alive or have to focus on treatment regimens that take
+3 to 4 hours a day in my case, you are also then focusing on
+the mental aspect of this also and trying to focus on if I get
+to this point am I going to have to make decisions basically
+that affect my care and my family's wellbeing versus
+essentially dying or not being able to access that care which
+then will shorten my life and others.
+ Mr. Harder. What do you would believe would happen to
+people like yourself and the people you advocate for if the
+Affordable Care Act was undermined by the court in the Texas
+case?
+ Mr. Riedy. You know, I worry if the court case is upheld, I
+worry that insurers will institute lifetime and annual caps
+again, that they will reinstitute the ability potentially for
+me to be denied coverage simply because I was born with a
+genetic disease and have a preexisting condition, and that I
+will lose the comfort knowing that no matter where I work or
+what happens to me that I can continue to be there for my
+family and focus on what needs to happen versus--to take care
+of myself versus what the cost of that medicine is that my
+doctor prescribed, or not even being able to go and see
+especially--the highly specialized care that I need to take
+care of my lungs and by body.
+ Mr. Harder. Thank you for your powerful testimony and for
+putting a face on what this really looks like. I think there
+are so many of us affected, nearly 50 percent of my district,
+and of many others. And we talk about millions of Americans, we
+talk about the 100,000 people in our community that would be
+without insurance if the Affordable Care Act were repealed and
+if it were undermined by some of these efforts of litigation,
+but I think the most important thing that we need to be
+considering is really understanding the day to day lives of
+folks who are living through these challenges today and
+understanding how those lives would be so different if we had
+not passed the Affordable Care Act.
+ Thank you so much for your powerful testimony today.
+ Mr. Chairman, I yield back my time.
+ Chairman Scott. Thank you. The gentleman from Georgia, Mr.
+Allen.
+ Mr. Allen. Thank you, Mr. Chairman, and thank you for
+having this hearing today. It is very enlightening. Obviously,
+you know, I have some preexisting conditions, I have family
+members that have preexisting conditions, so we are all very,
+very interested in how we go about making healthcare available
+to all Americans.
+ The question and the big debate is how do we pay for it.
+Obviously we have the resources in this country to provide--
+and, Mr. Riedy, thank you for your testimony--to provide
+excellent medical care and hopefully a cure. We are all praying
+for cures for Alzheimer's, for all types of issues that we are
+dealing with in this country. And we are spending a lot of
+money to try to find cures for those things. But in the
+meantime, what is the best way to provide health care?
+ Now, the question is, does the government do it more
+efficiently than the private sector? And I think, Ms. Turner,
+is there any information, like for every dollar of taxes that
+we pay, how much of that dollar gets back to take care of a
+patient under the Affordable Care Act.
+ Ms. Turner. I have not seen--well, there is a medical loss
+ratio, so we know that based upon the company's size that
+either 20 or 15 percent of the money can only go to
+administration, the rest has to go to medical care.
+ Mr. Allen. Right.
+ Ms. Turner. But I do think that it is important to look at
+the approach that the American Health Care Act that the House
+passed in 2017 took. It actually dedicated specific resources
+to help people that have high health care costs--$123 billion.
+A similar amount in a Senate bill that didn't make it through,
+but that would have separately subsidized and provided extra
+money for the people that have chronic healthcare conditions.
+The ACA put them in the same market with everybody else and
+that raised prices to the point that you are driving the
+healthy people out. So there is a lot of evidence that if you
+separately subsidize those with the highest cost and the
+highest risks, you can lower premiums for other, get more
+people covered, and then focus on providing the coordinated
+care that people with multiple health conditions actually need.
+ Mr. Allen. Exactly. And, you know, right now I think that
+Health and Human Services has a budget of about $1.2 trillion,
+the largest single piece of the Federal budget, and, you know,
+out of that $1.2 trillion I am interested--of course my
+background is the business world--and I am interested in
+exactly how much of that $1.2 trillion is taking care of Mr.
+Riedy. And I think we need to look at that and then we need to
+look at what would it cost if we returned health care back to
+the health professionals and we were able to, through programs
+deal directly in our health providers, deal directly with our
+health providers rather than got through HHS and these other
+agencies that have these huge budgets.
+ And, frankly, as I understand it, our health care in this
+country is much more expensive than compared to other
+industrialized countries in the world. Is that correct?
+ Ms. Turner. That is correct. We are also the research
+center for the planet. The great majority of new prescription
+drugs, like the one that Mr. Riedy says is so valuable, are
+developed in the United States. We pay a disproportionate share
+both for the research and for the drugs, and also new medical
+technologies and other innovations.
+ Mr. Allen. Right. So we are subsidizing health care across
+the world? Would that be correct?
+ Ms. Turner. Well--
+ Mr. Allen. How can we afford--we are $21 trillion in debt
+and, of course, you know, I do not know who is going to be
+paying my health care bills, but it is probably going to be one
+of my grandchildren or great-grandchildren, but we have got to
+solve this problem. We have the ability to take care--you know,
+I tell folks back home, we have got plenty of money to take
+care of folks, particularly those with preexisting conditions,
+I just think it is all in Washington, and we need to get it out
+in our States and our communities and make healthcare
+affordable.
+ And with that I yield back.
+ Chairman Scott. Thank you. Dr. Schrier.
+ Dr. Schrier. Thank you, Mr. Chairman, and thank you to our
+witnesses today.
+ I just want to say that I can't think of a more important
+topic to bring up today as our first hearing because one thing
+that I have heard about from all of my constituents is
+healthcare, and that is their No. 1 issue. And I sit here today
+not just as a Member of Congress, but also as a pediatrician, a
+doctor who is taking care of patients for the last two decades,
+and as a person with Type I diabetes. And so I really share a
+kinship with people in my district and in this country with
+preexisting conditions.
+ So, I can report to you first hand that my patients are
+worried. They are worried that either they or their loved ones
+will not be covered if they have a preexisting condition or
+that they will be priced out of the market, as we have been
+hearing a lot about, and they are worried even in these popular
+employer-based health plans that their prices are also going up
+and their deductibles are skyrocketing.
+ And so, you know, I came here to bring down costs and
+protect my patients and make sure that no family goes bankrupt
+because of medical expenses. And so, I hear about these
+solutions, like these short-term health plans. And you can
+imagine, as a pediatrician, that preventative care, essential
+health benefits, and mental health care, well woman care, these
+are all critical, and that is why they are essential health
+benefits.
+ And I just want to clarify, Dr. Gupta, you have not had to
+communicate anything for a while, so I thought I would give you
+a chance. Can you just be--very clearly, are those services
+covered under these short-term health plans?
+ Dr. Gupta. Thank you for that questions. Certainly they do
+not have to be covered. I mean the idea of motherhood being a
+sort of preexisting condition comes back after a decade again.
+The idea well woman, well child preventative care, knowing that
+we are going through an opioid epidemic today that we are
+having a lot of adverse childhood experiences and a whole
+generation is going to have to deal with as children and grow
+up. And that will be the future of this country. None of those
+things will be covered. Neither will be things like
+vaccinations. Those will not be covered. Mental health
+screenings, domestic violence screening will not be covered
+potentially. Of course mammograms, pap smears, none of those
+things have to be covered.
+ Dr. Schrier. Thank you. You are speaking my language. And
+then just also to clarify, do patients know that these are not
+covered when they buy these short-term less expensive health
+plans that are proposed to be a solution to skyrocketing
+medical costs?
+ Dr. Gupta. That will certainly be in fine print, as was
+mentioned today. And I am sure that most of us are not going to
+realize until you get sick and then that will be the time that
+most patients will realize that they were not covered for those
+services.
+ Dr. Schrier. And to read that fine print you would need
+glasses like these.
+ OK, my next question is that I have seen in my own
+practice, you know, the classic story, a girl with a terrible
+rash whose mom brought her in and it had been weeks that they
+had been trying to deal with this at home with all the powders
+and creams and everything they possibly could. And when she
+finally came to me it was a disaster, she needed antibiotics
+and steroid creams. But she delayed care because of the cost of
+care. She knew that because of her deductible it would cost her
+a lot to come in and that she may as well try everything in the
+kitchen cabinet at home.
+ And so when I think about these short-term plans and that
+preventative care would not be covered--and I know how
+important those well child checks are--I just would like your
+opinion as to how many families will show up for that
+critically important primary care and preventative care if
+those are not provided for free.
+ Dr. Gupta. We know from studies that compared to the
+insured population, uninsured individuals tend to delay their
+care. That leads to lack of those preventative services,
+ultimately poor outcomes, and more expensive outcomes, not just
+from health but also for financial reasons. And what we saw
+after ACA was the amount of uninsured childbearing women went
+down from about 20 percent to 13 percent. So additional 5.5
+million women got the care for things like maternity care. So
+those things are happening now that we will again walk back
+several steps and we will end up the emergency rooms with
+uncompensated care, at doctors' offices, while mostly in
+primary care, where we already have shortages of tremendous
+amount across the field. And those offices will once again be
+seeing a lot of patients who do not have insurance and, like
+you have, I often provide care for those without regard to the
+level of insurance they have.
+ Dr. Schrier. Thank you, Dr. Gupta. And I yield back my
+time.
+ Chairman Scott. Thank you. The Gentleman from Kentucky, Mr.
+Comer.
+ Mr. Comer. Thank you, Mr. Chairman. And I would like to
+talk about healthcare in Kentucky. Obamacare, or the Affordable
+Care Act, however you want to pronounce it, in Kentucky was a
+great deal for people who got free health care via Medicaid.
+But it was a terrible deal for working Kentuckians who actually
+have to pay for their health care premiums. In Kentucky, 30
+percent of the State is on Medicaid. That is pretty much free
+health care. But the rest of Kentuckians in the State who are
+working, struggling to pay health care premiums, they do not
+have a very favorable opinion of the Affordable Care Act.
+ Ms. Turner, I would like to ask you a question addressing
+the rising cost of health care, including premiums,
+deductibles, and out-of-pocket expenses. This is a huge concern
+for most Americans and it should be a concern for the
+democrats. What options do you think policymakers should
+consider when discussing how to lower the cost of health
+insurance and provide a variety of affordable options,
+especially for employers and workers?
+ Ms. Turner. I described in my testimony a plan that I have
+helped to develop with a number of my policy colleagues, called
+the health care choices plan. And it basically recognizes the
+States have a lot more knowledge about their individual markets
+and the needs of their citizens, and it is very difficult for
+Washington to finely tune legislation enough to let them do
+what they need to do. So we have recommended formula grants to
+the States to let them figure out how do they make sure that
+existing populations are supported. But they have the
+flexibility to be able to get coverage not only for the
+continued coverage for them, but to make sure that new people
+can come into the market and afford coverage, and quality
+coverage.
+ Mr. Comer. Mm-hmm. If there is one thing that I think all
+of us would agree on in both parties is that everyone should be
+protected with preexisting conditions in health care. No one
+should be denied coverage based on their medical history. Given
+that, and given current law, Ms. Turner, are any reforms needed
+to ensure that individuals with preexisting conditions have
+access to health coverage?
+ Ms. Turner. One of the things that several States have done
+is request waivers to use some of the ACA money to more heavily
+subsidize those with high risks to make sure they can have
+access to care and coverage. I talked about Janet in my
+testimony who is now under ACA coverage in Colorado, but it is
+inferior coverage to the high-risk pool coverage she had
+before. States can fine-tune that, high-risk pools, invisible
+high-risk pools, reinsurance, to make sure those with the
+highest healthcare costs are covered. Devote money to them, you
+cannot only lower premiums for other but increase access for
+the healthy people we need to come into the market.
+ Mr. Comer. In Kentucky, prior to passage of the Affordable
+Care Act, we had a high-risk pool, called Kentucky Access, and
+it was successful. But it was eliminated with the passage of
+the Affordable Care Act.
+ Just to followup on that question, would you say there are
+other factors that affect consumer access to health care?
+ Ms. Turner. Well, that is one of the reasons I believe
+these short-term limited duration plans are so important,
+because somebody may be, you know, in a bridge between--they
+have just graduated from college, they had coverage then, they
+don't have a job yet, they are older than 26. Somebody who is
+near Medicare eligibility needs bridge coverage, somebody who
+is starting a new business needs to--there are people who need
+these temporary plans and that is another option.
+ Indiana had a great plan called the Health Indiana Plan, a
+State-based plan. An account to make sure that people could get
+the preventative care they need, but they also had major
+medical coverage. There are a lot of other options, but I think
+that the State creativity, working with healthcare providers,
+is really valuable.
+ Mr. Comer. Thank you very much. Mr. Chairman, I yield back.
+ Chairman Scott. Thank you. The Gentlelady from Illinois,
+Ms. Underwood.
+ Ms. Underwood. So, we have just heard from our colleagues,
+Ms. Foxx and Mr. Comer, who mentioned how they support
+protections for individuals with preexisting conditions.
+However, congressional Republicans and the Trump Administration
+have had relentless--attacked protections passed by the
+Affordable Care Act. And so many of my colleagues here voted
+more than 70 times to repeal parts of the ACA. Moreover, last
+August the Administration finalized a rule that expands short-
+term limited duration insurance, commonly known as junk plans.
+Junk plans do not have to comply with key Federal laws that
+protect patients and they can pose a serious risk to patients
+with preexisting conditions.
+ Earlier today, along with Representative DeSaulnier, my
+Democratic colleagues and I introduced my first legislation in
+Congress to overturn the Trump Administration's rule expanding
+junk plans. Insurers should never have the option to
+discriminate against patients with preexisting conditions.
+ So, Dr. Gupta, can you tell us more about why they are
+called junk plans and what kinds of consumer protections can
+junk plans exclude?
+ Dr. Gupta. Well, thank you. I think part of the--what is
+important is not just the preexisting conditions protections,
+but also the affordability as well as the accessibility in
+terms of essential health benefits. So, none of this is covered
+or required to be covered in these short-term plans, or also as
+you termed them, junk plans. There are States that have taken a
+proactive lead, like California, Oregon, New York, New Jersey,
+who have actually worked to prohibit those plans in the way
+that they are today. And, obviously, other States will have to
+do more. Because what that does basically is sells people out
+there who may not be suspecting a bill of goods that they have
+no idea about. So, unless they read the fine print, when in so
+many ways stepping back to about a decade ago, and people when
+they find that they need the help that they need, they are not
+going to be able to get it because the preventative care, as
+well as a number of those essential health benefits, including
+maternity care, will not be covered.
+ For example, prior to the ACA only 11 States required
+maternity care in individual plans, and only 13 percent of the
+insurers' individual plans covered maternity care.
+ Ms. Underwood. That is why patients' groups, including the
+March of Dimes, the American Cancer Society, the American Heart
+Association are opposing the junk plan rule.
+ Mr. Chairman, at this time I would like to ask unanimous
+consent to enter a letter from those patient groups opposing
+the rule into the record.
+ Chairman Scott. Without objection.
+ Ms. Underwood. Thank you. Dr. Gupta, what effects can junk
+plans have on patient access to care, particularly patients
+with preexisting conditions?
+ Dr. Gupta. Ultimately it will cost their lives or their
+bank account, or both. The challenge with that is when somebody
+needs the help, early help to be able to detect cancer, like
+breast cancer, colon cancer, or be immunized for important
+conditions that could be communicable--we are seeing outbreaks
+of measles, for example--those could get worse. And people we
+diagnose much later in their stage and then they will not be
+able to be covered by those because of the preexisting
+conditions clause missing, and therefore they will be--again,
+will lose life and it will cost us a lot more. It is just the
+most--the least effective way of administering healthcare.
+ Ms. Underwood. In fact, an analysis by the Los Angeles
+Times found that not a single group, not a single group
+representing patients, physicians, nurses, or hospitals
+supports the junk plan rule. And 90 percent of the comments
+from the public on this rule were either critical or opposed
+the rule outright.
+ So, Ms. Corlette, are you concerned that public opinion on
+junk plans was disregarded when the rule was written? What
+needs to be done to ensure the needs of patients with
+preexisting conditions are truly represented in this debate?
+ Ms. Corlette. Well, certainly with respect to the comments
+on the short-term plan rule, it would suggest that the
+Administration's mind was made up about what they wanted to do
+before the rule was finalized and the public comments did not
+make much of a difference there.
+ I do think there is a real concern that a lot of people who
+are healthy before they sign up for these plans, have an
+unexpected medical event, and are left on the hook for
+thousands, tens of thousands of dollars in unpaid medical
+bills.
+ Of course, for those who have preexisting conditions, they
+couldn't buy these plans even if they wanted to. They would
+have to buy in the ACA market, but the ACA market will be more
+expensive. CBO has said it will be about 3 percent surcharge on
+premiums as a result of these plans.
+ Ms. Underwood. Thank you, Mr. Chairman, and thank you to
+all the witnesses for being here.
+ I yield back.
+ Chairman Scott. OK, thank you. The gentleman from Texas,
+Mr. Wright.
+ Mr. Wright. Thank you, Mr. Chairman.
+ Chairman Scott. Thank you.
+ Mr. Wright. I want to thank all of you all for being here
+today. Mr. Riedy, God bless you and your family. I think it
+speaks to your character and your determination that you are
+even here today participating. So thank you.
+ Ms. Turner, I think you would agree that, you know, we
+should never have laws on the books that are unconstitutional,
+and when the Supreme Court made its decision on the ACA, Chief
+Justice Roberts, of course, his opinion was that it was
+Constitutional by virtue of being a tax. I thought that was a
+very slender thread, but that is the opinion. If you take that
+thread away, then it follows that the law is unconstitutional.
+And as a Texas Congressman I am terribly proud of my State
+attorney general for leading the effort in this lawsuit.
+Because, again, if the reason it was determined that it was
+unconstitutional was that it is a tax and you take that away,
+doesn't it follow that it is no longer Constitutional?
+ What is your opinion, Ms. Turner?
+ Ms. Turner. Well, this is going to go through the Courts to
+determine whether or not the fact that the Congress did in fact
+zero out the tax penalty for individual insurance does
+invalidate the law, but I think the important thing is that we
+have seen since then all of the efforts by you and others in
+Congress to repeal and replace the law. So I think we have seen
+that there are definitely places that improvement is needed and
+to try to find a way to replace the coverage that people are
+relying on, but to allow markets to work better so that healthy
+people are not being driven out.
+ Mr. Wright. Yes, ma'am. And the key word there is replace.
+I think the assumption that if ACA had not passed or if it had
+been ruled unconstitutional, that nothing would have happened,
+that there would have been no improvements in healthcare, is a
+completely false narrative, just as if it were to go away
+tomorrow we are not going to revert back to the status quo of
+2009 because there was always, even in 2009--I don't know if
+you were part of crafting or helping either side on that, I was
+here then. I was the chief of staff for the ranking Republican
+on Energy and Commerce Committee. I sat in some of those
+meetings, saw the markup. There was always Republican
+alternatives that included coverage for preexisting conditions,
+even going back to 2009.
+ So this narrative that we keep hearing that Republicans are
+somehow opposed to that or don't want it, is patently and
+demonstrably false, and it needs to stop because it is not
+true.
+ My last question is this, it has to do with the idea that
+is being advanced by the other side, and we heard it earlier
+today, about Medicare for all. Well, Medicare-for-all is
+Medicare for none. Would you agree with that? Can you speak to
+it?
+ Ms. Turner. It certainly would not be the Medicare that
+seniors know now.
+ Mr. Wright. If we go to socialized medicine, where it is
+all run by the government, then doesn't Medicare cease to
+exist?
+ Ms. Turner. As I mentioned in my testimony, my colleague,
+Doug Badger, has done some research looking at these cross
+subsidies from the employer-based system with 170-some billion
+people participating. They pay a higher rate to physicians and
+hospitals that allow Medicare and Medicaid to save taxpayer
+money and to pay a lower rate. But if those reimbursement rates
+went across the board, 40 percent of physicians and hospitals
+would find that they couldn't even keep their doors open.
+ So we need the employer-based system.
+ Mr. Wright. Absolutely.
+ Ms. Turner. And the private sector, not only for its
+innovation but for the money that it provides to support
+existing public programs.
+ Mr. Wright. Right. Thank you very much. Thank you, Mr.
+Chairman.
+ Chairman Scott. Thank you. The gentlelady from Georgia, Ms.
+McBath.
+ Ms. McBath. Thank you, Mr. Chairman. And I do want to thank
+you for holding this hearing today. And I would like to thank
+the witnesses who are here to discuss the importance of
+protecting access to healthcare for all Americans.
+ This is an issue that is deeply personal to me. I myself,
+like millions of Americans, live with a preexisting condition.
+As a two-time breast cancer survivor, I understand what it is
+like to have your life turned upside down by this very
+diagnosis. I was first diagnosed with stage 1 breast cancer in
+2010. And after completing treatment my cancer returned again
+in 2012. My cancer was detected because of a routine mammogram.
+I will never forget the way that I felt when I first heard my
+doctor say the words stage 1 breast cancer.
+ For each of the two cancer diagnoses that I have received I
+underwent surgery through a procedure called a lumpectomy to
+remove the remaining cancer. And I received radiation treatment
+and drugs thereafter. I did it all while raising my family and
+working full-time. And I can tell you I was terrified. Despite
+being lucky and having good health insurance through my job, I
+was still worried about my financial security. I was concerned
+about making it to radiation treatments, sometimes every single
+day for weeks, and then back to work and then back home to
+raise my son, Jordan. It was exhausting, both physically and
+emotionally. But I had to do it, just like millions of
+Americans out there who share a similar story to mine.
+ I truly do not know what I would have done or what would
+have happened if I had lost that health insurance coverage. And
+I am happy to say today that I am cancer-free. But, Mr.
+Chairman, not everyone is as lucky as I am. And I am worried
+for Americans and for those in my State of Georgia who might
+not detect their cancer or chronic health condition early on,
+when it is most easily treatable.
+ The Centers for Disease Control and Prevention states that
+preventing diseases is critical to helping Americans live
+longer, healthier lives and keeping healthcare costs down. It
+is so important that Americans have access to the preventive
+services that are an integral part of the Affordable Care Act.
+These include screenings for certain cancers, screenings for
+Type 2 diabetes, and other critical health services. And I am
+worried about their future and their financial security.
+ We here in congress, we have a responsibility to protect
+people. That is what we must do.
+ Ms. Corlette, could you talk a little bit more about how
+the ACA protects patients and has created greater access to
+preventive services, like breast cancer screenings or high
+blood pressure screenings? Particularly how the ACA cost-
+sharing provisions impacts and also ensures Americans have
+access to these types of services?
+ Ms. Corlette. Absolutely. Thank you for the question. So,
+the Affordable Care Act requires insurers both in the
+individual market and in the employer market to cover a set of
+evidence-based preventive services without any cost-sharing for
+the enrollee. And that includes many of the services that you
+mentioned in your Statement, but also vaccines, contraception,
+tobacco cessation counseling, a range of services that not only
+prevent disease but help keep people healthy over the long-
+term. Those services can also help diagnose issues that people
+have and help get them early treatment in order to get a better
+outcome at the end of the day.
+ So, if the ACA were overturned or this decision in the
+district court in Texas is upheld, insurance companies would no
+longer have to provide that protection and people would face
+cost-sharing. And we know, and Dr. Gupta mentioned, that if
+people do face co-insurance or cost-sharing for those services,
+they tend not to get them or they delay them.
+ Ms. McBath. Thank you. And my followup question is how
+could the Texas litigation impact American's access and
+affordability of these lifesaving services?
+ Ms. Corlette. If the Texas decision is upheld millions of
+people will lose their insurance, about 17 million in the first
+year and up to 32 million by 2026. It is well documented that
+people without insurance delay, forego care. Before the ACA
+about 22,000 people died each year simply for not having
+insurance.
+ For people with job-based coverage, they lose access to
+critical protections, like the lifetime and annual limits that
+Mr. Riedy discussed, the protection against excessive out-of-
+pocket costs--ACA has a cap on that every year--as well as the
+preventive services and essential health benefits that you
+mentioned.
+ Ms. McBath. Thank you. Thank you.
+ Chairman Scott. The gentleman from South Dakota, Mr.
+Johnson.
+ Mr. Johnson. Thank you, Mr. Chairman. Mr. Riedy, you spoke
+so eloquently about your family. Are any members of your family
+with you here today?
+ Mr. Riedy. Yes, my father and mother and my wife are
+sitting behind me.
+ Mr. Johnson. I kind of suspected that was the case. And, of
+course, you were facing us during your testimony, and so I just
+want to take a minute to tell you, because you couldn't know,
+their faces were filled with an incredible pride during your
+testimony. And, of course, you should feel good because you did
+a good job. You should also feel very good because they clearly
+are very proud of you.
+ Mr. Riedy. Thank you.
+ Mr. Johnson. Almost every member of the Committee that has
+spoken has done a nice job raising their voice in support of
+protections for people with preexisting conditions. Of course,
+I want to raise my voice to echo theirs. Critically important
+and I am glad we are having this conversation.
+ I also like how the panelists all in different ways have
+called forth this important connection between employer-based
+health coverage and some of these preexisting condition issues.
+ I was a little concerned, Ms. Turner, in your testimony you
+talked about how 65 percent of employers offered health
+insurance in 2001, you mentioned that number had come down in
+recent years. I assume affordability is a key driver. Are there
+others that are maybe not as intuitive to me?
+ Ms. Turner. It is primarily affordability, and also because
+there are fewer carriers now offering coverage in the
+individual and small group markets. But one point that I think
+is so important about when employers do offer coverage, they
+have an incentive. They were offering coverage for preventive
+care before the ACA because they know it works. It is so much
+better to detect breast cancer at stage one than at stage four.
+So helping their employees stay healthy, making sure that they
+have access to preventive care, and being able to access the
+diagnostics that they need early on for their coverage. So I
+think that employer coverage brings particular value to our
+health sector without the mandates. They know this is important
+because it works.
+ Mr. Johnson. So I just want to make sure that I can square
+the math here. The number of employers how are offering this
+type of benefit has gone down. A number of people have talked
+about the how the number of people receiving that type of
+benefit has gone up. Is that just macRoeconomic trends, large
+employers getting larger, and smaller businesses being the ones
+more likely to drop this type of benefit?
+ Ms. Turner. I could look further into the research, but
+based upon everything I have read since the ACA, the cost of
+compliance in providing health coverage to employees is
+significant. So it is not only the cost of the coverage, but
+also compliance. And if a company is hitting near that 50
+employee threshold where the employer mandate triggers, they
+often will sometimes put workers on part-time, they will scale
+back their staff, to avoid having to trigger that employer
+mandate.
+ So I think in some ways the employer mandate has actually
+worked against smaller employers offering coverage. And without
+it and with more flexibility I think we would see more
+participation.
+ Mr. Johnson. This is an area of concern, and I suspect it
+is an area of concern for everybody on the Committee,
+regardless of party or region, because so many people, from Mr.
+Riedy to others, have talked about how well I had an employer-
+based coverage, or I had job-based coverage. It is clearly a
+really important leg of this stool about how we make sure
+Americans are covered, how they can get the healthcare service
+they need.
+ Are there things that we can do to strengthen employer-
+based coverage? Because the trends you are talking about we
+should not feel good about in this country right now.
+ Ms. Turner. What employers want most is flexibility to meet
+the needs of their employees without having to charge so much
+that health insurance eats up their employees' pay increases.
+So they are looking for affordability, they want more
+competitors, they want more options rather than having to meet
+such specific benefit requirements to really allow them to--
+there may be other benefits that their employees value more
+than the essential health benefits list. So giving them more
+flexibility to meet their employee needs and keep costs down
+would increase participation.
+ Mr. Johnson. Thank you very much. Well, Mr. Chairman, I
+just think this is a critical area for further study by the
+Committee. And, of course, I appreciate the time and I yield
+back.
+ Chairman Scott. Thank you. Gentlelady from Connecticut, Ms.
+Hayes.
+ Ms. Hayes. Thank you, Mr. Chairman, and thank you to all of
+the people who have come to share your testimony today. I
+really appreciate it on this very critical issue.
+ Before I begin my questioning, I cannot underscore what my
+colleague, Ms. Underwood, said before she left, that while we
+hear everyone talk about protecting preexisting conditions our
+Republican colleagues voted more than 70 times to either roll
+back or repeal the Affordable Care Act, which really undergirds
+those protections.
+ My questions this afternoon are for Dr. Gupta. In your
+testimony you talked about how the Affordable Care Act has
+improved the lives of millions of Americans, particularly women
+and children. And this was strengthened by those 10 essential
+health benefits that we all know about. Of those benefits, we
+have mental health and substance abuse treatment. Do you think
+that those are important benefits to protect?
+ Dr. Gupta. Thank you for the question. Absolutely. I think
+one of the things we have yet to appreciate is the increase in
+tens of millions of people across this country who are
+suffering now from substance use disorder that may not have
+been the case even a decade ago. And a lot of the--when we look
+at the data, access issues, fear of being fired from their
+employer are some of the reasons that people do not seek care.
+So, it is a big stigma issue as well. For women, things like
+breastfeeding supplies, very simple things like a breast pump
+and not having to cost share on those things, are another one
+of those things that we should be working to protect, in
+addition to the maternity care benefits.
+ Ms. Hayes. Thank you. Because I know we are talking a lot
+about preexisting conditions and our conversations are centered
+around genetic conditions or health-related diseases. So I am
+happy to hear that you recognize that addiction is also
+something that really further exasperates those conditions. It
+is undeniable that we are in a crisis with opioid addiction. In
+my own home State of Connecticut we have had significant
+increases. Over the past 6 years our numbers have tripled. In
+2017 my State marked a grim milestone of over 1,000 opioid-
+related deaths. And in June of last year we were on track to
+surpass that. In the district that I represent three of the top
+ten towns are the highest opioid deaths.
+ This is no stranger to me. I grew up in a family that
+struggled with addiction. In my own hometown 45 people died
+last year as a result of opioid-related deaths.
+ Does the current opioid crisis make the need for mental
+health and substance use disorder coverage more important?
+ Dr. Gupta. Absolutely. And, again, when we talk about
+employer-based coverage, here is the real problem on the
+ground. When I am seeing patients at a charity clinic who have
+substance use disorders they are unable to have gainful
+employment because of their addiction issues, which need to be
+treated in the first place. And that allows them to actually
+gain and have meaningful employment to begin with. So, I think
+it is very important for us to make sure that we have systems
+in place that allow the treatment and access to treatment for,
+you know, one of the biggest crises to face our generation
+today.
+ Ms. Hayes. I appreciate you viewing this as a crisis and
+talking about treatment and coverage and healthcare, as opposed
+to a criminal action, as we heard last week from our friends
+over at Purdue Pharma, who talked about people who were
+addicted to opioids as, ``reckless criminals''.
+ During your time at the Department of Health and Human
+Services in Virginia you led several important initiatives to
+address the opioid crisis in your State. Could you tell us what
+impact the Affordable Care Act had on access to treatment for
+substance abuse disorder and families, not just the individual,
+but I am the daughter of an addict, so how families were
+impacted by the protections provided by the Affordable Care
+Act.
+ Dr. Gupta. Absolutely. In a State like West Virginia, which
+is not any different from a number of States that are having to
+deal with this crisis firsthand on the ground, we found that
+having access to treatment, being able to expand those
+treatments and make that available--a part of which was
+Medicaid expansion. West Virginia was one of the first States
+that--we worked very hard to ensure Medicaid expansion. Allowed
+a number of people to enter the treatment spectrum and we found
+that the access to mental health treatment, access to the
+medications, being able to be able to transport it and being
+paid for being able to transport for treatment, are some of
+those factors that help us remove the stigma of addiction and
+help us move forward in that. And it is very important that we
+provide--reduce all the barriers to treatment when it comes to
+a stigmatizing disease, such as addiction.
+ Ms. Hayes. Thank you for your time. Mr. Chair, I yield
+back.
+ Chairman Scott. Thank you. The gentleman from Pennsylvania,
+Mr. Meuser.
+ Mr. Meuser. Thank you, Mr. Chairman, thank you Dr. Foxx,
+thank you to all testifying today.
+ Ms. Turner, I am Dan Meuser, Pennsylvania's 9th
+congressional district. And I appreciate you taking the time
+here, and all of you. I believe every American should have
+access to high-quality, affordable health care, regardless of
+health status, including preexisting conditions. Given current
+law, are there any reforms that you would feel, Ms. Turner,
+that are needed to ensure that individuals with preexisting
+conditions do in fact continue to have access to health care
+coverage?
+ Ms. Turner. I don't think there is one particular answer,
+Congressman. I think they need a myriad of options. I think
+giving States the option to recreate their high-risk pools
+would be helpful to make sure people who have preexisting
+conditions have a place to go if their health insurance becomes
+so expensive. As Senator Bryce Reeves' constituent described,
+$4,000 a month premiums or deductibles that are $10,000. They
+need other options. And I think States also could do things
+like the Healthy Indiana Program, an account-based plan that
+allows people resources to access primary care, but knowing
+that they have major medical coverage as well.
+ But I think the crucial issue is addressing cost and giving
+people more options, more flexibility, and giving companies the
+option to provide coverage that is more attractive, that
+healthy people want to get in the market, so they are not
+staying out of the market, putting more and more people who
+have high health costs in the market and driving up premiums
+for everyone.
+ Mr. Meuser. That is encouraging to hear. Now that we have
+established that we are in agreement on preexisting conditions,
+I would like to ask you your thoughts on the Affordable Care
+Act's effect on association health plans. In Pennsylvania, for
+instance, the Pennsylvania Farm Bureau had 12,000 members in an
+association health plan and it worked very well, along with
+other organizations. The Trump administration has issued a
+final rule allowing for the use of AHPs, however, many
+Governors, democrat Governors it so happens to be, across the
+country, including in Pennsylvania, are blocking the formation
+of AHPs.
+ Can you speak to the importance of the efforts to allow
+AHPs and maybe comment technically as to why these efforts
+would be blocked?
+ Ms. Turner. So far association health plans are available
+in 13 States, about two-dozen plans in all. And some States are
+considering invalidating or blocking these plans, which they
+have full right to do, just as they are short-term limited
+duration plans. But what they are doing is foreclosing options
+for people who are otherwise likely to simply be uninsured. If
+they don't have an affordable option their family cannot only
+face bankruptcy, but not having access to that good high
+quality care that private insurance brings.
+ So it is unfortunate if States take a view that because, I
+don't know, the Trump administration rules that therefore they
+should be opposed, because they are providing options for
+people who are desperate for coverage.
+ Mr. Meuser. Yes. OK. That is unfortunate. Thank you.
+ Medicare Advantage. I have people coming into my office and
+throughout my district talking about, speaking about how
+terrific Medicare Advantage programs are, how relatively
+affordable they are versus other Medicare plans. And, as a
+matter of fact, the Medicare Advantage plans have decreased,
+reduced in cost by 6 percent this past year when other plans on
+average are going up 12 percent. So would you say that this is
+a successful example of private sector innovation? And could
+you offer any other insight on the effectiveness of Medicare
+Advantage.
+ Ms. Turner. They were created, as you know, in 2003 through
+the Medicare Modernization Act and went into effect in 2006.
+And there was no real significant promotion of Medicare
+Advantage plans. It was offered as an option for private
+coverage to seniors, so they didn't have to be in something of
+a Swiss cheese of a program with a fee-for-service Medicare.
+They have been hugely popular. I think almost half of seniors
+now have individually selected on their own, without any
+mandates, Medicare Advantage plans. And these plans compete
+fiercely for seniors. They have to cover a basic level--not
+basic but very generous level of benefits and many of the plans
+offer much more comprehensive coverage than people can get in
+traditional Medicare. And many of them also incorporate
+prescription drug coverage.
+ I think that seniors see it is crucially important because
+it also provides an environment for coordinated care, rather
+than going from doctor to doctor and fee-for-service
+traditional medicine Medicare. Maybe getting the same
+prescription with different names from physicians and then
+winding up in the hospital with drug toxicity, they have
+somebody looking out for them and being able to really
+coordinate and help manage their care.
+ Very, very beneficial. And, of course, these are private
+plans within Medicare.
+ Mr. Meuser. OK. Do I have any more time, Mr. Chairman?
+ Chairman Scott. Not really.
+ Mr. Meuser. OK. Well, I yield the remainder of my time.
+ Chairman Scott. Thank you. I appreciate it. The gentlelady
+from Florida, Secretary Shalala.
+ Ms. Shalala. Thank you very much, Mr. Chairman. I don't
+want to add, a lot of my colleagues have asked the same
+questions I would have asked.
+ I do want to point out that Medicare Advantage gets a lot
+more money than traditional Medicare and therefore it is
+expected to provide a lot more benefits. It also pays
+dramatically for the kind of marketing that the private plans
+want to do. So, we are paying with taxpayer money for Medicare
+Advantage significantly. And most analysis has shown that we
+are overpaying for Medicare Advantage given the benefits that
+are provided.
+ I do have a couple of questions though. I want to ask Ms.
+Corlette, we focused here on preexisting conditions, but would
+coverage for preexisting conditions actually work very well if
+we didn't have the other consumer protections? I mean we could
+all agree on preexisting conditions, but if you don't take the
+caps off, preexisting conditions are limited. And Mr. Riedy
+would have a very difficult time with CF.
+ Ms. Corlette. Yes, absolutely. And, in fact, New York is a
+great example of a State that had a number of preexisting
+condition protections before the ACA was passed, but they had a
+very expensive individual market because they didn't have the
+other provisions that the ACA included, such as the subsidies
+to support people up to 400 percent of the Federal poverty
+level to buy insurance, as well as the individual mandate
+penalty.
+ So, it is important to note that the ACA included not just
+preexisting condition protections, but a number of provisions
+that were more holistically designed to try to make coverage
+accessible and affordable for people. All of those, of course,
+have been at least preliminarily ruled to be invalid by the
+Texas court.
+ Ms. Shalala. Thank you very much. And, Dr. Gupta, yesterday
+the President said that he was going to invest some money in
+HIV drugs. And I want to ask you about that, because it is very
+important in my district. We have the highest incidence per
+capita, and therefore I am very supportive of any investment in
+HIV. But those investments don't work without a comprehensive
+plan around them. And could you talk a little about that?
+ Dr. Gupta. Absolutely. Thank you for that question. So as
+opposed to the 1980's, where we had a challenge of diagnosing
+HIV, figuring out how to treat it, and make it a condition.
+People were dying on the streets because of that. Now, we have
+a challenge of finding those individuals who may not know that
+they have HIV. So, screening--that is why we have moved to what
+we call universal screening and you really have to opt out of
+it, otherwise most of us need to get screened. The idea behind
+that is most people that may have HIV do not know they have
+HIV. And if they can be caught early and put in treatment it
+becomes a chronic condition you can live with. You don't have
+to die because of the complications now.
+ When you start to remove the other legs of that stool, in
+terms of essential health benefits, then obviously those people
+are going to not want to be screened for the HIV. The diagnosis
+will not occur and then they will not be treated. As a result
+they will continue to transmit the disease and we will result
+in having more cases than fewer cases and our conquest to
+eliminate HIV from the United States will not happen anytime
+soon.
+ Ms. Shalala. Thank you very much. And, Ms. Turner, if I
+could ask a quick question about the flexibility you are
+talking about. Would it be OK with you if a State was willing
+to develop a plan that continued caps, had covered preexisting
+conditions but continued caps? Because, you know, private
+insurance is a mixed bag in this country. I have got half a
+million people in my own district that are covered by private
+insurance, but some of it is underinsurance because it has high
+deductibles. And how much flexibility would you give the States
+so that we would really recognize it as insurance and
+comprehensive insurance? Would you continue some of these
+consumer protections that we are talking about?
+ Ms. Turner. I think that it is important to recognize that
+State officials have to answer to the same constituents when
+they are making changes, health policy changes that Federal
+officials do. And so that needs to be a conversation with their
+voters, and to make sure that they are answering the
+constituents' needs for affordable, quality coverage, but doing
+so in a way that may give them more flexibility.
+ Some States in Medicaid, as you know, and I am sure under
+your Secretaryship some of the waivers were approved to give
+States like Oregon, for example, a lot of flexibility within
+its Medicaid program and what benefits were covered. So I think
+States can better fine-tune the mandates than a Washington
+mandate. The Affordable Care Act has been changed already
+either by administrative order or by acts of Congress 70 times.
+So, I think needing to give the States the flexibility to
+answer the needs of their constituents and know that their
+constituents actually can be better heard at the State level, I
+think is important.
+ Ms. Shalala. I should point out that the Oregon simply took
+the same package. It actually didn't mix up the package of
+benefits very much. I am asking you specifically about caps and
+about preexisting conditions. Do you think that States ought to
+be able and the other consumer protections ought to be able to
+waive those consumer protections and would it actually be
+comprehensive insurance at the end of the day if they had
+flexibility on those consumer protections including preexisting
+conditions?
+ Ms. Turner. We see with States that are saying they don't
+want short-term limited duration plans, California and offered
+in their States, Pennsylvania, restrictions on association
+health plans. If States feel that those consumer protections
+are important, I believe that they will keep them and if they
+feel that there needs to be some flexibility along with
+consumer awareness and transparency, then I think States should
+have the option of figuring out what works best for their
+constituents.
+ Ms. Shalala. So you wouldn't favor ERISA protections for--
+and overrule States--using ERISA protections?
+ Ms. Turner. I think that right now we basically have under
+HIPAA we have the protections that allow people to go from
+their employer plan--
+ Ms. Shalala. Right.
+ Ms. Turner [continuing]. to another employer plan and
+maintain that continuity of coverage and not be discriminated
+against. So those protections are already on the books and
+because of the community rating within employer plans, people
+are protected to make sure that their health status does not
+affect their premium costs.
+ Ms. Shalala. I yield.
+ Chairman Scott. Thank you. Gentleman from Wisconsin, Mr.
+Grothman.
+ Mr. Grothman. OK, thank you. Moving now, Ms. Turner, and
+one more time, I think you've answered this, but it seems to me
+the Republicans, the Democrats are all favored, in favor of
+protecting coverage for preexisting conditions. Can you just
+one more time tell us, we have said it so many times but not as
+many times as the ads we have saying otherwise running against
+us in election. Under current law, are workers with preexisting
+conditions allowed to be charged more, denied coverage based on
+their condition?
+ Ms. Turner. I'm sorry, repeat.
+ Mr. Grothman. Under current law, are people allowed to be
+charged more, denied coverage based on their conditions?
+ Ms. Turner. No, Congressman.
+ Mr. Grothman. OK. So that is the current law right now.
+Good. Now I will give you some other general questions. I am
+from Wisconsin. In 2018 last year, Scott Walker worked with the
+Trump administration and CMS to approve a 1332 State innovation
+waiver, which caused our premiums to drop. Are you familiar
+with that situation?
+ Ms. Turner. Yes, I am, sir.
+ Mr. Grothman. Could you talk about what we did in
+Wisconsin?
+ Ms. Turner. I mentioned actually in my testimony some of
+them, some of the impact that these plans have had and of
+course I can't find this chart when I'm looking for it. But
+they have been able to basically repurpose existing ACA money
+to help increase access to coverage or to improve access to
+coverage for people with chronic conditions, preexisting
+conditions, and therefore lower premiums in their general
+market.
+ So a number of States have--Wisconsin is often taking the
+lead in health policy innovations and waivers and I think that
+this is an important one to move forward with.
+ Mr. Grothman. And at least I am told that premiums dropped
+a little over 4 percent, is that your?
+ Ms. Turner. Premiums dropped and enrollment increased as a
+direct consequence.
+ Mr. Grothman. Good. And in the past, before this type of
+thing, we saw incredible increases in premiums and open
+enrollment falling. Is that--we saw that in Wisconsin. Is that
+your nationwide?
+ Ms. Turner. Because the premiums were so much higher--
+ Mr. Grothman. Right. As the premiums--a lot of people just
+throw in the towel.
+ Ms. Turner. People just can't afford it and they also--we
+talk about a high deductible. The deductibles are so high and
+the ACA plans that if people are not eligible for cost-sharing
+reduction subsidies they basically say they might as well not
+be insured because they can't afford to pay the first $10,000
+every year out of pocket before coverage kicks in.
+ Mr. Grothman. I am glad you mentioned association plans. My
+experience with health care in general, when you take a group,
+not a Statewide group because it is hard for the State to
+duplicate it, but when you take a business with a 1,000
+employees or something, a lot of those innovative businesses
+were doing a very good job. One of the things they did is
+employer-based clinics which saved tremendous amount of money
+for a variety of reasons. Is there any way that you can see
+that sort of thing can be duplicated through something like
+Obamacare or is this the type of innovation that is why we want
+the vast majority of Americans hopefully still insured through
+their employer?
+ Ms. Turner. Well, the Affordable Care Act did allow some
+innovation incentives for people to do--not association health
+plans, I'm blanking on the name of the creative coordinated
+care plans within Medicare. And because the rules that were
+written around the Affordable Care Act were so strict, even
+plans like the Mayo Clinic and Cleveland Clinic and others that
+had been--Geisinger, that had been very successful in managed,
+coordinated care, couldn't make it work.
+ So I do think that flexibility is really important and
+trusting employers--some employers have said for example that
+they feel it is worth flying their employee to another State
+and family members to get care at a center of excellence, of
+cardiac care, cancer care. So they really do try to innovate to
+get the best value and the best quality care.
+ Mr. Grothman. It is another thing. I did mention employer-
+based clinics but these centers of value, flying people to
+other States because an employer has the ability to hire
+somebody and do a good job. Now I know there are a lot of
+people who always feel that setting up another big Federal
+bureaucracy is going to work after this seems to have failed
+like 120,000 times in a row, but what you are telling me is a
+way that the private insurance plans and for individual
+companies and hopefully to be duplicated by associated plans,
+they are able to find ways to reduce premiums and reduce costs
+that really as a practical matter are not being duplicated with
+a government bureaucracy.
+ Ms. Turner. That is correct.
+ Mr. Grothman. Thank you.
+ Chairman Scott. Thank you. The gentleman from Michigan, Mr.
+Levin.
+ Mr. Levin. Thank you, Mr. Chairman. I would like to dig in
+a little more deeply to the Texas v. United States case and I
+have a question to start for Ms. Corlette. In a departure from
+long standing precedent of defending Federal law against
+constitutional challenges, the Trump Administration's
+Department of Justice filed a brief last year requesting that
+the court strike down several provisions of the ACA in the
+Texas case. Among the provisions that the administration argues
+should be overturned include guaranteed issue, community
+rating, discrimination based on health status and preexisting
+conditions exclusions.
+ Last week, President Trump told the New York Times that he
+is optimistic that the ongoing Texas lawsuit will terminate the
+Affordable Care Act. Would you say that the Justice
+Department's decision not to defend the ACA is consistent with
+Republican promises to protect patients with preexisting
+conditions?
+ Ms. Corlette. Well, I would say that the Justice
+Department's provision--position if it prevails would strike
+down the protections that the ACA provides for people with
+preexisting conditions. So no, it's not consistent.
+ Mr. Levin. And how does this, his statement reflect the
+Administration's approach to this issue?
+ Ms. Corlette. I--
+ Mr. Levin. Of preexisting conditions that we are here to
+talk about.
+ Ms. Corlette. I have, yes. I have a little trouble divining
+exactly what the Administration's position is given that there
+do seem to be differences between what President Trump has said
+and what the Justice Department position is so I am not sure I
+can comment.
+ Mr. Levin. And what they are actually doing. So you pointed
+out in your testimony that Republicans never have come up with
+a proposal to replace the ACA yet they continue with their
+efforts to unravel it, the most recent example being the Texas
+lawsuit.
+ During the last Congress when we were debating the
+Republican bill to repeal the ACA, Republicans put proposed
+segmenting the population and dumping sick patients into high
+risk pools. The CBO had the following assessment of this
+proposal: ``Less healthy people would face extremely high
+premium. Over time it would become more difficult for less
+healthy people, including people with preexisting medical
+conditions in those States to purchase insurance because their
+premiums would continue to increase rapidly.''
+ One of our witnesses, Ms. Turner, has put forth a similar
+proposal this morning or early this afternoon. Ms. Corlette,
+how do risk--high-risk pools stack up as an alternative to the
+coverage provided through the ACA?
+ Ms. Corlette. Sure. Well, we have a history of high-risk
+pools. Before the ACA there were about 35 States that had high-
+risk pools and they varied. They were different, but I can tell
+you that for people who were in high-risk pools, the premiums
+could be as much as two times the standard rate. They often had
+preexisting condition exclusions so the condition that got you
+denied coverage in the individual market you didn't get covered
+in the high-risk pool for up to a year. You had annual and
+lifetime limits quite often, high deductibles and often many of
+these high-risk pools limited enrollment. Even still, they
+operated at a loss so they needed to be subsidized by the
+government.
+ Mr. Levin. OK, thank you. I have a question for Mr. Riedy.
+In your testimony, you described the enormous cost of your
+medical treatments, totaling nearly $450,000 last year. Prior
+to the ACA plans in the both the individual and employer market
+were permitted to impose annual and lifetime limits on care and
+many of them did, including more than 90 percent of the plans
+in the individual market. You better than most people can speak
+to the real-world impact of these limits. Based on your
+personal experience, how do annual or lifetime limits on
+coverage impact patients with high-cost conditions?
+ Mr. Riedy. Thank you for the question. Annual and lifetime
+caps for me personally if they were allowed to exist again
+would cause a severe financial burden on my family. Not just
+from the cost of having to pay for the care that I receive, but
+also from the impact that if I do reach that cap, what happens
+next? Do I have to pay for them out of pocket? And if I do then
+those costs can be unmanageable.
+ As you mentioned my care last year just for the medicines
+was $450,0000. That is a lot of money to take and so the
+impacts of those caps, having them now provide peace of mind.
+They also know that I can continue to receive the highly
+specialized care and that I have access to that coverage that
+allows me to get that care.
+ Mr. Levin. I can't thank you enough for coming and sharing
+your story with us and with the American people. And just in a
+note of solidarity, I like the gentlewoman from Georgia who
+spoke earlier, I am a two-time cancer survivor but also Mary
+and I have four kids. The two oldest both have Crohn's disease
+and have for 14 years and we would have gone bankrupt multiple
+times over just trying to pay for their medications if they
+weren't covered and because of, you know, caps. Lifetime, we
+would have blown by lifetime caps already so I really thank you
+for sharing your story. I yield back, Mr. Chairman.
+ Chairman Scott. Thank you. The gentleman from Kansas, Mr.
+Watkins.
+ Mr. Watkins. Thank you, Mr. Chairman. My question is for
+Ms. Turner. Ma'am, I represent Kansas and in Kansas, Kansans
+with preexisting conditions face a number of challenges and
+hardships. And I am glad that a lot of Democrats and
+Republicans agree that Americans with preexisting conditions
+should and have been for years been protected, for decades
+actually. And so in that of course even before the Affordable
+Care Act so unfortunately since its passage, the ACA continues
+to be problematic. Premiums continue to rise and the answer I
+believe is not to double down on ACA but and seek a one size
+fits all government-run health care regime.
+ Therefore, Ms. Turner, since the passage of Obamacare, can
+you speak to the lack of actual affordability for the vast
+majority of Americans? Also the rate of continued premium
+increases because of the law?
+ Ms. Turner. Premiums in the exchange markets have about
+doubled on average since the law went into--since the exchanges
+took effect in 2014. That is much higher than in the regular
+market and certainly before that. And a consequence of that is
+that it's driving more and more healthy people out of the
+market.
+ The ACA as you know forces young people to pay a
+disproportionally high amount for their coverage because of the
+three-to-one age rating in the exchanges. And so we are
+losing--if young people are not eligible for their parent's
+coverage and trying to afford premiums on their own, they're
+paying a disproportionate amount for people who are older and
+sicker and therefore they're dropping out as well. So I think
+it is crucial if we really want to increase access to health
+coverage that we figure out a way to get cost down and to
+attract the healthy people into the market.
+ Senator Reeve's constituent in Virginia, he doesn't want to
+drop out of health insurance market but he can't afford $4,000
+a month for premiums and having no choices of coverage. Some
+people need more choices. They need to be able to have more
+flexibility with benefits to protect their family and they need
+some of these bridge plans like association health plans and
+short-term limited duration plans.
+ Mr. Watkins. Thank you. I also want to touch on our
+increasingly strong economy propelled by comprehensive tax cuts
+and regulatory reform. In fact, CNBC recently noted that
+January job reports just last week payroll surged by 304,000
+smashing estimates. Thanks to recent pro-growth Federal policy
+changes, more and more Americans are finally finding good
+paying jobs. Many of these jobs offer generous employer
+sponsored healthcare. So all the employers simply know that
+they can--that they have to be competitive to attract good HR.
+So, Ms. Turner, can a strong jobs market spurred by pro-growth
+policies lead to increased coverage rates nationally for
+employees--employers with preexisting coverage? What are some
+policies that can continue fueling work force participation?
+ Ms. Turner. You are absolutely right that employees highly
+value the, their workplace coverage and the workplace--the H.R.
+departments, especially for big companies work tirelessly to
+try to negotiate the best benefits, the best drug formulary and
+the access to the highest quality hospitals for their employees
+to attract them so that they won't go to a competitor. And
+there are how many, 2 million jobs, two and a half million jobs
+that aren't filled now and employers can't even find the
+workers to fill them. So being able to offer attractive,
+affordable health coverage with the flexibility to meet the
+needs of their workers, and having providers that are competing
+for that business to get, to offer those lower costs, higher
+value plans, I think is really a crucial part of a thriving
+economy.
+ Mr. Watkins. Thank you, Ms. Turner. I yield back, Mr.
+Chairman.
+ Chairman Scott. Thank you. The gentleman from Maryland, Mr.
+Trone.
+ Mr. Trone. I thank you, Mr. Chairman. Ms. Corlette, 30
+years ago I started my business with my wife and two little
+girls and I know firsthand starting a business can be scary
+without the fear you are going to be able to afford healthcare
+for yourself and your family. You mentioned prior to the ACA
+people were often tied to jobs they'd have otherwise left but
+simply because they needed to maintain healthcare, access to
+affordable health insurance. Could you elaborate on what the
+ACA's protections for patients with preexisting conditions has
+meant for entrepreneurship, startups, small business creation?
+ Ms. Corlette. Sure. So, before the ACA, if you were leaving
+a job-based plan, you were required to maintain what was called
+COBRA coverage which was continuation coverage, but you had to
+pay the full premium. And for most people that was
+unaffordable. And so, people often had a lapse in coverage and
+then if you had a preexisting condition it was almost
+impossible to find an individual market plan to cover you and
+your family.
+ With the ACA you can now if you have a business idea or
+want to go out on your own and start a consultancy or invent
+something, you can do so without having to worry that your
+preexisting condition would cause you to be denied or have a
+preexisting condition imposed on your--exclusion imposed on
+your policy.
+ Mr. Trone. So, Dr. Gupta, the opioid epidemic as you spoke
+about and you are from West Virginia. My district borders
+western Maryland so we are right there together in the heart of
+the opioid epidemic on I-81. I lost my nephew, age 24, to a
+fentanyl overdose a couple years ago and so many folks in my
+district have been adversely affected by this tragedy.
+ With the ACA, we closed a lot of gaps in coverage,
+especially in the area of behavioral health. And I think that
+is so important and it is all part and parcel of this disaster
+substance disorders. If the ACA was gone, what do you see as
+the human toll?
+ Dr. Gupta. Thank you for that question. Certainly we
+understand, you know, States with border counties populations
+don't treat those as States, they are one community within
+those areas. So, it's very important for people to be able to
+move across and not have to worry about what is the State
+regulation in this State and the State regulation in that
+State? ACA allows that consistency to happen State to State.
+The mental health protections as well as the ability to get the
+help that need and people would have so many other challenges
+ongoing at the same time. ACA really allows that to happen and
+I think that is the most important piece as we are combatting
+this opioid crisis is to be able to not have any extra barriers
+in terms of coverage and accessibility to care. As the good
+treatments are existing and more come up, we have got to be
+able to have the access to provide tens of millions of people
+who are suffering and dying actually, tens of thousands per
+year to be able to save them and get them back to work.
+ Mr. Trone. As we put together legislation on opioids to
+address that, what do you see as a couple key points that
+should be in that to address the mental health connectivity
+which was so crucial and part and parcel of this at all times?
+ Dr. Gupta. I think it is very important for us to go back
+to see what we did with HIV. We realized HIV was much more of a
+social determinant aspect of this in the 80's and we put
+together, you know, the Ryan White Care Act for example, that
+not just took care of you as an individual, your medication,
+but you--looked at your house and your access and all those
+things.
+ So I think it is very important when you look at this
+crisis, we are looking at housing, we are looking at access,
+daycare, all of those tools that surround somebody who is
+suffering from addiction to be able to be provided so that they
+can get into treatment and then they can have a successful,
+fair chance of recovery and back into employment.
+ So, it is a lot more than just pills or just counseling.
+There is a societal response that we must have to this crisis
+in order to address it and I think that is the part that we can
+do more, not less.
+ Mr. Trone. OK, thank you. I yield the balance of my time.
+ Chairman Scott. Thank you. The gentleman from Indiana, Mr.
+Fulcher.
+ Mr. Fulcher. Thank you, Mr. Chairman, and panelists.
+ Chairman Scott. Excuse me, Idaho. Excuse me.
+ Mr. Fulcher. Yes, it is a common mistake. Thank you.
+Panelists take heart. I think the end is near. It is coming
+close here OK and please forgive the lack of attendance by some
+of us on the front end. I, for one, am still struggling with
+the multiple committees as the same time. And so please know
+that wasn't rudeness.
+ My question and I will probably address this to Ms. Turner
+because I know some of this has been covered and I am going to
+shorten things up because Mr. Watkins hit part of that. But in
+our State of Idaho, 2012 I think it was we--I believe we were
+the only State with Republican leadership in the House, the
+Senate, and the Governor's office that embraced the State-based
+exchange. And I was in the Senate leadership role at that time
+and in hindsight it just hasn't worked out well for us.
+ Our insurance premiums across the board have averaged
+somewhere between a 15 and a 27 percent per year increase. And
+so as we speak right now, in our State, there is a lot of
+things on the table. It is--that have been--that are being
+discussed right now. Alternatives to try to figure out a better
+path and I would just like to get your counsel, your input, on
+some of those things and I will just list a few. But the
+expansion of HSAs, medical memberships, medishare, charity
+care. The expansion of insurance procurement across State lines
+which in our State we can't do, high-risk pool reform. Those
+types of things which are--they are more market-based and given
+our history and our struggle with the status quo that there is,
+your thoughts, your counsel on that type of an approach.
+ Ms. Turner. States do talk about the difficulty of figuring
+out how to address the needs of their State but it's even more
+than the State. It's sometimes at a county level. You have
+rural counties who have very different problems then Cincinnati
+and Canton and Cleveland. They've really need to have the
+resources and the flexibility to meet the needs of those areas.
+ And I want to really reinforce what Dr. Gupta was saying
+about the social determinants of health. We put so much money
+just into health care when people may actually need other kinds
+of supports to make their lives work better. And I believe that
+Ohio is one of the States that has--is implementing work
+requirements as well for Medicaid. And people who work with
+these communities say that is a valuable thing to make sure
+that people have someplace to go once they get through
+rehabilitation treatment, to have a job, something to give
+stability to their life. Help them with housing.
+ If States had more flexibility and I believe the Trump
+Administration is working to do that. As we have said before,
+Congress had repeatedly voted for money to dedicate money to
+high-risk pools. Many States that were doing--the States that
+were doing high-risk pools in the past were doing it all with
+State money. With the ACA there is new money to put on the
+table to make those risk pools work better so that you can
+provide dedicated resources for them and more comprehensive
+care for chronic conditions.
+ So care management for those high end patients, being able
+to have more flexibility, to provide the kinds of benefits
+structures that people actually want to purchase to protect
+themselves and their families I think are really crucial. And
+hopefully we can work with Ohio and other States in trying to
+think about what some of those waiver options might be to
+work--make it work better for your State.
+ Mr. Fulcher. Thank you. Mr. Chairman, a quick followup and
+I will--thank you. Ms. Turner, in a few words because I am
+going to yield my time here in just a second. But that makes
+sense. But when it comes right down to it, should we be
+focusing on solutions that come out of this room and out of
+this building and out of the building next door or should be
+focusing on more market--enabling market-based solutions to try
+to improve our situation?
+ Ms. Turner. We see in Medicare advantage for example that
+market-based solutions to provide more comprehensive care and I
+believe it is really based upon a formula very close to what
+traditional Medicare pays for Medicare advantage, can give
+incentives to begin to find the same kinds of cost efficiencies
+in the health sector that we see at other sectors of the
+economy.
+ When you have so much of the time of health care providers
+and administrators focused on following Washington's rules
+rather than figuring out what is best for the patient, what is
+best for our State that it really takes away time and energy
+from solving the problem.
+ Mr. Fulcher. Thank you, panelists, Ms. Turner. Mr.
+Chairman, I yield back.
+ Chairman Scott. Thank you. Gentlelady from Michigan, Ms.
+Stevens.
+ Mr. Stevens. I would like to take a minute to thank our
+panelists today. Ms. Corlette, your expertise and knowledge
+was--is so welcome and we thank you for taking the time.
+ Mr. Riedy, thank you for your courage and your words of
+wisdom and sharing your personal story. It was a delight to be
+in this room with your family who was looking at you with very
+proud eyes. You are one of the reasons why the ACA was so
+critical and critical to every American taxpayer and American
+worker and I admire you from the bottom of my heart.
+ And, Ms. Turner, I want to thank you for your eloquence and
+answering a lot of questions today. And, Dr. Gupta, thank you
+for being here.
+ As we are here examining threats to workers with
+preexisting conditions, this topic could not be more critical
+as our Ranking Member Foxx indicated. We have a healthy economy
+and the health of our taxpayers and our workers is paramount.
+ And Dr. Gupta, I would like to take my questions to you and
+your expertise which we are delighted to have in the room
+today. In your testimony, you discussed the issue of high-risk
+pregnancy and delivery and how women prior to the enactment of
+the ACA often found that, you know, they reached their policy's
+cap. They would reach their policy's cap on the amount of care
+provided. They would find themselves exposed financially,
+unsupported in the workplace, and generally pushed to a brink.
+And so, I would like to ask you, what is the cost of high-risk
+pregnancy and how likely are women to run up against these caps
+in the absence of the ACA protections.
+ Dr. Gupta. Certainly, thank you for that question. March of
+Dimes certainly is doing a lot of work around this because we
+know that maternal mortality and morbidity amongst the 49
+developed countries in the world, we are number 49. We are
+actually three times mortality of the next country in line
+which is UK. So we are really in a bad shape right now. For--we
+have women dying every single day.
+ The cost can be tremendous and when we look at the cost
+really it is not just human lives lost, but we are talking
+about one complicated pregnancy can cause that woman to lose
+potentially her absolutely full annual lifetime limits. So, she
+may not have coverage for the rest of the year and have to take
+care of not just the baby but the rest of the family.
+ Same way we go back to the severe prematurity. One simple
+birth with severe prematurity can land a child, an infant for
+multiple months in a neonatal ICU. So, when the baby returns
+home for the first time when there should be a cause for
+celebration, it would then be a cause that the baby could meet
+his or hers lifetime limits on care and not be insurable until
+Medicare. And that's just a terrible thing to think about and
+those are the challenges we are dealing with where we need to
+be making progress to work in those maternity care deserts.
+ We have a third of the counties in this country or 1,000
+counties, 5 million women, 150,000 babies that are being born
+what no obstetric care. And so that we are actually, you know,
+talking about walking backwards.
+ Mr. Stevens. Well, and not only is this a cost to the
+mother and the family, it is a cost to the employer as we, you
+know, are talking about the workforce and our economy writ
+large. And, Dr. Gupta, as you know, the Affordable Care Act
+requires insurers to cover preventative health services without
+cost-sharing and these obviously include family planning, well
+women visits, screenings for domestic violence and other
+crucial health services.
+ And I, just to back this out a minute, I would love for you
+to just reflect on how pregnant women and other new members--
+mothers, excuse me, utilize these services and what impact
+would overturning these provisions maybe through the Texas
+litigation have on these women?
+ Dr. Gupta. So first of all, just the idea of preconception
+care to be healthy in order to get pregnant is very important.
+That would not happen. Then within prenatal care the notion of
+having things like vitamin--folic acid and vitamins, which we
+think is very basic, we recommend that all across the globe,
+yet we can have women that can have, deliver and cause real
+harm to the babies developing because of neural tube defects
+and other things that are not being provided. Throughout the
+prenatal care we know the amount of visits that happen with the
+doctor's office and this following a standard of care leads to
+better delivery, better care of not just the mother but also
+the baby as a result, getting the family dyad back together,
+the mom and baby. None of that would be possible if we were to
+remove that.
+ And obviously one of the things that used to happen was the
+only time you could get into Medicaid was if you were--if you
+got pregnant and then it would be removed the coverage right
+after. Now we have 60 days, up to 60 days coverage post-partum.
+When we are dealing with challenges of post-partum depression,
+suicide, post-partum hemorrhage, hypertension, eclampsia, heart
+conditions, it's very critical for us to build on that coverage
+post-partum up to a year because of the increasing maternal
+mortality that is happening.
+ This is still the most dangerous place for a woman to have
+birth in the developed world. And we need to be working again
+not at removing that but actually developing more steps but at
+this time, removal of ACA provisions will cost women and their
+children not only just their jobs but potentially their lives.
+ Mr. Stevens. Yes. Well, Dr. Gupta, while you don't share my
+gender, I appreciate you sharing the stories of women and
+mothers and making that at the forefront of our minds today.
+Thank you.
+ Chairman Scott. Thank you. The gentlelady from Nevada, Ms.
+Lee.
+ Mr. Lee. Thank you. I wanted to first thank all of the
+panelists today for your testimony and answering the questions.
+And, Mr. Riedy, I wanted to speak directly to you. First of
+all, CF has had a place in my family. My husband lost a cousin
+about 30 years ago before groundbreaking technologies and
+treatments were available. And more importantly, my sister,
+Mary Lester, is a respiratory therapist at Keck Medical Center
+at USC and dealing with adult cystic fibrosis. So, through her
+years, through my years and I have experienced alongside her
+many of the struggles that patients like you go through. So,
+thank you very much for being here and your testimony.
+ I wanted to ask, in your testimony you pointed out that
+you're fortunate to have comprehensive health coverage through
+your wife's employer. If your wife were to change jobs, choose
+to start a small business or possibly take time off for
+education, you might end up in a situation where you would have
+to change this coverage. And I wanted to know from you how do
+the Affordable Care Acts protections for patients with
+preexisting conditions provide peace of mind that you would
+never be without coverage?
+ Mr. Riedy. Thank you for that question. Knowing that my
+wife or I could switch employers and still be adequately
+covered, it gives us peace of mind that allows us to be
+flexible and explore new opportunities potentially that before
+the ACA may not have existed. And without the ACA, you know,
+there is always that fear that leaving a job if I went to
+another one that I could still be denied insurance because of
+my preexisting condition or if my wife changed jobs, you know,
+would they deny me coverage because of my preexisting
+condition.
+ Mr. Lee. And thank you. And to followup on that, what
+impact would an adverse decision in Texas case have on your
+wife's ability to change jobs?
+ Mr. Riedy. Well, if the ACA was--if the ruling stands, my
+wife would have less of the opportunity to explore new
+opportunities. She is a teacher so she is at a great place
+right now but if she had to--if she wanted to do something
+other than teach or switch employers there's still that fear
+that we may be or I may be denied coverage or access to it. So,
+it could lock her into where she is.
+ Mr. Lee. Lock her in. All right, thank you. One other
+question. According to the Department of Health and Human
+Services, the number of Americans with preexisting conditions
+ranges from at least 23 percent, 61 million people to as many
+as 133 million people. And prior to the Affordable Care Act
+these Americans with preexisting conditions could be denied
+coverage or charged an exorbitant premium to get coverage,
+something that my parents had experience both having high blood
+pressure at one point in their lives.
+ Some families have even declared bankruptcy from high
+medical bills due to having a preexisting condition. Today,
+however, insurance companies cannot discriminate against people
+based on their medical history.
+ Mr. Riedy, without employer-sponsored health insurance or
+insurance through your family prior to the Affordable Care Act,
+do you believe you would have been able to attain affordable
+health insurance?
+ Mr. Riedy. Before the ACA I would have likely been denied
+coverage because of my preexisting condition without the access
+to employer-sponsored health coverage. And the ACA provides me
+with the opportunity to be adequately covered on the individual
+market I'm currently in. Without them I don't know if that
+would be possible.
+ Mr. Lee. Well, thank you so much for your testimony. I want
+to say I texted my sister to tell her I was going to be
+speaking with you today and she sent me this message back that
+said please make sure we help people with cystic fibrosis
+because these patient needs to have their medical needs met and
+it is extremely expensive illness. She said they didn't cause
+this disease, but they must fight it and so thank you for your
+courage for being here. I appreciate it.
+ Chairman Scott. Thank you. The gentlelady from
+Massachusetts, Ms. Trahan.
+ Ms. Trahan. Thank you. Thank you, Mr. Chairman, for having
+this hearing and thank you, everyone, for hanging in for a long
+hearing. Part of the challenge of being later in the program
+and new here is so many of the thoughtful inquiries have
+already been made but I do have a couple of questions. I am a
+mother of two young girls, 8 and 4 as well as three grown
+stepsons who have benefited from the ACA and being able to stay
+on my health plan as they enter the workforce.
+ Before the ACA women were often charged more than men just
+because of their gender and some couldn't even get coverage on
+the individual market. For women of childbearing age, the
+discrimination was particularly blatant, and the vast majority
+of plans excluded maternity coverage of any kind. And I
+appreciate my colleague from Michigan and her inquiry around
+maternal care.
+ Dr. Gupta, I am wondering if you could just explain to us
+what it was like for women to get health insurance coverage
+before ACA and how many plans covered maternity coverage in the
+individual market and what improvements have women and their
+families seen since ACA?
+ Dr. Gupta. Certainly, thank you for that. We know that
+prior to the ACA, only 11 States mandated the coverage of
+maternity care. Only 13 percent of the individual health market
+actually covered maternity care. We know that at that time
+obviously the gender of being female was a preexisting
+condition in effect. We also know that 47 percent of people who
+tried, adults who try to get coverage with preexisting
+condition were either denied, charged more or were precluded
+from at least one condition. That's from the Commonwealth Fund
+Study. So, we know that this was a big problem.
+ Since then, March of Dimes did a study in 2015 and found
+that between 2013 and 2015 the uninsured coverage for
+childbearing age women went down from about 20 million to 13
+million, I'm sorry 20 percent to 13 percent. That means that
+another 5 and a half million of childbearing age gained
+coverage. Not only that, the unmet needs actually went down by
+10 percent points of those women. So clearly that has been a
+big gain.
+ I would say when we talk about preexisting conditions,
+health inequities are the first cause of preexisting
+conditions. And when I talk about maternal mortality, a black
+woman in this country is more likely to die--three to four
+times more than a white woman. So, we still have for healthcare
+institutions across and healthcare systems across the country,
+today, race is a preexisting condition and we need to continue
+to work on that and I think that is a critical piece that I
+must bring up as well.
+ Ms. Trahan. Thank you. Thank you, Dr. Gupta. and, Ms.
+Corlette, to borrow a phrase that is going around a lot, the
+dignity of work is something that means a lot of me. And I am
+the daughter of a union ironworker. My mom worked multiple
+part-time jobs while raising my sisters and me. I am constantly
+thinking about how are we going to support work and labor as it
+transitions to the future and what the future of work actually
+looks like?
+ We talk a lot about our economy and adding more jobs but
+those don't always translate into employer-sponsored plans. So,
+a recent Department of Labor survey found that 10 percent of
+the workforce are categorized as either independent contractors
+or self-employed. This represents a growing segment of the
+workforce, in fact more than half of all ACA marketplace
+enrollees are small business owners, self-employed individuals
+or small business employees.
+ I am wondering if you have looked at any additional
+research on the impact of the Texas lawsuit or even just the 70
+plus ACA repeal attempts would have on the future of work? And
+also, if we have time, can you discuss the impact of removing
+preexisting condition protections for gig economy workers,
+independent contractors specifically?
+ Ms. Corlette. Sure. Thank you. It's a great question. So,
+for folks who do have job-based coverage, there are a couple of
+things to be concerned about if the Texas court decision
+stands. One of course is that people could lose--with chronic
+or high-cost health needs could lose some of the protections
+that Mr. Riedy has spoken so eloquently about. The other issue
+of course is job lock, and this is a phenomenon that was well-
+documented before the ACA where folks sort of hung onto their
+jobs and their job-based coverage because of the uncertainty of
+the individual market. And they may have had a great business
+idea or been a terrific entrepreneur but did not pursue that
+because of their need to maintain job-based coverage.
+ Ms. Trahan. Great. Thank you. Thank you, Mr. Chairman, I
+yield back.
+ Chairman Scott. Thank you. The gentlelady from North
+Carolina, Dr. Adams.
+ Ms. Adams. Thank you, Mr. Chairman and thank you all very
+much for your testimony and for sitting out with us, we
+appreciate that very much. Mr. Riedy, thank you so much for
+sharing your story.
+ Mr. Chairman, I would like to enter into the record first
+from the--some organizations that have commented regarding the
+preexisting conditions and the GOP plan. First, the American
+Cancer Society Action Network who says that these protections
+are hollow if patients and survivors can't afford insurance.
+From the American HealthCare Association, the plan would do
+just the opposite and not serve the health needs of all
+Americans. And then they also say that the greatest achievement
+of the ACA is protecting those with preexisting conditions. The
+National Disabilities Rights Network says that GOP plan permits
+discrimination against people with disabilities in the
+insurance market for preexisting conditions and I would like to
+enter this into the record, Mr. Chairman.
+ Thank you. Let me just say as I have listened to you, all
+of you I thought about Dr. Martin Luther King, Jr., who talked
+about healthcare and inequities and who said that ``of all the
+forms of inequality, injustice in healthcare is the most
+shocking and most inhumane'' and indeed it is. I do want to
+just mention the impact that ACA has had on communities of
+color, in particular the protections of those with preexisting
+conditions.
+ I am a diabetic and that's an illness that was considered,
+is considered a preexisting condition. It is very prevalent in
+my family. I had a sister who suffered with sickle cell, from
+sickle cell anemia, a preexisting condition who passed away
+before she was 27. African-Americans are 80 percent more likely
+than Whites to have been diagnosed with diabetes. About 365
+African Americans suffer with sickle cell anemia. Latin--Latino
+Americans have the highest rates of cervical cancer and Asian
+women are at the highest risk of osteoporosis.
+ Simply put, the Affordable Care Act has saved lives and has
+provided healthcare to millions who previously thought
+affordable treatment was just a dream. Folks like me, families
+that grew up who didn't have healthcare at all, no health
+insurance, having to go to the emergency room to get our care.
+ Dr. Gupta just one or two questions. For those with
+preexisting conditions or minority communities, how many more
+people with chronic illnesses have been covered and have those
+who suffer from chronic ailments seen improvements in their
+conditions as a result?
+ Dr. Gupta. I can tell you that there has been a great
+progress made in that and I will certainly get you the exact
+numbers but the great progress made in that and the ability to
+again, level the playing field in our pursuit to level the
+playing field to get people to be covered. And we, I say that
+because these conditions are a part and representative of your
+socioeconomic condition. They're representative oftentimes of
+the culture we come from and lots of other things. What we call
+social determinants of health, education level. So being able
+to provide the basic healthcare that has happened as part of
+the health ACA has allowed our communities of color actually to
+be--have one less thing to worry about. So that's one of the
+things.
+ The other piece I will go back to, you know, as March of
+Dimes we are focused on the health of moms and babies and
+nowhere is it more evident, the disparities and health
+inequities when we look at moms and babies. As I mentioned,
+three times to four times more likely to die if you're a black
+woman. Same way prematurely. Twice as likely to die if you're a
+premature child who is African-American. So, these are the type
+of things that we are fighting for and I think it is very
+important to understand that this will take us many steps
+backwards and we need to be moving forwards.
+ Ms. Adams. Great, thank you very much. Wanted to just, you
+know, note that since the President assumed office we have seen
+a constant attack against ACA. So much so that we are seeing a
+reversal in quite a bit of the progress that we have made and
+just wanted you to just briefly comment on how this reversal in
+progress has impacted people of color specifically.
+ Dr. Gupta. I think what we are--once again will end up
+happening, we will have individuals who will be dependent again
+on emergency care and urgent care as a result of which
+screenings will not happen, preventive visits will not happen.
+As a result of which we will not have--be able to catch those
+diseases early. It will be delayed, it will be more expensive
+and it will cost more lives. As Ms. Corlette eloquently pointed
+out a couple of times that we have clear data for ACA that when
+people were uninsured there were about, over 20,000, 22,000
+people we know in this country were dying every year because of
+the lack of insurance per say. We will go back to that.
+ Ms. Adams. Thank you very much. I yield back, Mr. Chairman.
+ Chairman Scott. Thank you. Gentlelady from Minnesota, Ms.
+Omar.
+ Ms. Omar. Thank you, Chair. Thank you all for being here.
+Thank you for having this really important, critical
+conversation but sometimes frustrating conversation. And I say
+frustrating because of two reasons. One, to see the disconnect
+between what some of my colleagues would say in committee about
+healthcare and what their votes say about where their
+priorities and their values are, seems very, very frustrating
+for me.
+ And the second is for us to have conversations about policy
+that have real impact on humans but to not really think about
+the humans that we are talking about in this discussion. So I
+am one that sees healthcare as a human right and I want to take
+some time for us to humanize this particular conversation
+because, you know, there are--there are people who will talk
+about the costs, they will talk about, you know, what struggles
+corporations will have or companies will have or a small
+businesses or all of these kind of things. But oftentimes we
+don't talk about the kind of stresses and the traumas that
+people like yourself, Mr. Riedy, have lived with as you not
+only deal with getting the diagnosis and figuring out how you
+go on with life, with the condition that could be a hindrance
+to your day-to-day life or could, you know, maybe end your
+life.
+ So, what I wanted to do was maybe have you walk us through
+what it must have been like to go through the process to
+receive those letters from insurance companies before the
+passage of the ACA.
+ Mr. Riedy. Well, thank you for the question. And this was,
+back in 2007 and to know--have spent 7 days in the hospital and
+to know that--what the cost of that care is and then after that
+I also spent 14 days at home on IV antibiotics at home which
+required a home healthcare nurse who came every couple days to
+draw blood and just check on the dressing and the IV and
+everything.
+ But to receive information that describes the cost of your
+care A, is a shock to see how much it actually costs. But then
+to see how that is then compiled toward a limit of what an
+insurance company or someone is willing to pay is worrisome and
+scary because you know that without that care or access to--
+without access to the coverage that will give you that care, it
+will be much harder for you to stand a chance. And not just for
+me but for others with CF or with other preexisting conditions
+that faced those same struggles.
+ It takes a toll not only on us as people but also on our
+families and those that love us because it, it's not just me
+that would sit and think about it. It's my wife, right. And my
+kids are--at the time at 2007 they weren't alive yet. But now
+if that was to happen again, that puts an unnecessary burden on
+them as well.
+ And having the knowledge that there are no caps and not
+having to receive those letters anymore allows us to focus on
+our family and to continue to seek the best coverage and care
+that allows - and medicines that are highly specialized to
+target what the issues are with my disease and to help prolong
+my life so that like I mentioned earlier I can see my children
+grow up and go to college and not fear that I may have to make
+a decision one day so that they can continue to grow and me not
+have to have that coverage.
+ Ms. Omar. Thank you. I see an immorality in the way that we
+are creating policy without taking in the actual impact that it
+has on the people's lives. We take a constitutional oath to
+protect the safety and the wellbeing of the people that we
+serve. So, thank you so much for sharing your story and I will
+tell you that you have people here in Congress who will make
+sure to constantly center that. So, thank you. I yield back.
+ Chairman Scott. Thank you. And I recognize myself now for
+questions and the vote has been called so these are going to be
+some quick questions. Appreciate some quick answers.
+ Ms. Corlette, you mentioned the New York situation where
+they covered--they guaranteed issue notwithstanding the
+preexisting condition and when the Affordable Care Act came in,
+is it true that the cost for individual insurance dropped more
+than 50 percent?
+ Ms. Corlette. Yes. It's true.
+ Chairman Scott. The effect of the Texas case, is it true
+that if the case is upheld there will be no protection,
+national protection against--for preexisting conditions?
+ Ms. Corlette. The ACA protections will be stuck down, yes.
+ Chairman Scott. Now we have heard that if it is
+unconstitutional the court would provide some transition time.
+Is there any--you are a lawyer, is there any guarantee that
+there would be a transition time if they call it
+unconstitutional?
+ Ms. Corlette. There is no such guarantee.
+ Chairman Scott. Now the repeal and replace, are you
+familiar with the American HealthCare Act that passed the
+House?
+ Ms. Corlette. I do remember it, yes.
+ Chairman Scott. OK. Is it true that if that had passed 23
+million fewer people would have insurance, costs would go up
+about 20 percent the first year, and there would be fewer
+consumer protections?
+ Ms. Corlette. I don't remember the exact numbers but that
+sounds like what I remember, yes.
+ Chairman Scott. And we have heard a citation in the bill
+that protects people with preexisting conditions but what
+wasn't read was an ability for States to waive that protection,
+so if you are unlucky enough to be in the wrong State that you
+could have no protection against preexisting conditions. Is
+that right?
+ Ms. Corlette. Right.
+ Chairman Scott. 11 million people who have, who got
+coverage through Medicaid expansion would they lose their
+coverage?
+ Ms. Corlette. Yes.
+ Chairman Scott. And the 10 essential benefits including
+prescription drugs, mental health, maternal and newborn care,
+preventive care, would those evaporate if the bill, if the
+law--if the ruling is upheld?
+ Ms. Corlette. Yes.
+ Chairman Scott. And we have heard about essential benefits
+and Dr. Gupta has been very articulate on that. If maternal
+and--maternity care were optional, who would buy it?
+ Ms. Corlette. Well, who would offer it is the first
+question? Insurance companies generally would not offer it. And
+if they did, it would typically be as what is called a rider
+and the cost would be exorbitant.
+ Chairman Scott. Because the only people that would buy it
+would be those who expect to have a baby in the next year.
+ Ms. Corlette. Right.
+ Chairman Scott. And the cost would be not insurance but
+essentially prepaid maternity care.
+ Ms. Corlette. That's exactly right.
+ Chairman Scott. And that is why it would be unaffordable.
+Now on the association plans, as I understand it you can get a
+healthy group, young healthy men and who would pay less. The
+arithmetic therefore says everybody left behind would pay more.
+Is that right?
+ Ms. Corlette. That's correct.
+ Chairman Scott. Now the navigators which you mentioned are
+community-based organizations that help consumers sign up for
+coverage. Language recently published by the Centers of
+Medicaid and Medicare--Medicare and Medicaid--states that
+priority will be granted and funding organizations that promote
+``coverage options in addition to marketplace plans such as
+association health plans, short term limited duration
+insurance.'' Is that consistent with the original purpose of
+the navigators?
+ Ms. Corlette. No. Navigators are supposed to help people
+enroll in marketplace coverage.
+ Chairman Scott. The--you know what has happened to the rate
+of bankruptcy because of medical bills as a result of the
+Affordable Care Act?
+ Ms. Corlette. I don't have that data at my fingertips, but
+it has gone down.
+ Chairman Scott. And can you say another word about job lock
+and why the Affordable Care Act gives people, particularly
+entrepreneurs the opportunity to switch jobs?
+ Ms. Corlette. Sure. So, for people who have a preexisting
+condition themselves or somebody in their family who has a
+health condition, economists documented this phenomenon called
+job lock which prior to the ACA led a lot of people to stay
+with job-based coverage even if that job was not optimally
+deploying their skills or talents.
+ Since the ACA if you are an entrepreneur or you want to
+start your own business, you can do so without worrying about
+coverage for your preexisting condition and if you are at least
+initially not earning much income, you can qualify for
+subsidies or even Medicaid.
+ Chairman Scott. Thank you. I would like to thank our
+witnesses for their testimony. I now recognize the
+distinguished ranking member for closing comments.
+ Mrs. Foxx. Thank you, Mr. Chairman, and I want to thank our
+witnesses also for being here. I particularly appreciate the
+opportunity that this hearing has given for Republicans to set
+the record straight on our position on preexisting conditions.
+ I believe most every member spoke to it but we know that
+every member believes in coverage for preexisting conditions
+both those of us who were here to vote for the replace bill and
+the other, and the numerous replacement bills that we have
+offered.
+ There is so much to say to correct the record here that
+there is not enough time. Perhaps I will submit some things for
+the record but I want to point out that if the court rules the
+ACA illegal, it would not repeal ERISA. It would not repeal
+HIPAA. There are safeguards in both of those pieces of
+legislation for preexisting conditions. Some of our witnesses
+have been extremely careful in how they have answered those
+questions and I appreciate that because they have been very
+careful not to completely mislead people about that situation.
+Contrary to what has been said about the work of Republicans,
+we have made provisions in all our proposals and past
+legislation that protects people with preexisting conditions.
+And I think it is important we continue to say that.
+ The Affordable Care Act was built on lies. If you like your
+insurance, you can keep your insurance. If you like your
+doctor, you can keep your doctor. All of those things were said
+and they--or costs will be lowered. Those were not true. The
+ACA ordered people into a one-size-fits-all plan which
+increased costs dramatically and we know that. What America--
+what Republicans have done is to offer Americans freedom and
+choice. And what we should have been talking about today was
+what the ACA has done to raise the costs of healthcare and make
+it less affordable and less accessible. And with that again I
+thank the witnesses and I yield back.
+ Chairman Scott. Thank you. Again, I want to thank the
+witnesses and members for their participation. What we have
+heard I think is a very valuable. The hearing has allowed us to
+take stock of where we are, to examine the attacks on
+preexisting conditions through unnecessary litigation, harmful
+rules that have a negative impact on those with preexisting
+conditions and I think we should try to improve and protect the
+healthcare that we have now and not jeopardize it.
+ It is obvious that even the employer-based coverage with
+the protection for preexisting condition, those with employer-
+based coverage if we don't have the individuals covered, we
+will have uncompensated cost-shifting so they will be paying
+more if these, all off these other protections are repealed. If
+there is no further business to come before the committee, the
+hearing is now adjourned.
+ [Additional submissions by Ms. Adams follow:)
+ [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
+
+
+ [Whereupon, at 1:49 p.m., the committee was adjourned.]
+
+ [all]
+