tv House Oversight Hearing on Affordable Care Act Enrollment CSPAN October 20, 2020 8:59pm-11:00pm EDT
potential improvements to the healthcarere law. this is two hours. >> thank you for joining us today. we are holding a this hearing virtually. before we turn to today's topic they help you navigate the virtual narrative and first consistent with regulations, the committee would keep microphones muted. members are responsible when
they seek recognition or when recognized. second members must have their cameras on at all times. if you need to step away from the proceedings, please leave camera on rather than loggingat out. third, we will dispense with our practice of observing and instead go in order of seniority alternating between majority and minority beginning with members of the oversight subcommittee first. finally, without objection, the representative is authorized to serve as the chair in the event that i have some technical difficulties or whatever. ive thin thank you all for your continued patience as we navigate this technology in order to continue serving our country together in this great time of need.
and with that i will now turn to the important topic of today's hearing. maximizing health coverage and administration sabotage. sounds like a movie. so, good morning everyone. today we will focus on access to health coverage in the trump administration continues unconscionable sabotage of americans care. since its passage over a decade ago, republican leaders have treated the destruction of the affordable care act. since 2011 neither side has voted more than 70 times to eliminateth the aca. 2017 they even held an outdoor party at the white house with a
plan thatr would cause millions to lose their healthcare coverage. that same year, one of the greatest abuses of power in the dead of night republicans amended the aca and remaking one sixth of the american economyann a bill they introduced hours earlier. the president recently bragged about his healthcare. of course he has great coverage paid for by all of us, the same taxpayers that saved the protection. they are not going to let up. i want to remind everyone in court right now demanding to destroy the aca. the administration is fighting to remove healthcare programs and protections for millions in a pandemic.
using virtually every tool to dismantle thea healthcare syst. they have greenlight plans without any protections and proposed a rule to prevent women from having access to reproductive healthcare and they've gutted funding for navigators and assistance while failing to crush the aca, they are destabilizing the american healthcare system. the administration has gone out of its way to prevent americans from getting and maintaining coverage between february and may of this year, 21.9 million workers lost their jobs. of these workers, 5.4 million became uninsured due to job loss. in march i joined my colleagues to help the subcommittee
chairman and nearly 100 house members calling for a special enrollment period for people to seek marketplace coverage during the pandemic. even during the pandemic, hhs refused likely making many americans suffer. no other word i can think of except sabotage. when you see my administration and friends across the aisle swearr they support protections for pre-existing conditions they assert with a straight face while spending ten years packing the aca. repeat the republicans have sought to remove pre-existing conditions over and over and over. it's onn the record. states are working hard to expand access to coverage.
one of them is the great state of new jersey. in new jersey and colorado we will discuss how they are making a besit best work for their cit. as senate republicans race to confirm a new justice they are downplaying their challenge to the aca. if the republicans have changed their mind onwh the aca why wont they join us in defending the law. when we voted in june to protect, 177 of 179 republicans opposed it. if you don't have a calculator handy that is 99%. given a chance 99% of our colleagues across the aisle voted against protecting pre-existing conditions. we know why. a few short weeks the supreme court will hear the aca case.
the future of the healthcare system hangs in the balance. and i want to yield now to my good friend the ranking member from pennsylvania and we will keep things to five minutes because we saw what happened last time. we went over. we talk too much. [laughter] >> thank you for holding the hearing. this is a tough time [inaudible] there's been nothing more devastating iner our time than e china flu and during this time the cost of healthcare undermined so i appreciate the opportunity to discuss the issues today. far from being perfect, our healthcare system is the best in the world and with a hearing like this i'm reminded of how fortunate we are to live in a country with access to the most innovative healthcare ontr the
planet and i hope we can use this hearing to put things in perspective and correct some of the myths about the healthcareto we have been gearing up to have a hearing on on the campaign trail. today i want to talk about two things, first successful healthcare policy developments we have achieved over the last couple of years and second, to correct the record on some of the rhetoric we've been hearing about american healthcare. a lotan of the rhetoric seems designed to scaream the american people in advance of an election and i think that effort is unfortunate and misleading. the idea that this administration has sought to sabotage the healthcare system if that's the truth this is the worst sabotage the world has seen. i can't look at this and say come on if we are really going to fix this let's fix it and not talk about things that sound good on the campaign trail but all of us when it comes to truth. we've made progress on stabilizing the aca. insurance premiums are down, coverage is up and enrollment is
stable so this administration has made many strides to see more affordable healthcare s tions for americans who may not want, need or be able to afford some of the coverage plan so i'm pleased we have chris with us today to speak to some of these successes including the restoration of short-term healthcare plans and enhancements to help reimbursements. these crucial events and reforms haveve provided options letting them choose what is best for them emphasizing, letting them choose what's best for them and not having something shoved down their throat they don't have a choice in. let's remember by getting rid of the a individual mandate we save lower and middle income taxpayers and nearly $95 a year and that is huge when you look at that group of people. they tried to block the efforts and i understand why and use the scare tactics to stop the progress of the administration.
like saying republicans would eliminate coverage for people with pre-existing conditions which couldn't be further from the truth and pretending pre-existing conditions democrats want to take yes for an answer. it makes no sense to me but that's where we are at. the first legislation offered by republicans in the 116th congress said no one and, i mean, no one should be charged more or denied coverage based on their pre-existing conditions. democrats objected that offered to try to serve it as an election issue so any suggestions to that it is just flat-out wrongnd and a miscarrie of the truth. meanwhile instead of working together on bipartisan efforts to improve the health care system, 118 democrats have cosponsored medicarear for all this new and enormous program would destroy the current healthcare system starting with the repeal of the affordable
care act. many democrats simply want an unpopular partisan government takeover of healthcare when we should be working together for coverage for everybody, to get more options to the american opople. this one-size-fits-all approach is wrong and doesn't make sense to anybody other than somebody trying to push an agenda the wrong way. the plans that would take away choice from hard-working americans in my district would also destroy their healthcare options. the affordable care act much of the law has changed over the last ten years. yet democrats keep looking to the past rather than working together to improve the future but we can build on recent successes and healthcare policies by continuing to bring down premium prices and increase coverage choices for all americans. increasing the number of options
available and people can actually buy something that fit their needs. i hope we can stop the fear mongering and come together in the future to work on bipartisan support to improve the lives of our constituents. mr. chairman i want to thank you for holding thisti hearing and alsot want to thank the paneliss were taking time out of their lives to come and talk with us. s thank you and i will yield ba. >> i would say to you and all of the democrats and republicans who were at the last hearing i thought of going ove going overg after the hearing tremendous questions from both sides of the aisle on the subject of tax fairness. it's tough to get people together before an election but i want to complement both sides for what i think was a spectacular job. next we will hear from the
panel. and thank you to the distinguished witnesses for taking the time to appear before us today. to discuss this very important issue. i will introduce the witnesses and then turn to each of them for their testimony. first witness commissioner marlene, the commissioner leading the new jersey department of banking and insurance. previously she was a member of the new jersey general assembly representing the 36th legislative district. the next witness is kevin patterson. mr. patterson has served as the chief executive officer of contact for health colorado since april of 2015 and has a long history of public service including as interim chief of staff to governor john hagan --
hagan -- mr. slavitt serves as the mr. pope serves as a senior fellow at the manhattan institute of the research focuses on healthcare, payment policy and insurance market reform. each of your statements will be made a part of the record in its entirety. i would ask you summarize your testimony in five minutes or less. to help you at this time, please keep an eye on the clock that should be on your screen. if you go over your time i will notify you with the tap my gavel. commissioner, you may begin.
>> thank you and good afternoon, everyone. thank you, chairman pascrell, ranking member and members of the committee. as mentioned by the chair man, my name is marlene and i am thee commissioner of the new jersey department of banking and insurance and we regulate the banking an insurance and real estate industries and operate cover new jersey, the state's official marketplace that launched this month. under the leadership of the governor, new jersey has led in protecting the affordable care act, stabilizing its insurance market and increasing access to coverage based on the guiding principle that healthcare is a right. the state has moved in a deliberate way towards where we are today opening the states exchange making coverage more accessible and affordable for the residents and providing more financial help than ever before for those purchasing coverage on the marketplace in this open
enrollment. in 2018 the state enacted two major policies. first in the nation actions to continue the requirement to have coverage after its elimination from the federal level and we implemented a reinsurance program beginning with plan year 2019 to cover high-cost claims, reduce the rates in the individual market. they resulted in health insurance rates and the individual market that were 22% lower than they would have otherwise been. the state decided to establish its own marketplace and wanted to better secure access to affordable coverage for the residents. the fact is while we have been sending funds to washington for the use of the federal marketplace, we continue to see policies enacted that threaten the progress made by the affordable care act and made our work more challenging. from 2017 to 2018, enrollment in
the individual market dropped for the first time since 2014 and continued to drop the following year. when new jersey took control of outreach and enrollment assistance in 2020 as a state-based exchange on the federal platform began to reverseng the trend. get covered new jersey will perform on november 1st and keep more than $50 million in the state to spend in the marketplace. residents will see benefits that include subsidies on tops of premium tax credits. the estimated average subsidy for an individual would be at least $578 a year, and at least 2,313 a year for a family of four. the average net monthly premium for those eligible for financial health is estimated at $117 a month for 2021 compared to $164 a month in 2020.
increased navigators to provide free enrollment assistance with 3.5 million in funding 16 navigators up from one under the federal government in 2019, three months to enroll compared to a six week window under the federal government and residents will also benefit from our ability to respond to the needs of the state with a special enrollment period for covid-19 and quality of pregnancy that improves maternal health which has been a focus of this committee as well as the committee of new jersey. we have taken deliberate progressive steps to stabilize our market and improve access to coverage all leading to the establishment of the marketplace to this open enrollment period beginning november 1st. with the public health emergency we are facing, we believe there is no better time than now to make this t transition.
thank you for the opportunity to speak before you and your panel. >> commissioner, i am honored to see you again. you happen to live in my district, right? >> that's correct. >> our next witness is kevin patterson who served as the chief executive officer of connect h for colorado since apl of 2015 and of course he was an interim chief of staff to governor hickenlooper. >> thank you mr. chairman and subcommittee members for the opportunity to submit testimony on behalf of the insurance exchange in colorado and the people that rely on getting coverage through the individual market. my name is kevin patterson and i'm the ceo for connect health colorado. our mission is to increase quality and choice for
ilindividuals, families and smal employers purchasing health insurance. i'm proud of the innovation and collaboration in the state to reduce the uninsured rate and increase enrollment. i'm pleased to share more today about the achievement in the marketplace and how thisas uniqe position allows us to expand coverage to the people of colorado. since we opened for businessdo n 2013he we've helped hundreds of thousands get the coverage t thy need to protect their health and livelihood however increasing access to affordable healthcare and choice started years before the passage of the affordable care act. in 2006 a bipartisan group of lawmakers created a commission to study models for comprehensive reforms under the republican governor with the passage of the aca in march of 2010 our state legislature passed a bill creating the benefit exchange as a public nonprofit entities that has a bipartisan legislation oversight committee. board members are appointed by the governor both democratic and republican members of the legislature. connect for health
colorado's ceo in 2015 when the state's uninsured rate reached a record 6.7% one of the lowest in the country. charged with further increasing access and readability and the rechoice for residents i knew we had to prioritize meeting people where they are so whether i'm having a conversation with a single mother in denver or farmer on the eastern plains i and the rest of my team are listening and learning from colorado about viable solutions for accessing health care in their community. generally every fall i visit many communities around the state to hear from them and share the upcoming open enrollment period. this year these challenges of the face-to-face visits are having the conversations virtually. i'm thankful for the opportunity toan see our partners, community leaders and policymakers outside of denver. we funded the program or what we call the assistance network in $2 million a year and about 45 sites they are integral to our success and rolling the customers to provide literacy. the assistance to sites have
built relationships with small businesses, hospitals and surrounding communities and the work is vital to the ability to reach especially vulnerable populations including families with low income, disabled populations, folks in the rural corners of the states. the ongoing public health emergency also underscored the value of the relationships with local counties and flexibility to the state marketplaces. mid march we made the decision to open a special emergency enrollment period in response in early april they informed me the constituents were still expanding hardships as a result of efforts to combat the coronavirus. we decided to expand the special enrollment period through the end of the month and the assistance network and brokers were ready to field questions from those unexpectedly without coverage and help them and roll and as a result over 14,000 individuals enrolled during this emergency special enrollment period. we continually explore ways to expand with advocates and we will be integral in the
implementation of programs at the legislature this year, the health insurance coverage easy enrollment program and insurance affordability enterprise. i'm excited we can expand access to affordable health coverage with the simple act of checking a box. i'm also looking forward to greater stability to the reinsurance program especially for consumers who do not qualify for financial help under the still struggling to access coverage. the job loss income and stability all-time high in the state is more important than ever that we remove barriers by providing affordable healthcare options like those through the marketplace. amidst the challenges we face every year as a state marketplace i'm encouraged by the fact we have flexibility, crucial relationships and proven capability to ensure the residents have access to coverage they need. thank you. >> thank you very much mr. patterson for summarizing your remarks. our third witness is andy slavitt who currently serves at the board chair for the united
states healthcare. aipreviously he was the former acting administrator for the cms. mr. slavitt. >> chair man pascrell, ranking member kelly and members of the committee, the former head of the center for medicaid and medicare services board chair of thee united states care founded in 2018 we represent nonpartisan citizens, policymakers and experts committed to working so that every single american has quality affordable healthcare regardless of status or income. before i continue i want to recognize the leads chairman lewis th for the great service e had for this nation. thank you for inviting me to testify on the status of the affordable care act. we sit at a perilous moment in the nation's history and for millions of american families. the coronavirus pandemic has taken hundreds of thousands of american families in a matter of mere months. as many as 14.6 million people
have lost their health insurance coverage along with their jobs atfo a time when the health of more american is more connected than ever before. unfortunately, covid-19 isn't the only threat americans are facing right now. rather than support americans through these trying times, the administration has added to the uncertainty facing americans by attacking the very existence of the affordable care act. aca serves two main functions come basic protections and affordable care. the law provides every single american guaranteed set of ieprotections including preventg insurance companies from discriminating on a pre-existing conditions and outlaws them from stopping coverage in arbitrary lifetime limits. the aca provided coverage to tens of millions of americans through expanded medicaid and aca exchanges. this quite simply has been life-changing. the aca is saving americans
$4,000 per family and many now can afford prescriptions and to see their doctors for the first time. 12 million seniors an average of $2,200 in the position medications and eliminating the age tax that made insurance unaffordable to americans 50 and older. rather than implement the law as congress intended over the last 40 years, this administration undermined the law with a clinical callousness. these have included cutting funding from those that assist people as well as others like 90%. to discourage them from participating in the exchanges, promoting would have substandard or limited benefits which raises the price of insurance and brings back the gotcha policies against so many people from getting the health insurance coverage they allge they purch
purchased. passed by bothhth democratic and republican controlled congresses i understood i had a duty to implement the law to the best of my ability. the executive branch didn't get to choose which we liked and didn't. ebut not so with the trump administration. they've taken this to a new level by refusing to defend the people in the case brought by republican attorneys general to invalidate the affordable care act and take their health insurance. the public now faces uncertainties to the future of the law. they would put 130 million americans in the situation to be illness and this is even more troubling because the
ultimate pre-existing condition virus attacks multiple organ systems, immune systems, rendering the entire body a pre-existing condition. in 12 days the enrollment period for the aca will commence despite the efforts dug up and to build on the law despite millions of americans would get health insurance coverage for their families. hand americans do not understad why protecting is controversial and has been opposed at every term by the administration. in times like these people will expect to not make their life more t challenging. they certainly would like to stop fearing the government they elect. this shouldn't be much to ask.
>> thank you. we appreciate your presentation today and now we will call on the last witness. five minutes to summarize and we are honored to have you. >> chair man inc. you for the subcommittee hearing on expanding health insurance coverage to more americans. american people prepared to head to the polls by taking time to review the arguments made and the claims made against them and how they worked out the affordable care act isn't just to protect people with pre-existing conditions but also changes the insurance market role. the affordableal care act would
price the same as it was for people who sign up before they got sick. [inaudible] or the individual market altogether and situations when befour years ago the average premium and the amount of money a family would pay to get coverage would be $22,000 before they had any medical care paid for. that is least of all success. to establish an alternative coverage and appropriately priced insurance to give people value if they signed up.
the limited duration wasn't perfect. for thee individuals they are able to get better benefits for the same price and a cheaper price. the administration was right to trike to make the plans more available. congress is also repealing the mandate. the mandate has proven ineffective and the exemption to being creative under the obama administration when it was an unfair and inequitable tax. a lot of claims were made that this guy was going to fall if the mandate was narrowed down
and with the plan that the pland to be made available none of these predictions came true at all. before the mandate was repealed it's been eliminated and premiums have been stable. enrollment itself since the mandate has been zeroed out. so it's been the effect with the regulation if you look at the states where plans are made available, premiums on the market have increased and enrollment hasn't plummeted any more than it has. there's been no discernible harm whatsoever. all that's happened is they've
been able to buy affordable insurance and the majority of which with the insurance market in a regula registry framework d been established restricting under the administration and for the plans to restrict long-term coverage of the conditions these are real problems guaranteeing renewability plans for the long run and eliminating restriction from guaranteed renewability so that if an individual develops a chronic condition the insurer has to cover it into the future. the puzzle to restrict the plan renewability as under the obama administration an individual
enrolled in the plan the insurer would be thought to drop them from coverage and would be banned from covering them again. that is exactly the wrong way to proceed. we should protect consumers, not eliminate options from them. >> thank you so much for your presentation. we appreciate it and at this time i will open the hearing for questions without each, members will be recognized to question the witnesses. if the witnesses will respond with short and concise answers all members should be able to ask questions. as mentioned earlier we will not observe the individual in this remote setting. alternating between minority and majority beginning with members of the oversight committee
members are reminded to unmute yourself when you are recognized. i will begin by recognizing myself. let me add a quick question before i start. do you advocate that we eliminate or that the courts eliminate the aca? >> that isn't what i meant. >> you are not advocating that. that's interesting. i have a question for the entire panel. please answer with a simple yes or no. the nation continues to battle the virus pandemic with over 8 million cases and more than 220,000 deaths. too many families are struggling to make ends meet. do you agree access to health
insurance is more important than the ongoing pandemic and i will start with the commissioner yes or no mr. patterson. >> the answer is yes. >> i ask now. >> the answer from new jersey is yes. >> yes, mr. chairman. >> why did new jersey decide to establish the marketplace rather than relyingma on the federally facilitated marketplace? >> thank you, chair man, for that question. asha i mentioned previously, we
were sending to washington and the money that we were sending we were not able to utilize it properly. and on top of that, we were seeing policies that were coming outt of washington that was just creating confusion and making our job much more challenging. by keeping those in new jersey, we are able to tailor specifically to our residents. we've been using it to improve and expand the navigators program outreach, education. >> the organizations in the communities that help our residents to educate them about the exchange we had one navigator in 202019 while under the federal platform and we have
managed to possess much more money now, 3.5 million and expanded it to 16 navigators to this coming open enrollment. >> thank you very much. >> mr. slavitt, how destructive would it be for the supreme court to overturn the affordable care act during the pandemic? >> there's never a good time to take coverage away but at a time when they are dealing with a serious illness we don't even understand, with children and college students are getting an illness that appears to be asymptomatic decades from now they could develop things such as heart arrhythmia or asthma. insurance companies will be able to deny coverage on the basis of pre-existing conditions if it is eliminated. the vast majority of americans i
think that it would be a significant mistake but it might also add it's important to report their illnesses so we can contactat to prohibit the sprea. people do not disclose their illnesses and the virus will spread even more rapidly. >> will is this an exaggeration onon my part that will in the pandemic millions of people lost their jobs and many lost their insurance. is that an exaggeration or hyperbole? >> no in fact press reports and data and analysisat suggest you are right, mr. chair man. >> what is going to happen to these folks if the supreme court says that's enough, no more of
this? >> i think that americans will go into bankruptcy and avoid and we will be back to where we were in early 200 but worse with the disease spreading around the country nearly unchecked. finally have you seen the republican plan to replace the aca? >> i have not. >> thank you. i appreciate that. i want to recognize my friend to ask his questions. >> thank you mr. chairman. i appreciate it. i am a small employer myself and we do provide insurance for people on the team. most look atr their workforce t as an unimaginable group of people. they are people that [inaudible] i want to go over one thing. in the written testimony, he says that there's 14.6 million
americans and here's the key that may have lost employer-sponsored insurance since the pandemic began. but according to the ceo about 3.9 billion are dealing with permanent job loss and a number of insurance, so of thema 3.9 million that may have permanently lost their jobs, 1.3 million are estimated to be uninsured, so a third of those while others have obtained new coverage, so there's no question is put a strain on all of us but i want to address one of the myths. they have committed to providing the health insurance options that americans want and need. any indication that this administration is sabotaging the affordable care act isn't supported by the fact. healthcarere premiums are down.
choices are up, competition between insurers is up and they said time and time again for those with pre-existing conditions. despite t that there are a lot f issues. you think this is an issue solved by washington and if not, what can our congress t do today to bring down the rising cost throughout the entire healthcare sector? >> that is a great question. the big problem with the affordable care act is you can have any health when you wan plo long as its obamacare and that isn't a real choice. there have to be growing choices and it can't just be that there are plans out there that are priced the same.
if we make available options for individuals signing up early for coverage, then as they develop conditions it won't even be a pre-existing condition because they will always have had insurance coverage. >> one of the things i want to point out is as a part of those, both house republicans and senate republicans were talking about allowing people to actuallyof become part of the association health plan. that means they could spread the risk and access the same lower cost high-quality healthcare coverage. the democrats in several states have actually sued them so can you tell us about why they are a potential benefit.
if you look at where has been the strongest health insurance coverage in america, it's in large employers in part because from a lot of state regulations said to the association health plan to allow smaller employers to funnel together it benefits the same or give three freedoms and flexibility in health insurance costs as they've always been able to benefit from so it really leveled the playing field and allow them to do with the businesses have always been able to do. >> as a small employer myself, there's nothing more valuable to us than the people that come too work every day so we can have mutual success. thank you for being here today. one thing i want to point out, there is a constitutionality of the affordable care act let's make sure we put that in the right light.
thank you for the opportunity to have an exchange with the panel and i will yield back. >> now the chair, recognizes yu for five minutes. >> thank you mr. chair man and for convening this important hearing. i want to thank the witnesses for joining us today in a global pandemic of such devastation, it's critical we turn our attention to maximizing healthcare coverage throughout the country with opportunities created by the affordable care act. mr. patterson, like colorado the state exchange has been quite successful in fact earlier this health plangton finders announced the proposed rate for next year are expected on averagepe decrease by 2.3% if everything goes as expected this would be the second year in a row that they've gone down. washington state took several
steps to destabilize the individual marketplace. the best way to lower the insurance premiums is to bring in more folks and expand the risk. unfortunately the administration slashed funding for the navigators and marketing. this means a smaller risk pool and higher premiums. but washington state chose to fund marketing. did colorado take similar steps and were you successful? >> we worked very closely with our partners. we've had an exchange of ideas and we do a lot in colorado and we had a very diverse state and eastern the plane on the western slope and we try to make sure we have navigators on every corner so n our site we have been fundg at about 2 million.
first it was a grant we committed those funds out of our own revenue so that's been important to make sure we were able to work with communities that are being missed or that have a language barrier so we have a lot of support from brokers and different languages not just along the front where a lot of the population is but all corners of the state so i hope that answers your question. >> the administration allowed short-term plans to be extended up to three years. these are intended to serve as a bridge between coverage because they don't have the protections that qualified plans have. they don't cover essential health benefits like maternity, mental health and prescription drugs, they don't have the state limits, they don't have to cover pre-existing conditions. so allowing them to sign up for the plan fractures the individual market and drives of the places in the aca
marketplaces. in washington we are fortunate that the limited short-term plans preserve the robust individual market and again, has colorado been able to help the short-term limited duration plans? >> thank you,ss congresswoman or division of insurance did put some different restrictions and regulations they updated around the plans. hea lot of them are making sure they have essential health benefits as they cover preventative services, prescription drugs, hospitalizations, so all of those pieces were in there and of theso looked at some age, ratings, a lot of the components but i do know that has been an effort we have seen
we've been talking and listening to t our citizens about facilitating the right kind of approach will. >> i forgot to mention the report based on the members in attendance and consistent with the committee practice we will move to the 221 questioning after the representative. now i would like to please call on my friend from indiana. thank you for being here. >> thank you so much to the panel appreciate you being here as well. instead of having a hearing on how we can work together in the bipartisan solutions the only thing we have seen so far is political messaging and we all
know there's fewer options in the chaotic healthcare system fortunately under this administration, we have made progress in these areas. but these are ongoing issues that need to be improved on my district. so that's what i think we should be focused on. the only thing we get from the other side's finger-pointing and accusations that republicans and the administrations have undermined. i think that if we put politics aside and work in a bipartisan wayme with the rank and file members i have no doubt we can pbuild some kind of better patient centered system that would lower cost and maintain protections with pre-existing to give states more flexibility ane give families more choices and greater control over their ownre healthcare. the committee was able to pass the bill so americans wouldn't have to worry about unexpected health care bills. even though it hasn't become law at least we are able to come
together in agreement we can work together and expand access individuals more control towards patient protection. we have watched the majority try everything they can to entice people into the plans going so far as to allow other insurance plans. the latest package attempted to throw more money at the problems even though there are thousands of dollars in subsidies. can you walk us through some of the reasons why in 2019, two thirds of the eligible americans offer different options? >> that is a good way of putting the context. i think the affordable care act comes down pretty simple.
the benefit, the deductible is very high. but if the premium was low, the e networks aren't very good butf the premiums were low, the outlooks would be okay. the benefits are fine. premiums are relative to what people again especially if they sign up before they get fixed so if you are a cancer patient with a safety net, somebody that never got into insurance before and all of a sudden you need aen safety net, the obamacare plans are as a last resort and as a t good quality that gives peopla reason to sign up before they mention but it isn't good enough. >> how would you characterize the current state of the healthcare system acrosss these areas first, what happened to premium costhr and the four yeas following the establishment of
the reform and in the two yearsn since the mandate was repealed and limited duration plans expended and the number of options available to the public and third on the number of enrollees in the aca? >> the premiums increased from 2013 to 2017 as the insurance regulations were changed. the policies have potentially no impact on premiums. premiums have leveled up and we have seen again yesterday enrollment is as stable as it has been in years and it's
starting to come back. some of the major insurers are starting to realize the stability they know will what they are dealing with and it's as a safety net. >> thanknk you mr. chairman andi will yield back. >> thank you very much. our friend from indiana. next i would like to call on the gentle lady from california, ms. >> take you mr. charan for holding today's hearing. also want to thank each of the witnesses for taking the time to be here. for the last decade, we have been so busy working to protect patients. we know more work needs to be done at this pandemic has magnified we must do more to eliminate the disparities affecting our community. that's why i am so tired of the president and his administration blatant attacks to make
healthcare harder to access. they are making people fear for their healthcare during the pandemic where over 8 million americans have contracted the virus and 220,000 have lost their lives. an executive order saying you protect patients with pre-existing conditions doesn't negate the fact that the administration is in courtrt rit now trying to overturn the aca. overturning the aca means removing protections for 300,000 people under 65 with pre-existing conditions in a district that i represent. they help with cancer, diabetes, asthma, mental illness and many other conditions. apart from pre-existing conditions, i want to talk about another provision. in 2009 i was one of the authors and simply put, it doesn't allow
a woman to be charged more than a man for the same healthcare plan simply because of her gender. my question do you imagine this gender-based provision would be protected if they were overturned in court and what would that mean for the women of the country? >> thank you, congresswoman. one way to tell that is the short-term plan and association plan that was talked about or able to charge more for their coverage and also to deny essential things that are important to everyone's health insurance coverage. even provisions that affect those like mentalik health and s these policies often do americans don't know so discriminating against them andl leaving out things in the
policies do an important disservice. >> would it be fair to say women would pay more for their health insurance if they were taken away and they probably wouldn't get the services that they need? >> they didn't before and they won'tt after. >> i also want to discuss specifically how the communities of color are impacted. can you talk a little bit about why the aca is important in reducing the health inequities and how has the administrations constant attack on the navigators and advertising for the marketplace impacted communities of color? things like reduction that's the great news without the outreach
included in the package there is no ability to reach the margins whether it is a language issue or cultural issue and that's why we've seen reductions in congress and increases in the uninsured race that they've began seeing the affordable care act. >> is it fair to say they've been trying to undermine or sabotage what they could provide? >> they have in fact undermined and sabotaged the act. >> thank you for being so forthright on that. i am also interested in briefly learning about how your states are helping communities of color and why the administrations sabotage confusing messaging is detrimental and you need to be brief because we have about a minute left. >> thank you, congresswoman. in new jersey we went from one navigator in 2019 while we were under the federal platform since
taking that control, we have now 16 navigators that will be able to blanket the state reaching the communities that are uninsured. asif a latina, it killed me to e that my community is doubled in the percentage of uninsured when compared to the rest of the uninsured market here in new jersey. and if you look at the communities throughout the country, it is one of the highest uninsured so we have invested as well as in our navigators to make sure that we are able to reach here in new jersey. >> i believe my time is up but before i yelled back to the chair man i would ask mr. patterson be allowed to respond in writing at a later time. ..
democrats created a multipronged approach to protect those with pre-existing conditions. under the aca you cannot be denied coverage for having a pre-existing condition but you also cannot be charged more were subject to a lifetime cap and you are required to offer minimum benefits like projection drugs. lip service has been paid to those with existing conditions the proposals for short of doing so. last month president trump issued an executive order that he claims would protect those with pre-existing conditions.. so to protect those buildable americans and if not, why not so why do they fall short of those protections of pre-existing conditionsdo? >> my parents taught me to watch what people do, not what people say ando unfortunately
the continued action of the trump administration too soon to get rid of and propose laws that do not cover pre-existing conditions like short-term duration plans all of it shows me what they want to do not just what he said if any american would put out the executive order from the president of the united states to say they are happy with existing coverage and take it to the insurance company they would laugh because the executive order does not have the power of law so a we encourage americans to look at actions not statements. >> thank you mr. patterson the wonderful work thanks to massive investment from the implementation of the aca, colorado physics able to expand access to contraceptives including the long-lasting iud girls ages
between 15 to 19 dropped more than half and similarly the abortion rate among those 60 percent during those years these are remarkable statistics. however the affordable care act is to be struck down patience would be required to pay for the cost of their contraceptive and family-planning care that could be thousands of dollars the cost can be bad barrierhe. o access the health care that they need so with those preventing services to impact family-planning and colorado were losing this benefit increasen: cost? >> thank you congresswoman. going back to my time with the
governor's office that is one of the things we are proud of pac-man is the contraceptives go like you showed me have shownes less tried to read use those and those outcomes would be the opposite if those resources were not there. >> thank you. >> i'm so proud of my state of california is one that have prohibitedpl the sale the short-term duration plans on the marketplace. so to undermine the aca marketplace are they sufficient? >> it is an important point that was part up earlier which is to say will education americans have? everybody believes there should be trace were certain guardrails thatt exist to suggest those benefits that
americans are in no position to say i don't want to have hospital coverage for prescription drug coverage those are good ideas until thats occur occurs. those are not expensive provisions mental health coverage is one or 2 percent of the overall premiumsth but if we have a philosophy it doesn't cover the kitchen only the living room. there are certain basics that they showed agree to and for the month. , it is accessible for people to be in that circumstance so to find out they routinely require the aca would be enormous issue issues. >> thank you gentle lady so
using the term china virus is unacceptable in this committee. now the gentleman from ohio. >> thank you mr. chairman and thank you all for being here today and contributing to this conversation i will start off by echoing will my republican colleagues have said about pre-existing conditions that combined with the aca is not mpmething that we were against. we have patience with existing conditions that they become the law of the land there is a difference between challenging the existence of the aca versus the constitutionality of a component would never want to take the right of any american a way to challenge
the constitutionality of a bill that would the past, republicans want to patience back into the driver's seatkn the word sabotage could be used in i'm sorry but i cannot help think of wine but the test pride where he says that word is a doesn't mean what you think it means although it did help some i am reminded of what mr. cooper said working with the obama administration with a cadillac tax the proposal because the american people to and one - - too stupid to understand the difference. used to work with mr. gruber and to me that is sabotage it does not give people choicesy, and we give patients options instead of a one-size-fits-all approach. families can now take care of
reimbursement and short-term limited plans and hopefully in the future the better association plans another way to put them back in the driver seat is to advance policy to increase policy and i can tell you the position that is a bigs deal and that has to take place at a time in our nation with elected leaders and those with the manufacturer's with a bipartisan work on this committee and with those -underscore healthcare task force with representatives in davis and what the shared goal in hope to move past those to
support pre-existing conditions but we do to work together and apply on - - in a bipartisan fashion with quality healthcare for the american people that doesn't want access to healthcare so the concern result rose one --dash resolution is the joy of taking care ofanot people and then to support medicare for all with a one-size-fits-all it is dangerous the republicans want to expand the plan option available so they can decide what is best for their families. do you talk about the administration to choose the coverage that is right for them?
conditions and then with a better alternative and more practical alternative which is the whole problem of the affordable care act. >> c would say what has helped many americans? >>. >> i yieldel back. >> thank you to my friend from ohio and we thank you also. >> thank you for being here today. >>. >> to those twos ask questions of w them but talking about the
affordable care act. i just want mr. andrew come i cannot see it right here. i'm sorry i just need to clear things up for me. so with the case of the affordable care act requiring the individual mandate to bring in healthy people and to be affordable to everyone. >> i believe that was congresses intent at the time. >> wasn't the theoryovnm also tt the government would provide things like the sharing reductions to make it more affordable and the rest
just five years later said the united states has to pay those cost they are just go out of business and leave people stranded with that particular sabotage. what do you agree with that quick. >> i would agree. >> so for me with the math while i still have time. the short term limited duration plans. i have a minute the one - - the nephew 20 years old playing task - - playing basketball my sister-in-law said something was wrong arrest him to the hospita hospital, he was on a waiting list for two years for a new heart. it with the short-term limited duration insurance plan for 20 oh like he was have done with that happened?
>>. >> and then to have an affordable plan, age 47 a plan, but once a basketball game was over, what would have happened to him? and with the sabotage the affordable care act with regard towards is one - - but the incentive that we gave the insurance companies to cover a broad base because the math doesn't work do you agree with that? >> we have 49 seconds left.
we just don't understand your assertion the uninsured rate has gone down all the data that i have seen i am very sympathetic with the notion that it cost too much but you never mentioned like the risksharing or the other kinds of sabotage this administration did it would you stipulate that also has something to do with the affordable care act not being as good as it could have been? >> the sense of the uninsured rate went down in one of the surveys. >> and the problem is and it has been limited and remains
limited. but then the copy and in some cases that's why these people cannot have good protections from the short-term plans and from continuing those protections that's what congress showed do. >>. >> and the chair recognizes for five minutes. >> thank you mr. chairman for following one - - holding thisto important hearing this is an important topic at any time but now eight years and
leading the world in most covidd s we're 4 percent of the population but still account for 20 percent of the committee cases and more than 20 percent of the covid s. >> i want to thank all of the witnesses but especially andy and with the information that you provide very helpful and the service i want to thank you for that. also directing my first question to you exactly one week after election day, the
supreme court will hear oral arguments in a case about the constitutionality about the affordable care act. given that was only found to be constitutional by a five / four vote in 2012, if they were to be struck down by the supreme court to bring it home to my constituents and all able to california direct of the consequences nationwide or for mypp state what are the consequences if they were to disappear? >> thank you congressman i appreciate the question that i know the people of pennsylvania millions of more hundreds of thousands of whom in the philadelphia area received coverage for the first time and i know what that means because i was part of the turnaround process and is constituents in your area
that said she got insurance for the first time after the affordable care act she could allow her daughter to play high school volleyball before that she was concerned t if she got in sure she cannot afford medical care. i have seen so many letters like that. that not only puts americans which are fearful of the local pandemic and they were not helpful to pay for healthcare somebody could get sick and if theyey do you ever be curable again. and then to strike down the affordable care act to be calamitous at any time especially in this environment. how people would recover from that.
we hope that governments would help us and not undermine us. >> thank you fornt o that and to point out that specific to my state not just people in the exchanges that would lose out those that would benefit from that medicaid expansion happening several years later. those were people in particular that were the working poor and working full-time s. >> for my view the aca is found to be constitutional and the exchanges are vibrant and plenty of competition. especially early on with some
states and marketplaces there was challenge of competition. so what could congress to at the federal level to assure we had much competition on the exchanges as possible and as much choice for the consumer? >> i actually think give them the flexibility that we need all states are different with 104,000 squareht miles and then how we leverage the right networks and to allow states to have the right amount of flexibility to meet the geography and the demographics is really important. >> the gentleman's time is up.
i now want to ask mr. smith to start his five-minute question. >> i do record at the height on - - the entire political system has become so political to the healthcare system but one witness said he participated in the turnaround of the aca n. i want to take the time to get into the turnaround those that have faced such high premiums
and then as to the angst that it becomes so expensive. more money is not sustainable we cannot carry that on for a long time.um and then as to the angst that it becomes so expensive. more money is not sustainable we cannot carry that on for a long time.ol and those who had high premiums but now when folks in the individual market and we use to find offensive the concern for those who pay such high premiums now. i realize many of my colleagues they think it is fantastic and has been performing so well, but it hasn't. and i am just going on what i hear from but then to have
their african-american and excellent one - - access with a world community where who is the only color whether women. they were disadvantaged into the system we had before the affordable care act and indeed disparities are quite significant over the five-year period for african-americans cancer care disparities and outcomes were reduced after a five-year period of the affordable care act. it would be a shame the difficulty for african-americans and other minorities are having access to the healthcare system during covid-19 to take away the one lifeline that has shown improvement so what
i am glad we were able to be joined by officials from new jersey in colorado to states that have made great strides inle expanding coverage and access. holding the united states accountable for their choices is an imperative. and we should start by focusing on the damagehet but neither has asked since the affordable care act was enacted. >> and fortunately we have seven hospitals alabama has some of the highest uninsured rates but today there are nearly 6 million americans who fall the on - - in the united
states would expand our hairdressers and fast food workers and cashiers working americans cov have made too lite to qualify for subsidies or for coverage and then to make more than $4000 annually. not monthly, $4000. to make matters worse as they work to turned on - - afford of carriers but those that are also the currently but those
that are left of the poor states are left with the worst access and coverage often options because of failed leadership on the state level. the consequences are cyclical especially when combined with a global pandemicilsp leaving people suffering with chronic illnesses especially those of racial minorities. a third generation farmer thanks to the affordable care act in before he was in a terrible farming accident is us and issues review process his family for being bankrupt. he knew that if it were a little here he probably would
not haveve signed up with those navigators that knocked on the door telling aboutfo getting health insurance so i was actually the through thursday the supreme court on november 1h who on - - marketplace subsidies and thank you january affordable cared act. >> i think the message you look at a country that when the status expand m medicaid
the home of those constituents on - - constituents to the better. where it is an insured. i need medical caree and that would happen again. >> peaking so much i truly believe healthcarean should be a writer not a privilege. thank you for you and then to show up healthcare in america.thaico >> and this comes at a very important the first i want to
affordable care act in the best availability. >> not flexibility to undermine t those foundational characters of the aca. but that flexibility could be interpreted different ways and attack from one member you may have interpreted moving away from those guardrails in the position i believe comports. >> i would agree with your characterization of that. >> so just turning for a moment to existing conditions andhe michigan, before the implementation of aca, 11 percent of the states population had no health insurance whatsoeverom it would cut the number by more than hal half. despite a lot of rhetoric and
promises my colleagues on the other side say they want to protect with pre-existing conditions they are suing right now to take away all the provisions of the aca including those important provisions so talk about the damage that would be done to people with pre-existing conditions like my daughter who is diabetes, my wife is multiple sclerosis. even if somehow that reported promise of those with existing conditions is genuine, word overturning the aca also allow insurers to return to annual or lifetime caps for example? allow those premiums the existing conditions that they only have the right to coverage and cannot afford it?
comment on that. >> the truth is that if in fact the aca is overturned americans will find themselves in a position they found themselves in 2008 and 2009 where insurance companies will not be required to cover themhm then they may say your asthma or cancer or mental health condition is excluded. and we were charging the unlimited amount of money more.d so in the midst of the pandemic is even worse because no one knows what covid-19et brings with those conditions that come from it.
but for people like your daughter once again it's hazardous for her to change jobs or disclose that she has diabetes because if she did they could be discredited one --dash with those that not disclose they have covid-19 and for contact tracing. and to be even in worse shape than we are today. >> also just comment on the annual all caps. >> typically if you have 500,000 or 1 million cap and there is a bad case of cancer arbitrary lines the aca does not allow them to cross
and much more freedomre from people so that would go away of the affordable care act is overturned. >> i appreciate that. i yield back. >> thank you mr. chairman it's hard to know where to turn our energy especially with covid-19 pandemic with the long-term impact the trump administration to undermine the law of the land not only before bed during the crisis 220,000 american lives and
many if not most in other wordsou covid-19 is creating those pre-existing conditions. heart and lung and pancreas and kidneys and brains. and with the obama administration as congress intended. this is true with all laws and 70 million americans no doubt it is the aca. those that have the existing conditions member the - - free
preventive care. this is a normalal times but for need it. when you but those have no value if we don't try to sabotage at every turn. and those that cover up existing conditions and as we convene here today the administration however to go acrossss the aisle and those to have changes and improvements to build on the aca with the basic shortcomings of healthcare for all americans
by our republican counterparts and with the betterment of our constituents that is been the political reality too often i probably want twitter i appreciate your insight when you are still serving in the administration and then to recommend. in congress? >> thank youou congressman absolutely to recapture the communities in need ofhe coverage that this is available to them in most cases under $75 and then to continue to expand the aca 45 years in a row we reduced from 17 percent down to eight or 9 percent that has gone up if
you believe it should be about results and not actions and those of the kind of results we have to commit ourselves to deliver and then to correct some of theer things that has been pointed out, there are opportunities for us to make the law better and it was past ten years ago not intended to be the final word the great start and there are plenty of opportunities working together to build on what we have this is what americans want they want support in times of need. >> i cannot agree more we need time to come together all those things are so important as myy time expires i would
like to enter inton the record an increase of the number of uninsured not a decrease. >> thank you very much i appreciate that without any objectionsth. >> you have five minutes thank you for being here. >> thank you mr. chairman the reason i came to congress and the reason i work so hard to join this committee was to increase access to bring down out-of-pocket cost of prescription drugs for people all across the country. i agree with my colleague and those who have spoken todayar. we need to improve on the affordable care act and make
it work for all people to address the weaknesses in order to improve on it. instead of doing that president trump as time and time again made his number onene goal to strip healthcare away from americans with no plan to replace it. shirley it's one thing when the trump administration and my colleagues on the other side repeated the thought to repeal the affordable care act and of the 220,000 americans the likes we have never seenti before thisun administration literally racing and one that has already been stretched too thin so instead of focusing we should be improving access and
coverage because now is the time americans need that the most. but also mean strengthening the health system by expanding telehealth and then to implement a real testing so no more american lives are lost with those assault of the affordable care act and with the medicaid expansion and serving in the state senate and working with a republican governor at the time. he was the first republican governor in the country to enact the medicaid expansion it was bipartisan.
now the administration looks to and those with existing conditions which now includes the coronavirus. and to underscore that with those ongoing effects ofly covid-19 on the economy we have nearly 200,000 work andls out of then to maintain health insurance but some are relying on cobra coverage to return to workey and then to provide financialti assistance to workers and families by covering the full costr of premiums for those lost jobs
or had hours reduced. you share there are an estimated 14.6 million people who may have lost their employer-sponsored health coverage. what the last three quarters of 2213th of those who lost employer-sponsored insurance coverage would become uninsured.d. and why need to protect the aca and 30 employer-sponsored plan. >> more word lose coverage and those were pre-existing condition and and then to go
back and then to go back or 10 percent up to 16 percent that would be a tragedy for a minute on - - millions of american families. >> and to make sure we safeguard the aca at all cost and then to protect those benefits of words workers and families have i sacrifice thank you for this very important and timely hearing.te >> and please. brought on - - advised written