Transcripts For CSPAN2 House Oversight Hearing On Affordable Care Act Enrollment 20240712

First, consistent with regulations, the committee will keep microphones muted to limit background noise. Members are responsible for unmuting themselves when they seek recognition or when recognized for five minutes. Second, members and witnesses must have their cameras on at all times. If they need to step away from the proceeding, please leave your camera on rather than logging out. Third, we will discuss instead go in order of seniority. Alternating between minority and majority beginning with members of the oversight subcommittee first. Finally without objection, representative judy chu is authorized to serve as chair any event that i have some technical difficulties or whatever. I thank you all for your continued patience and to navigate this technology in order to continue serving our function together in this time of need. With that i will now turn to the important topic of todays hearing. Maximizing Health Coverage involvement administration sabotage. Sounds like aen movie. So good morning, everyone. Or good afternoon, rather. After an today will focus on access to Health Coverage in the Trump Administration continued unconscionable sabotagere of americas care. Since its passage over a decade ago Republican Leaders have treated destruction of the Affordable Care act like captain ahab treated the white whale. Since 2011, the other side has voted more than 70 times to eliminate daca. In 2017 they even held an Outdoor Party at the white house after passing the plan that would cause millions to use to lose their Health Care Coverage. That same year, one of the greatest abuses of power in this era and the dead of night republicans came within one vote of ending the aca and in making 1 6 of the american economy. On a bill introduced hours earlier. The president recently bragged about his health care. Of course he has great coverage. Coverage paid for all of us. All of us. By the same taxpayers who stand subscription by if the administration succeeds in the courts. The administration is in court right now demanding to destroy the aca. To destroy protections of millions during a pandemic. They are using virtually every tool to dismantle the Health Care System. They have green lit sham junk plans without any protections. They have imposed a gag rule for having access to Reproductive Health care. They have gutted funding for cevigators and assistan while failing to crush the aca. They are destabilizing the American Health care system to a breaking point. The administration has gone out of its way to prevent americans from getting and maintaining coverage. Between february and may of this 21. 9 million workers lost their jobs. Of these workers, 5. 4 million became uninsured due to this job loss. In march, i joined my Colleague Health subcommittee chairman Lloyd Doggett and their 100 house members calling for a special Enrollment Period for people to seek aca marketplace coverage during the covid19 pandemic. Even during the pandemic, hhs refused, likely dooming Many Americans to suffer. No other word that i can think of except sabotage. Between seeing the administration and my friends across the aisle swear up and down they support protections for preexisting conditions. They assert with a straight face while spending 10 years attacking the aca. Lets repeat, republicans have sought to terminate preexisting protections over and over again. Its on the record. In contrast, some states are working hard to expand access to coverage. One of them is the great state of new jersey. We have Witnesses Today from new jersey and colorado to discuss how they are making the aca work best for its citizens. As Senate Republicans raced to confirm a new justice, they are downplaying their challenge to the aca. If the republicans have changed their minds on the aca, why would be joining us in defending the law . When we voted in june to protect the aca, 177 of 179 were given a republicans opposed it. Dont have a calculator handy, thats 99 . So given the chance, 99 of our colleagues across the aisle voted against protecting preexisting conditions. We know why. In just a few short weeks the Supreme Court will give the aca a vote. The future of our Health Care System hangs in the balance. I want to yield down to the Ranking Member. I am going to keep you for five minutes. You saw what happened last time, we went over. We talk too much. [laughter] michael, you are up. Thank you for calling me. This is really a tough time. I put all my thoughts and prayers to anyone dealing with the virus. There is nothing been more devastating in our time than the china flu and during this time the cost of health care is on the minds of almost every americans. So i appreciate the opportunity to discuss the issue today. While far from being perfect, our Health Care System is the best in the world. With a hearing like this im reminded how fortunate we are to live in a country with axis to the most Innovative Health care on the planet. I hope we can use this hearing to put something in to perspective and correct some of the myths about the American Health care we are having a hearing on on the campaign trail. Today i want to talk about two things. I want to talk about some Successful Health Care Developments we have achieved over the last several years. I want to correct the record on the rhetoric we have been hearing about American Health care. A lot of this rhetoric seems designed to scare the American People in advance to the election, and i think that effort has been both unfortunate and very misleading. The idea that this administration has sabotaged our Health Care System, if thats the truth i cant actually look at this say if we are really going to fix it, lets fix it, lets not talk about things that sound good on the campaign trail but ring hollow when it comes to truth. We have made some very positive progress on stabilizing the aca exchanges. Premiums are down, coverage choices are up and enrollment is stable. This administration has made many strides towards more Affordable Health care options to Many Americans who may not be able to afford some of the acas coverage plans. He can speak further to the successes, including the restoration of shortterm plans and major enhancements. These crucial events or reforms have actually provided options to family letting them choose what is best for them. Again, emphasizing, letting them choose what is best for them and not having something shoved down their throats that they dont have a choice in. Getting rid of the individual mandate we have saved lower and middle income taxpayers 695 a year. That is huge. Democrats have been trying to block these efforts and i understand why, and also using scare tactics to block the progress of this administration. What tactics . Like saying republicans would eliminate coverage for people with preexisting conditions, which could not be further from the truth. On protecting preexisting conditions, democrats wont take yes for an answer. It makes no sense to me, but thats 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 preexisting conditions. Democrats rejected that offer to preserve it as an election issue. Any suggestions that republicans wont bite to protect americans from preexisting conditions is just flat out wrong and a great miscarriage of the truth. Instead of working together on a bipartisan efforts to improve our Health Care System, 118 democrats have cosponsored medicare all. This deal and enormous program would destroy our current Health Care System starting with the repeal of the Affordable Care act. Sadly, Many Democrats simply want an unpopular and partisan government takeover of health care. When we should be working together to lower costs and coverage for everybody. Get more options to the American People. This onesizefitsall approach is absolutely wrong. It doesnt make sense to anybody other than somebody trying to push an agenda the wrong way. This will take away a choice from hardworking americans in my district and will also destroy their Health Care Options. The Affordable Care act is 10 years old. Much of that law has changed on a bipartisan basis, yet democrats keep looking to the past rather than working together to preserve the future by continuing to bring down premium prices and increasing coverage choices for all americans. Increasing the number of options available and people can actually buy something that fits their needs. And something they can afford. I hope we can stop all the fear mongering on this issue and Work Together for bipartisan reforms that will improve the lives of our constituents. Mr. Chairman, i want to thank you for holding this hearing. I want to thank all of our panelists for taking time out of their lives to come and talk to us. Thank you so much. I yield back, sir. I say to you and to all that democrats and republicans who were on last week with our last hearing, i thought going over everything after the hearing, tremendous questions from both sides of the aisle on the subject of tax fairness. I think its tough to get people together before an election. I want to complement both sides for doing what i think was a spectacular job. We are going to hear from our panel and thanks to our witnesses for taking the time to appear before us today to discuss this very important issue. I will introduce our witnesses and then turn to each of them for their testimony. Our first witness, commissioner marlene. She is the commissioner currently leading new jerseys department of banking and insurance. Previously she was a member of the new jersey General Assembly representing the 36th legislative district. Our next witness is kevin patterson. Mr. Patterson has served as the chief executive officer of connect for health, colorado since april of 2015. He has a long history of public service. Including as interim chief of staff to governor john hickenlooper. Andyhird witness is slavik. Mr. Slavik currently turn serves as the board chair. Previously he was the former acting administrator of the cms. And our final witness is chris pope. Mr. Pope currently serves as a senior fellow of the manhattan institute. His research focuses on health, Health Care Payment policy , and Insurance Market reform. Each of your statements will be made a part of the record in its entirety. I would ask that you summarize your testimony in five minutes or less. To help you at this time, please keep an i on your clock. That should be on the screen. If you go over your time i will notify you with the gavel. Commissioner, you may begin. Thank you and good afternoon everyone. Andk you chairman pascrell Ranking Members of the committee. Of the newmmissioner Jersey Department of banking and insurance. Banking andthe Insurance Industries and now operate the state Officials Health marketplace that launched this morning. And in the leadership of governor murphy, new jersey has lead in protecting the Affordable Care act. Insurance market and increasing access to coverage based on the guiding principle that health care is a right. The state has moved in a deliberate way opening our statebased exchange, making coverage more accessible and affordable for our residents, and providing more Financial Health than ever before for those purchasing health care on our open enrollment. In 2018 the state enacted two major policies. We took first in the nation action to continue a requirement to have coverage after its elimination from the federal level. And we implemented a reinsurance 2019 tobeginning with cover high costs claims that reduces rates in the additional market. The two laws result in Health Insurance rates in the individual markets that were 22 lower than they would have otherwise been. Decided to establish its own marketplace in order to better have access for affordable quality for residents. Sending funds to washington for the use of the federal marketplace. We continue to see policies enacted that threaten the policies made by the Affordable Care act and made our more challenging. Enrollment in the individual market dropped for the First Time Since 2014, and continue to drop the following year. When new jersey to control of outreach and enrollment assistance in 2020 as a statebased exchange on the federal platform, we begin to reverse that trend. Get covered new jersey will open for enrollment on november 1, and will keep more than 50 million in our state to strengthen the marketplace. Residents will see benefits that include new state subsidies on top of premium tax credits. The estimated average subsidy for an individual would be at least 578 a year and at least 2313 a year for a family of four. The average net monthly premium for those eligible for Financial Health is estimated at 117 a month 2021 compared to 164 a month in 2020. Increased navigators to provide three point million dollars. 16 navigators from one navigator 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 such as for covid19 and qualifying life events, including pregnancy, which improves maternal health, which has been a focus on this committee as well as the focus of the first lady of new jersey. We have taken deliberate progressive steps to stabilize our market and improve access to coverage, all leading to the establishment of our marketplace for this open Enrollment Period beginning november 1. What the Public Health emergency we are facing, we believe there is no better time than now to make this transition. Chairman, thank you for the opportunity to speak before you and your panel. Chair pascrell commissioner caride, i am very honored to see you again. You happen to live in my district, right . Commr. Caride thats correct. Chair pascrell trying to get that commercial in. Our next witness is kevin patterson. Mr. Pattison has served as the chief executive officer of Health Connect in colorado since april of 2015. Of course he was an interim chief of staff to governor hickenlooper. Mr. Patterson, please. Mr. Patterson thank you for the opportunity to submit testimony. About the Insurance Exchange in colorado and the people who are getting coverage through the individual market. My name is kevin patterson. Im the ceo for connect for health colorado. Our mission is to increase access, affordability for families and employers purchasing Health Insurance. Im proud of the innovation to reduce the uninsured rate and increase enrollment. How thissed to share unique division allows us to expand health to the people of colorado. Since we opened for business in 2013, we have helped hundreds of thousands of coloradans at the desk get the coverage they need to protect their health and livelihood. Increasing health care started years before the passage of the Affordable Health care. In 2006, a Bipartisan Group of lawmakers studied models under then republican governor bill owens. With the passage of the aca, our state legislator passed a bill creating that colorado benefited exchange as a public nonprofit entity that had the bipartisan legislative oversight committee. Board members are appointed by the governor and both democratic and republican members of the legislator. I joined connect for health in april when the state reached their record of 6. 7 , one of the lowest in the country. Charged with further increasing access for our residents, i knew we had to prioritize meeting people where they are. Whether im having a conversation with a single mom in denver or a farmer on the eastern plane, i am listening and learning about Viable Solutions for accessing health care in their community. Generally every fall i visit many Rural Communities to hear from them and share the upcoming open Enrollment Period. This year these challenges by leading me to have these conversations virtually. I thankful for the opportunity to still see our partners, Community Leaders and partners outside of denver. We have funded our navigator program, or what we call our assistant network at 2 million a year at 45 sites. Success integral to our in providing Health Insurance. Our assistant sites have also built relationships with Small Businesses, regional hospitals and surrounding communities. Their work is vital to reach especially vulnerable populations, including families with low income, disabled populations, immigrants and folks in rural places of the state. The state the ongoing Public Health emergency has underscored our relationships with local counties. In midmarch we made the decision to open a special emergency Enrollment Period in response to covid19. In early april the Adams County Commissioners informed me that their constituents were still experiencing hardships as in efforts to combat the coronavirus. We listened and extended our special Enrollment Period through the end of the month. Our assistant networks and brokers were ready to field questions from those without coverage. As a result, 14,000 individuals enrolled in the special enrollment peirod. We continue to explore ways to expand coverage with policymakers. We will be integral in the passage of two new programs in the colorado legislator this year. The easy Enrollment Program and the affordability enterprise. I am excited we can extend access for coloradans with visible active checking a box. Im looking forward to greater stability for the cost reinsurance program, especially those were not qualified and are still struggling to access coverage. With job loss at an alltime high and our state, its more important that we provide Affordable Health care options like those offered through our marketplace. Amidst the challenges we face as a statebased marketplace, i am encouraged that we have flexibility, crucial relationships and capability to ensure our residents have access to coverage that they need. Thank you. Chair pascrell thank you, very much mr. Patterson for your remarks. I deeply appreciate that. Our third witness is andy slavik. He currently serves as the board chair for the United States health care. Previously he was the former acting administrator for the cms. Mr. Slavik. Slavik i am the former head of the sentence for medicaid and Medicare Services founded in 2018, u. S. Of care repre nonpartisan citizens, former policy makers and experts committed to working so that every single american has quality Affordable Health care regardless of Health Status. Social media or income. Before i continue, i want to please recognize the late chairman lewis for the Great Service to this nation. Thank you for inviting me to testify on the status of the Affordable Care act, we sit at a perilous moment in our nations history and families. The global coronavirus pandemic has taken families in mere months. 14. 6 Million People have lost their Health Insurance coverage and their jobs at a time when each american is more connected than of before. Unfortunately, covid19 is not the only threat americans are facing right now. Rather than support the americans through these trying times, the Trump Administration has attacked the existence of the Affordable Care act, aca serves two functions, patient protections and Affordable Care. The law provides every single american a guaranteed set of protections including prohibiting Insurance Companies from discriminating against them because of preexisting conditions or annual lifetime limits. Aca provided coverage to tens of million of americans through medicaid and the aca exchanges. This quite simply has been life changing. The aca is saving americans 4,000 per family and many now can afford their prescriptions and see their doctor for the first time. The aca saved 12 million seniors an average of 2,200 on Prescription Medication and eliminate the age tax that made insurance unaffordable to americans 50 and older. Rather than implement the law as congress intended over the last four years this administration has undermined the law with a clinical callusness. These actions have included cutting funding for navigators who assist people enrolling in coverage as well as other jut reach and advertising by 90 . Shortening the open Enrollment Period, ill really attempting to end payments owed to insurers to discourage them from participating in exchanges. Promoting Insurance Plans which have substandard or limited benefits which raises the price of insurance and brings back the fine print gotcha policies that kept so many people from getting the Health Insurance coverage they thought theyd purchased. When i served in the Obama Administration, i had responsibility for administering the laws passed by both democratic and republican controlled congresses. I understood that i had a duty to implement the laws passed by congress to the best of my ability. That the executive branch did not get to choose which we liked and which we didnt. Not so with this Trump Administration, they refuse to defend the people in a case brought by the attorneys general to validate the affo Affordable Care act. And the public faces uncertainty, just as a deadly and serious virus is making its way unchecked through the country. The success of the lawsuit to be successful and put 130 million americans where they could be unsurable for prior illness and with the covid19 this is more troubling. The ultimate preexisting condition. The multiple attacks on clotting systems, immune systems and our entire body. In 12 days, the Enrollment Period for aca will commence. Despite the efforts of repeal, despite the refusal of congress to build on the law, despite the negligence as advertised millions of americans will get Health Insurance coverage for their families and the americans do not understand why protecting their families is controversial, and has been opposed at every turn by this administration. Americans would like nothing more than for the bipartisan fighting over their health to stop. At times like these, people expect the support of their government, not making their lives more challenging. All people ask is to be able to care for their families, keep them healthy and not bankruptcy through the first sign of illness. They certainly would like to stop fearing the very government they elect. In this country that should not be too much to ask. Thank you, mr. Slavitt, we appreciate your testimony today. Ill call on the last witness, mr. Pope. Mr. Pope, you have five minutes, try to summarize and were honored to have you here. Thank you. Chairman, Ranking Member kelly, thank you for the opportunity to testify before the ways and Means Oversight Committee on expanding health care to more americans. As more people prepare to head to the polls, the committee is doing an Important Service taking time to review the arguments made the past four years and the claims made against them and evidence regarding how they worked out. Now, its clear that the Affordable Care act expands if necessary, to guarantee coverage to individuals with preexisti preexisting conditions, it wasnt just for people with preexisting conditions, but to change the Insurance Market rolls. And the insurance be priced for people if they waited to get sick as for people who signed up before they got sick. This had the obvious consequence premiums spiraled up, deductibles, insurers panicked and many dropped out of the Insurance Industry or the individual market altogether, and left with a situation when four years ago the average premium plus deductible, the amount of money im sorry, a family would pay to get coverage would be 22,000 before they had any medical care paid for. Thats not an attack on the Insurance Market, its not saying its going to be its success. It was an urgent necessity to establish an alternative source of coverage and appropriately priced insurance which gives people value if they find it before they get sick, saying a proportion to their risk and proportion to their needs and rewards them for signing up in a timely manner. In the short limited time duration, it was not perfect, but a vast opportunity to do this and for those individuals who enroll in the market, are able to get Better Benefits for the same price, and the same price as they would as the Affordable Care act. And much cheaper price for cheapest available plan, at the same price for equivalent aca plans they will find better satisfaction ratings. They were right for the making the plans more available. And the right in repealing the mandate for the mandate effect because so many exemptions are created under the Obama Administration, really it was unfair and inequitable task. A lot of claims were made that the sky was going to fall if the mandate was zeroed out and the plans were allowed to be made available to americans, none of these predictions came true at all. We were told that premiums would soar. In fact they soared before the mandate repealed and since the mandate has been eliminated, premiums have been stable, in fact, slightly reducing. Enrollment itself has also been unstable in the aca market since the mandate has been zeroed out. So has so has been the effect where the fdldi regulation where plans are being made available, premiums on aca market havent soared or inclosed and enrollment hasnt plummeted in the states than the nonfdldi states. All thats happened is millions of americans have been able to buy affordable insurance, the majority of which would involve being insured there are plans in the Insurance Market. To be done in a Regulatory Framework that had been established by the Affordable Care act. Restricting plan time length to three months as had been done under the Obama Administration creates a huge incentive for plans to restrict longterm coverage of chronic conditions, these are real problems. And guaranteeing plans for over the long run. The ability of shortterm plans and an individual developed major chronic conditions while enrolled, the insurer has to cover it, this year, next year, and into the future. Under the proposal to reshortterm plan renewability. If the insured got cancer the insurer would ask for the drop for coverage and banned essentially from covering them again. And thats exactly the wrong way to proceed. We should protect not the options from them. Mr. Pope thank you so much for your presentation. We appreciate it. At this time i will open the hearing for questions. Without objection, each member will be recognized for five minutes to question our witnesses. If the witnesses will respond with short and concise answers, all members should be able to ask questions. As mentioned earlier we will not observe the gibbons rule in this remote setting and instead go to the order of seniority for questions, alternating between minority and majority. Beginning with members of the oversight committee. Members are reminded to unmute themselves when youre recognized for your five minutes. Ill begin by recognizing myself. Mr. Pope, let me just have a quick question before you start my questions which i had prepared. Do you advocate that we eliminate or that the courts eliminate the aca . Youre advocating . Thats not what im advocating, no. Youre not advocating that, thats interesting. Thank you. I have a question sh, for th entire panel. Please continue with a simple yes or no. The nation continues to battle the coronavirus pandemic with over 8 million cases and more than 220,000 deaths. Too many families are struggling to make ends meet. Do you agree that access to Health Insurance is more important than ever amidst the ongoing coronavirus pandemic . Now ill start with the commissioner. Yes or no, mr. Patterson . For mr. Patterson inle colorado the answer is yes. The [inaudible]. Yes, chairman the answer from new jersey is yes. Mr. Slavitt. Yes, mr. Chairman. Mr. Pope . Yes, mr. Chairman. Thank you. Commissioner, why did new jersey decide to establish a statebased marketplace rather than relying on the federally facilitated marketplace . Thank you, chairman, for that question. As i mentioned previously, we were sending funds to washington and the money that we were sending, we werent being able to utilize it properly. And on top of that, we were seeing policies that were coming out of washington that was just creating confusion and making our job much more challenging. By keeping those funds in new jersey, we were able to tailor it specifically to our residents. Weve been able to use that money to improve and expand our navigators program, outreach, education. Please explain, please explain the navigator. Yes, chairman, the navigators are individual organizations in the communities that help our residents to enroll them on the exchange, to educate them about the exchange, to explain the exchange. We had one navigator in 2019 while under the government under the federal platform and we have managed to possess much more money now, 3. 5 million and expand to 16 navigators for 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 a pandemic . Mr. Chairman, theres never a good time to take Peoples Health Care Coverage away from them. But at a time when they are beginning a Mysterious Illness that we dont understand. Where many indeed children and College Students are getting an illness that seems to be asymptomatic, years later they could have heart arrhythmias or asthma, and insurance compani companies a vast majority of people do not want the aca to be eliminated, but in a pandemic its important that people are able to report their illnesses so we can Contact Trace and prohibit the spread. Once people start to worry about Insurance Coverage again, they will not disclose their illnesses and the virus will spread even more rapidly. Is this a mr. Slavitt, is this an eago ration on my part exaggeration on my part that millions lost their jobs and many, many of them lost their insurance . Is that an exaggeration . Is that hyperbole . No, in fact, press reports and Data Analysis suggest youre exactly right, mr. Chairman. Well, whats going to happen to these folks if the Supreme Court says thats enough . No more of this . I think americans will go into bankruptcy, theyll avoid getting medical care, well be back where we were in the early 2000s, but worse with a disease spreading around the country nearly unchecked. And finally, have you seen the republican plan to replace the aca . I have not. Thank you, mr. Slavitt, i appreciate that. I want to recognize my friend mr. Kelly for five minutes to ask his questions. Thanks, mr. Chairman, i appreciate it. First of all, im a myself and we do provide insurance for people on our team. Most Small Businesses look at work force as family, not as some unimaginable group of people. They are the people we were work with for mutual respect. Let me go over in mr. Slavitt testimony there are 14 million, the key, may have lost insurance sponsored insurance since it began, but cbo of those 3. 9 million americans that may have permanently lost their job, im saying may have, 1. 3 million are estimated to be uninsured, so, a third of those are estimated to be uninsured while others have obtained new coverage. So, i mean, listen, theres no request he that this pandemic has been a strain on all of us. I want to look at a myth that the administration is trying to sabotage the aca. And they want Insurance Options that americans want and need. Any indication that this administration is sabotaging the Affordable Care act is not supported by the facts. Health care premiums are down, all right . Choices are up. Competition between insurance is up. And republicans have confirmed time and time again our support for protection for those with preexisting conditions and i wish wed quit saying thats the republican plan. And despite that, making it unaffordable for many, mr. Pope, as an expert, you think this is an issue that should be solved by washington and if not, what can our congress be doing today to bring down the rising costs throughout the entire health care stature . Thats a great question. The big problem with the Affordable Care act, it said you could have any plan you want so long as its obamacare. Thats no choice. There has to be a broader array of choices and there couldnt just be plans out there priced the same if you sign up after you get sick as before you get sick. People need to be able to have a reward for signing up early, get a good value plan thats priced appropriately to someone who is doing the and if we make available options to individuals who are signing up early for coverage, then, as they develop conditions, it wasnt need to become a preexisting condition because they will have always had Insurance Coverage. Thank you. One of the things i want to point out as part of the Health Association plan act of 2019 both House Republicans and Senate Republicans were talking about allowing people to actually become part of an Association Health plans. That means they could spread the risk of the Health Insurance across a larger number of people and access the same lower costs and High Quality Health Care as large employers have and unions have. Democrats in several states have actually voted to block this vote. Can you tell us why Association Health plans are potentially for businesses and selfproprietors and selfemployed . Its a huge issue. Where has been the strongest Health Care Coverage its traditionally large employers. In large part, large employers are exempt from like arissa. Small business would get together and some of the regulatory freedom and flexibility in pooling Health Insurance costs as large employers have always been able to benefit from. So, it really levels the playing field, allows small employers to do what big businesses have always been able to do. I appreciate that and again as a small employer myself, nothing more valuable to us than people that come to work every day and have mutual success. Thank you for being here, and all the panelists. The Supreme Court future actions, its really about the constitutionality of the Affordable Care act. Lets make sure that we put that in the right light. Mr. Chairman, new for the opportunity to have an exchange with our panel and ill yield back. Thank you, mr. Kelly. And now the chair recognizes you for five minutes. Thanks mr. Chairman, and thanks for convening this very important hearing and i want to thank all of our witnesses for joining us today during a Global Pandemic of such devastation, its critical that we turn our attention to maximizing Health Care Coverage throughout the country through opportunities that were created by the Affordable Care act. Mr. Patterson, like colorado, the Washington State Health Exchange has been quite successful. Earlier this month washington finder said proposed rates are expected on average to decrease by 2. 3 , if everything goes as expected this would be the second year in a row that rates have gone down. Washington state took several steps to counter act the administrations efforts to destabilize the aca, the individual marketplace. The best way to lower insurance premiums is it to bring in more folks and expand the risk. Unfortunately, in 2018, the administrations funding for aca navigators and marketing left marketing, people signing up for coverage, a smaller risk pool and higher premiums. But Washington State chose to Fund Marketing and sign up assistance. Mr. Patterson, did colorado take similar stems and were you successful . Thank you, congresswoman. We worked closely with our partners in every state. So i think that pam does a great job with folks. And weve had an exchange of ideas. We do a lot in colorado very similarly and have a diverse state, corridor and Eastern Plains and the slopes. And we meet with people and try to make sure that we have navigators literally in every corner and weve been funding at about 2 million, first it was a grant we committed those funds out of our own revenue so thats been really important to make sure that were able to work with communities that are being missed or have language barriers, so, we have a lot of reports from brokers and assisters in different language and not just the front range where the population is, but all corners of the state and i hope that answers your question. Thank you. The administration allowed shortterm for years. These plans are intended to serve as a bridge between coverage because they dont have the protections to qualified aca plans have. They dont cover all essential health like maternity, Mental Health, Prescription Drugs, they dont have out of pocket limits. They dont have to cover preexisting conditions. Allowing people to sign up for these plans drives up prices are the aca marketplaces. In washington, were fortunate that our insurance commissioner limited shortterm plans to only three months preserving the robust individual market. Again, mr. Patterson, has colorado been able to halt shortterm limited Duration Insurance plans . Thank you, congresswoman. In january, i believe, of 2019, our division of insurance and our insurance commissioner Michael Conway did put some different restrictions and regulations that theyve updated around shortterm limited duration plans. A lot of them around making sure they had in an essential Health Benefit as colorado law to cover Preventive Services, Prescription Drugs, hospitalizations, maternity and newborn care, so all of those pieces were in there and they also looked at some of the age, ratings, a lot of the components that i think the commissioner would probably a lot better in answering your question, but i do know that that has been an effort that we have seen in colorado and partly with our division of insurance to help implement. And then lastly, just collectively. The impact of premiums and enrollment of the aca market in colorado . As ive said, weve done a lot in reinsurance and 20 reduction in a rate. And looking at large r er reductions in some of the iran cost. But colorado 1. 46 if my memberly serves me correctly and added carriers, and so, weve gone weve got now, we used to have seven carriers last year and weve got eight going into open enrollment and about 160, almost 160 plans, standard plans for people to choose from. So, weve been able, i think, with a lot of outreach and a lot of work weve been doing on the ground and talking and listening, more importantly, listening to our citizens in every corner, as i say about what theyre needing and trying to facilitate the right approach given the success that were proud of. Thank you so much. Thank you, mr. Chairman, i yield back. Thank you. I forgot to mention this before, based on the members in attendance and consistent with the committee practice, we will move to two to one questioning after representative. Now, id like to please call on our friend, my friend from indiana, miss walarski. Thank you for being here. Thank you, mr. Chairman. Thanks so much and thanks to our panel. Appreciate you being here today as well. Well, here we go again. Instead of having a hearing and how we can Work Together and find Bipartisan Solutions in health care, were back to the only thing that weve seen so far, which is political messaging. And we all know that americas been faced with rising costs and a chaotic Health Care System. Fortunately, under this administration weve made progress in these areas, but these are ongoing issues that need to be improved in my district. So thats what i think we should be focused on. The only thing we get from the other side is finger pointing and accusations that republicans and administrations from undermined the aca. I think if we put politics aside and work on this in a bipartisan way, if i think if we had all the rank and file members together, i have no doubt we could build some kind of a patientcentered system, lower costs, preexisting and no lifetime caps and give states more flexibility. Give families and individuals more choices and control over their own health care. This committee was able to pass a bill in surprise medical billing so americans wouldnt have to worry about Unexpected Health care bills. Even though it hasnt become law at least we were able to come together in agreement on fixing the problem. I still think we could Work Together. Lower costs and increasing choice and giving individuals more Important Patient protections. Mr. Pope, weve watched the majority do everything they could to entice people into a aca plans, going so far as to outlaw other plans. Speak speak speaker pelosis latest covid proposal can you walk why in 2019 twothirds of aca eligible americans opted for a different option . Thats a very good way to putting the conflict the Affordable Care act problems with the individual markets come down to one thing, its pretty simple. Its the price. These plans, theyre far too expensive for what they are. The benefit, the deductibles are very high, but if the premium was low that would be okay. And if the premiums were low that would be okay and the covered benefits are fine. Premiums are far too high relative to what people are getting, especially if they sign up before they get sick. So, if youre a cancer patient as a safety net if youre someone who never bought insurance before and awll of a sudden, you need a safety net. Theyre fine as a safety net as a last resort, but as a good quality Insurance Coverage that gives people to sign up while theyre reasonably healthy before they have a Major Medical condition, theyre not good enough. Let me ask you, how would you sate our Health Care System across three areas, what happened to the premium costs in the following of the establish the and two years since the repeal and second on number of options available to the public and third on number of enrollees in aca . So the premiums increased by 105 from 2013 to 2017 as the aca Insurance Regulations for change, thats more than doubling, really. And weve seen that a lot of along with that that this was going to be outweighed by the impact of rolling back shortterm insurance, limiting the mandate. And those two policies have had sngsly no impact on premiums. Premiums have leveled off, in fact, slightly fallen, weve seen again yesterday, nice came out that they slightly declined. Enrollment is as stable as its been in years and in terms of options were finding that insurers with the market in chaos, some of the major insurers trying to realize theres now stability and they know what theyre dealing with and its not great Insurance Coverage, but as a safety net thank you. Mr. Chairman, i yield back. Thank you very much, our friend from indiana. Next id like to call on the gentle lady from california, ms. Sanchez. Thank you for holding this important hearing and i want to thank each of the witnesses for taking time to be here. For the last decade weve been so busy working to protect patients, we know more work needs to be done and this pandemic has magnified we must do more to eliminate the Systemic Health disparities affecting our communities. Thats why im so tired of the president and his administrations blatant attack to make them fear in a pandemic where over 8 million americans have contracted the virus and 220,000 have lost their lives. Its an absolute disgrace. An executive order saying that you protect patients with preexisting conditions does not negate the fact that the administration is in court right now trying to overturn the aca. Overturning the aca means removing the protections for over 300,000 people under 65 with preexisting conditions in the district that i represent. The protections help our neighbors with cancer, diabetes, asthma, Mental Illness and many other conditions. Apart from preexisting conditions, i want to talk about another provision of the aca. In 2009 i was one of the authors of the provision that stopped Health Insurance companies from gender writing. Simply put the aca does not allow a woman to be charged more than a man for the same Health Care Plan simply because of her gender. Mr. Slavitt, i want to start my question with you. Do you imagine that this gender rating provision would be if the aca was overturned in court and what would it mean for women in this country . Thank you, congresswoman. No, in fact, one way to tell that is the shortterm plans that we have talked about are able to charwomen more for covee and deny them with importance to everyones Health Insurance coverage. Even those that affect both gender, Mental Health. Excluding those from coverage, these policies often do, is an incredible disservice, americans dont know when theyre going to need a particular service, so against them and leaving out things that they have in their policies do them an important disservice. Would it be fair to say that women would probably pay more for Health Insurance if aca were taken away and probably wouldnt get the help that they need . They did before the aca and they will after. Thank you. I want to discuss how communities of color are affected by the aca. Mr. Slava slavaets. How have they i am acted people of color. And disparity in cancer care and mortality and infant health and Home Ownership and things like reduction of bad debt. So thats been great news. Unfortunately, without the outreach with the aca and this congress and its wisdom included in the package, theres no ability to reach communities that are on the margins and help them enroll for coverage, whether its a language issue or a cultural issue and thats why weve seen reductions in coverage and increases in uninsured rates the Trump Administration has begun overseeing the Affordable Care act. Would it be hair to say this theyve been drying to underline or sabotage . Well, they have undermined the Affordable Care act. Thank you. Im briefly learning about how our state is helping individuals of color and why [inaudible] youll need to be brief, weve got about a minute left. Thank you congresswoman. In new jersey, we went from one navigator in 2019 while we were under the federal platform. In taking back control, we have increased it to 16 navigators that will be able to blanket our state reaching communities that are uninsured. As a latina, it kills me to see that my community is double in percentage of uninsured when compared to the rest of the uninsured market here in new jersey. And if you look at the Latino Community throughout the country, its one of the highest rates the population with highest uninsured rates, we are invested in our communities as well as our navigators to the communities in new jersey. I believe my time is up. Before i yield back, i would ask the chairman that mr. Patterson be allowed to respond in writing at a later time. Thank you. And now, from california, miss choo. Thank you, mr. Chair. First, let me say to those on the other side of the aisle who used the term china virus in this hearing. The scientific term is p nfl coronavirus virus or covid19, by not using the term, youre stoking the xenophobia which resulted in crimes. Pivoting to mr. Slavitts. Should the aca be struck down. When we wrote the Affordable Care act, democrats created a multipronged approach for those with preexisting conditions, you cant be denied for preexisting conditions and you cant be charged more or have lifetime caps and minimum Health Benefits like hospital stays and Prescription Drugs. Although the president and republicans have paid lip service to protecting americans with preexisting conditions, their proposals fall short of actually doing so. Last month, President Trump issued an executive order that he claimed would protect those with preexisting conditions. Mr. Slavavitts. Would you say that it president elects vulnerable americans and if not, why not. And why is it short of protecting these with preexisting conditions. My parents taught me to watch what people do, not what people say. Unfortunately, what the continued actions of the Trump Administration to eliminate aca to sue to get rid of it, to propose laws that do not cover preexisting conditions like shortterm duration plans, all of which showed me what they want to do not just what he said. Unfortunately, if any american was to print out an executive order from the president of the United States saying they would have their previous condition to an insurance company, they would laugh at them. An executive order does not have the power of law. I would urge americans to look at his actions, not as his statements. Thank you. Mr. Patterson, i wanted to ask you about the wonderful work colorados done to expand its Family Planning program. Thanks to massive investment from a private branch and implementation at aca. Colorado was able to have contraceptives for young people including the long lasting iud. The teen birth rate for girls 15 to 19 dropped by more than half, 59 2009 to 2017 and similarly the abortion rate amongst colorado teens fell during those years. These are remarkable statistics, however, if the Affordable Care act were to be struck down patients would once again be required to pay for the cost for their contraceptives and Family Planning care and that could be thousands of dollars. For young people the cost can be the barriers to accessing the health care that they need. So, mr. Patterson, how Preventive Services benefit of the aca impact Family Planning in colorado . Would losing this benefit increase costs to the state . Yes, youre going back to my time with the Governors Office and with the long acting contraceptiv contraceptives, as you said showed Great Strides in reducing those and those costs and outcomes would be the opposite if these resources werent there. Thank you. Mr. Slavitt, im so proud that my state of california has prohibited the sale of shortterm limited duration plans or junk plans on the marketplace. So mr. Slavitt, can you explained how these junk plans will undermine the aca marketplace and put parents at risk . Are these junk plans sufficient replacement for aca . I think its important, its an important point that mr. Pope brought up earlier, which is to say, what kind of choice should americans have and do americans want . I think that everybody believes there should be some amount of choice, but certain guardrails that exist and the aca builds those in to suggest there are 10 essential benefits, that americans arent in a position to say i dont want hospital coverage, i dont want Prescription Drug coverage, those are good ideas until that occurs. Those are not expensive provisions by the way. Mental Health Coverage about 1, 2 of premiums. People think its a big deal if they save premiums, its if as they got a Fire Insurance policy and come to read the fine print to read it doesnt cover the kitchen, only conference the living room. There are certain conditions ma americans should agree to. In threemonth transitional period, its probably acceptable to be in a circumstance. But to buy insurance for their family and find out they cant use it and routinely prior to the aca would be an enormous issue. Thank you, and i want to thank the gentle lady and i want to say that using that term china virus, congresswom congresswoman, is unacceptable in this committee period. And now im going to call on from ohio doctor . Well, thank you, mr. Chairman and thank you all for being here today and contributing to this conversation. I just want to start out by echoing what my republican colleagues have said about preexisting conditions. Theres a preexisting component of the aca was not something that we were against. We stand with patients with preexisting conditions and continue to ensure that those protections become the law of the land and remain the law. Theres a difference between challenging the existence of the aca versus the constitutionality of a component of it. And i would never want to take the right of any american away to challenge the constitutionality of a bill that we passed. Bigger than that, republicans want to put patients back in the drivers seat especially when this comes to their health care. You know, the word sabotage keeps being used. And im sorry, but i cant help, but think of a line from the Princess Bride are he says, you keep using that word, i do not think it means what you think it means. While the Affordable Health care act helped some patients were sabotaged. Im reminded what mr. Gruber said when working with the Obama Administration, about the cadillac tax, he said they proposed it and that passed because the American People are too stupid to understand the difference. Maybe mr. Slavitt worked with mr. Gruber and i think that that to me is sabotage, but Affordable Care act did not give people choices and we have advanced policies to give patients Health Care Options instead of leaving them with one size fits all approach. Families can now take advantage of Health Reimbursement arrangements, shortterm limited duration plans, and hopefully in the future, Better Association plans. Another way weve put patients back in the drivers seat by advancing policies to increase Health Care Price transparency, and i can tell you as a physician, that is a big deal. And that has to take place. At a time in our nation when americans want to see their elected leaders coming together to restore our way of life, im disappointed weve gathered today for yet another partisan hearing predicated on half truths and manufactured fears. We do a lot of compactful bipartisan work on this committee and our bipartisan rule and Underserved Health care Task Force Im a cochair of with representative sual and davis is how we can Work Together to advance our shared goal of improving health outcomes. I hope we can move past the fallacy that republicans dont support preexisting conditions because we do and working in a bipartisan fashion to improve choice, access and Quality Health care for the American People. There is no part about me as a doctor that doesnt want all americans to have access to health care. Its too important. As the only one here who has served patients, i can tell you that the burdensome regulations the governments put in place over time has taken the joy out of taking care of people and now, democrats want to go even further, 118 House Democrats have determined to end the current employmentbased Health Care System as we know it by supporting medicare for all. And another one size fits all washington approved plan. Its dangerous. The republicans want to expand the plan options available to all americans so they can decide what it best for their family. Mr. Pope, quickly, i know we dont have much time. Could you talk about the administrations exchange on shortterm coverage and why folks choosing the coverage that right for them is important. If obamacare so great why is the market or alternative growing so fast that my colleagues the democrats want to eliminate. Mr. Pope. The Affordable Care act plans were designed around the needs of people with preexisting conditions, which is important and needs to be a safety net for them. Not everybody has a preexisting condition. Having an Insurance Plan thats tailor made if you have already have cancer is important, but somebody who has to buy coverage a long time before they develop cancer or a heart condition. You need to entice people to buy coverage with insurance thats priced in proportion to their risk and thats shortterm insurance option does. It basically creates an opportunity for people to buy insurance in proportion to their risk without negative impact on preexisting conditions that the exchange provides. It coexists and better price alternative which is the core problem of the Affordable Care act. It comes down to price. So you would say that its helped Many Americans . Yes, that we dont know exactly how many, but millions, surely. Thank you. I yield back. I want to thank my friend from ohio, appreciate his questions and mr. Pope, we thank you, also. Now id like to ask the gentleman from wisconsin, thank you for being here. Mr. Chairman appreciated the comments of all. Its frustrating not to be able to ask questions of each of them. I guess i really want to essentially had a lot of discussion on the when we were talking about the Affordable Care act. I want i think mr. Mr. Andrew cant see it right here. Mr. Slavitt. Clear some things up for me. It was the theory around the case of Affordable Care act by requiring the individual mandate were going to draw in Healthy People like young people and therefore reduce the cost of reduce the cost of care for everyone such that it could be affordable to everyone. Wasnt that the theory of the case . I believe that was what congress intended at the time. So it wasnt the theory of the case also that really the government would provide things like the cost sharing reductions to make it more affordable and also the risk quarters so that as we started as we provided enrollment to these younger people that the amounts of monies that they lost, that we would share in the coverage, the loss that these companies endured, wasnt that also part of the theory of the case. Yes, attempted to and where im going with this is that when we talk about there being no intentions of getting rid of coverage for preexisting conditions, wasnt the theory of the case that wed be able to support people like me who have cancer because were getting premiums and getting the mix and so therefore, the mask doesnt work at all when you take out the mix of younger people that notions that mr. Pope shared with us that are more uninsured people or you know, we had, you know, that the court just, just five years later said that the United States had to pay those risk sharing costs because we had Insurance Companies all over the country just go out of business and leave people stranded as a result of that particular sabotage of obamacare, wouldnt you agree with that . I would agree with that that right, so tell me help me with the math while i still have time. Help me with the math how insurance works, tell me a little about the shortterm limited Duration Insurance plans and ill give you an example. I have a nephew 20 years old. He was 20 years old 10 years ago, playing basketball, having a good time my sisterinlaw something was wrong, took him to the hospital. On the list for two years for a new heart. Never smoked anything like that. What would the shortterm limited Insurance Plan for a 20yearold like he was done once that happened . He would have no idea because doesnt have to cover theres no minimum coverage. Right, and so, you know, he would have had an affordable plan, he would have had a choice of a plan, but once that basketball game was over and what would have happened to him . And weve sabotaged the Affordable Care act, the mask does not work, im sorry with that, without the protections for preexisting conditions, talk make all kind of speeches about it or resolution toss protect people, but if you dont have the incentive that we gave the Insurance Companies that wed have this broadbase of people paying, then the math doesnt work. Do you agree with that mr. Slavitt . Yes. All right. And i have 49 seconds left. So i guess ill give mr. Pope an opportunity to respond. I just dont understand your assertion that the uninsured rate has gone down. According to the data ive seen that the uninsurance im sympathetic with your notion that it costs too much, but you never mentioned stuff like the risk sharing, the other kinds of sabotage that this administration did including not marketing it or anything, would you stipulate that that also had something to do with the Affordable Care not being as good as it could have been. The that the uninsurance rate went down this year in one of its survey. The key thing with it doesnt they took the skinny plan. Yeah, and i agree that there are i think the core problem the renewability has been limited a remains limited and exactly your nephews problem is the problem that needs to be fixed is the shortterm plans cant be renewed for more than three years and some states not more than six months and thats why these people arent able to have good protection from the shortterm plans because the insurance is just banned from renewing them and from continuing those protections over the long haul. I think my time expired, thank you. For some questions and for the response of all the witnesses so far. The chair now recognizes five minutes the gentleman from pennsylvania, mr. Boyle. Well, thank you, thank you, mr. Chairman for holding this important hearing. Health care would be an important topic at any time, but especially as were now eight months though it seems like eight years into this covid crisis and were unfortunately the country thats leading the world in most covid cases and most covid deaths. Thats not just because of our population. We are 4 of the worlds population and yet, still account for more than 20 of the covid cases and tragically more than 20 of the covid deaths. Speaking of covid, i would like to thank all the witnesses, but i want to especially thank you, thank andy slavitt, i personally follow your twitter and throughout this covid crisis ive found the information that you provide very helpful and a real service so i want to thank you for that. I also direct my first question to you. As you know, and as come up exactly one week after election day, three weeks from now, the Supreme Court will hear oral arguments in yet another case about the constitutionality of the Affordable Care act. Given that it was only found to be constitutional by a 54 vote in 2012, if the aca were to be struck down by the Supreme Court, could you help me bring it home to my constituents in my home state of pennsylvania . Are you able to direct what the consequences would be . I know they would be nationwide, but specifically for my state what would be some of the consequences if the aca were to disappear . Thank you congressman and appreciate the question. And i know that the people of pennsylvania and in your distri district, millions of whom in pennsylvania, hundreds of thousands of whom in the philadelphia area receive coverage for the first time. And i know what that means because while i was not part of the law, i was part of the turn around process as the law was implemented and i received and read many, many letters from constituents in your area one woman the first time after the Affordable Care act she allowed her daughter to play volleyball. And before that if she got injured she wouldnt afford medical care. I got so many letters like that. You add them up. You think about the law going away, it not only puts americans fearful this have Global Pandemic into a more fearful state, it puts them in a state where theyre not sure theyre able to pay for their health care if someone is to get sick and if they get sick whether theyll ever be insurable again. So the Court Decision to strike down the Affordable Care act would be calamitous at anytime. It would be especially calamitous today in this environment and i cant imagine how people would be able to recover from that. This is a time when if we look to our government for help and we hope that the government will help us, not underminus. Thank you for that. I would just further point out that specific to my state, it wouldnt just be the people on the exchanges that would lose out, it would also be all of those who benefitted from the Medicaid Expansion which happened several years later because of the aca. And those are people working poor. People working fulltime yet arent covered by their employer for Health Insurance. Seniors as well. Their Prescription Drug benefit. Yes, im glad you pointed that out. In the minute i have left. Moving ahead to mr. Patterson, if optimistically from my view the aca is again found to be constitutional, we still have longterm the issue of insuring that the exchanges are vibrant and plenty of competition on them. I know, especially early on when the exchanges were rolled out in some states, in some marketplaces there was a challenge of a lack of competition. What are things that congress could do at the federal level to ensure that they had as much competition on the exchanges as possible and as much choice for the consumer . In terms of what congress would do, i have to be careful of my answer, but i actually think just giving us the flexibility that we need, i think all states have a little bit different, you know, were about 104,000 square miles in colorado. Its a lot to try to figure out how do we help leverage the right networks and the right choices that people have, and i think just allowing states to have the right amount of flexibility to fit the needs, the geography and gee graphics after their own state is really, really important. I think the gentlemans time is up. Here. Rep. Smith thank you, mr. Chairman. I appreciate the opportunity to have an exchange here. I do regret that the entire Health Care Issue has become so political. The mere title of this hearing is evidence of that. It is interesting to hear one of th its interesting to hear one of our witnesses say he participate in the turnaround of the aca or obamacare. I dont want to take the time to get into the socalled turnaround. I wish that there were room on the panel to hear from some of my constituents who have faced such high premiums that some are opting not to buy. That contributes to some of the unsure because it become so expensive. I dont see the solution as throwing more money at it. Thats not sustainable. I dont think we can carry that on for a long time, but i am just absolutely puzzled as to the numbers and the premiums. Before the aca we had the highrisk pool, that i will tell you come hadar some offensively high premiums. But now when folks in the individual market ace a similar high premium and we use to find offensive, i dont hear the concern for those folks paying such high premiums now. Ea and and i realize that many of y colleagues here today, they think daca is just fantastic and has been performing so well aca. But it hasnt. Im going on what i hearrom my own constituents. There was some relief offered with some Association Health plans. Of course, the opponents to these consumer driven choices have been sabotaging, by all means, sabotaging these consumer choices. I think thats unfortunate because i think its based on politics. I long for a day when we can have a thoughtfulho discussion about how we can get more people covered with Affordable Healtha insurance through Affordable Health care. But lets face it, the aca was not health care reform. It just kind of shifted around some payment, and for what . The net result is more americans their income for high premiums for Health Insurance. I just think we can do so much better. Its interesting, i just heard ms. Patterson say we need more flexibility. I cant agree more. He noted he had to be careful with how he wanted that. I can imagine. It clearly we need more flexibility. We need consumers to feel the empowerment to be able to decide for themselves what is best for their household, for them as individuals, in exercising the freedom to choose among plans, hopefully more plans, rather than fewer plans. There were so many promises made about the aca. I think about the Health Insurance coops and how much of a disaster that was, where we had a hearing after more than half of the coops had collapsed, and we had a hearing from the Previous Administration saying that everything is just fine. I dont know what metrics should be used in making that analysis, but man, we can do so much better. We as elected officials i think over the American People a better discussion than what has been taking place. Im certainly willing to participate in that. Mr. Pope, can you tell me, with Association Health plan, we know that our antagonists out there who are opposed to consumers deciding for themselves to enroll in the plan of their choosing. Can you tell me what would be necessary to revise these Association Health plans that so many consumers have found benefits in . So the Association Health plans that are for Small Businesses that really grouped together. It isnt an employee process health care option. Traditionally, the large employers have beenin the ones o have been given a lot of flexibility in terms of what Health Insurance can be offered to their staff. The Association Health plan expands, option expands that right to small employers, they can get together to offer essentially exempt from a lot of state regulation, the same plans the large employers can. Mr. Smith, your time is up. Thank you very much. Thank you, thank you, mr. Pope,r responding. Thank you. The chair recognizes the gentleman from illinois, mr. Davis. Thank you for being here. Thank you very much, thank you for holding this very informative hearing. I also want to thank you for giving me the opportunity to waive onto it, although im not a member of the committee. But i think that Health Policy and health care is so important, that attaches everybody in our country. Ssion. And i want to thank all of the witnesses for participating. Representative boyle mentioned earlier that the United States Supreme Court has health care on its agenda in a couple weeks. And they are going to be discussing the same issues that we are talking about today. And im a big fan i make no bones about it of the Affordable Care act. I think it is one of the best things thats happened to health care since the indians discovered cornflakes. And that the aca is the best thing we have had in modern years since medicare and medicaid, because it give poor people, low income people, an opportunity to have care paid for, which the previously did not have. I think that all the witnesses mr. Slavitt, let me commend you for your tenure when you ran cms. Its a complex agency with complex issues in question. And i think that you did an outstanding job, so i commend you for that. There are many components of the Affordable Care act that we have heard about, and we have heard about them. But let me ask specifically, in terms of the disparities we have learned about as we have discussed and dealt with covid19, African Americans have tremendous disparities in terms of Health Status, health care, followed by latinx communities. If the Affordable Care act did not continue, or was dismantled, what would be the impact of that action on the Health Status and health care for africanamericans and other minorities in this country . Thank you, senator davis. You know, i think that anybody who is disadvantaged in this country, whether africanamerican, whether they live in a rural community, whether they are poor of any color, and whether they are women or older, they are disadvantaged or were disadvantaged under the system before the Affordable Care act. Disparities have shown over the last five years for africanamericans. I will give you one example. Cancer care, um, disparities and outcomes were reduced after a fiveyear period of the Affordable Care act, so it would be a shame i think right now the difficulty that many africanamericans and other minorities are having, accessing the Health Care System during covid19, and to take away that one lifeline that has shown improvement. Rep. Davis what has made it possible for colorado to enact the policies you have discussed . I do not think i heard the first part of your question. Rep. Davis what environment existed in colorado that has enabled you to do what you have done . My apologies. I think that we have a way that we reach out because we have a Great Network i have spoken to. Listening to folks, hearing where they are struggling. I have heard the Business Owners say that insurance was more than his mortgage, and we have been able to find more affordable programs, having options is the key. Rep. Davis thank you very much. I commend the state for its efforts. Rep. Pascrell thank you, mr. Davis. We appreciate your questions. Just before i call on representative sewell to ask her questions, i would ask a congresswoman chu to take over the chair for a few minutes. You ready to do that . Rep. Chu absolutely. Rep. Pascrell you are in charge. The next speaker will be the congressman from michigan, i believe. Ok . Yes, thank you. I want to thank you for hosting todays hearing. I am glad that we are able to be joined by andy slavitt and officials from new jersey and colorado, two states that have made Great Strides in expanding coverage and access. Holding our states accountable for their Health Coverage choices, i believe, is imperative. And we should start by focusing on the damage that republican governors have done to their citizens that did not expand medicaid. Both of your states have expanded their programs, neither state has had a closure since the Affordable Care act was enacted. Unfortunately, my home state of alabama has had seven hospitals go under. Alabama has some of the highest uninsured rates and a low percentage of folks covered by employersponsored coverage. Mr. Chairman, no one wins when states like alabama do not expand medicaid. Today, there are nearly 6 million americans who fall into the medicaid gap in the 14 states that did not expand medicaid. They are hairdressers, maintenance workers, servers, cashiers, these are working americans who make too little to qualify for subsidies, or to afford coverage in the private market, but too much to meet their states requirements to qualify for medicaid. Even with alabamas barebones minimum plan, what this means is a single parent of two in alabama cannot qualify for medicaid if she makes more than 4000 annually, not monthly, annually. Thats 4000. To make matters worse, as americans work to earn at least of the poverty line so they can afford Health Care Insurance with subsidies, the Republican Attorney generals across the state have, of the same states, are also currently denying them coverage in courts, as was said earlier. One of the greatest injustices is those in the poorest states are left with the worst Coverage Options because of failed leadership on the state level. The consequences are cyclical and compounding, especially combined with the Global Pandemic that has really left people suffering with chronic illnesses, especially those of racial minorities. I think about a Third Generation farmer in the rural part of my district named hank. He was able to afford insurance for the first time in his life in 2014 because of the Affordable Care act and its subsidies. He signed up for a plan months before he was in a terrible farming accident, which would have he would have lost his arm if he was not airlifted to a hospital, which saved his life and his family from being bankrupt. Hank admitted if he knew it was called obamacare, when he was signed up, or he signed up, he probably would not have signed up when the person who knocked on his door told him about the chance to get insurance through the Affordable Care act. My question is twofold for andy. Why is protecting and enforcing the Affordable Care act important for those whose health care, who cares about health care inequities, particularly in Rural Communities and underserved black communities . Can you also talk about the advantages of expanding medicaid . Secondly, if Republican Attorneys generals are successful in the Supreme Court on november 10, would alabamians like hank lose their subsidies . Thank you for all of you thank you for all you have done regarding the Affordable Care act. Mr. Slavitt i think the message people get around the country, when their state does not expand medicaid, or if they are not offered affordable coverage, is you do not matter enough to earn Health Care Coverage. That you have to either be of a certain social status, you have to be of a certain income level, you have to be of a certain race, you have to live in a certain zip code, then coverage is for you. The Affordable Care act is far from perfect. But we have made an effort to say this is no longer about the Insurance Companies, who could to make whatever rules they want, but it is in fact about us as individuals, families and americans. And so, it is a vital part of our message that health care in this country is not something to be earned. It is something that we this is our ultimate source of freedom because it allows us to live better, more prosperous lives. So now, if the court case or anything was to take away the Affordable Care act, your constituent, and all your constituents, would be back to a situation where they would be uninsured. That wouldnt mean they wouldnt get medical care, but they would be going to emergency rooms, waiting until their cancer progressed, instead of getting mammograms. We saw that all over that was before the aca, and unfortunately it would be the norm again. Rep. Sewell thank you. I believe health care should be a right and not a privilege. Thank you again for all you have done to shore up health care in america. I yield back. Rep. Chu the ladys time has expired. The chair recognizes the congressman from michigan for five minutes. Thank you, madam chair. Thank you to the chairman for organizing this important hearing, which comes at an important time. I have a couple questions to get into, but before that i want to give mr. Patterson an opportunity to clarify, i think the way that his statement around flexibility may have been interpreted. I assume, mr. Patterson, that you would agree that the flexibility granted to the states is the flexibility that would build upon the existing protectional foundation of the aca, not flexibility to get away from those . Is that a more fair characterization of what you articulated . Mr. Patterson im sorry, i was on mute. The flexibility within the congress within the Affordable Care act to the best of our ability in the state. Not flexibility to undermine the foundational characteristics of the aca. I think flexibility can be interpreted different ways, and i took from one member that he may have interpreted your point to be flexibility to move away from what the aca provides, and i want to be careful that not be a position i do not believe that works with the way that you represented yourself so far today. Mr. Patterson i would agree with your characterization, yes. I wonder if i could turn to mr. Slavitt on the issue of preexisting conditions. In michigan, before the implementation of aca, about 11 of our states population had no Health Insurance. By 2018, because of the aca, we cut the number by more than half, but i am worried that despite the rhetoric and promises, that what some of our colleagues on the others said about protecting people with preexisting conditions, they have to accept the fact that they are suing to take away all the provisions of the aca, including those provisions. Can you talk about the damage that would be done, number one, to people with preexisting conditions, like my daughter who has diabetes, my wife who has multiple sclerosis . I i wonder if you might couch it in these terms. Even if somehow the reported promise of destroying coverage for people with preexisting conditions is a genuine one, would returning the aca also allow insurers to return to annual or lifetime caps, for example . Would it allow the premiums paid by people with preexisting conditions to be so onerous that they only have the right to coverage in name only, but cannot afford it . I was wondering if you could comment on that. Thank you you, congressman. The truth is that if in fact the aca is overturned, americans would once again find themselves in the position they found themselves in 2008, when the Insurance Companies would not be required to cover them for preexisting conditions. They might say that your asthma, cancer or Mental Health condition, or your heart arrhythmia is excluded. Or they may say that you can have those things, but we will charge you an unlimited amount of money more. That is what discrimination is and it would affect consumers directly. In the pandemic, the situation would be even worse, because no one knows what covid19 brings in terms of conditions that will come from it. We do not know yet. So it is a blanket path to pass to Insurance Companies to say i do not even want to cover you again. So for people like your daughter, once again it would be hazardous for her to change jobs, it would be hazardous for her to disclose to people that she had diabetes, because if she did, she may not be covered. Imagine trying to handle a pandemic with everybody in the country with the incentive did not disclose they have covid19, imagine trying to Contact Trace or get people to agree to testing. It would be worse than where we are today. Rep. Kildee thank you. If you could also comment on the lifetime caps, what would happen with that . Mr. Slavitt was think about what that is. Typically, if you have a 500,000 cap, if a baby is born a three weeks early, or if there is a bad case of cancer, that is it. Those are arbitrary lines. Those are the lines that the aca does not allow the Insurance Companies to cross. They are able to eliminate that, so much more freedom for people. That would go away, of course, if the Affordable Care act is overturned. Rep. Kildee i yield back. Rep. Pascrell thank you for your questions. I now call on mr. Schneider, the gentleman from illinois. Rep. Schneider thank you, mr. Chairman. I appreciate you having this hearing. It is hard to know where to turn our energies. But this hearing put this issue on the front burner, especially in light of the covid19 pandemic, and its longterm impacts it is likely to have. The administration has taken steps to undermine what has been the law for decades. Not only before, but during the health crisis, we lost more than 220,000 american lives. Millions of people have the infection. And most are likely to have lifetime related effects. In other words, covid19 is likely to be a preexisting condition. As you noted, early evidence indicates that it could impact the brain, kidneys and immune systems. You also noted, mr. Slavitt, that you are dutybound to implement the laws of that congress intended. The administration should not pick and choose to enforce the laws. This is true of all laws, but especially those in question that will be beneficial to somebody millions of americans many millions of americans. Theres no doubt the Health Care System is stronger because of the aca. 130 million americans have preexisting condition protections and it is noted that that number will grow because of covid19. Free preventative care, expanded Medicaid Eligibility and in the list goes on. These benefits are valuable in normal times, but have proven absolutely critical during the pandemic, when getting care when you need it is at a premium. But those critical improvements will be of no value if we have an administration that tries to sabotage the law. Trump is promoting plans at that do not cover preexisting conditions. He is getting support for enrollment assistance. As we convene, his administration is looking to invalidate the law through the courts. However, less eyecatching, but just as disappointing is any laws as large as the aca is bound to need improvements, but for a decade any effort to build on the acas successes, fix its shortcomings and explore ways to improve health there have only been met with disdain by our republican counterparts. This should not be controversial. But that has been the political reality for too long. So, mr. Slavitt, i follow you on twitter and i appreciate your insight. My question is, if you were still serving in the administration, what would be the top suggestion that you would immediately make to improve the aca for all americans . Mr. Slavitt thank you. I think that the first thing is to absolutely reach out to the communities in need of coverage and to hear them, to tell them that this is available for them, in most cases under 75, and to reach out to young people and continue to expand the aca. We had five years in a row where we reduced the uninsured rate from 70 to 8 or 9 . That has gone up. If you believe government should be about results, not about actions, those are the results we would have to commit to deliver again. And also work with congress to correct some of the things that mr. Pope and others pointed out, can be improved upon. There are opportunities to make the law better. It was passed 10 years ago. It was not intended to be the final word. It was intended to be a great start. There are plenty of opportunities, if congress would Work Together, to build on what we have, not eliminate or reduce it. So i would say that this is what americans want, they do not want both parties fighting over their health care, they want support in times of need. Thank you you, i could not agree more. We need to find a way to come together and improve health care for all, so that they have it as a right, not a privilege and they can get the care they need from doctors that they trust. That is also important. As my time expires, i want to enter into the record the most recent report showing an increase in the number of uninsured, not a decrease as was mentioned earlier. Rep. Pascrell ok, thank you very much. I appreciate that. That is entered into the record without objection. Rep. Schneider thank you. Rep. Pascrell now, the last congressman from nevada. You have five minutes. Thank you for being here. Thank you for letting me be here, mr. Chairman, and for holding this hearing today. And the reason i came to congress, the reason i have worked so hard to join this committee was to increase access to health care and bring down the outofpocket costs of Prescription Drugs for people across the country. And i agree with my colleague and those who have spoken today, that we need to improve on the Affordable Care act. We want to make it work for all people. And address the weaknesses that may exist in order to improve on it. Well, instead of doing that, President Trump has time and time again made it his number one goal to strip Health Care Away from americans, with no plan to replace it. It is one thing when the administration and colleagues on the other site repeatedly sought to repeal the Affordable Care fought to repeal the Affordable Care act, but now, in the middle of a Global Health pandemic that has taken the lives of more than 220,000 americans, the likes we have never seen before, this administration is running, running, racing literally to undermine our Health Care System, one that has already been stretched too thin. Instead of focusing on Cutting Health care to americans, we should be improving access and coverage, because now is the time that americans need that the most. That also means strengthening Health Systems by expanding telehealth for Rural Communities, protecting frontline workers, and implementing real testing, tracing and treatment strategies for covid19. No more american lives need to be lost. Yet, here we are again discussing the full onslaught and assault of the Affordable Care act, which would dismantle nevadas Medicaid Expansion for 371,000 nevadans. When this bill was passed, i was in the state senate and i worked with our republican governor at the time, and he was the first republican governor in the country to enact the Medicaid Expansion. It was bipartisan. Because we knew it was important to put nevadas health above any party. This administration is now looking to strip away protections for over 1. 2 million nevadans with preexisting conditions, which now includes the coronavirus. So, i want to underscore that right now in nevada, because of the ongoing effects of covid19 and its impact on the economy, we have nearly 200,000 individuals who are out of work. And many are furloughed, laid off currently. They have the opportunity through some employers to maintain Health Insurance, but some are relying on coverage until they are able to return to cobra coverage until they are able to return to work, covid coverage. That is why i introduced the Worker Health care protection actto provide Financial Assistance to workers and their families by covering the cost of premiums for people who lost their jobs or had their hours reduced. So, in your testimony, mr. Slavitt, can shared that there was an estimated 14. 6 Million People who may have lost their employersponsored Health Coverage. The Commonwealth Fund found in the last three quarters of 2020, one third of those who lost employersponsored insurance through pandemic related job loss, will become uninsured. So, if the trump aca lawsuit succeeds, what will happen to these americans . Why do we need to protect the aca for individuals like those that are covered through their employersponsored plans . Mr. Slavitt thank you. I think that two things will happen. First, more people will lose coverage and not have a place to get it. Secondly, as they continue, those with preexisting conditions, including anybody who contracted covid, will be in a situation where they may not be able to get coverage again. So we will be back to a situation that is worse than we were 10 years ago, and i suspect the uninsured rates will go back, from the 10 they came down to, to over 15 , which would be a travesty for american families. Thank you, that is why i will continue to work to safeguard the aca. [inaudible] and across the country so that they can have access to the aca, to protect the hardfought benefits that americans have sacrificed for. The gentlemans time has expired and all members have completed questioning, so i want to thank our witnesses for joining us today. Be advised that members have two weeks to submit written questions to be answered later in writing. Those questions, and your answers, will be made part of a formal hearing record. With that, the subcommittee stands adjourned. [captions Copyright National cable satellite corp. 2020] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] with that the subcommittee stands adjourned. Today Health Care Officials and lawmakers discuss the covid19 thatll response and its impact in the pharmaceutical supply chain. Live coverage at 1 p. M. Eastern on cspan2. With seven days left until election day on november 3, with the Voters Decide who will control congress and occupy the white house next year. Stay with cspan. Watch campaign 202020 coverage every day on cspan, streamer on demand at cspan. Org or listen on the cspan radio app. Your place for unfiltered view of politics. The president , available in paperback, hardcover and ebook from Public Affairs present biographies of every president inspired by conversation with noted historians about the leadership skills that make for a successful presidency. As americans go to the polls next month to decide who should lead our country. This collection offers perspectives into the lives and events that forged each president ial leadership style. To learn more about the the president and the books featured historians visit cspan. Org thepresident s and order your copy today, wherever books are sold. We are back with david canon threats of political