At the table is james gelton, Senior Vice President for policy. An operation under the ee rrisa industry. Explain what the Erisa Industry Committee is all about . Eric for sure is an association that represents about 100 of the very largest businesses, each with at least 10,000 u. S. Employees. Those businesses offer comprehensive and Health Retirement benefits to their employees. We represent them on benefits issues. Lets get systems numbers. How Many Employers offer Health Insurance. There are 178 million americans who get Health Insurance through a job. And thats a significant number of folks. How much are their Companies Paying for the premium these days . Whats the average . Well, so, i think its important to note that on average the company pays about 80 of the cost of premium and as well as the Overall Health care costs. So the employees are paying usually 25 of the premiums. That monthly cost that an employee pays, thats only 1 4 of the cost. Take us to large employers and how theyre affected. Give us the recent history. So its true that there were some effects on large employers from the Affordable Care act. If you think of rule changes that took place in 2010, such as the requirement to have a dependent up to the ainge of 26 on your plan, but for the most part the Affordable Care act plan was those who were in government insurance. Lets put the phone numbers up on the bottom of the screens. James gelton of the Erisa Industry Committee. We have two lines here for this segment. If youre insured through your employer call 2027488000. For everyone else call 2027488001. Were looking forward to hearing from as many folks who are insured through their employer. You said the number is 170 178 Million People. So plenty of folks out there, but as we sit here, there are changes underway for the Affordable Care act. We know the house passed a bill. We think the senate is working on something. We havent seen any committee action. Speak to us about what changes youre watching out for based on what you know about the house bill so far and what youre hearing about the senate bill. So the house bill you had four different categories. You had changes to medicaid, changes to the individual market. You had changes to the sorry, to the tax structure that governs health care and changes to Consumer Directed Health plans, so things like a Health Savings account or flexible spending arrangement. For businesses and people who are employed through or people who get their Health Insurance through an employer, you really only care about those last two because the individual market and medicaid, thats not whats affecting you. So what you would be looking at if youre in an employer sponsored plan is your costs would probably go down because taxes would go down. At the same time if you have a consumer directed account like an hsa, you get a better coverage. You have higher limits. What are you hearing about the senate bill . We know about the house bill. Senate bill information has been scarce. What are you hearing . The latest ive heard is they are really close to a deal. You have moderates. Gop senators from red states whereby they have done a Medicaid Expansion. They have a tough deal because they dont want to lose the coverage expansion that theyve gained but in terms of changes to hsa, et cetera, thats kind of baked. Its done. In the house something called a macarthur amendment which sort of came out of the blue it seemed at the very end of their process dealt with this concept of essential benefits. Can you remind us what this concept of essential benefits means and what this amendment said in the house bill . If you purchase Health Insurance in the individual market through a Health Insurance exchange, every plan sold on that exchange is required to cover each of these Ten Essential Health benefits. They cant have lifetime or annual limits on those benefits either. If your in the employer sponsored market in a selfinsured plan, the essential Health Benefits, or ehbs, dont apply. You cant have lifetime or annual limits. A little bit from the wall street journal under the house bill large employers are allowed to lower their benefits under the waiver. They impose lifetime limits and eliminate the out of pocket cost gap under the gop legislation. Do you want to think of that . I think that was a sensationalist story but if you look at the latest Congressional Budget Office report what they said is that was not going to happen if the ahca were to become law. I want to ask you about the cadillac tax. Very much on the minds of people on the hill. What is the cadillac tax and whats at stake here . The cadillac tax is the term for short to describe the excise tax on high cost Health Insurance sponsored by employers. What this tax says is if your Health Insurance costs a certain amount of money per year, then its subject to a new 40 tax and the only way that an employer can avoid that 40 tax is eefither by increasing costso consumers or by reducing the benefit. I would say if you have employer sponsored Health Insurance today, even though the cadillac tax isnt going to take effect until 2020, youre already seeing the effects of the cadillac tax because youre having higher deductibles, higher premiums, higher coinsurance. Your coverage is covering less, network is getting narrower. And on that cadillac tax theres a little bit from the committee who are responsible. They write first cadillac tax will help control Health Care Costs by discouraging overly generous employer provided Health Insurance plans. Second it would help wage growth by reducing Employee Share compensation. What do you make of that . So this is an assertion thats so silly only economists could believe it. What theyre saying essentially is that if they launch a new tax on employees Health Insurance benefits, that everybodys going to so you can believe the economists or you can believe the people who are signing the paychecks. Either way the assertion that benefits are too good and that Health Insurance is overly genero generous, ive got to tell you, i never hear that from employees. I never hear that from people in real america. Its a very washington d. C. Thing to suggest. A lot more to go through here. Steve is calling from woodridge, virginia. Youre on with james gelton. Go ahead, please. Caller yes, sir. I have to disagree with the man thats on there. My wifes been on health care with her employer for her whole career, and she said the cost will go down. It never went down from day one until she got into the program. It always goes up. I dont care if its 3, 4, 5 but it goes up every year, and i dont care what you do with it, theyre not going to give it to you at the same price or not increase their profit. Thats all i have to say. Thank you. Thanks, steven. Generally health care does tend to always go up. Question is always about the rate of the increase. Is it going to go up by 5 , 10 , 15 . What happens is when you launch more taxes on employer sponsored Health Insurance it goes up more quickly than it otherwise would. We have jim calling from royal oak, michigan. Good morning, jim. Yes. Caller yes, i was a corporate employer for Blue Cross Blue Shield for michigan at that time i was called the erisa expert. Any changes will not affect just small employers but will affect we had employers with employees that were choosing the erisa exemption. I would like your we will ask our guest to respond to that. Go ahead, james gelton. Absolutely. If a plan is fully insured its required to cover all of the various coverage requirements that different states impose, whereas, if a plan is selfinsured and its governed by erisa, it only has to cover federal mandates. So what you see is in certain states there are literally hundreds of different requirements and those requirements are good for some patients but they end up raising costs pretty considerably. You will have Small Businesses that say maybe we ought to consider selfinsuring in order to get away from those mandates. The recent letter that you wrote to the senator, what were you telling the senator in this . Senator hatch and the finance committee reached out to trade associations and they asked for business and other people to weigh in on whats important in health reform. I think we laid out several key points that weve gone over previously. Lets reiterate them. Number one, the clakd tax has got to go. Its going to eventually destroy the Health Care System that 178 Million People rely on. Number two, we have got to improve Health Savings accounts. Health savings account is a wonderful concept, the problem is, there are a whole lot of people who dont have several thousand dollars to put into an hsa. For those people we need to tweak these plans so that they work better for them. Then third is its super important that you worry about lowering costs. If youre going to do health reform, the most important thing is that you lower Health Care Costs. In fact, it was then senator barack obama when he was running for president who originally said its not that people dont want Health Insurance, its that it costs too much. Are there realistic options to replace the clakd tax . We dont support options to replace the cadillac tax. The question is are there realistic options to replace the budget. Those taxes, most of them are probably going to end up being repealed under the ahca. The question is when will they be repealed. If theyre repealed now, they wont bring in any money but if theyre repealed in the next two or three years theyll bring in money over the next two or three years. Lets go back to calls. Conway, missouri. Is it delana . Delano. Caller thank you very much. I have a dermatologist. He is retiring. The last time i went to see him i was in there for about 30 minutes. My bill was 535. I got to looking at how much he got and he only got 57 out of that money. Where did this other 500 go . You know, generally im not sure how that would work. Oftentimes costs are vastly increased given whether a doctor participates in a network. If its not in your network then you could have been given a much larger bill than you would have had you gone to a specialist in your network. That being said, there are all kinds of practices that could raise the amounts of money you would have to pay. For instance, balance billing in which your Insurance Company would say were only going to pay 57 out of that 500. Then the provider would go ahead and send you a bill for that additional 433. There are some states that are going to take action on that. Nicholas calling from pikesville. Caller hi, good morning. I have a question regarding employers. When an employer offers Health Insurance to its employees, it normally subsidizes the cost of the insurance. That means for every employee that the employer would hire the employer has, so to speak, an exposure whereby the employer would be would would would have to bear the cost for that subsidy. In the events where the employee elects not to have Health Insurance through the employer, perhaps because the employees spouse covers the employee, then could not that exposure that the employer has be, so to speak, channelled towards call it a tax, but could it not be siphoned off to generally Fund Health Care . Because after all the employer is any way on the line for that cost . Lets hear from our guest. Certainly i think there are all different kinds of ways that you could raise revenue and a tax on employers is one that has been proposed before, but its not one that we would support. In the end every dollar that your employer ends up having to pay, whether its for taxes or anything else, is one less for capital investments, for expanding their offerings, for hiring more people. When youre draining funds away from employers to pay for the Health Care Costs of people who that employer does not employ and who are not their family or retirees, what you are really doing is hurting employers. One tweak to ask about the practicality of an hsa, how will an hsa pay just one stay in a hospital which might cost tens of thousands of dollars . One of the proposals in the American Health care act was to tax the annual contribution limits to an hsa to an annual out of pocket limit meaning you could fully fund your Health Care Costs through the hsa. Now you have to find the money to put into that hsa. For an individual, that could be five, 6,000. You could get an instant 30 savings. Hospital stays are incredibly expensive. Well have about 10, 11 minutes with our guest. Take calls for james gelfant who is Senior Vice President for erisa. Been the director of federal affairs at march of dimes. Counselor to senator tom coburn on the u. S. Senate Homeland Security committee and is working as a lobbyist at the chamber of commerce. We have senson from l. A. Good morning. Reporter good morning. How are you doing this morning . Doing fine. Caller you know, my point is the president of the United States do all of this, youve got sick people out there and taking the People Insurance away from them. You know, he can afford it, but we cant, you know . So i think that you might be referencing the Congressional Budget Offices estimate that if the American Health care act as passed by the house became law, ten years from now there could potentially be 23 million fewer people that would have insurance than under current law. I think its important to look closely at those numbers and break down that 23 million. Of that 23 million, about 11 million of them are people who under current law are forced to buy Health Insurance, whether or not they want it. The Congressional Budget Office says those people wont buy it unless theyre forced to. The question is there are 5 Million People who have not done a Medicaid Expansion. Cvo says they will do a medicide expansion. They didnt say which states they would be. I think we should focus on 4 Million People who cbo said are currently covered by medicaid. They are going to legitimately need help. The question is would the subsidies available to them under this gop bill, would they be sufficient . I think right now theres a robust debate going on in the United States senate over whether or not its enough money and its doubtful to me that a piece of legislation could get through the Senate Unless and until they put enough money into the actual credit. Medicaid in its piece on the hill, the senate gop is seeing a path towards obamacare repeal. There are major obstacles ahead. Critically Senate Moderates say they can add that albeit on a slower timetable. A compromise would remove one of the biggest obstacles for the bill. The moderates want to phase out of the medicaid and take seven years while the Majority Leader Mitch Mcconnell said two. A little bit of a difference there. What do you think . I think its interesting were talking about ending a Medicaid Expansion. You might remember that in order to get the Affordable Care act through the senate, a special deal had to be cut with then senator ben nelson from the state of nebraska, and that deal was he didnt want to pay for the Medicaid Expansion in nebraska. He wanted it to essentially be free for them. Their deal was then called the cornhusker kickback was that the federal government would take 90 of the costs, not for all medicaid people, so not for disabled people, pregnant people, the poorest of the poor, but only for people who were in that Medicaid Expansion population, which was mostly between 100 and 138 of the federal poverty level. So if you were super poor, so below 100 or you were disabled, pregnant woman, the federal government would give less money than they would give if you were in that expansion population. What the gop is trying to do is to save that aspect of it out such that if a state wants to cover people who are hired and would currently be in the expansion population, theyve got to pay the same as what they pay for their normal population. Where do you see democrats overall in the senate right now on the Health Care Issue . Well, i dont think a single democrat is going to vote to undo president obamas signature legislative achievement. That being said, there have been points in the last couple of months where republicans and democrats have worked on issues related to health care. You had a great segment prior to this on the opioid crisis. There were provisions in the 21st century care act which would bring new devices and drugs to market. Mental health carey form is another thing that happened last year. Theres definitely going to be some bipartisanship. On undoing the Affordable Care act, i wouldnt expect a single democratic vote. We continue to speak with james gelton from the erisa industry. Brian has been hanging on. Good morning. Caller yes, good morning. I can tell that youre a member of the chamber of commerce republican but why would you want to go back to a system of insurance that actually costs so many people their whole livelihood and another thing, you know, you talk about these 23 Million People like its something out of an oz book or something. 2 of that 23 Million People are going to die, period. The other thing, you have not raised the point that youre trying to give the richest people in the world a trillion dollar tax cut. Answer those three things. Thank you. A lot out there from mike. Thank you. Thanks, mike. First, lets talk about taxes. It is true that there are certain taxes in the Affordable Care act that only apply to an individual making 200,000 a year or a couple making 250,000 a year. It is true that the proposals would get rid of those taxes although many economists say that those taxes are a drain on the economy and hit Small Businesses disproportionately because many Small Businesses file taxes as individuals. Lets talk about, again, ive already debunked the 23 million number. I do think that there needs to be solutions for those people that are truly going to need help affording Health Insurance but i think the senate will have a solution to that before they pass a final piece of legislation. When you talk about whether or not people will be unable to get Health Insurance, lets once again go back to the Congressional Budget Office report. What they estimated was if that mcarthur meadows amendment that we talked about stayed in the legislation, which by the way theres no guarantee it stays in the legislation, it might fall out with conversations they have to have with moderates, it may fall out with the birg rule. If it does stay in what the cbo 12i789s is 1 6th of people would live in markets that had essentially deregulated and gone back to something similar to the aca. In those specific markets there would be a subset of people with very high medical costs. That subset of people would be able to get insurance but it would cost a lot more. Im not saying thats a good thing. Im thinking hopefully theres this 140 billion fund included in the bill called i think the patient and state stabilization fund. That fund is supposed to be used to incentivize the Insurance Companies to offer Affordable Health care to those who can afford it, either because their pain is so high, because theyre older or because theyre very, very sick. I think the goal in the Republican Health care reform plan is not to have those people fall out of coverage and not have those losses. We have betty on the line from kentucky. Whats your name of your actual . Caller cerulean. Thank you for that. Go ahead, betty. Caller i have im retired, and i have insurance through my humana and then i have medicare and then i have blue cross and blue shield from my husband who retired from Civil Service and is now deceased and he had continued to cover me as a survivor under his plan when he retired. And i have continued to keep that since he retired. Question for our guest . What . Question for our guest, betty . When i have that under blue cross and blue shield, i do pay a premium but it comes out of my monthly retirement check, and i kind of consider that a health kcare savings account. Any thoughts . Yeah. So if youre receiving coverage through what i assume is the federal employees Health Benefits plan as a survivor, there shouldnt be any changes to your plan as a result of the proposal of the ahca, in part because they literally cant change it under those senate rules. In fact, if theres any part of the ahca that is deemed to be targeted on the federal employees Health Benefits plan, it would cause the plans to be referred to another committee. It would derail the whole thing. So i think youre probably safe where you are. Miguel is calling from gaithersburg, maryland. Good morning. Reporte. Caller good morning. Thank you for taking my call. You bet. Caller im surprisedthe speaker said, somebody pointed out to me that theyre going to die. Hes been eloquent in logging for the republican, looked like hes lobbying for republican. Doesnt the question i want to follow on that question. Where does the money go . Little money go to the doctor. Where the money going . Oh, i dont know. I dont know where the moneys going. The money go to the Insurance Company, man. The Insurance Company gets more money when you said the Insurance Company losing money, they are not making less money than before so you want to regulate them and regulate. Thank you. Thanks. Response there. Yeah, so, under the Affordable Care act there is a provision called the medical loss ratio, and literally in law it limits the amount of profit that an Insurance Company is making. Depending on what Insurance Market theyre working in, their profits are capped at either 15 or 20 . I think you did make a good point, miguel, in the United States we pay the most out of anyone for health care and we have some of the worst outcomes in the industrialized world. Why is that . There are all kinds of reasons for that. Our system is largely based on fee for service. We pay doctors to do more. We paid for the entire year of prescription drugs. We pay three, four times than what others pay because were funding the research. I hope we can get into this and get us realigned but not under the American Health care act reformation. To the assertion that people are going to die because of a change in legislation, you know, it just hasnt been proven. Its an assertion by people who love the Affordable Care act. I get it. Folks love it, folks hate it. H. Robert writes on twitter, can you exexplain why they refused the help of the aca. You make a good point. It was a whole bunch of free money and things said we dont want any part of obamacare. Were opposed to aca, therefore were not going to do the Medicaid Expansion. A lot of it is ideological. Theyre looking back saying theyre arguing to keep the Medicaid Expansion. We should have taken it. If you think about the original Affordable Medical care act, the Supreme Court struck it down and made it so that those red states avoided being able to manage it. Probably everybody would have done it. Going forward theres a pretty good chance that those states that have not expanded medicaid will find a way to expand it in a conservative manner. If you look at what they did, for instance, in indiana where then governor pence had designed this conservative version of Medicaid Expansion, thats what it takes. Well, i want to expand medicaid because were going to go do it in a way that reflects our values. One last call. Good morning. Caller good morning. How are you . Im good, thank you. Caller im disabled and im on my husbands Health Insurance. So what im asking, were paying high plus i get medicare on top of it, but were still hes having hsa, which is only 1500 a year. We have all of these caps, anyway, that we can only do so much. They only take 80 of my husbands and then we have to take 20 of whatever, so he doesnt have it yet. He just turned 60 but in a couple of years he wants to work until hes 70, he has no other choice. This is going to affect me really bad, affect us. We could go under. We could go bankrupt, this 40 plus where he works at, its just really bad. Were hardly getting anything. Final thoughts for our guest. Kathy, youre not alone. Millions of americans are upset that the deductible is going up. 9 coverage is dwindling down. Youve had blockages such as step therapy where you have to try this drug before you do this drug or gate keeping before you see a certain doctor. Thats because of the cadillac tax because it gives employers no choice even though the cadillac tax isnt supposed to start until 2020, the employers have been making changes since 2010. They have to gradually make the changes. Firsttime guest at the table, james gelton at the erisa policy industry. Thank you for your time and your take on things. Thanks for having me. Secretary of state Rex Tillerson is on capitol hill to testify on the president s 2018 budget request and other priorities for the department. Thats live before the Senate Foreign Relations Committee here on cspan 3. Later in the day, live coverage of attorney general Jeff Sessions speaking to the Senate Intelligence committee. Hell speak about other issues raised by former fbi director james comey. This is the first time the secretary has spoken in front of congress. The hearing gets underway at 2 30 p. M. Eastern. Thats also live here on cspan 3. Mike lee talks about forgotten historical figures who fought against Big Government in his book written out of history. Senator lee is interviewed by former acting solicitor neil paqhuil. I asked other people who thought they should get more than they get. In the case of the chief, he was from the onondaga tribe. I was intrigued on that because this is not a name that most americans know anything about and yet he had a profound impact on our system of government. Hes the guy that enabled Benjamin Franklin to learn about federalism
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