We are holding our first hearing on stabilizing premiums and ensuring access to into intervals Health Insurance market for 2018. We have five state Insurance Commissioners. Thank you for coming from long distances to be with us to give your testimony on how to help the 18 million americans in individual Insurance Market. Manyve an idea of how people are interested in this, we invited senators who were not on our committee, which is about a quarter of the senate on this committee to come to a coffee with commissioners that we have completed for an hour and 31 senators were there. That is a remarkable level of we will have an Opening Statement and we will introduce the five witnesses. Ask questionskend in fiveminute rounds. This committee includes 23 United States senators. It includes senators with the whitest diversions of abuse. It has a republican majority of only one. Working together during the last two years, we have been able to agree on big steps, big issues, about which we have a differences of opinion. As fixing no child left behind, which president obama called a christmas miracle, 21st century cares. The majority leader said was the legislation that passed Congress Last year. The first overhaul of Mental Health laws in a decade. In early august after two years of work, i want to thank the staff for that two years of work, and we passed new laws to get safe drugs into medicine cabinets and prided funding for the fda. I congratulate senator murray and democratic as well as republican members of the committee for those accomplishments. The united way states expects the senate to work. Those were big and this hearing is about taking one small step, a small step on a big issue that has been locked in partisan stalemate for seven years, Health Insurance. It is a step congas needs to take by the end of this month. By the end of this month. To the 18 million americans, songwriters and selfemployed farmers, those that dont get Congress Needs to take by the end of the month. To the 18 million americans, songwriters and selfemployed farmers, those that dont get their Health Insurance from the government or onthejob committees 18 million by their Health Insurance in the individual market and about half of them have zero Government Support to help buy that insurance. 18 million is only 6 of those who have Health Insurance in america. So thats the individual market. Nearly 300 million have Health Insurance 18 million have the. Individual market that is 6 of all of the insured and 9 million of the 18 million have no government help to buy their insurance and are the ones hurt by higher premiums and higher copays and deductibles. Hypothetical from tennessee. A 35yearold making 48,000 a year in lynchburg would receive no tax benefit to cover her 7,100 a year premiums. She is an estimate of takehome pay of 39,000 and zero cents after taxes, which means a fifth of her takehome hay is spent on Health Insurance premiums which doesnt include deductibles or copays. Next year, department of insurance premiums are going to go up by an average of 21 to for herh is an average between 1,523,000 more in premiums next year. That doesnt include increases in deductibles and copayments. She ought not have to pay a fifth of the income for Health Insurance. Tennessees insurance commissioner, who is here today has described the state , individual market as very near collapse. At the end of september last year, blue cross, the largest insurer pulled out of the market in knoxville, nashville and memphis, not just for tennessee with Affordable Care act subsidies but for everybody. That could happen again at the end of the september if congress does not act. And if it happens again, up to 350,000 tennesseans and millions of americans could literally be left with zero options to buy insurance in the individual market. Last year, only 4 of american counties had one insurance commissioner on the exchange. This year, 36 have won the one insurer on the exchange and for 2018, one half of the counties will have one insurer only on the exchange. In tennessee, it is 78 of the 95 counties. If we do act, we can limit increases in premiums next year, 2018. We can continue support for the copays and deductibles for many lowincome families and make certain that Health Insurance is available in every county and lay the groundwork for future premium decreases. I would suggest we do this by taking two actions, although there may be others that come from the hearings. One, appropriate cost sharing payments through the end of 2018 to help with copayments and deductibles for many lowincome americans. Number two, amended the section 13321332 waiver already in the Affordable Care act so that states can have more flexibility to devise ways to provide coverage with more choices and lower cost. On the first, cost sharing payments or extra subsidies or discounts for many lowincome individuals who receive premium subsidies under the law. They help these individuals pay for outofpocket costs like copays and deductibles but the overall effect is the lower premiums in this individual market. On the second, the section 1332 waivers, as i said, are already written into the Affordable Care act and under some circumstance they allowed allow the flexibility from certain elements of the law such as the essential Health Benefits but they do not in any way reduce the patients protections most of us support. Including protections for those with preexisting conditions and ensuring those that are under 26 may remain on their parents insurance and have no annual or lifetime limits. Right now, 23 states have begun steps to apply for section 1332, seven states have applied and two states, alaska and hawaii , have received the waiver so far. To get the result, democrats will have to agree to something, more flexibility for states and some may be reluctant to support. And republicans will have to agree to something, additional funding for the Affordable Care act that some may be reluctant to support. That is called a compromise. A much smaller but similar agreement to the compromise that created this United States senate in 1789. When the founders created with o mbs om eacste d use ofepresentates space based on population, that was a compromise. This is a compromise that we ought to be able to accept. The great payments were included in both the senate and House Republican bills to repeal and replace major parts of the Affordable Care act. These section 1332 waiver is already in the Affordable Care act it just has not been very appealing to the states because it is a difficult tool to use. We hope to hear more about that from the witnesses today. If we were able to take the big steps i mentioned earlier, fixing no child left behind in the 21st century we ought to be able to take this small limited , bipartisan step on Health Insurance, we know millions of americans will be hurt. Timing is a challenge so i propose that we tried to come to a consensus by the end of next week when the hearings are complete so that congress can act on what we recommend before the end of september. Otherwise we wont be able to , affect insurance rates and the availability for insurance next year. Thats because the department of health and Human Services requires Insurance Companies to submit their final rates by september 20, and the Department Plans to put the rates on health healthcare. Gov by september 27. I believe we can do this here because we have a very familiar ground. Our goal is a small step in so Many Americans will be hurt if we fail. If we dont do it, it will not be possible for republicans for republicans to make political blaming democrats for democrats to make political hay to blaming republicans. The blame will be on every one of us, and deservedly so. We will have four hearings from state Insurance Commissioners today, five state governors tomorrow, various experts on state flexibility next tuesday and a variety of perspectives next including representatives thursday, from doctors, hospitals, insurers, patients and Insurance Commissioners. This is what we call a bipartisan hearing, as most of our hearings are. The senator and i have agreed on the hearings and on the topic and who the witnesses will be. The committee has a clear jurisdiction over the rules that govern the individual Insurance Market which is what we are , discussing today. We have jurisdiction over private insurance and exchanges created by the Affordable Care act and the costsharing reduction. The purpose of the hearings is to provide a forum and create an environment for raising the consensus we can act on quickly during the month of september. Note that we do not have jurisdiction over taxes including the Affordable Care , act, tax credits subsidy nor over medicare or medicaid. Those belong to the finance committee, although there are at least nine members of that committee on this committee. There has been such great interest in this effort that senators that are not members of our committee are being invited to coffee before each of the four hearings, and 31 senators came to the one today. And i haveray invited them to do that and participate in this process. My goal is to get a result on a small bipartisan and balanced stabilization bill. Sense we will , work with other committees and members to get that result. It has been very bipartisan topic for a long time. But the bottom line is 18 , million americans need our help. Senator murray. Thank you very much. I hope we can stay focused on getting a result. I want to start by expressing my appreciation for your leadership in holding these hearings. It is refreshing to have an opportunity for these discussions on the whole through system and consistency as he said with longstanding tradition from working across the aisle in the committees are committees. Thank you very much. Im also very grateful to the Insurance Commissioners have come a long way to join us today. Your perspective is incredibly valuable in the discussion and i look forward to hearing from each of you. And i particularly want to acknowledge that commissioner who came all the way from Washington State today. Good to have you here as well. We are beginning these conversations at an important moment for haitians and families. There is a lot of work that needs to be done to undo the damage this administration caused in the Healthcare System because the administration is trying to create term care by sabotage. The Healthcare System is more stable than President Trump would have you believe that its weaker than the steps that have been taken. Unfortunately, the president has undermined outreach efforts and put forward executive orders , seemingly designed to inject uncertainty into the markets. Just last week, this administration cut funding for outreach by 90 and funding for consumer assistance by over 40 . Another pressing example is the threats to cut off payments to reduce coverage cost for low income people. Should these outofpocket Cost Reductions be discontinued, independent analysis suggests premiums would be an average of 20 higher at year than most popular plants on the exchanges. There will be even more uncertainty in the market and patients and families will have fewer options when they go to pick their plans. That is unacceptable and it is avoidable. Congress can act right away to confirm once and for all outofpocket reductions will continue and we will have a very narrow window to do that, as the chairman said, before insurance is finalizing the plans for 28 2018 later this month. Im very glad there are members on both sides of the aisle who agree we do need to take the steps and i believe it is critical we work towards the multitier solution in order to provide the kind of certainty there will have the most impact on families premiums have choices in the marketplace. It takes plans months to develop their rates. If we dont find a multitier solution, we will just be back in this room to pass the same problem a few months from now and thats simply not what , certainty looks like. This kind of discussion around strengthening the Health Care System is exactly what democrats hoped for over the last few years. We put forth a number of ideas that would stabilize the market and lower costs in the near term. And as i said before to Work Together on one to consider additional ideas from the other side of the aisle to make our Health Care System look better for our families and patients. But to be clear that means , moving forward not backwards on the affordable on affordability, coverage and quality of care. Families have rejected the approach taken which would have raised families cost indicating critical protections like those with preexisting conditions and congress should listen. Willding that this data not be easy, but i do believe an agreement that protects patients and families from higher costs and uncertainty and maintains the guardrails in the system is possible. This would not only make a difference to the patients and families we serve that could provide a bipartisan foundation for future work. I said many times this didnt end when the Affordable Care act past. It is certainly true today. There is much more we need to do to strengthen the system to lower costs and expand coverage and improve quality of care. These are the issues we should be able to Work Together on in a bipartisan way. I hope with todays conversation we continue to turn the page the page away from trumpcare and partisanship that we have seen way too much of and working on health care for patients and families to afford. That is the goal we should be focused on. Im so glad we have interest on both sides of the aisle for coming together and working to find Common Ground on these issues and i want to thank all of the commissioners and all of our colleagues that are joining us and turn it back over to the chairman. Thank you senator murray. Our first witnesses commissioner of tennessees department of commerce and director of the insurance administration. Isour second commissioner mike. He is a washingtons eighth insurance commissioner for the state of a washington and the countrys longest serving commissioner. I will ask senator murkowski to introduce the next witness. Introduce pleasure to an individual who has been for director and alaskas director of insurance she has been in that position since 2014 and has done an exceptional job. We recognize not only her service there, but she is also indianir of the american Liaisons Committee and on the association of Insurance Commissioners she is, as you have noted, one of two states waiver, received a 1332 and it has been under the whennce of director higher. I thank her for being here but for her leadership and persistence in working at only with the Obama Administration but with the Trump Administration in getting that final signoff. I am pleased to introduce Teresa Miller who is pennsylvanias acting secretary secretary miller served as commissioner from 2015 through august of this year and she was nominated by Governor Wolf to serve as secretary of Human Services. In her role as insurance commissioner, she has been a person of the marketplace and demonstrating a deep understanding of the Insurance Industry while advocating for policies in the best interest of pennsylvanians very i congratulate her on being nominated to serve as secretary of Human Services and happy to welcome her to the Health Committee today. Thank you for your testimony today. We are grateful you are here. Our fifth witness is mr. Doak. He is commissioner for oklahomas department of insurance. He is wellknown for health care finds state and six to answers to health care challenges. There is a lot of interest among the senators. If you could please a summarize your remarks in about five minutes, will then turn to a series of questions from senators. Thank you. Good morning, chairing members of the committee. I am the commissioner of the tennessee commissioner of insurance. Today i plan to highlight tennessees history with the aca and discuss Immediate Solutions congress can consider to stabilize the individual Insurance Market. Before i get started, i would like to thank you for holding the hearing and inviting my state colleagues. In an interview last year, i characterize