▶ 0:25:57>> the senate committee will please come to order. Senator paul is two minutes out so we could go through a lot of this. Your presence here will be considered as being present.
▶ 0:26:14We reconvene for scott mayer to be named to the labor relations board and mary carter to be head of the -- chairperson of the national endowment of the arts.
▶ 0:26:29Sen. Sanders: I will ago presidt trump illegally fired a member. Trump effectively muted the only federal agency responsible for holding corporations accountable for unionbusting and protecting the rights of workers to form unions.
▶ 0:26:58Sen. Sanders: I believe it would be appropriate for us to be voting on any new members of this board . All over this country, workers are standing up trying to form unions. They are looking at an economy where people are doing phenomenally well. They are struggling to pay their rent.
▶ 0:27:27Sen. Sanders: They have been trying to form a union for the last four years against the incredible illegal unionbusting activities. We need a board of this country designed to do what it was designed to do for workers being treated unfairly by other companies they work for. I would urge a no vote on that nominee.
▶ 0:27:56Sen. Cassidy: I will now move to report senator mayers -- Mr. mayor's nominee. [voting]
▶ 0:31:14Sen. Cassidy: >> 12 aye's, 11 nays.
▶ 0:31:24Sen. Cassidy: I now move to favorably report Ms. carter's nomination. [voting]
▶ 0:32:15Sen. Cassidy: >> 14 aye's, nine nays. >> the health committee stands adjourned. We will have the executive session establishing your presence.
▶ 0:33:04Sen. Cassidy: [indiscernible conversation]
▶ 0:34:39Chair Cassidy: The senate committee on health, education, labor, and pensions will come to order. I think it's pretty well-established the american people are having a hard time affording health care. Prices are up for everyone. The status quo is not sustainable. They are looking to congress to work together to find solutions.
▶ 0:35:02Chair Cassidy: In july this committee discussed affordability across the commercial insurance market we are looking at why costs are going up within the individual and small business marketplaces. If you are in those marketplaces you are paying more.
▶ 0:35:20Chair Cassidy: During the pandemic democrats passed enhanced premium tax credits which ultimately send money to highly consulted insurance companies. They are essential to our society. By using these subsidies they are hiding the true cost. This doesn't actually lower the cost of health care, it masks it. It tapers over it.
▶ 0:35:50Chair Cassidy: It puts a band-aid on a broken bone. Let's get some facts they covered 68% of the obama care exchanges. By 2020 68 percent had become 80%. From 2021 through 2025 the tax credits, the taxpayer share grew to 93%.
▶ 0:36:18Chair Cassidy: Despite this increase in subsidies, total premiums never decreased. The enhanced premium tax credit masked the cost. Increase subsidization increase the prices of the unsubsidized and the small group market where they are included in the same actuarial pool. Think about that. Subsidizing to some increases the premiums for those who are not subsidized are in the same actuarial pool.
▶ 0:36:50Chair Cassidy: Now, how do we address this? We should go to the root cause of rising health care costs. To be sure, we are having two conversations here. Just from here to eternity. A very immediate conversation about january 1, 2026.
▶ 0:37:16Chair Cassidy: What do we do for those folks particularly in the 50's and the 60's when it becomes unaffordable because of the increased use of health care and having to put more of their budget to this. Republicans are not interested in the status quo. Putting a band-aid over a broken bone does not help anything.
▶ 0:37:45Chair Cassidy: They are absolutely interested in figuring out a solution that could make health care more affordable and health insurance more affordable for 2026 and beyond. My democratic and republican colleagues. I'm hoping we could find a bill that could get 60 votes and fix the problem of the exchanges for january 1, 2026.
▶ 0:38:13Chair Cassidy: It shouldn't be a republican solution. It shouldn't be a democrat solution, it should be an american solution. This is a committee of jurisdiction. Maybe occasionally we yell at each other. Let's find a solution. The american people are looking at us to find a solution. We could push for big ideas on the right or the left. We have to have a solution three weeks from now.
▶ 0:38:49Chair Cassidy: Senator sanders will speak about medicare for all. That will not be ready in three weeks. In fairness, people on my side will speak about things that cannot be ready in three weeks. We should focus on what should get done three weeks from now. That means we have to build on what we have. Neither side will particularly like that.
▶ 0:39:14Chair Cassidy: If you want an american solution that is the reality. There is a sweet spot that which republicans and democrats would like to do knowing that we have to have a solution in three weeks we have three choices, we could do nothing. We accept the premise that no deal is possible.
▶ 0:39:36Chair Cassidy: That no reforms and we have a failed vote where there is a democratic bill and a republican bill and they both go down. That is one option. Alternatively, we could roll up our sleeves and seek out something we can all live with. From my perspective, that recognizes increased support for some people must continue.
▶ 0:40:17Chair Cassidy: Repurchasing those dollars for pre-funded savings accounts because when you put it in hsa, 100 percent goes to the patient. By the way, when you give it to the insurance company, 20% goes for overhead and profit. Let's address the elephant in the room. The donkey.
▶ 0:40:46Chair Cassidy: There are people who strongly held positions on issues of life on both sides. I am pro-life, I am not going to compromise that. There are people who are pro-choice who do not wish to compromise that. They define common ground for many years. We can't address that.
▶ 0:41:18Chair Cassidy: And then allow people in the 50's and 60's that afford premiums. Let's find a way that we could all live with incredibly important issues no matter what side of that issue you are. This clearly strengthens the chance of passing.
▶ 0:41:45Chair Cassidy: They want an american plan, not a side-by-side republican set of plans both of which fail. The american people want something to pass. Let's give power to the patient, not power to the insurance company. Let's make health care more affordable again. I recognize senator sanders.
▶ 0:42:12Chair Cassidy: Thanks to the panelists for being here. Thank you for holding this important hearing. I agree with some of what you said. It's hard to dispute the current health care system is completely broken. It is dysfunctional and it is cruel.
▶ 0:42:33Chair Cassidy: Most americans recognize the function of the health care system today to make the insurance companies incredibly wealthy and provide huge compensation packages and make drug companies extremely profitable to their ceos, massive amount of stock buybacks. That is what the system is about. The system is working really great.
▶ 0:43:03Chair Cassidy: Unfortunately for the rest of the american people, the system is not working very well. What does that mean? It means unbelievably as a nation we are spending $15,000 per person today on health care adding everything together.
▶ 0:43:26Chair Cassidy: If you are spending $15,000 per person you must be getting the best health care system in the entire world. Everybody in america, we are spending twice as much per capita. Not quite the case.
▶ 0:43:47Chair Cassidy: The reality is despite spending $15,000 per person we have 85 million americans who are underinsured or uninsured. What does that mean? It means if you are underinsured you get sick, you don't go to the doctor. You know what happens? Sometimes you die.
▶ 0:44:15Chair Cassidy: In the richest country in the history of the world by the time they walk into a doctor's office it is too late. Clearly in the richest country our life expectancy is higher. Four years lower. Clearly in america, we have more doctors and nurses, psychologists and dentists.
▶ 0:44:45Chair Cassidy: Not quite the case. We have a massive shortage of mental health providers. What is the bottom line? I appreciate your sentiment about wanting to do something quickly. The reason for this is my republican friends understand they have a political problem. What is their political problem?
▶ 0:45:15Chair Cassidy: The affordable care act are opening up packages and guess what? Their premiums and in some cases in my state are tripling and quadrupling. I don't want to go explain to people why their premiums are doubling or tripling. Yes, the current system is broken. We need to create a new system.
▶ 0:45:45Chair Cassidy: We aren't going to do it in two weeks. The common sense would suggest you have a broken system. Let us extend the current aca tax credits for at least another year or two years and I would love to work with you on this, we tackle the real issues.
▶ 0:46:14Chair Cassidy: The first thing I think we should do is have a panel with people from different countries around the world who are providing health care to all of their people as a human right and we are the only major country that doesn't do that.
▶ 0:46:38Chair Cassidy: Say to those in france and japan , how do you provide quality care, what could we learned from other countries? I think that would be the first approach. I think the immediate approach is we don't want to see a doubling or tripling and let's sit down and see what works for the american people.
▶ 0:47:05Chair Cassidy: Drug companies in my view, it is going to be to emulate what many other countries do, guarantee health care by extending medicare for all.
▶ 0:47:19Chair Cassidy: The reason people are uninsured is $6,000 deductibles. That is the status quo. We could change that status quo for next year.
▶ 0:47:38Sen. Sanders: Would you guarantee health care to all people?
▶ 0:47:42Chair Cassidy: That would not happen by january 1, it is something we could's consider. In 2026, that is where the immediate need is.
▶ 0:47:57Sen. Sanders: Let's extend tax credits and then have that discussion.
▶ 0:48:02Chair Cassidy: We will not accept that.
▶ 0:48:07Sen. Sanders: We will not accept the doubling of premiums.
▶ 0:48:14Chair Cassidy: Then we will proceed. I will introduce our first witness. We are joined today by joel white. Mr. white has two decades in health policy and has led coalitions focusing on health care costs and improving market competition.
▶ 0:48:47Chair Cassidy: He has expertise in forms to design the small business. Here and a bachelors in economics. Thank you for being here.
▶ 0:49:03Mr. White: Thank you for the opportunity to testify today. I leave the council for affordable health coverage. We want to ensure every american has access to affordable coverage. The cost of health care is a threat to our economy. It is an escalating burden. It is a ticking time bomb and unsustainable for the united states of america.
▶ 0:49:33Mr. White: When those words were set in 2009 they were true then and they are true today. The problem is the situation today is even worse. Health care is becoming less affordable to consumers. Premiums and out-of-pocket costs keep rising. Consumers pay more for less.
▶ 0:49:58Mr. White: The more restrictive plans and push 12 million small business employees out of better employer coverage than the higher cost exchange plans. Twice the pace of employer coverage. Out-of-pocket costs doubled as well. They are expected to exchange -- expand 26%. Premiums are only the start.
▶ 0:50:30Mr. White: Even after paying record high premiums, families must spend thousands of dollars before coverage begins. When they access care they face friction and delays from prior authorizations and restrictive drug formulators, taxpayers and working americans finance these high premiums and deductibles that pay for shrinking access while monopolies grow stronger.
▶ 0:50:59Mr. White: Simply put the aca poured gasoline on health care cost fire. The system is unsustainable for businesses, taxpayers, it's a major driver of deficits and debt. Adding more subsidies won't fix these underlying problems, it only reinforces that. Relief from the high cost requires a different approach. One that empowers consumers, not corporate america.
▶ 0:51:27Mr. White: I suggest you make health subsidies portable. Let them use this to make it that is used for them. Lower premium plans, services at cash prices, depositing subsidies that patients own and control will give them real purchasing power and force plans to compete on price and quality.
▶ 0:51:56Mr. White: In every market there are health plans less expensive than aca policies. If they were empowered to shop and you subsidies competition would drive down cost and access to care would improve. Second, it is imperative that we help small businesses. They face the highest premiums and the fewest choices.
▶ 0:52:27Mr. White: Updating the broken small business tax credit and expanding options like association health plans will let them offer coverage again. The small group market is in a death spiral. One third of small businesses offer coverage today. Half the exchange market is made up of small business employees where they pay higher premiums, deductibles that is not common in small group market.
▶ 0:52:59Mr. White: You could keep people in small group plans and give them better coverage at two thirds less cost. We should empower states to bring down costs that have been proven to lower premiums by 40%. Long-term affordability requires addressing the cost of medical care in self. Hospital markets are monopolies that drive up prices for consumers.
▶ 0:53:26Mr. White: For too long we have restricted the supply and we need policies that promote competition. Prices fall and innovation rises. The path forward is pretty clear. Empower consumers, lower medical costs. That is how we make health care affordable again. Thank you. Mr. white, thank you.
▶ 0:54:01Mr. White: We are joined today by marcie strouse, owner and partner of capital benefits group with two decades experience with small business owners navigating health care costs that keep their employees healthy. Even more importantly she brings a personal perspective as a mom of three who has seen the realities families face in affording health care. Thank you.
▶ 0:54:33Ms. Strouse: Thank you for the opportunity to testify today for small business owners who care about building stronger communities. I have a benefits consultant at capital benefits group. For more than two decades I have helped small business owners navigate the small business landscape.
▶ 0:55:03Ms. Strouse: As a small business owner myself I understand how the uneven playing field could hold that growth. I know firsthand what it means to navigate the health care system, this dual perspective as a consultant and a parent it is my understanding how the system is failing families and employers alike. They are facing a health care coverage crisis.
▶ 0:55:31Ms. Strouse: Small businesses are the foundation of the american economy, they represent 99% of all american businesses and generate half our gdp. They create opportunity every day. A key part of that commitment is offering employer-sponsored health coverage. For four decades the number one problem small business owners report is the high cost of health insurance.
▶ 0:55:57Ms. Strouse: Premiums have risen 120% since early 2000's while the number of insurers offering small plans has sharply declined. It is no wonder that 98% of small business owners fear they will no longer be able to afford coverage in the coming years. Too many government regulations and industry middlemen suffer from the care they need.
▶ 0:56:21Ms. Strouse: Nine out of every $10 limiting employers and employees that truly fit their needs. It is time for congress to increase choice, flexibility, affordability. Enacted choice arrangements. They are already a valuable tool that let employers contribute to health care coverage in a predictable and budget friendly way.
▶ 0:56:51Ms. Strouse: Strengthening these arrangements, expanding eligible expansions for small businesses that use them. This gives employers a sustainable option for providing meaningful benefits. So small businesses have the ability to join together to purchase coverage the same way large employers do.
▶ 0:57:13Ms. Strouse: Similar regulated structures mean lower premiums, stronger networks with the duration plans when paired with direct primary care. Codifying these plans would expand lower cost options for individuals. Hsa should be modernized so they could get small group premiums as true long-term health investment tools.
▶ 0:57:40Ms. Strouse: These empower consumers to make smart decisions and better manage unexpected costs. The community rating and lifetime limits that unintentionally contributed to rising costs, industry consolidation and reduced flexibility. It requires benefits that they may never use.
▶ 0:58:07Ms. Strouse: Medical loss ratio with higher claims discouraging cost control and encouraging market consolidation. They inflate premiums pushing many out of the market and driving up rates. The renewal has contributed to uncontrolled cross growth across the system. Eliminating or at a minimum rightsizing these bring them back in line with what small employers could afford.
▶ 0:58:33Ms. Strouse: Small business owners must buzz it carefully, many feel trapped as premiums continue to rise and options dwindle. The private market is developing drug sourcing, surgical rates and more. Government barriers are reduced these could work not just for large employers but the smallest groups including those with fewer than 25 employees. Thank you for allowing me to share my testimony.
▶ 0:59:02Chair Cassidy: I asked senator sanders to introduce his witness.
▶ 0:59:07Sen. Sanders: I would like to introduce Dr. claudia fegan. Dr. feagin recently served as chief medical officer of cook county health in chicago as a past president of the health and policy research group. Thank you for being with us.
▶ 0:59:26Dr. Fegan: I want to thank you for the opportunity to address the issue of health care affordability. I have the national coordinator of position for health care. Everyone in this room knows that the U.S. health care system does not work. It does not meet the needs of the american people. Expanded medicare for all solve many of our problems related to the call to health care.
▶ 1:00:00Dr. Fegan: High-quality trustworthy universal health care free from profit driven conflicts of interest and delivers better health outcomes. Without enhanced tax premium credits, americans will die. The subsidies established in the affordable care act expanded in the american rescue plan act allow workers to purchase health insurance saving lives.
▶ 1:00:24Dr. Fegan: When 10 million people lose coverage with the changes in the bill, 42 thousand people may die because of the result. I practice internal medicine for over 40 years. Before retiring as chief medical officer last december, I saw patients that could have been prevented had they come in earlier. I saw patients who came in with kidney failure who needed dialysis.
▶ 1:00:56Dr. Fegan: As people are looking at the increases in premiums they are facing, they are weighing the decision to go without insurance. There are patients trying to get screening tests done or get preventative services while they can. Every year, more than 31,000 people died as a direct result of not having health insurance. That is because when people lose coverage because they can't afford to lose medicaid they don't get necessary care.
▶ 1:01:28Dr. Fegan: Common sense and basic compassion to prevent a stroke is better than dealing with the possibility of permanent disability and rehabilitation. It saves money and lives with routine care instead of waiting for conditions to spiral out of control. Allowing companies to manage medicare through medicare advantage plans has led to fraud and abuse.
▶ 1:01:56Dr. Fegan: The practices that improve quality actually deny care and cut costs. It harms patients and prevents them from getting needed treatments. Medicare advantage plans improve requirements averaging two per enrollee. 80% of them are overturned upon appeal. Additional medicare uses just one prior authorization for nearly every 100 enrollees.
▶ 1:02:26Dr. Fegan: When we deny care or take access to caraway, people died. It is well documented that we waste 20-30% of our health care budget on bureaucracy and profit. Makes more red tape for the government and participants. I would like to speak to the recent proposals to expand the use of a medical savings account to address health care affordability. The idea of giving the cash benefit directly is a farce.
▶ 1:02:59Dr. Fegan: They will use the money to purchase health insurance because there is no access to care in this country without insurance. The only savings will come when patients except greater out-of-pocket expenses without the savings that come from large populations. Low-wage workers will make poor choices when having to decide between preventative services and immediate needs such as rent and groceries. We know pap smears, mammograms, colonoscopies and even blood pressure checks save lives.
▶ 1:03:31Dr. Fegan: People living paycheck-to-paycheck have a hard time investing in the prevention of future problems. An underserved workforce unable to receive basic services and lower profits. Somehow we have come to believe people who can't afford health care are disposable. Our society is worse off because of it and we could improve our society by giving people the care they need. Every year tens of thousands of patients died because of it.
▶ 1:04:04Dr. Fegan: That is only if you are wise enough to access it.
▶ 1:04:13Chair Cassidy: Senator sanders spoke about people being underinsured and the problems of having to have significant co-pays. If you have a 6000 dollar deductible, that is the definition of being underinsured. You could imagine because they cannot afford the deductible.
▶ 1:04:41Chair Cassidy: I'm saying this, quickly, what is the impact of a $6,000 deductible on somebody's ability to access care?
▶ 1:04:56Ms. Strouse: Prior to the aca if I had told somebody there out-of-pocket maximum was $5,000 I wouldn't have sold the policy. Now people are begging for $5,000.
▶ 1:05:10Chair Cassidy: What is the status quo folks want to continue?
▶ 1:05:14Ms. Strouse: About $8,300.
▶ 1:05:17Chair Cassidy: That's what people are trying to continue? Thank you. If you had a pre-funded hsa with your own family history, money is placed there, it doesn't come out of your paycheck. It is put there.
▶ 1:05:43Chair Cassidy: That would give you first dollar coverage, with that impact your ability to access care?
▶ 1:05:51Ms. Strouse: Part of the problem is we can't force people to go to the doctor. We have preventative health benefits and we have zero dollar costs, which they are.
▶ 1:06:03Chair Cassidy: That is one issue. Some people wish to go with that $6,000 deductible is a barrier. I like to talk about the total cost of being insured. Folks are focusing on premium subsidies and an $8,300 maximum pocket. We are talking about a pre-funded hsa.
▶ 1:06:35Chair Cassidy: Speak about the cost of being insured versus the cost of the premium?
▶ 1:06:42Mr. White: We are talking about $27,000 is the average for 2026, about the cost of a new chevy trailblazer. Every year. Really the outrage here is with the deductibles. We are seeing six, 10,000, $14,000 deductibles on failing policies. That is restrictions on access to care.
▶ 1:07:11Chair Cassidy: The deductible we would continue the status quo is a restriction on primary care.
▶ 1:07:21Mr. White: It is not just the most restrictive type of health plan where you can only see a network Dr.. You have to meet your deductible before the insurance will kick in. You have to pay out of pocket when you go see that Dr. until you hit your deductible limit. First united bank says the typical american has $1000 in their account.
▶ 1:07:48Chair Cassidy: Status quo does not work for that family with $1000. Let's not pretend otherwise. Mr. white, according to the budget office, reduction payments as originally intended reduces premiums by 11% and reduces the deficit by $30 billion.
▶ 1:08:11Chair Cassidy: Could you explain which in fairness was part of the original obamacare lowers premiums and saves taxpayer dollars?
▶ 1:08:18Mr. White: The original law, one of them was premium subsidies. That funding for the cost sharing reduction was never funded by congress. The court ruled that congress either had to appropriate the money or those funds weren't available. Congress has never appropriated those funds.
▶ 1:08:48Mr. White: What insurers have done is silver loading. They have increased premiums and take that to provide a higher actual value plan to consumers. That lowers the out-of-pocket cost. The challenge with that is everyone pays the higher premium .
▶ 1:09:14Mr. White: If you are an unsubsidized individual, premium costs are way up. If you appropriated the money that silver loading, the premium increases go away. Premiums go down for everyone. That's how you save $33 billion.
▶ 1:09:44Sen. Sanders: We agree, the status quo is not working. I look forward to you signing on to medicare for all so we could do what every other country does, guarantee health care. I don't have a lot of time. Should the united states join every other major country on earth and guarantee health care to all people?
▶ 1:10:04Mr. White: I think the experience we have seen in every other country is it doesn't work well.
▶ 1:10:11Sen. Sanders: Ms. strouse?
▶ 1:10:16Ms. Strouse: Width of the aca has worked, absolutely not. You have studied countries around the world. Countries want to join the united states. Seeing a doubling in their health care costs. Is that what the trend is?
▶ 1:10:33Ms. Strouse: You should ask people with the conditions in those countries.
▶ 1:10:41Dr. Fegan: Every other country has covered their population and their life expectancy is longer than ours. They spend half of what we do.
▶ 1:10:52Sen. Sanders: Our partisan congressional office, this has been -- medicare for all would save the american people $650 billion per year. $650 billion, that is not me, that is the ceo.
▶ 1:11:19Sen. Sanders: When we talk about an expensive system, a current system, we are talking about an enormous amount of waste and bureaucracy in administering hundreds of separate plans. She has a $10,000 deductible, I have a $5,000 deductible. You have no health insurance. Basically you have experienced it. What does that mean?
▶ 1:11:46Sen. Sanders: The complexity of the plan and the cost and impact on patients who walk into your office?
▶ 1:11:56Dr. Fegan: We could save hundreds of billions of dollars and we know over 50,000 people year diodes a result of not having health insurance.
▶ 1:12:08Sen. Sanders: As you well know trumps big beautiful bill is going to throw approximately 15 million people off of medicaid. These are low income and working-class people. That decision was made to give $1 trillion in tax breaks.
▶ 1:12:35Sen. Sanders: What happens when you throw 10 million, 15 million lower income people off of medicaid?
▶ 1:12:42Dr. Fegan: When we take away health insurance, people died. They do not get the basic problems we know how to treat. Diabetes becomes uncontrolled. We know people have greater disabilities.
▶ 1:13:01Dr. Fegan: Working-class people will make decisions that will be skipping health care until they are desperate and at the time they present with their illnesses, it will cost us more to put patients on dialysis. It cost us more when patients have diabetes. We know eventually they will come into the emergency department and we will take care of them regardless of the cost.
▶ 1:13:31Dr. Fegan: We are costing ourselves more at the back end.
▶ 1:13:34Sen. Sanders: Which raises the question of why we spend half as much per capita on primary health care. Disease prevention. Do I want to invest end is that where isaac my money?
▶ 1:13:50Dr. Fegan: The united states have 0.3 primary health care patients per thousand. Every country has 0.8 or 0.7 primary care physicians per 1000. We don't produce enough to take care of the population.
▶ 1:14:09Sen. Sanders: We underpay those physicians as well. You and I a couple of years ago were in toronto, is that right?
▶ 1:14:19Dr. Fegan: That is correct.
▶ 1:14:23Sen. Sanders: What is the bill when somebody comes out of a major procedure, how much do they owe?
▶ 1:14:28Dr. Fegan: Absolutely nothing.
▶ 1:14:41Sen. Sanders: Maybe we should study that.
▶ 1:14:48Sen. Collins: Thank you, Mr. chairman. I feel compelled to respond to the ranking members remarks about whether or not republicans care about this issue. It is obvious that we care deeply about the affordability of healthcare for our constituents. I would point out that the chairman of this committee is a republican.
▶ 1:15:16Sen. Collins: He is the one who has convened this important hearing. He is also the one who has worked night and day with many of us to talk about solutions. By contrast, the policy that we are talking about during the biden era was ran through with no republican support.
▶ 1:15:46Sen. Collins: And it was supposed to sunset so that we can have a more thoughtful approach and it has now placed working americans in a terrible bind. Mr. white in his written testimony refers to the affordability gap, the growing difference between the high price of coverage and workers earnings.
▶ 1:16:15Sen. Collins: And that is why we should be putting partisan politics aside and trying to work together to come up with solutions. The so-called free bronze plans have huge out-of-pocket deductibles. Enormous, unaffordable deductibles. That is an untenable situation.
▶ 1:16:46Sen. Collins: Which is why our chairman has talked about health savings account, cost-sharing reductions. I want to bring up another issue and let me say, I think there is a limit to what we can do in this first year. I think we are going to need a two year plan. Senator murkowski and others have proposed multi-year plans as well. I want to ask Mr.
▶ 1:17:16Sen. Collins: White about a short-term solution that could be added this year and then a longer-term solution that I would like to hear the panel's views on. First, there is no income cap on the tax credits, on the enhanced premium tax credits.
▶ 1:17:46Sen. Collins: That means, according to our calculations, that a family of four living in augusta, maine making $325,000 per year, which I can tell you will cover very few people in augusta, maine, qualify for a taxpayer-funded subsidy. Mr.
▶ 1:18:10Sen. Collins: White, do you think we should put a reasonable cap, phase it out so we don't have a cliff, on who qualifies for these enhanced premium tax credits?
▶ 1:18:24Mr. White: Absolutely, yes. We need to understand that those subsidies above 400% of poverty are financed in part by taxes on working americans. So someone working in a bakery, a gas station, a lower income family is paying taxes to subsidize the subsidies for someone making $400,000 per year.
▶ 1:18:53Mr. White: That is not fair so there needs to be some kind of recognition that we cannot tax low income people to pay for high income people's subsidies. The second point I want to make is there is no asset test on these enhanced subsidies. As an early retiree I might have a sizable nest day, maybe $1 million with an income of 200,000 dollars and still qualify for a subsidy paid for by a lower working class american. That's not fair either.
▶ 1:19:22Sen. Collins: Thank you. Ms. strouse, same question.
▶ 1:19:26Ms. Strouse: I agree that if we keep the subsidies, we need an income cap on there. Also for those people who potentially are underestimating their income to receive subsidies, they should be required to pay subsidies back at the time that they verify their taxes at the end of the year. So there should be some sort of safety net that makes sure they are paying the appropriate amount that they should be paying.
▶ 1:19:49Sen. Collins: Dr., what about an income cap?
▶ 1:19:53Dr. Fegan: I would have to get back to you on that. I have concerns about health expenses that people can have that can make their income problematic.
▶ 1:20:04Sen. Collins: My time has expired. For the record, I'm going to submit some questions on the use of invisible high risk polls and reinsurance which also can lower premiums. We did that in the state of maine with some can.
▶ 1:20:33Chair Cassidy: Success thank
▶ 1:20:33Youchair Cassidy: , senator collins.
▶ 1:20:43Sen. Moran: The time to save people from these huge costs was before these premium hikes were all but locked in. Let's start talking about fixing this now. One month into open enrollment instead of at any point earlier this year when we actually had time to stop premiums from skyrocketing or look at some of these different reforms.
▶ 1:21:05Sen. Moran: This is about as serious as expressing concern about rfk jr.'s back jr.'s baanti vaxx crusade after voting to make him one of the most powerful politicians in the country. The only way now we can stop people from seeing these huge increases is a clean extension and a longer open enrollment. We should be honest about that.
▶ 1:21:31Sen. Moran: I appreciate the ideas being tossed around it even though I have concerns with some of the proposals. But if republicans had come to the table at any point earlier this year, there would be time to sit down and about this. But we have now seen the republicans run out the clock. They blew right past the start of the open enrollment. Forget about time spent negotiating. Even if we passed this bill today, there is not time to implement anything more complicated than a clean extension.
▶ 1:22:01Sen. Moran: So if republicans are serious about preventing the maga healthcare hike, they should work with us now to pass a clean one year extension as fast as possible right now and if their call for reform tax credits is serious, we should look at that. We can talk about those reforms ahead of the 2027 year.
▶ 1:22:27Sen. Moran: I have to say I'm not optimistic that most republicans are serious about this because they refuse to talk about this problem before right now. And I've been down this road before. During the trump administration, the first one, I sat across from chair alexander. We hammered out a bipartisan plan to lower costs. We were on the one year large line -- yard line. Then a call came down from trump and republican leaders. They did not want to get to a deal.
▶ 1:22:57Sen. Moran: They did not want to lower healthcare costs and they started demanding restrictions on abortion, something that had never been an issue before until then. And used that pretext to torpedo months of bipartisan negotiation. Excuse my skepticism today when we have seen this tired playbook. If republicans want to talk about healthcare, great. Unfortunately, we have heard many republicans make it clear they are not serious. If that changes, Mr.
▶ 1:23:26Sen. Moran: Chairman, I'm at the table. I'm ready to talk about our healthcare system in this country. Dr. fegan, let me talk to you. Did any of the cuts republicans made in their reconciliation bill this summer make healthcare more affordable for american families?
▶ 1:23:43Dr. Fegan: They did not. Sup on
▶ 1:23:51Supen. Moran: Can you tell us why?
▶ 1:23:55Dr. Fegan: The reality is that when we make people pay more for their deductibles, they do not get care. When they get a health savings account, the only choice the patient has is to purchase health insurance. When you purchase on an individual basis, it is more expensive than when you are part of a large pool. The only way that you get a cheaper price is when you agree to have greater deductible or greater out-of-pocket expenses.
▶ 1:24:26Dr. Fegan: And you have fewer choices. They did not save any money and giving the money to the patients does not help the patients make better decisions.
▶ 1:24:36Sen. Moran: We heard a lot about coverage being more affordable for small businesses. It is important to acknowledge that nearly half the adults within the aca marketplace are small business owners or self employed and letting these tax cuts expire is going to hurt them dramatically.
▶ 1:24:56Sen. Moran: Before my time is up, I do want to note that tomorrow cdc's vaccine committee is meeting to discuss the childhood vaccine schedule and the hepatitis b vaccine's. Something the chair of this committee has said many times save lives.
▶ 1:25:11Sen. Moran: The cdc advisory committee is going to hear from who knows who but based on the fact that the cdc's own website now spreads anti-vax disinformation, I want to state for the lacquered -- record I am deeply alarmed that this committee has not done more oversight and we still have not done a to force rfk jr. To answer questions about his decision to fire the cdc director and limit access to lifesaving changes. Mr.
▶ 1:25:41Sen. Moran: Chairman, I hope that will change.
▶ 1:25:42Chair Cassidy: Senator murkowski.
▶ 1:25:45Sen. Moran: Quickly I want to submit for the record unanimous consent to enter a record into the statement from the american cancer society.
▶ 1:25:52Chair Cassidy: Without objection.
▶ 1:25:54Sen. Murkowski: Thank you for this hearing. I want to accept the chairman's challenge this morning. You challenged us here. We have a couple of things to be thinking about. We have short term and it is really short. It is really short. It did not have to be this short.
▶ 1:26:13Sen. Murkowski: I believe it was december 12 of last year that I raised a flag about this, that we were going to see this and we were going to be dealing with this cliff and it was not going to be comfortable. And for a host of different reasons, that conversation was deferred early in this year and things started to heat up the summer. And we are where we are.
▶ 1:26:41Sen. Murkowski: But I am in this encampment as senator collins has outlined, as a republican who cares deeply about this issue because my home state of alaska appears to suffer some of the most extremes of the extremes when we are talking about these high costs. And people are expecting us to come up with a solution.
▶ 1:27:01Sen. Murkowski: They are looking at this cliff and saying what we are paying alreadym already, the status quo is not sustainable but if we fail to act, if we fail to do something relatively soon, the consequences are severe. When you are talking about close to one third of your family's income going toward your healthcare coverage -- I got a text from a friend over the thanksgiving break.
▶ 1:27:31Sen. Murkowski: She was telling me about the insurance that she and her husband currently have. They are in their late 50's. This was before the aca. For two years they paid $2600 per month, $30,000 per year for a terrible plan. High deductibles, no dental, no vision. Terrible plan. We just watched our money go out the door.
▶ 1:28:01Sen. Murkowski: Every one of us gets messages like this from friends and colleagues. They were able to receive support through the subsidies. Their premiums went down to $500 per month and even lower than that and just recently they got their notice saying that for the exact same terrible plan, they are going to be paying $3000 per month, $36,000 per year.
▶ 1:28:27Sen. Murkowski: She asked me the question, she says, I asked you why you voted against the repeal of the aca back then and you said it was because there was not a replacement. Have you or others been able to come up with a replacement? So we have two issues here. We have a situation where she is now going to be looking at $36,000 a year that she and her husband will have to pay.
▶ 1:28:52Sen. Murkowski: But she also fairly wants to know what the plan here for reducing overall cost of care. Mr. chairman, you have pegged it. We need to address the short term reality we are facing and we need to be looking long term. Again, this is the role of this committee, to be doing exactly that. I want to focus on not the message, not to be able to say I told you so.
▶ 1:29:23Sen. Murkowski: I want to be able to say we have helped address this. I think we are going to need to have a short-term extension. But I think we can put reasonable caps on. I think we can put some of the parameters we have been talking about. There is no secret sauce to how we are going to deal with this particular dilemma. But we've got to be looking longer term to how do we reduce these costs of care.
▶ 1:29:53Sen. Murkowski: I have one minute left in my comments and I want to ask the question about the longer-term because we are going to work out or not work out whether people like my friend are going to be going off of this cliff and making a decision that they are not going to be covering themselves potentially. We focus a lot and we talk a lot about the prevention side.
▶ 1:30:21Sen. Murkowski: We know that if we can keep you from getting sick in the first place, we save some money. I have been watching what we have been doing recently and I am concerned that we are seeing some major cuts to public health and prevention funding. I worry about that because I think that actually helps us in the long run.
▶ 1:30:45Sen. Murkowski: If you had to pick one or two prevention type programs that had the strongest evidence for reducing long-term costs, what would you tell us to prioritize? If have two seconds. Quickly, what would it be?
▶ 1:31:02Mr. White: I would allow premium discounts in the individual market for wellness programs. These are currently illegal. We can incentivize people to take better care of themselves through financial incentives.
▶ 1:31:14Ms. Strouse: I would open up hsa accounts to allow for a more holistic and preventive services to flow through those accounts. Also really highlighting primary care and the ability that we have to go lower prices through direct primary care and making sure people are actually getting the care that they need.
▶ 1:31:33Dr. Fegan: I think primary care as well as screening. The things that we know save lives.
▶ 1:31:42Chair Cassidy: Senator baldwin.
▶ 1:31:46Sen. Baldwin: Thank you Mr. chairman. As much as we disagree on things, I just want to note the underlying agreement that this system needs a lot of reform. Mr. chairman, you opened up with saying we have three weeks. We have 12 days. That is how long we have until open enrollment closes.
▶ 1:32:14Sen. Baldwin: Obviously, we could take some future accident to extend open enrollment -- some future action to extend open enrollment. This is an immediate issue and of course there is a lot of agreement on the systemic problems in our healthcare system. I want to make a point that just under 50% of americans get their health insurance through employers or group insurance. 20% are on medicaid. 15% on medicare. 1% on tricare v.a.
▶ 1:32:46Sen. Baldwin: Just over 6% are in this market. There are problems with this market. But I have to say that abandoning the aca by getting rid of these and trying to overturn it or distract it -- judistruct it is not going to solve our system as a whole.
▶ 1:33:17Sen. Baldwin: Many of our panelists talk about the pervasiveness of middlemen in the healthcare system and private equity in healthcare. Part of the solutions will involve much greater visibility with what happening behind the curtain.
▶ 1:33:35Sen. Baldwin: Transparency efforts and I know there is bipartisan agreement on a number of them, will inform this committee in major ways of what we need to do to extract reforms and make sure that this is not just a profit motivated system, but is in fact focused on patients and the well-being of americans. The solution is not to let these enhanced tax credits expire. We have to buy ourselves time to do these larger reforms.
▶ 1:34:10Sen. Baldwin: What allowing the affordable care act tax credits to expire will do is move people who are currently the 6% of americans who currently buy their insurance in the individual market, they will become uninsured or go for junk plans. We can talk about that later.
▶ 1:34:36Sen. Baldwin: The affordable care act with all of its flaws requires that health insurance plans cover a wide range of preventative services at no cost to the patient. So no matter how big your deductible is, your preventative care is covered under the aca.
▶ 1:34:53Sen. Baldwin: A lot of the wisconsinites I have been talking to who are lamenting the fact that their premiums are doubling, tripling, quadrupling, are saying I get it for the preventive care that I can provide my entire family before dipping into the deductible. Then it is a medical bankruptcy prevention insurance, right?
▶ 1:35:22Sen. Baldwin: It means that if you have a $10,000 deductible but you have a crisis, an injury, an accident, an illness that costs more than that, you will not lose everything. We can definitely improve the aca. We can improve the entire system but the solution is not to let 4 million people not be able to afford it anymore.
▶ 1:35:51Sen. Baldwin: So we must figure out a way to extend the affordable care act tax credits to allow our committee, the mines in this room, to work on structural and systemic reforms. Dr. fegan, why is it so important that we extend the enhanced premium tax credits as soon as possible?
▶ 1:36:18Dr. Fegan: Because people are making those decisions now about whether or not they should keep their health insurance because they realize, we have to recognize that this is a huge financial burden on the household and people are making decisions that maybe I should go without health insurance. It is a huge problem for working-class people because it allows people who otherwise would not have insurance to have insurance.
▶ 1:36:41Dr. Fegan: The idea that they are going to go without, you cannot predict when you are going to have, you feel tired and an abnormal blood test shows you have leukemia. You cannot predict when you will be an automobile accident and subject working people to that stress in addition to everything else that is going on in the country today is frightening.
▶ 1:37:03Chair Cassidy: Thank you, senator baldwin. Senator husted.
▶ 1:37:10Sen. Husted: Thank you Mr. chairman. I appreciate the work you have put in to advance the conversation in a bipartisan way. I know that january 1 whether we say it is 12 days, 30 days, we have a tight bridge. It is interesting to me because if you don't work, you get free health insurance in this country but if you do work, you are getting screwed right now.
▶ 1:37:39Sen. Husted: It is just not fair for people who are trying to do it the right way, who are working. I have a fresh approach to this because I was not here when the aca was created. I was not here when the tax credit subsidies were implemented and scheduled for expiration.
▶ 1:38:01Sen. Husted: But I do see a lot of americans and I've talked to many of them who do not care whether the democrats created the problem or the republicans created the problem. They just want their government to fix it. They just want their government to help them. And we have a few days to prove that we care, that we are going to try.
▶ 1:38:30Sen. Husted: And it is frustrating and I know we can do this. Senator hassan and I had the smart otc act which was a bipartisan effort to make it easier to take prescription drugs and make them over-the-counter drugs and we got that done in the last few weeks. That is one small step. There are a dozen small steps or even moderately successful steps that we can take to reduce the overall cost of healthcare in this country.
▶ 1:39:00Sen. Husted: It is the number one driver of inflation in the 21st century. It is a burden on small businesses and married pairs. I propose a simple start to this, I've called it fraud, freeze and fix.
▶ 1:39:28Sen. Husted: Brands are susceptible to fraud because insurance brokers find the people who do not even know they are being signed up, siphon off hundreds of millions, billions of dollars of money that go to the insurance companies and never actually cover a person. We can fix that. Even if it is just a dollar.
▶ 1:39:50Sen. Husted: To say, I am a real person and this is a real policy and we are going to eliminate the fraud and we can freeze the subsidies where they are right now for a temporary period of time. I don't know if it is one year or two years, to help give some relief. By the way, just because we continue those tax credits does not drive down the cost. It transfers the burden to the taxpayer and future generations.
▶ 1:40:21Sen. Husted: But it is a little help right now that we both can agree on. And then we have to fix it. There are at least five to 10 really solid pieces of legislation that I know have some bipartisan support that we can tackle to prove that we are serious about driving down the overall cost.
▶ 1:40:46Sen. Husted: That's what I hope we will do that is what I hope we will do because there are a lot of people out there -- I talked with a gentleman recently who makes $83,000 per year. He does not want government insurance. He said, but the government created this problem. I have one plan to choose from. That is all I can get in my little rural community. It is going to cost almost one third of his salary to pay for it all. Plus it has a huge deductible.
▶ 1:41:18Sen. Husted: That is what the government did to people. The aca and other things. Again, we can start fresh. We just have to get better. It is going to be one piece at a time. It is going to be a moment of time. And we have a lot of ideas.
▶ 1:41:35Sen. Husted: I know I'm going to run out of my time here to be able to do this but I'm going to introduce the healthy competition for better care act that enables more group health plans and health insurers to ensure agreements to providers to guide for high value providers. Literally we have contracts that people enter into that they say no, you cannot tell people about a better deal. Seriously, that is what we allow in this country.
▶ 1:42:07Sen. Husted: We do not allow real consumers and shopping and healthcare. I guess I'm out of time. How does that sound to you, Mr. white?
▶ 1:42:15Mr. White: Sounds good.
▶ 1:42:19Sen. Husted: Thank you, Mr. chair.
▶ 1:42:22Chair Cassidy: Husted is at the foot of murkowski in terms of milking the clock. Senator kaine.
▶ 1:42:30Sen. Kaine: Thank you, Mr. chair. A lot of agreement about what we need to do. A sense of urgency. A commitment to look longer-term at bigger solutions. Just to tell you the life of a senator, we get a lot of letters. Let me tell you about healthcare letters this year.
▶ 1:42:48Sen. Kaine: One, last year in the period from the beginning of the year to the beginning of december 2024 I got 55,000 pieces of correspondence about healthcare last year. This year in the same period, 144,000 pieces of correspondence about healthcare. Almost triple.
▶ 1:43:09Sen. Kaine: If you examples, a family's coverage will triple in price without the aca subsidies. A couple in richmond virginia, their premiums will double to $220 per month without the extension of the aca enhanced subsidies. A gentleman from frederick, virginia in the northwestern part of the state on a fixed income will be paying $2600 per month if the enhanced subsidies expire.
▶ 1:43:40Sen. Kaine: This is just a small snapshot of 150,000 pieces of correspondence. We missed an opportunity and I just want to put this on the table. The reconciliation bill that was passed at the end of june gave tax cuts to people in the top 1% of american wealth, totaling $1 trillion over 10 years. We gave tax cuts to the top 1% totaling $1 trillion over 10 years.
▶ 1:44:12Sen. Kaine: What would it have cost for us to extend the premium tax subsidies? $350 billion. Not cheap, but one third of the tax cut that we gave to the top 1% of people in this country who did not need a tax cut. We could have given them $650 billion of a tax cut and extended the aca subsidy and that was not the choice.
▶ 1:44:41Sen. Kaine: That's one of the reasons why I voted against the reconciliation bill. We are talking about doing a short-term extension possibly, the tax credit is about $30 billion per year. Two years, 70 billion dollars up against $1 trillion of tax cuts to the wealthiest? We can do this. We should extend the enhanced tax credits for a period of time and then work on the ideas around the table. Let me just focus on ideas.
▶ 1:45:11Sen. Kaine: We want solutions that promote competition and support small businesses and working-class families, that are affordable, that do not pad the pockets of middlemen. I am so frustrated with middlemen. I have two ideas that I will put on the table. Actually, one is for the longer-term discussion. One can be short-term.
▶ 1:45:35Sen. Kaine: Senator bennet and I will soon introduce our medicare choice act which would direct cms to offer a nonprofit insurance plan covering the obamacare essential health benefits. Medicare operates on in that ministry of cost of 1% to 2%. It exists in every zip code in the U.S. it does not have to pay fancy salaries. It does not have to mark it on tv. It is not have to do a return to shareholders or pad peoples pockets.
▶ 1:46:06Sen. Kaine: Policy directed by cms with premiums that would cover the cost of it. But the ability to use premium tax credits to bring the premium down even further would be such an attractive option. We don't want to have just one option available to everybody. So make a public option available. What's wrong? It would promote choice. It would promote competition. It would bring down cost. I recognize this proposal would be part of a long-term solution that is different than the one that senator sanders is talking about.
▶ 1:46:38Sen. Kaine: But these are the kinds of big ideas we should be talking about as we are trying to find a long-term solution. The second one I think is even short, we have already done it. Pbm reform. This committee passed a fantastic bipartisan pbm reform.
▶ 1:46:57Sen. Kaine: I don't like the consolidation of the insurance industry and that huge profit margin that shakes up everybody's costs and I do not like pharmacy benefit managers who do not do any medical research, who do not produce any products. I do not like them charging based on a percentage of the drugs that they are sending out which gives them incentive to not focus on low-cost affordable drugs with the skewed market toward higher cost drugs.
▶ 1:47:28Sen. Kaine: We passed this bill with a 19-2 vote and it was almost taken up at the end of last year and ran out of time. You now. Let's hit some singles on things where we agree. Would pbm reform to be a good idea to the panel?
▶ 1:47:49Dr. Fegan: It is essential.
▶ 1:47:51Mr. White: Absolutely.
▶ 1:47:56Ms. Strouse: I agree however a one-size-fits-all does not solve the problem. There are great pbm's the do the right thing. There are a few.
▶ 1:48:11Sen. Kaine: I'm glad that there is not only agreement here but on the other side. Thanks.
▶ 1:48:15Chair Cassidy: Thank you,. >> thank you, chairman. I just see a great opportunity. The stars are aligned. We share motivations. We recognize the challenge that the cost of healthcare is a major challenge for americans.
▶ 1:48:32Chair Cassidy: Most of us recognize that the aca empowered insurance companies we are sending $150 billion per year to insurance companies and one of our solutions is to take part of that money and add it to an hsa where patients get to make their own choice. If we give patients choices and turn them into consumers again, they are great shoppers. Americans are great shoppers if you give them the opportunity to look at price tags.
▶ 1:49:01Chair Cassidy: Senator sanders mentioned that a medicare for all according to cbo would save $650 billion per year. Putting it in proportion, we are spending $5 million per year right now on healthcare. Our price tags bill would save americans $1 trillion per year. That is according to 40 economists from the west coast, the east coast, the midwest. I even saw people from the southeast with economists.
▶ 1:49:37Chair Cassidy: I did not know that. If the price tax this is so important to go along with giving expanded hsa's. Mr. chairman, I would ask unanimous consent to enter four documents. The first is a letter of support pointing out ways price transparency will lower the cost of healthcare. The second is a letter of support from the national associations of benefits insurance professionals. The third is a letter from the 54 employer groups.
▶ 1:50:06Chair Cassidy: And unions highlighting the importance of passing patients deserve price tags act's. Senator hickenlooper is my cosponsor on the bill. We have eight senators sponsoring it. It is bipartisan. The fourth is a report from the patients rights advocate showing price transparency reducing healthcare costs to more than $1 trillion.
▶ 1:50:27Chair Cassidy: Without objection. >> this is not a single or a double. This is a home run bill. I would just like to ask for some type of a mark on it hopefully sometime this year.
▶ 1:50:40Chair Cassidy: Absolutely. Senator baldwin also echoed that sentiment. There is bipartisan consensus on the need for transparency. >> let's get it done. Probably 86% of the solutions we agree upon. Let's move. The american people need it and they deserve that as well. I will ask Mr. white, what do you feel like the impacts of price tags for consumers would do?
▶ 1:51:08Mr. White: It would be a game changer. Right now we have a system where people don't know what they are buying until after they have bought it, after they get built by the company after they get the care from the doctor. Having that upfront price disclosure is absolutely foundational and critical to getting better market results at a lower cost. In specific markets, within one zip code the price of m.r.I. Can go up by up to seven times.
▶ 1:51:40Mr. White: $500 at one imaging facility. $2500 at another imaging facility and the consumer may not even know that they are getting a bad deal. Disclosing that upfront can absolutely encourage shopping and lower costs.
▶ 1:51:51Sen. Marshall: Especially if you know that the outcomes are better at a less expensive plays. I think hip surgeries are a great example. You might have a hipper placement at a surgical center that is $10,000 and at another hospital it is $50,000. Ms. strouse, let's consumers. Women make 80% of the health care decisions for families. When I was running a hospital, we marketed to women as well.
▶ 1:52:19Sen. Marshall: By giving shoppers price tags and expanding their hsa's whether it was for direct primary care or for preventive medicine, not just the government subsidies, how do you think it impacts the real spend of healthcare?
▶ 1:52:36Ms. Strouse: I think it would have a tremendous thing cap -- tremendous impact. What other plays in the world we buy something without knowing what the actual cost is. We have to make sure that transparency is a big part of that. I think having accounts where people can be in the driver's seat of their own health care is essential. It also makes them more accountable for the choices that they are making. When they are spending the money and they know exactly where it is going, they are going to be more thoughtful about that.
▶ 1:53:04Ms. Strouse: Again, on the preventive, we can give free preventive all day long but if someone is not taking advantage of it, they are not getting the service.
▶ 1:53:14Sen. Marshall: There are great opportunities with expanding healthcare plans across state lines through association healthcare plans. I think amazon and costco is able to offer their members some type of an association health care plan that would help those small businesses as well. I want to briefly circle back to the importance of community health centers. It is the closest thing to medicare for all is expanding these community health centers.
▶ 1:53:39Sen. Marshall: This is going to take funding as well and making america truly healthy again, a more holistic approach. Thank you.
▶ 1:53:46Chair Cassidy: Senator hassan.
▶ 1:53:49Sen. Hassan: Thank you to the chairman and the ranking member for this hearing. Thank you to our witnesses for hearing your expertise. I want to start by echoing what I think we have heard on both sides today which is there is an agreement on things like price transparency, something I have worked on with senator cassidy. On pbm reform. There is a lot of good ideas about ways to lower the overall cost of care.
▶ 1:54:16Sen. Hassan: But we also know that one of the ways you lower the overall cost of care is to make sure that people get the preventive care they need and get their care at the right system. As important as these bipartisan ideas are right now, I want to emphasize and agree with my colleagues who pointed out we have three weeks to solve this. Open enrollment for people who need coverage starting january 1, ends on december 15. If you are waiting for for first covers, it is on jay gray 15th.
▶ 1:54:48Sen. Hassan: We are running out of time. This means we need to do a short expensive -- short-term extension. There are a couple of reforms and I think there is bipartisan agreement we might be able to get to but we need to do that right now and then think about what is next in terms of overall cost reduction. But I also want to make a couple of other points. The pbm reform we are talking about, that was in a bill that was ready to be passed last year until elon musk vetoed it.
▶ 1:55:20Sen. Hassan: One tweet essentially vetoed what was a bipartisan bill. I just think we all have to go back to some of the work we have done and get to it, understanding that it has come to the committee, understanding that it reflects a lot of bipartisan work. The other thing before I get to questions is, I do want to acknowledge how difficult and broken the system is right now.
▶ 1:55:47Sen. Hassan: But also, what it was like before the aca because I think there has been some amnesia. Before the aca, my constituents with pre-consisting -- predicting conditions had no options for insurance. Senator husted said there is only one planned for some of his rule taugt -- rural constituents.
▶ 1:56:14Sen. Hassan: Before the inferable care act put medicare expansion in place which my state adopted on a bipartisan basis, people who needed addiction treatment could not get care. People who did not work enough hours to be counted as a full-time employee, maybe because they had caregiving responsibilities that they were not paid for, could not get coverage but medicaid expansion allowed them, people who were working, to get coverage.
▶ 1:56:47Sen. Hassan: The affordable care act to the point that I just want to emphasize, it covers preventive care at no cost. So I want people to understand that even if you have a high deductible and we do need to bring those deductibles down, you can get preventive lifesaving preventive care because of the affordable care act. That was also not true for a lot of folks before the affordable care act passed.
▶ 1:57:17Sen. Hassan: Now, my office recently heard from one of my constituents named karen who lives in new hampshire. She will have to pay $200 more each month in order to keep her health insurance next year if we don't extend these tax cuts. However, karen's family cannot afford to pay those higher premiums. She cannot afford the extra $200 per month because of the rising cost of groceries, energy and housing. She cannot afford it unless we do something. Dr.
▶ 1:57:45Sen. Hassan: Fegan, what action can congress take to ensure the people like karen and her husband can afford their health insurance on jerry first and have you heard any proposal discussed here today that can lower my constituents premium payments in 2026 which is just four weeks?
▶ 1:58:04Dr. Fegan: The logical thing is to extend these subsidies that currently exist. I can tell you that I have had patients -- I had a nurse's aide who went without insurance and came in with a sore throat she had had for several weeks and it turned out she had inoperable throat cancer but she made that decision.
▶ 1:58:34Sen. Hassan: That is one of the things we are trying to prevent. Before the aca insurance companies could deny pre-existing condition coverage for people with pre-existing conditions. They could also set an arbitrary lifetime limit for patients, meaning they could deny a claim when the limit was reached. At some of the testimony submitted by the other two witnesses today suggest that we should reinstate lifetime limits and health plans, meaning that insurance companies could stop paying for care for a patient with a chronic or pre-existing condition. Dr.
▶ 1:59:01Sen. Hassan: Fegan, can you talk about the dangers of lifetime limits on care?
▶ 1:59:08Dr. Fegan: I can tell you nothing worse then telling a person who has been diagnosed with cancer that they can no longer get insurance for their problems. 56% of our inpatients were unfunded in cook county so it has made a real difference for us.
▶ 1:59:26Sen. Hassan: Thank you very much.
▶ 1:59:28Chair Cassidy: Senator hawley.
▶ 1:59:33Sen. Hawley: Thanks to all the witnesses for being here. I want to start with number that are absolutely unbelievable. The cost of health insurance, the increased health insurance expenditure since 1960's up, I think we have a chart over my shoulder, since 1960 there has been a 2109% increase in the cost of health in the united states healthcare spending. 2109% increase.
▶ 2:00:02Sen. Hawley: Today americans spend more on healthcare than on groceries or housing. This is extraordinary. More than on groceries or housing. 41% of adults in the united states have debt for medical expenses. The recent report found that 31 million americans borrowed money last year to pay for healthcare. 31 million americans. I want to add to some of the testimony that has been offered here today by reading something from a constituent in my state, the same mother from my state of missouri.
▶ 2:00:33Sen. Hawley: She wrote to me recently and said the health insurance coverage for myself and my daughters is showing to be $1500 a month, enough to actually make a mortgage payment. I am a small business owner and wondering how I'm going to be able to afford this. She goes on to say that I thought about just getting insurance for my daughters but I remember the time where I could not afford insurance one year and the doctor and hospital bills were twice as much for cash pairs because they bill you the maximum amount possible.
▶ 2:01:05Sen. Hawley: We should be honest about what we are facing. This is a crisis. I realize that in washington it is treated as a numbers game. It is treated as a white paper to be discussed. But for people at home, they cannot afford to go see a doctor. I am a father of three small children. I cannot imagine what it would be like to say no, I cannot afford it. I can take my kids to the hospital. We are fairly frequent visitors to the hospital. I have two boys.
▶ 2:01:35Sen. Hawley: We are there a fair amount with their various injuries. Thinking about parents in my state or anywhere else saying I think my kid has a broken bone but I cannot go to the hospital. I cannot go to the doctor. I cannot afford it. Millions of americans are saying that. On the subsidies, on the premium tax subsidies, let's be honest. If we don't do something on this issue, if congress does not take action on this issue in the next few weeks, this will be a crisis for 24 million americans and counting.
▶ 2:02:03Sen. Hawley: In my state premiums are already going up between 24% and 50% depending on the region of the state. So we are looking at a massive crisis unless congress acts and asked soon -- acts soon. My messages to the leaders of this body, maybe it is time you lock yourselves in a room and got to a solution because it is not going to be a solution in a couple of weeks to say we just could not get it done, we cannot think of anything.
▶ 2:02:34Sen. Hawley: Better luck next year. If that is the attitude that is being taken in this body, millions will go without healthcare coverage. Let's be honest, millions of americans cannot afford it now, before we hit the cliff. I think it is time to get serious about the crisis that we are facing. We have to take action on the subsidies. As I said for months now, I am open to proposals. I am open to any proposal that will keep the cost down but we have to take action, doing nothing is not a solution.
▶ 2:03:04Sen. Hawley: I have another suggestion to make. And it is a proposal that I would like to introduce today, ambition to subsidies -- in addition to subsidies, why shouldn't we make healthcare tax-free in this country? Why shouldn't we exempt all healthcare from taxes? We did no taxes on tips, no taxes on overtime. How about no taxes on healthcare? If you pay premiums, you ought to be able to deduct that from your taxes.
▶ 2:03:32Sen. Hawley: If you have out-of-pocket medical expenses, you should be able to donate every dollar off of your taxes. You want to lower the cost of healthcare immediately? Do that. No taxes on health care for any american. Then you set an upper limit so you don't have rich people gaming the system. But let's think about working people in this country who cannot afford healthcare. What if we said to them today, we are not going to tax your healthcare costs? Does anybody on the panel have a reaction to that? What do you think, no taxes on healthcare?
▶ 2:04:03Dr. Fegan: It could work. [laughter] people are paying a lot for their healthcare. Working people will look for any advantage that they can get.
▶ 2:04:17Ms. Strouse: Simple answer is yes, anytime you can get a savings on a savings undetected action, absolutely.
▶ 2:04:27Mr. White: Taxes increased costs so eliminating them should lower costs. The people here have to itemize up to 7.5 percent of their income in order to get the same tax benefits that a big company can get. What you are talking about is leveling the playing field for everyone. That makes sense.
▶ 2:04:49Sen. Hawley: In set 7.5% and you have to itemize, let's move it above the line. Let's say you can take that deduction no matter if you are itemizing or not. Let's allow them to take the deduction on the first dollar. That would lower healthcare costs for millions of americans. It is something we should seriously consider. I am out of time. >> you are out of time. Senator hickenlooper.
▶ 2:05:19Sen. Hickenlooper: Thank you. I think all of you for your service in this. Ms. strouse, I will start with you. Some of the ideas you discussed will take us back to the affordable care act, before the affordable care act was passed.
▶ 2:05:44Sen. Hickenlooper: Things like removing the requirement to recall the essential health benefits, prescription drug coverage, mental health treatment. These are things that affect the vast majority of americans. I'm concerned some of the changes could take our nation's medical debt problem that you referred to and make it much worse.
▶ 2:06:11Sen. Hickenlooper: We have more than 20 million americans reporting having some amount of medical debt that hangs over their head. In colorado, that is over 360,000 people. Have you ever actually modeled how are we imposing by time limits and other changes with impact the current medical debt crisis?
▶ 2:06:29Ms. Strouse: Yes, we have information on how quickly as you saw the chart that senator hawley just put up, you can see it. Our cost increased much significantly faster than prior to the aca. When you look at things like that, what we did was we just pulled off the cap on what people can charge. We are seeing $32,000 monthly cost for drugs, cancer drugs.
▶ 2:06:58Ms. Strouse: You are seeing people charging for imaging at a huge amount where before there was some sort of control. I will give you an example. My twins that were born with a neuromuscular disease spent the first few months in the hospital. They each got a hospital bill for $400,000 for one month. We did not even come close to our lifetime maximum. The numbers that you are looking at did not always feed into what that lifetime maximum was.
▶ 2:07:26Ms. Strouse: I never ran across somebody who did not have coverage and I did see very high cost claimants come through that system. Also with the affordable care act I will just give you an example of my own personal. My family is my grandmother plan . We have a 2500 individual that the, $7,500 out-of-pocket maximum. For my family of five in 20 26, our premiums are 1200 block dollars per month.
▶ 2:07:54Ms. Strouse: If I look at a marketplace plan, the same plan that takes my out-of-pocket maximum, it is doubled at 2400 $41. We have a crisis due to the affordable care act regulations. What it did was exactly the opposite. It lined the pockets of all the middlemen and them their own ability to charge and collect income on much higher members with no negotiating happening at all.
▶ 2:08:25Sen. Hickenlooper: That leads me to my next question. Some of the ideas are worthy of our attention and discussion but we will not have time in the next few days to effectuate certain change especially as so many people are seeing their premiums skyrocket.
▶ 2:08:45Sen. Hickenlooper: One proposal is our patients deserve price tags act with senator marshall which really looks at how you create transparency and give people that manage the health plan for a large number of employees the data to really hold the market, create some market competition. Dr.
▶ 2:09:09Sen. Hickenlooper: Fegan, you have seen firsthand the impact of high costs on patients regarding accessing care and prescription drug treatment. Do you believe it is more important for any future legislative work on healthcare reform to include transparency into the operating norm?
▶ 2:09:31Dr. Fegan: I think price transparency is important. I think the people need to understand that healthcare does not behave with normal market forces and people do not have the capacity to shop as we imply for some elected procedure. You could look and see if an m.r.I. Is cheaper here or there but the majority of the time people are making serious health decisions, it is a time of health crisis.
▶ 2:09:59Sen. Hickenlooper: I am not suggesting people shop every time they see a doctor. What I'm suggesting especially with large employers that can actually manage the healthcare of thousands of people, when they can see what hospital is charging versus another for the same thing, they begin to use pressure to make that data available and use it in making decisions on which insurer they are going to use.
▶ 2:10:26Dr. Fegan: I think that is essential. In chicago we have seven medical schools. No one knows what each one is charging. People are charging with the market will bear. We don't know what northwestern charges. Why don't we try this? That would make a difference.
▶ 2:10:44Sen. Hickenlooper: Thank all three of you for being here. >> thank you, senator hickenlooper. They put the most junior member in charge of the gallo. -- gavel. Thank each of you for being here today for taking the time to talk about the skyrocketing premiums we are seeing for all americans.
▶ 2:11:10Sen. Hickenlooper: We are talking about a limited scope in terms of the democratic push structure of subsidies that have been enacted over the last few years but we are really talking about skyrocketing premiums for all americans because I firmly believe that the misguided, ill-informed reckless decisions on some of these things and the allowed fraud, the taxpayer money we are just lighting on fire and giving to bad actors and not going to
▶ 2:11:42Sen. Hickenlooper: Healthcare, has caused this rapid increase in all health care premiums for all americans. I appreciate your time being here today because I think the best way to govern is to roll up our sleeves, talk about the facts, figure out how we got here and how can we fix things. I come from the state of florida. I am really proud of that. The way we govern and lead there.
▶ 2:12:03Sen. Hickenlooper: So much of what we've done is because we are willing to put in the hard work and our answer is not all the time just throw more money at the situation and cross our fingers and hope the problem goes away. It is how do we unravel where things might have gone wrong or put in safeguards to make sure we save money and operate more efficiently. I was really excited to be here as the newest united states senator to bring some of that approach and perspective to D.C.
▶ 2:12:31Sen. Hickenlooper: This is one of the main things that I don't think people can wrap their heads around. How did we get here? In florida, I want to just point out, we are now ground zero for fraud and some of this money that has been pushed out there. I think we should always go back and say taxpayer money. I think it is in many instances because we have a system build with virtually no safeguards, where fraud prevention is an afterthought.
▶ 2:13:01Sen. Hickenlooper: We are wasting taxpayer money when it could be going directly to healthcare. In florida, we are ground zero for this fraud. We had a great congressman, former cfo who lifted nine investigations into subsidy fraud. He says there was less justification for those covid subsidies than there was for signing up for uvber.
▶ 2:13:29Sen. Hickenlooper: We had a federal grand jury in west palm beach who convicted two people for $233 million in obamacare fraud, a scheme that signed up homeless and drug addicts for subsidies and those people got huge kickbacks. There was a convicted in april where a man was defrauded -- were a man defrauded the government, the taxpayers, for over $130 million by fabricating documents for ineligible people to get them signed up for zero dollar plans. It is this example.
▶ 2:13:59Sen. Hickenlooper: I hear time and time again that, let's just keep doing everything the way we have been doing it. That is not responsible. We are not living up to what we have committed to the people who sent us here to do. Yes, let's address skyrocketing premiums. Let's talk about what is the best place, how do we get to making sure we have healthcare and people can afford healthcare in this country. What we are doing is not working.
▶ 2:14:33Sen. Hickenlooper: Causing them. When I hear let's keep doing everything the same I'm thinking is it just me? Is it because I'm new here? That is insane. That is not what we signed up as leaders saying we are here to help the american people. Let's do it the florida way.
▶ 2:14:59Sen. Hickenlooper: Bad actors are taking advantage of this government, taxpayers, and people seeking health care. Vulnerable people are being taken advantage of. I would like to ask you, why is it that we are seeing so much fraud in these subsidies, due zero dollar premiums incentivize fraud?
▶ 2:15:29Mr. White: There are four things that happen. The only place you could use your subsidy is on those expensive plans. And then we said we will send the subsidy to the insurance company, not the person. And then under the enhanced subsidies we said there will be zero dollar premiums. Once you set the premium to zero dollars, that's when fraud took off.
▶ 2:16:00Mr. White: 35% of people had zero claims on their plans. It encouraged the fraudsters because someone is signing up for a plan they don't even know they are being signed up for. That is fraud. There are tools we could use to prevent that fraud. The biggest thing that kicked off that event was the zero dollar premium.
▶ 2:16:29Mr. White: Do something reasonable to get a financial incentive in place to say I'm actually enrolled in this plan. I get a notice like I do with any credit card to say I'm actually enrolled in this plan. I never signed up for this, what is going on here so we could stop that fraud. These subsidies on the table is billions of dollars in fraud loss.
▶ 2:16:56Mr. White: >> thank you for holding this hearing.
▶ 2:17:06Sen. Kim: Thank you for coming out here and talking to us about this important issue. When I was preparing for this I was trying to talk through to some of my constituents in new jersey and here are the challenges they are facing right here and now. I was talking to cindy, she said I received a new premium estimate for 2026. I want you to share them with your team.
▶ 2:17:37Sen. Kim: This year the same plan will cost us approximately $50,000 in increased by 85%. 85 percent increase is half of the average increase we are expected to see in new jersey of 174%. I've heard a lot of these stories across the country.
▶ 2:18:01Sen. Kim: I'm worried about what we will be able to do as a physician and former chief medical officer, I know you have seen firsthand how devastating it is not to have access to care. What kind of choices have you seen your patients make when it comes to health care becoming unaffordable in being able to provide some insights and how many americans will forgo regular visits and what the overall cost would be.
▶ 2:18:34Dr. Fegan: It would be devastating. We are already four years shorter than most. What we see is patients forgo preventative services. Patients don't get mammograms, things that don't hurt, we are treating more advanced stage cancers, more of the cardiovascular disease in
▶ 2:19:05Dr. Fegan: Patients with diabetes. The corporation did a study back in the 70's where they looked at propane and it was as low as $.50 to a dollar. They repeated that study in the early to thousands where they looked at copayments for medications. First they stopped taking their arthritis medicine or they took it once a week.
▶ 2:19:33Dr. Fegan: Next they did their blood pressure medicines where they spread it out every other day. The last thing they stopped was their diabetes medication. When we put that cost between patients and care, they will have shown necessary care just as often as unnecessary care.
▶ 2:19:56Dr. Fegan: There is a high price we play -- pay because of workers who are not able to function at full force.
▶ 2:20:09Sen. Kim: Is it their fault?
▶ 2:20:10Dr. Fegan: Absolutely not.
▶ 2:20:14Sen. Kim: Is it these families fall?
▶ 2:20:15Ms. Strouse: It is the aca and congress.
▶ 2:20:20Sen. Kim: Mr. white?
▶ 2:20:22Mr. White: It is the law and inflation. I very much wanted to be on this committee to try to find bipartisanship in terms of the solution. The challenge I am having, there are lots of different plans out there that we talk about.
▶ 2:20:43Mr. White: Is there something we talk about that could be implemented in the next month that could offset the costs that these families are facing? Is there something here that could be implemented within a month?
▶ 2:20:58Mr. White: Within 2026 there is three things that you could do.
▶ 2:21:06Sen. Kim: I'm asking about the remainder of 2025.
▶ 2:21:11Mr. White: The first thing you should do is fund csr. That was in the one big beautiful bill. The house version that passed.
▶ 2:21:22Sen. Kim: That could be implemented by january 1?
▶ 2:21:24Mr. White: Midyear. You could immediately give those subsidies to consumers through the hsa product. Bronze and catastrophic plans are hsa possible in every section of the country. You could get at least half of it.
▶ 2:21:48Sen. Kim: More importantly they cannot be used for health insurance premiums. Could you explain how that will lower the premium cost?
▶ 2:21:55Mr. White: That would be a fundamental part of that law. The subsidy payments going to those individuals allowing them to use those dollars to pay for premiums.
▶ 2:22:10Sen. Kim: I'm open to exploring different ideas that are out there. All these other people, they will have the rug pulled out from under them. Even if it's not perfect, we will be able to give them some support. I feel like we are playing with other people's chips and they are right. We are not the ones that will be feeling this. I encourage them to figure out how we could help them in the meantime.
▶ 2:22:43Sen. Kim: Chair cassidy if they request a bronze plan they will have a lower premium. If you look at it, for most people on a bronze plan it is less than 8.5% of their income, which is kind of the target we have been shooting for. They get a higher deductible. If you use that subsidy to put into the hsa, the net deductible could be lower. As Mr.
▶ 2:23:10Sen. Kim: White said, we already made those bronze and copper plans eligible, that law is in place. The only difference is you want that subsidy to flow to the patient instead of to the insurance company. Yes you could lower premiums simultaneously under the current law.
▶ 2:23:37Sen. Banks: Thank you. Mr. white, you talk about in your testimony you talk about the rule of hospital consolidations and the lack of competition. You should nationally 97% are not competitive. That is certainly the case in indiana. We have five major hospital networks that control all of the major hospitals in our state.
▶ 2:24:08Sen. Banks: Could you give us more of a background on how that happened, how did they encourage hospital consolidations?
▶ 2:24:16Mr. White: It builds off a long-standing trend. It just accelerated that trend. Basically there are several things happening at the same time.
▶ 2:24:32Mr. White: The big change was the drug discount program available with hospitals providing extra cash to buy up other prison -- physician practices to the point where 40% of doctors work for a hospital. Pharmacies, the biggest thing was the medical loss ratio. It allowed insurers to vertically integrate. Those two factors were the biggest factors.
▶ 2:25:03Mr. White: 97% will say so what. That means prices are higher. Highly concentrated hospital markets, prices increased by 30%. Those prices go straight through to premiums. That's what every americans are paying for. These concentrated markets.
▶ 2:25:31Sen. Banks: Give us ideas to do something about it. In indiana we have a strong health care merger. Our attorney general gets a 90 day advance notice to review all acquisitions, is that a good model or are there other ideas for what we could do to create more competition?
▶ 2:25:53Mr. White: The ftc looking at mergers. It is hard to get the two spaced -- toothpaste back. It's not like a service company that you could break up. I think taking a look at the economic incentives is important. We pay hospitals more for the same service a physician delivers. That should be the same so we don't have these incentives.
▶ 2:26:25Mr. White: On the input cost side there is drug discounts only given to nonprofits. They get lower input costs and higher reimbursement and they use that cash to buy up other entities. Local review boards are more beefy and changes to how hospitals are paid and financed could go a long way towards creating competition.
▶ 2:26:52Mr. White: The last thing I mentioned is what we see in local markets is these most favored nations, the price discount, people and health plans being sent from lower-cost cost higher quality provider. The healthy competition act which jodey arrington introduced would ban these clauses and create free markets that saves $5 billion on those premiums.
▶ 2:27:22Sen. Banks: You have been around the capital for a while. Could be consumed that in your opinion?
▶ 2:27:29Mr. White: That bill is bipartisan. If we have this much competition and empowerment, we need to do something.
▶ 2:27:50Sen. Banks: Walk me through how the community rating works and how changing into a 5-1 breakdown in premiums.
▶ 2:27:58Ms. Strouse: Prior to the aca we had the ability to rate people based on maybe their age and risk. I lived in a state who had a solution for everyone. One of the senators mentioned new hampshire, their state had people uninsured. We didn't have that in the state of iowa.
▶ 2:28:22Ms. Strouse: If you were excluded, we had a high risk pool that could be the high risk place today to help manage some of those things. What we have our individual market previously, the younger population based on their risk they were $120.
▶ 2:28:44Ms. Strouse: When we went to this 3-1 ratio, a 60-year-old and 20-year-old inflated all of the numbers and brought everyone's rates up. That same 20-year-old person now had a $300 monthly premium. These are the people who weren't using the insurance. Maybe they had a few things that were going on. We needed to keep them in the marketplace to keep the rates down.
▶ 2:29:14Ms. Strouse: Which is what we are seeing today on a much bigger scale. People are going completely uninsured because in their minds they think they don't need to have the coverage.
▶ 2:29:30Chair Cassidy: Thank you.
▶ 2:29:32Sen. Blunt-Rochester: We are all here today because health care in america is unaffordable. For families, farmers, small businesses. Two weeks ago I heard it from the delaware chamber of commerce. We have thousands of letters and emails and calls from our constituents. What we are on the precipice of seeing.
▶ 2:30:03Sen. Blunt-Rochester: As we pursue solutions to lower costs for hard-working families, I want to make sure we continue to pull this up as a priority and a sense of urgency that it is. Also remember some of the things that had gone before us so we don't drop some of the positive things. I thought about the fact that 15 years ago a woman could be charged more than a man for health insurance because of their gender.
▶ 2:30:33Sen. Blunt-Rochester: 15 years ago, those with diabetes or even asthma could be denied coverage or charged more because of their pre-existing conditions. I hear that so much. Insurers pose lifetime limits. On what would pay for essential health benefits leaving those with costly conditions exposed to significant financial strain.
▶ 2:31:01Sen. Blunt-Rochester: The aca change those things to ensure millions of people could get access to health care. That doesn't mean it is perfect. That doesn't mean we can't make things more affordable in this country. My concern is some of the proposals, some are really good. I signed on to senator marshall's bill while we were here. That is something I worked on in the house.
▶ 2:31:29Sen. Blunt-Rochester: Some of what is being proposed might lead patients to fend for themselves in an already complicated and overpriced health care system. If doubling or tripling in premiums wasn't bad enough, the trump administration hasn't made it easy for us to stick patients with more cost.
▶ 2:31:51Sen. Blunt-Rochester: In june and administration change the rules that would increase out-of-pocket costs for 160 million americans including people who are covered through their employer. This change would amount to a $900 more per year for a family with significant health needs. The rule would allow aca plans to raise deductibles while covering fewer services. In other words pay more for less.
▶ 2:32:21Sen. Blunt-Rochester: This is currently held up in court. Could you explain how allowing insurers to raise deductibles and other costs might impact individuals with chronic conditions?
▶ 2:32:31Dr. Fegan: I saw patients who would tell me they were worried about the visit. If we scheduled a test for them as well as on the same week that they had a visit I should choose between which was more important. We have a tendency to underestimate how small the charge could be when it comes to managing their care.
▶ 2:32:57Dr. Fegan: The study has shown patients with copayments as low as $.50 or a dollar made poor choices. Patients who make decisions about not getting screened because they can't afford it this week, it's going to interfere with their rent payment or groceries. We saw this on a daily basis.
▶ 2:33:19Sen. Blunt-Rochester: Tomorrow I will be introducing a bill to tackle these issues. My new bill will do four things. First it will prevent premiums from spiking by extending tax credits for three years. It would eliminate redtape and unnecessary paperwork making it easier for busy, working people who want coverage to enroll.
▶ 2:33:50Sen. Blunt-Rochester: It would force insurance companies to be more transparent about eligibility options. It would lower out-of-pocket costs for millions of americans including employer-based coverage. We have talked about different options. I urge my colleagues to look at this legislation.
▶ 2:34:12Sen. Blunt-Rochester: I think the biggest message of nothing else is that we are 12 days away, 12 days away for many americans of seeing the end of open enrollment and them having to make really difficult decisions and feel the impact. My time has run out.
▶ 2:34:40Sen. Blunt-Rochester: We know as a committee in congress act on behalf of the american people. I yield back.
▶ 2:34:47Sen. Alsobrooks: I'm really glad we are actually having this discussion, I have to note the very conversation that we are begging to have before open enrollment. This is not an abstract policy for marylanders.
▶ 2:35:11Sen. Alsobrooks: My constituents calling and writing, so many of them sharing stories with me and have done so across the state about their health care premiums and how they will skyrocket. It is an extreme concern. It feels like we have taken a time machine to a time before the affordable care act reimagined what health care was supposed to look like when patients with pre-existing or chronic conditions were denied outright or priced out of coverage.
▶ 2:35:44Sen. Alsobrooks: Few laws are but more needs to be done to increase affordability and get access to coverage. We should work together on good-faith solutions instead of revisiting what I believe about gutting patient protections at the core and put simply I'm not willing to go back to a time when a family member's cancer diagnosis was a sentence for bankruptcy. I have a few questions.
▶ 2:36:14Sen. Alsobrooks: It's that we know pregnancy dramatically changes a person's calculus and need for health coverage. I introduced a bill that would create a special enrollment period for women to enroll after they became pregnant. Your testimony recommends how to find limited duration insurance plans.
▶ 2:36:40Sen. Alsobrooks: They can if you are on one of those plans prior to being pregnant it will have coverage for you. There is underwriting involved in that. I do think the affordable care act does have a burden on these women who do get pregnant because of some of the restrictions and restraints around when you put enroll. That is something that needs to be looked at.
▶ 2:37:10Sen. Alsobrooks: If there is a pregnancy where maybe they did not have access to health care coverage previously there needs to be limits on it to get them to the next open enrollment date so that way they have to actually enroll and get signed up like they should for that next policy year. There needs to be parameters around it. In that situation we should have different enrollment opportunities.
▶ 2:37:37Sen. Alsobrooks: These short-term plans do not cover a pregnancy. 0% of the ones we look at so far were covered. Just be reminded it costs $30,000. It is so draconian to suggest pregnant women should have to lose half of their salary just to cover the cost of pregnancy.
▶ 2:38:08Sen. Alsobrooks: That is what we are looking at when we talk about going backwards to a short-term plan.
▶ 2:38:13Ms. Strouse: Our insurance division looked at the short-term plans and put additional parameters out there to protect situations like that. If you haven't looked at the iowa plans I would encourage you to do that. This is where each state comes in with their population and has the ability to do something that is right for them. We had a plan that covered everyone regardless of if they had a new diagnosis of cancer.
▶ 2:38:45Ms. Strouse: They have the guaranteed issue. That is the program you should have instituted to ensure the most vulnerable people in society have coverage. This really destroyed our health care.
▶ 2:39:01Sen. Alsobrooks: The vast majority of the country I must point out this is also weighing. We would go back to a time where pregnancy would not be covered. Individuals who have these cancer diagnosis would have either the short-term plan or there would be a limit on how much you could cover. It is the case that we are looking at the situation now.
▶ 2:39:33Sen. Alsobrooks: There is a ceiling on how much of your care could be covered or how much your cystic fibrosis care could be covered. We are looking at a time where we are totally going backwards. I want to be very clear we are asking people to face a time where it is more expensive to be a woman and if you are sick or vulnerable your health care will not be covered.
▶ 2:39:59Dr. Fegan: The maternal mortality rate in this country has gone up. When I went into practice 40 years ago it was less than 10. We are unlike any other country in the world.
▶ 2:40:18Chair Cassidy: Thank you so much. My wife was the assistant surgeon general. It is an absolutely ongoing critical issue. I appreciate this opportunity to discuss the challenges americans are facing to afford health care.
▶ 2:40:45Chair Cassidy: I cannot overlook the irony that president in my republican colleagues are blaming rising costs on the very protections and programs that have helped to make health care more affordable for so many. Just this summer trump and republicans cut $1 trillion from medicaid. 15 million people were stripped off of their health care to give billionaires tax breaks.
▶ 2:41:12Chair Cassidy: Republicans have ignored the taking health care timebomb on expiring aca premium tax credits. Now heading into christmas instead of picking up presence, millions of families are wondering how will they be able to afford to stay healthy when everything doubles or triples next month. In your testimony you described the aca as restricting flexibility and driving up costs.
▶ 2:41:41Chair Cassidy: The reality was health insurers regularly excluded pre-existing conditions. Families were drowning in medical debt. I am a little bit dismayed that you and some of my republican colleagues, chronic conditions we are regularly denied coverage.
▶ 2:42:08Chair Cassidy: The benefit of those recommendations to cut benefits and force families to pick up the tab. As the ranking member of the senate small business committee I appreciate you being here testifying on behalf of millions of small business owners. There was a recent survey that found 87% of small business owners want the aca tax credits to be made permanent.
▶ 2:42:45Chair Cassidy: As a number that touches any polling number. I will tell you why, 10 million small business owners and employees who lie on tax credits are actually going to lose health coverage. That is 10 million small businesses. Right after christmas they lose this benefit.
▶ 2:43:09Chair Cassidy: Those are cool audience -- rotarians. Five weeks from now, four weeks from now. Just absolutely unbelievable. That is a big problem that I have. They are absolutely going to get crushed. You have spent four decades caring for patients.
▶ 2:43:39Chair Cassidy: Some of the republican proposals focus on standing health savings accounts and encouraging people to enroll in junk plans. As you know millions of americans can't even afford to cover an unexpected offense would you say increasing access to hsa is an effective replacement for families who
▶ 2:44:10Chair Cassidy: Will lose their medicaid coverage?
▶ 2:44:16Dr. Fegan: It looks pretty good in the front but is hanging out in the back.
▶ 2:44:29Dr. Fegan: It is the out-of-pocket expenses that they have to shoulder. Because of the high deductibles, because of the high copayments, people make decisions about forgoing care or not getting the test. At the end of the day, they have less care. >> we just have to be realistic about what is going to unfold.
▶ 2:44:59Dr. Fegan: They are about to see the loss of their health insurance are a dramatic increase in their costs. I have one man a native of massachusetts who right now his costs for stage four lung cancer drugs is $30,000 per year. In four weeks it is going to 300,000.
▶ 2:45:28Dr. Fegan: It's going to be 22 million others at dining room tables all across the country on christmas day. We have to solve this problem. We just can't allow it to expire and become a health care catastrophe. Thank you.
▶ 2:45:50Chair Cassidy: With the problems Dr. fegan identifies are the problems with the status quo. If you give somebody a health savings account they actually have first dollar coverage for their deductible for the their co-pay and the net deductible would be less than the status quo. I think that is a misconception that has been repeated several times as a misconception.
▶ 2:46:22Chair Cassidy: With that this concludes the hearing. I think my witnesses for being here. Questions for the record will be due, the tension is building -- at close of business what is
▶ 2:46:53Chair Cassidy: Today? Any senator wishing to ask additional questions may do so by 5:00 p.m., thank you for being here, we are adjourned.