The Senate Committee on Health, Education, Labor, and Pensions (HELP) conducted its third hearing today, offering testimony of 5 advocates for state flexibility: Governor Michael O. Leavitt (R-Utah), Allison Leigh O’Toole, CEO at MNsure, Tarren Bragdon, CEO at the Foundation for Government Accountability, Bernard J. Tyson, Chairman and CEO at Kaiser Foundation Hospitals and Health Plan, Inc., and Tammy Tomczyk, Senior Principal and Consulting Actuary at Oliver Wyman.
With extensive experience in helping states offer insurance and addressing concerns around rising costs and healthcare accessibility, each witness shed light into innovate ways of addressing concerns within the individual health insurance market.
“States and the federal government see the word flexibility differently,” opened Govenor Leavitt. Advocating for national standards and state solutions, Govenor Leavitt suggested the need for the federal government to establish new guardrails and allow the states to determine their own solutions. Additionally, recommendations which would alter the 1332 waiver process was provided. This includes the Departments of Health and Human Services (HHS) establishing a waiver menu in which states can rely on being approved for, the conversion of 1115 and 1332 waivers, and modifications of budget neutrality under the waiver.
Ms. O’Toole highlighted the success of MNsure, which has a 96% insured rate – a record in the state of Minnesota. Despite this, O’Toole highlighted the numerous challenges her state has overcome. “…We are very proud of that,” she added. According to her testimony, this was achieved through working with both trusted partners and brokers with strong ties to the community. She also alluded that being a state-run Exchange offered numerous benefits, such as providing consumers extra time to enroll. She urged for action on the federal level, sharing 3 recommendations: provide permanent funding for CSR payments to provide certainty, establish a long-term reinsurance program which will be more sustainable than state funded program, and to continue to provide states with flexibility via 1332 waivers. Using these waivers, she suggested that states will be in a better position to establish creative solutions to provide consumers with affordable coverage options.
Highlighting Maine’s success, Tarren Bragdon recommended the Committee implement invisible risk sharing as a measure of providing those with pre-existing conditions financial relief. Essentially, this would be invisible to those who are sick but would reduce premiums for all, as in the case of Maine. Citing the state’s success, Bragdon explained how the state lowered premiums by 70% and increased enrollment by 13% over the course of 18-months. According to his testimony, Milliman estimates that implementing this at the federal level would cost approximately 3-5 billion dollars. His recommendation, have the federal government jump start the program and transfer it to the states after 2-3 years. Other recommendations included providing a reasonable timeline for 1332 waiver approval, 1332 waiver guardrails, more flexible options for states, and bipartisan reforms that would reduce the cost of coverage for consumers.
There are two important laws for the health and well-being of the American people, suggested Bernard Tyson in his testimony when referencing the Social Security Act that established Medicare and Medicaid and the Affordable Care Act. “I remain optimistic,” he stated when speaking to a future state where all have access to health insurance coverage. To stabilize the market, he believes the government and the marketplaces must work together, and reform must be taken of our healthcare delivery system to improve both coverage quality and accessibility. Among his recommendations; multi-year funding of CSR, promote and increase consumer protections; preserve the individual mandate; support consumer outreach; repeal the health insurance tax; and demand that insurers “step up to the plate.”
Tammy Tomczyk examined Alaska’s 1332 waiver success. Suggesting the early signs of success, she advised how premium increases have dropped from 42% to close to 7%, and explained that the state’s sole insurer has requested a 20% decrease for 2018. Her recommendations included coordinating the 1115 waivers with 1332 waivers, strengthening the definitions of essential health benefits (EHB), providing more flexibility on plan design to permit value based designs, and new provisions of the ACA.
The final HELP hearing scheduled for Thursday September 14. During this time, members of the Committee will hear testimonies from Health Care Stakeholders; this will be made available for public viewing via a live feed.
A recap of the HELP hearing’s first and second hearings are available on our blog:
- Senate Hearings Day 1: State Insurance Commissioners Testify
- Senate Hearings Day 2: U.S. Governors Offer Recommendations
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