▶ 0:00:28spe for
▶ 0:02:28St for
▶ 0:03:01I know
▶ 0:05:27yeah all right okay the subcommittee on Health employment labor and pensions will come to order I note that a quorum is present without objection the chair is authorized to call a recess at any time thank you to our Witnesses for joining the subcommittee to discuss today's topic a healthy Workforce expanding access and affordability and employer sponsored healthc care as the committee of jurisdiction
▶ 0:05:58over employer sponsored Healthcare education Workforce committee members understand that employers want what is best for their employees despite not being required to offer health coverage small businesses often choose to do so in order to attract and retain top talent according to nfib 56% of small employers offer health insurance and 89% of small businesses with more than 30 employees offer health benefits as
▶ 0:06:28a small business owner my myself I learned that investing in the health of my employees paid long-term dividends both in productivity and the morale of the company unfortunately it's getting more challenging for businesses of all sizes to offer competitive health care benefits to their employees I have often said that competition is the only way to bring down cost according to the Kaiser Family Foundation premiums for family coverage for employees have increased 7% in each of
▶ 0:06:58the last two years years Rising costs have a disproportionate impact on small businesses as they are less able to absorb the impacts of rising health care cost 94% of small employers find it challenging to manage the cost of their health plans and 98% believe that the cost of their health plans will become unsustainable within this decade the Biden Administration uh Biden Harris administration's inflationary agenda intent on tying the hands of employers with costly and
▶ 0:07:28burdensome regul regulations contributed to the health care cost challenges that small businesses face today fortunately president Trump and House Republicans have common sense solutions to give small businesses flexibility to expand access and affordability affordability to their health care offerings the first solution is expanding access to Associated health plans or ahps an ahp allows employers to band together to purchase health coverage by combining
▶ 0:07:58purchasing power small employers can negotiate more favorable rates the same way that larger employers do in 2018 the Trump Administration finalized a rule that expanded ahp availability to more businesses and to self-employed individuals however this rule was regrettably tied up in the courts and ultimately reversed by the Biden Administration the results speak for themselves while the Trump rule was in effect new ahps produced Savings of up to
▶ 0:08:2829 % on average while realtor ahps like the one Mrs Shields will speak about today saw an average savings of up 15% or 50% Congress should ensure that ahps are a viable option for small businesses and self-employed individuals for years to come which is why it's important for Congress to pass chairman walberg's Association Health Plans act businesses of all sizes can use stop loss or reinsurance to insulate themselves from unexpected
▶ 0:08:59High medical claims however Democrat led states have sought to overregulation classifying these plans as fully insured with the intended result of removing small businesses ability to innovate and contain cost uh Dr under's self-insurance uh protection act would clarify that self-insured plans W uh with reinsurance are still self-insured health plans as we hear in
▶ 0:09:29testimony today the covid-19 pandemic created an opportunity for small businesses to innovate by expanding telea health coverage options chairman Wahlberg's telea health benefit expansion for workers act would return to employers this in this important tool used to expand coverage options in lower cost employers have also innovated by participating in direct contracts with providers removing middlemen and uh bureaucracy and allowing employers to C optimize their
▶ 0:10:00Co coverage options to meet their employees health care needs this hearing will examine expanding businesses uh ability to use Innovative coverage models like direct contracts lastly this committee on a bipartisan basis has historically held Arisa pres uh preemption of State insurance law to be fundamentally important Arisa a pre uh Orissa pre uh preex preemption has allowed self-insured Health Plans the flexibility to design their plans in a way
▶ 0:10:30that works best for over 50 years we look forward to closely uh working uh with the Department of Labor to uh def uh defend Orissa preemption I am hopeful that our Democratic colleagues will work with us to give businesses more options more flexibility and more opportunities to offer high quality affordable coverage to their employees I thank the sub committee members for joining this important discussion and I look forward to our Witnesses expert testimony now yield
▶ 0:11:00to the ranking member for an statement thank thank you Mr chairman I want to thank you for having this hearing uh as you know as soon as we both knew we were going to have these assignments again um I reached out we had a wonderful conversation and as two former small business owners or I'm a former um the gray hair and the white hair came from politics mostly well no owning restaurants probably was worse uh so we've we both met payrolls we've paid for insurance um
▶ 0:11:30I want to really and my hope is uh that while we go into our ideological approaches to this um Zen saying if you do what you've you've always done you get what you've always got that we go through this we could work in a way that seems to me to be completely bipartisan how do we improve efficiently with performance standards the delivery of care and the cost to these this Marketplace for you and I as you stated and for for large employers
▶ 0:12:00clearly if you're a business owner you want to get value out of your insurance and you don't want to have high denials you don't want to have your constit as you said your employees um not being as effective because they're not getting the support that they paid for so my concern is what's happening to the marketplace in this field the previous session uh the previous chair and I we had hearings on pbms what an inefficient part of the healthc Care delivery system we have stories now about private Equity companies going in
▶ 0:12:30and buying out rural hospitals taking out all the assets and leaving and having emergency response people have to take people an hour and 15 minutes to the next nearest hospital as opposed to 15 minutes all of that is a structure that I don't know what the solution is I have my own ideas as you do but it clearly for me is a level of urgency that this committee should really dive into and my respect for you Mr chairman and our collegiality over the years having been in the same class backgrounds um
▶ 0:13:00I think gives me hope that we can approach this in a way that we get good value for the employers the employees and the value includes the cost but also the quality of care and I don't think we're talking enough in this hearing but hopefully in future ones about the quality of care um and then secondarily you know my Um passion about Behavioral Health making sure people have that access but we've also had hearings in the previous session bipartisan hearings about denials and
▶ 0:13:31the the facts about denials are just outrageous I've had doctors tell me all over the country that claims they put in routinely for decades they're now being denied and I have one example in my comments so thank you for this um however I got to start out with a reality that the last uh three months with the current Administration and Doge and Mr musk they have done irreparable harm without analysis uh to the health and safety of American workers and this is is the next part
▶ 0:14:01The Reckless closure of key offices within the Department of Health and Human Services and firing of tens of thousands of essential workers is contrary to the administration's supposed enthusiasm for efficiency you don't take years of experience in any operation private or public and just indiscriminately get rid of them there's value that taxpayers lost by doing this I'm fine with greater efficiency we can always look at that but efficiency all also requires us to look at the current um positive
▶ 0:14:31sides of the delivery of services to me that's the essence of owning a business is problem solving without already already assuming what the solutions are and being open-minded to how we achieve those Solutions the administ the administration of Community Living or ACL which is slated for closure was formed specifically to streamline and bring under one umbrella the various programs in the health and human services department I'd like to submit for the record a letter
▶ 0:15:01signed by more than 450 organizations expressing their dismay over the plan to eliminate the ACL and split its faction functions across three other agencies I'd like to submit this I'd like unanimous consent at this time to submit it for the record with that objection thank you today we could discuss ways to improve access to care through employer sponsored insurance by addressing exorbitant prescription drug cost or unjustified claims denials by large insurance companies
▶ 0:15:32these are challenges we should tackle in light of the fact that last year alone 31 million Americans had to borrow an estimated $74 billion to pay for health care for themselves or family member health care costs is the number one reason for personal bankruptcy in the United States of America that is completely unacceptable instead against this backdrop my congressional Republican colleagues are working to cut Medicaid based on their budget decisions to pay for tax cuts for billionaires and
▶ 0:16:02corporations while we could partner on efforts to expand coverage for all Americans including through employer sponsored Insurance my colleagues unfortunately are press in my opinion are pressing forward on efforts to eliminate health coverage and make health care costs Skyrocket for many people without an analysis of the quality of care in February house the House Majority approved a budget resolution that would give tax cuts to the Richard one 1% with a price tag of over $1.1 trillion
▶ 0:16:33to help pay for this Republicans directed the house in Energy and Commerce Committee to cut 8 88888 $880 billion the nonpartisan Congressional budget office CBO reported last month that there is no way for the majority party to meet their targeted Cuts without forcing the most significant cuts to Medicaid in American history I would like to enter this report into the record and I ask unanimous consent to do so without objection I might add that
▶ 0:17:03the CBO also did a report on the on the tax cuts and their analysis showed that over 85% of the benefits did not trickle down to Americans it went to the top 1% so they in in an age where we have the highest concentration of wealth in the history of the country this tax cut actually made it ex worse that's according to the CBO I challenge my colleagues from across the aisle to hold town halls and list know what their constituents say I've had four in three months say about how much
▶ 0:17:33they rely on Medicaid constituents like Alisa Rio who lives in my district proud to represent and is a parent to children with disabilities she would be irreparably harmed and her children by Reckless cuts Medicaid one in five Americans are covered by Medicaid and they're understandably Furious and afraid that their health is being sacrificed to pay for billionaires tax cuts our priorities have never been clearer Republicans
▶ 0:18:04are fighting to slash Medicaid for millions of people I hope they change their mind and I hope their constituents are telling them not to do that and raise taxes for consumers in ACA plans and dismantle federal agencies that comp combat corporate greed all in order to fund 4 and a half trillion dollars in tax cuts for billionaires and large corporations and also they've just cut the national Institute for health including serious cuts to the American Cancer Institute which we'll talk about
▶ 0:18:34further with Miss Lily on the other hand Democrats have solutions to to take on big Farmer Insurance companies and large corporations and not all of them we support corporations that have social responsibility and want to work with us and expect a profit from those contributions and their efficiencies but unfortunately too many corporations are driving to the to the lowest most common denominator in terms of return on investment without any kind of long-term strategy
▶ 0:19:04for the quality of the product they offer last week we celebrated the 15th anniversary of the Affordable Care Act which dramatically expanded millions of Americans access to Affordable Health Care Congressional Democrats continue to build on this progress with the American Rescue plan Act and the inflation reduction act much more work needs to be done to improve healthc care in this country and make it more affordable however aing aing the services and coverage that so many people so many Americans rely on
▶ 0:19:35is not the way to accomplish those goals I look forward to us working together to increase efficiency and the quality of care in our health care System nothing I think should be more bipartisan in spite of our differences of our approach in order to extend people's lives and the quality of lives for all Americans irrespective of where they live or what their party affiliation is thank you thank you Mr chairman i y back uh thank you Mr Sonia uh pursuit to committ committee
▶ 0:20:05rule HC all members who wish to insert written statements into the record oh sorry uh and without objection the hearing record will remain open for 14 days to allow such statements and other extraneous materials noted during the hearing to be submitted for the official uh hearing record uh now I would like to introduce
▶ 0:20:35our Witnesses I will now turn the introduction of our three distinguished uh turn to the introduction of our three distinguished Witnesses our first witness is Miss Angela Shields the chief executive officer for Tennessee realtors in Nashville Tennessee uh great state and a great City Mrs Shields is testifying on behalf of the National Association of Realtors our second uh witness is Miss Bethany Lily the executive director for public policy at the Leukemia and Lymphoma
▶ 0:21:05Society in Washington DC our last last W witness is Miss Marcy Strauss a partner with capital benefits group in desm AA Mrs Strauss is testifying on behalf of the national Federation of Independent businesses we thank the witnesses for being here today and we look forward to your testimony pursuant to committee rules I would ask ask that you each limit your oral presentation to a three minute three minute summary of your written statement the clock will count down for 3
▶ 0:21:36minutes as committee members have many questions for you and we would like to spend as much time as possible on those questions pursuant to committee rule eight D in committee practice however we will not cut off your testimony until you reach the five minute Mark I would also like to remind the witnesses to be aware of their responsibility to provide accurate information to the subcommittee I will first recognize M shields for your opening statement thank you chairman
▶ 0:22:06Allen ranking member danane and members of the subcommittee thank you for the opportunity to testify on behalf of the National Association of Realtors my name is Angela Shields and I am CEO for the Tennessee realtors in 2019 Tennessee and other realtor associations created an association health plan to provide high quality lowcost health coverage options to our members we succeeded realtor ahps offered
▶ 0:22:36Comprehensive Health Coverage for pre-existing conditions in all 10 ACA essential health benefits our ahps also had lower deductibles and broader provider networks than the ACA we did not negatively affect the AA markets our members are generally older and most most don't obtain their health insurance from the ACA so there was no competition of the few who did leave the
▶ 0:23:06ACA most were older less healthy individuals seeking the lower deductibles and broader networks are ahp offered unfortunately a federal district court overturned the regulation allowing our associations to offer the ahp forcing us to discontinue our plan we were devastated my leadership team and I cared deeply about our members and families
▶ 0:23:37for the past 5 years I have fielded hundreds of calls and emails from Members many with serious conditions I had to explain why we took away their affordable Comprehensive Health Care plans chairman Walberg has introduced the association Health Plan Act which would allow our realtor associations to once again have comprehensive and affordable coverage
▶ 0:24:07we support this bill because it provides a choice which allows self-employed individuals and small businesses to shop around and decide which works best the ACA or ahps I would like to end by saying this the ACA has helped many of our members and we will continue to support the ACA but High deductibles and limited networks make the ACA unworkable for most Nar members ahp
▶ 0:24:37Health coverages offer a VI excuse me offers a viable Insurance option for those members who find the ACA does not work we urge Congress to work together and build on the ahp ACT to provide a choice to self-employed individuals and to small businesses is once again I'd like to thank you for your time and your consideration and I'll be happy to answer any questions that you would like to ask thank you Mrs
▶ 0:25:07Shields I now recognize Mrs Lily for your testimony thank you um and thank you for inviting me to be here today chairman Ellen and ranking member D it's also wonderful to see chair uh chairman Walberg and ranking member Scott um I am delighted to join you today to talk about health insurance and how it does and does not work for patients with blood cancer um my name is Bethany Lily and I serve as the executive director of public policy at the Leukemia and Lymphoma Society where our mission is to cure blood
▶ 0:25:38cancers and improve the quality of life for patients and for their families no one knows when they or someone they love will be diagnosed with a blood cancer but once a diagnosis occurs our patients must often immediately start treatment for some every additional day of delay can reduce their chances of survival for unfortunately this is often the moment when our patients discover that their insurance is far more limited
▶ 0:26:08than they expected it to be the last thing anyone with cancer should be have to think about while undergoing treatment is whether their insurance will or will not cover the health care that they need it is also no longer tenable to ignore the unsustainable growth in the cost of care in this country regardless of whether someone has been diagnosed with cancer or not the cost of health insurance is significantly impacting American pocketbooks costs that patients don't pay directly in co-pays or
▶ 0:26:38deductibles are too often passed back to them in the form of higher premiums insurance companies and public officials respond to efforts to reduce costs by inventing new ways to shift costs back onto the patients who receive care higher deductibles additional non-covered care more prior authorizations and denials increased Co Insurance Rising premiums and more red tape at LLS we have focused on identifying ways to drive down the cost curve
▶ 0:27:08for blood Cancer Care without eroding the underlying quality of health insurance coverage including policies mentioned in my written testimony that have been before the committee in this and previous congresses we are excited to work with the committee to address issues related to denials and appeals to prevent anti-competitive Contracting practices to advance neutral reforms and to limit facility fees I would be remiss if I didn't mention two additional and deep fully impactful issues related to coverage before Congress
▶ 0:27:38this year the reauthorization of the aca's enhanced premium tax credits and preserving access to the Medicaid Program um LLS urges the Congress to take action to extend the tax credits that make ACA coverage more affordable and similarly we are deeply concerned about proposals to cut the Medicaid program that will result in coverage losses now is the time for policy makers to stand up for patients survivors and caregivers by advancing solutions that bend the cost curve without sacrificing
▶ 0:28:08patient care we need bold action in order to make the system sustainable for patients today and in the future and we need to ensure that every one of the approximately 188,000 people who will be diagnosed with a blood cancer this year and every year after that have access to comprehensive high quality and affordable health coverage thank you all for your time and attention to these important issues today LLS looks forward to working with all of you to improve HealthCare coverage for blood cancer patients and I look
▶ 0:28:38forward to taking questions chairman Allen ranking member Danier and members of the subcomittee thank you for the opportunity to testify today my name is Marcy Strauss I'm a small business owner in benefits consultant in De Moine Iowa but more importantly I'm a mom of three amazing kids including twins who are diagnosed with a neuromuscular disease that diagnosis turned my world upside down and
▶ 0:29:08it changed how I see Healthcare it's not just policy issue for me it's personal it's about ensuring that people can access the care they need when it matters most for over 20 years I've worked directly with small employers across Iowa I sit across from family run businesses hearing their fears and frustrations they want to take care of their people they want to be competitive but they're drowning and Rising costs and limited choices in Poke County where I live family premiums for small group plans have gone up 85% in just eight years
▶ 0:29:39for my own family of five we pay $1,100 a month for a pre-aca plan a comparable ACA plan today would cost my family more than $2,100 a month almost double that's simply not sustainable and I can tell you I'm not the exception most small business owners are feeling the strain of rising costs and thinking to themselves how can we stay competitive retain and attract employees and support our teams when we're paying more for Less coverage every day according to the latest nfib
▶ 0:30:10job survey 38% of small employers couldn't fill open jobs this February offering health benefits is one of the only ways we can compete with big companies but 95 94% of owners say it's getting harder to afford so what can Congress do small business owners are resilient and innovative they just need the tools to succeed Congress should Empower small businesses with more choices greater flexibility and better tools to support healthier teams and stronger communities P the self-insurance protection
▶ 0:30:40act self-insurance gives small businesses the freedom to design smarter plans over the last three years one of my two person clients saved 17,500 by moving to a level funded plan Congress should protect small business access to vital tools like stop loss Insurance letting expand Association Health Plans letting small businesses pull together regardless of Industry levels the playing field with big employers and provides more options uh promoting Innovative models such as direct primary care and reference-based pricing
▶ 0:31:11I have employers that have saved over 40% by switching to um a plan with DPC and reference-based pricing um the models lower costs and put consumers back in the driver's seat preserve and expand tella Health tella health is a Lifeline especially in rural community ities and it saves time and money Congress should pass the teleah health benefit expansion for workers act to make this a permanent option under orisa protect Arisa preemption and cut red tape we need clear uniform rules so we can focus on our people
▶ 0:31:41not paperwork finally promote transparency Market consolidation and hidden costs have driven prices up small employers deserve to know what they're paying and why we want to take care of our teams offer strong benefits and build businesses we can be proud of but we need Washington to give us the tools to do that I look forward to working with the committee to accomplish these goals thank you for the opportunity to testify
▶ 0:32:13today uh I will start with my questions uh first um and before I do I'd like to clarify just a few things for the witnesses and for everyone attending uh uh the hearing today uh first uh in at least in my meetings with Elon Musk and his team in our conference meetings uh his team has no authority to hire and fire a single federal employee uh
▶ 0:32:43what they are doing is what I would do in my business they're going in they're analyzing it they're running algorithms they're looking at production how many people it should take and what it takes to run the government uh I would think that any organization uh would would want someone to take a look at that uh unfortunately Congress hadn't been able to do that and that is seriously our responsibility but for what whatever reason politics gets in the way uh and so he's providing a very valuable service to this
▶ 0:33:13country and I think it's I think you know we should be ashamed of demonizing somebody that actually wants to help us get out of a serious serious situation the other thing I would say is this uh they two things that got to happen uh for us to sustain this country uh first is we have to and all the analysts say this we have to reduce government spending by 3% and grow the GDP by 3% if we don't do
▶ 0:33:43this it's unsustainable we have run2 trillion doll deficits long after covid CO's been over for three years and we're still running $2 trillion deficit that is unsustainable no country can our interest on our debt is a trillion dollars the American people need to wake up to this fact there is a way to deal with it first you have to have incentives we have been told by analysts if we don't
▶ 0:34:13pass and extend the tax credits that there will be you know we will lose incentives for businesses to grow their business and to hire more people you have to have incentives to GDP uh and and and so these are just business principles that I learned in my business and I'm sure other folks who have learned in business this is the way to do business now miss Shields getting back to you and self-employed individuals like the Realtors you represent that often struggle
▶ 0:34:43to find a health Affordable Health Care coverage what options do realtors have to obtain coverage thank you Mr chairman my members when we were offering our health healthare plan they had um some options available obviously they had the ACA um they did have our plan at the time that they no longer have many of them that were married were able to obtain through their spouse um and then
▶ 0:35:13frankly we have 15% Nationwide that are not insured at all so that is our biggest concern what we did find was that when we offered our plan they were um comparing our plan to the ACA so some did stay in the ACA the ones that we attracted were the ones that the ACA was just too expensive for them they could not afford it so we were able to save them some cost um they also found our deductibles were a little better and so they made the change
▶ 0:35:44for that particular reason and again back to the spouses they were able to save money sometimes because they were having to pay for their spouse that might not have been insured as well so why are H ahp so important for self-employed individuals Realtors thank you again for that question it's so important because um for many reasons and and I could talk to you all day about it but the ones I would uh highlight is again the deductible savings um many cases we are uh able to keep them with the doctors they're already
▶ 0:36:14using um we do take pre-existing conditions uh and and it just gives them good high quality coverage um we are a plan that uh was ACA compliant we had all 10 of the key essential programs that is required by ACA so we were offering them good coverage yeah not going to understand why anybody would object to that um uh Mr St small employers with fewer than 50 employees are not required to offer health coverage to the employees but many
▶ 0:36:44choose to do so can you discuss the reasons why small employers choose to offer health coverage yes that's a a great question and one that I get a lot um it's because they want to take care of their people they want to take care of communities they want to be also competitive to the large employers that are out there um right now they pay twice as much as a large employer does for health care costs however they are employing the people that they see at church on Sundays that they see on the soccer field
▶ 0:37:14and so these are not just employees to them they are their community and so they want to make sure that they have that opportunity to provide benefits and just as mentioned you know the ACA in Iowa specifically limits um the uh access to network so we only have HMO options within our Marketplace in Iowa which is like most States so in order to offer a group plan you have more flexibility and you can offer more of those National po networks that then have that broader
▶ 0:37:45Network so people are not losing their their coverage and you know there was a promise made in the HCA uh ACA that uh your premiums would go down and what we've done is health employer based health insurance has become so expensive it's actually driving people to Medicaid yes which is you know the problem we have with the mandatory spending issue so uh if we can make customize it make it more affordable obviously
▶ 0:38:15uh we can get these people on great plans and obviously the company has the in and and the impact of this uh coverage uh I mean it's got to be positive in other words the is is coming from the employer and not from the federal government would that be a ab ab absolutely yeah uh you're written testimony and I've got about a minute uh notes how Innovative coverage models such as direct contracts and direct Primary Care allow businesses to lower cost and improved quality what barriers
▶ 0:38:46do small employers face in using these Innovative models and what can Congress do to make it easier for small employers to use these models yeah so um currently when you use direct primary care the there's a subscription or a membership fee that's included um for Access for those plans and they are not HSA qualified um so if you have an FSA plan in or an HSA plan in you don't receive those um tax benefits on those plans uh direct Primary Care also has a
▶ 0:39:16huge impact on outcome of Health Care so typically those employees that are using direct Primary Care have a much higher level of direct access to their provider and so in in the case of maybe diagnosing a chronic disease earlier um those things are going to be caught so there's a lot more advocacy on that side of things so that that for me is a big piece of it is just making sure that those employees and employers can afford to offer those direct primary care options great thank you so much and I'll yield my time
▶ 0:39:46now and uh uh recognize Mr Courtney for your questions thank you uh Mr chairman and thank you uh to the witnesses for your thoughtful testimony uh again I'm also somebody who can say that I spent 20 years as a small employer and um like the chairman and the ranking member um you know definitely acknowledge that there there's realities there in terms of that end of the market that we should always be focused and and working on um last Congress uh as Mr Danier mentioned you
▶ 0:40:16know we actually came together on a bipartisan basis to uh have the transparency and the pharmacy benefit managers uh which again small business community supported strongly because that black box of how prescription drugs are negotiated uh is unacceptable in terms of really trying to make sure that the customer which is businesses who are buying these Health Plans understand um you know where their dollars are going and large companies like Boeing um is part of their contracts
▶ 0:40:46with uh pbms required full transparency and because of that a lot of them didn't bid on their uh their um offering and as a but the ones that did Boeing uh saved millions of dollars because of just the fact that they could be able to see what happened unfortunately the bill was pulled during the lame duck session at the behest of the Trump uh transition team and again speaker Johnson had signed off in terms of the legislation and unfortunately it got withdrawn we're going to start again because that's
▶ 0:41:17getting to the core costs of of healthc care is got to be part of the plan here in terms of how you lower premiums if you don't do that then you everything you're doing is just cost shifting it's whack-a-mole and and that's just not going to work and speaking of moles uh Mr Dan mentioned the the $880 billion cut to to Medicaid which is not a mole that's a like a gorilla that is going to again have Ripple effects to the employer Community
▶ 0:41:48um Mr chairman I have a list of the 50 uh major healthcare provider groups that have come out uh opposed to the $880 billion cut and again it deals with the high-end providers the American Hospital Association Catholic Hospital Association children's uh Health Association physician groups patient groups uh that have all come forward and recognize the devastating impact this is going to have for access to care and I ask that this list be uh U unanimous consent to be added to the record without objection
▶ 0:42:18so again if that goes through you know we're looking again at um you know a a program that provides 40% of the live birth um coverage in America for for babies and and um mothers uh again it's about 40 45% of children are covered some are actually working families because Medicaid and uh provides for coverage again miss uh Lou maybe you can talk about that that you know um that's part of the solution
▶ 0:42:49in terms of helping with small with employers to have options I will say um just to start off that I think having cancer is incredibly expensive anyone in our community who has had cancer can tell you that and for a lot of kids as you said Medicaid is one either their source of coverage or it comes in as a secondary source of coverage when their parents realize exactly how expensive this is going to be um Children's Hospitals across the United States I'm sure they're on your list because they are one of the largest recipients of Medicaid
▶ 0:43:19funding so when our kids end up in these children's hospitals that have the necessary Specialized Care Medicaid is often the program that is picking up the tab there um I will say you know I also think a lot about caregivers um if you are say a mom or a dad who has had a kid diagnosed with cancer and that kid is in the hospital for months or weeks on end you may not be able to maintain your job you may not have access to paid leave you may not be able to do that
▶ 0:43:49and so you also need health insurance if you something were something additionally awful would were to happen you would also need that health insurance and Medicaid also picks up those families um Medicaid is also incredibly important for people with disabilities and many people deal with the long-term implications of having a cancer so for instance um I know you have personal experience with this sir but if you have been through that chemo if you have been through that radiation if you have been through frankly the
▶ 0:44:19the treatments that we still need to develop better options for um those can have really long-term implications on your health and you may need access to long-term services and supports which are only available through the Medicaid Program um and so really Medicaid kind of comes around all cancer patients and really helps um all of that um I will add that I think um in addition to uh caregivers and kids you and people with disabilities you also have a lot of older adults on Medicaid
▶ 0:44:49and that's actually one of the biggest uh populations of people with blood cancer are older adults right thank you I yield back thank you Mr chairman and I want to say thank you to you and uh ranking member D for your flexibility and continuing this hearing today starting a little earlier than we' planned as the schedule's changed but thank you I think it's important hearing
▶ 0:45:20I would also say I I look forward to the apologies that will come out from my Democrat colleagues uh when we find it all worked out that there were no no Medicaid benefit Cuts uh the the unfettered fear-mongering that's going on that people with cancer and everyone else are concerned with unnecessarily I look forward to that and the and the conscious effort to try to declare before the American people that 880
▶ 0:45:50billion dollars of cuts which will cut the entire Medicaid uh funding is is intended uh so we'll see I look forward to that when in fact the president and and leadership in congress have said no Medicaid Cuts I hope that gets out misss thank you for being here uh the Congressional budget office estimates that expanding Association Health Plans will will result in 400,000 uninsured individuals gaining coverage
▶ 0:46:21what are additional advantages of allowing small businesses to band together to offer coverage through AG P thank you um again there's many benefits to allowing these programs one uh you do pick up additional people who had not been insured we've had uh to not to repeat myself but 15% that were uninsured across the entire nation with n AR so we're picking them up secondly we're we have a comprehensive
▶ 0:46:51plan that is U offering great benefits to our members that they were otherwise unable to get uh the cost savings the deductible that is lower and we were able to lower the deductibles for our members um where they were paying for a family $11,000 we were able to bring that down significantly anywhere from 4,000 to 6,000 depending on which plan they picked um and these are high quality plans that were ACA compliant and had all
▶ 0:47:2110 essential pieces in it um they're able to keep their doctors we were um allowing them to um choose uh these planes allowed them to choose their doctors um we also had um where we were allowing pre-existing conditions so it was everything that we were able to provide it was as if you were going to work for a large employer um but it was a plan that they were able to do as
▶ 0:47:51self-employed which for us our job is to offer our members benefit and this was one of the biggest benefits they were asking for so the disruption of the Tennessee Realtors ahp ultimately put people on the unaffordable Care Act again absolutely or or uninsured or uninsured which was basically the same in many cases you had an insurance policy under under unaffordable Care Act but you couldn't use it in in in so many cases right um
▶ 0:48:22we we heard heard terrible stories from members uh particularly when we had to tell them that we had to cancel the program um I had a member who unfortunately has passed since that time um who had everything from heart conditions to uh diabetes and ended up dying from lugaric disease so to have to tell somebody like that that we finally got you on a plan um and then have to tell him we're so sorry but now we have to take it away yeah the cruelty of the courts and the Biden Administration and taking people off a
▶ 0:48:52plant that worked for them which provides insurance coverage when you figure across ination for 85% potentially of our Workforce in small business thank Youk you um Miss Strauss use of teleah Health drastically increased during the pandemic and as a result we saw new and innovative ways of delivering care what feedback did you Reed from workers about increased access to tellah health benefits yeah the tella health benefit was actually pretty significant during that time um and then going
▶ 0:49:22forward people got used to it and the access to care through telea health and so for us what we saw in the state of Iowa was more access to Behavioral Health Providers during that time because um like Iowa like many states have challenges with providers and access to Providers especially in rural communities like Iowa has and so that tah Health piece actually helps to keep people from running into the doctor for things and incurring a cost um a claims cost to that a lot of these things can be done at no cost to the employee
▶ 0:49:52depending on plans and and how these are set up so what also happened with was it actually encouraged people to actually seek that care um because maybe that barrier of getting in to see a provider face to face is gone so tah health is is very significant we'd love to see that continue forward especially on the the health savings accounts qualified plans which saves costs as well and helps Healthcare thank youut I yield back the chairman yields back the chair next recognize is Miss Lee
▶ 0:50:23from Pennsylvania thank you Mr chair um I think I might take just a a a slightly different route and I would like to start by saying that I don't think that we should have Healthcare that's tied to employment in the first place the United States has the largest economy on Earth but we are one of the only wealthy countries we getting sick can bankrupt you and your access to care depends on what kind of job you have or whether you have one at all our current Healthcare System tells people that their worth and their health depends on their specific employment status
▶ 0:50:53in the wake of the Trump Administration and Doge's Reckless Mass fire ings across the federal government is now clearer than ever why trying something as or excuse me as tying something as essential uh as healthc care to a paycheck is harmful we're hearing heartbreaking stories after heartbreaking story about the tens of thousands of people who are waking up one day suddenly unemployed and also suddenly without Health Care a woman about to give birth to twins a man in the middle of chemotherapy we've heard from
▶ 0:51:23a senior desperately needing hip surgery but let's also not forget even those with employer sponsored Insurance can still struggle with healthc care access and affordability often I hear from working families who are underinsured burdened by high out-of-pocket costs skipping appointments or drowning in debt for care that barely meets their needs if they even have coverage it often doesn't go far enough and many are forced to choose between rent or groceries or paying thousands for their life saving medication
▶ 0:51:54Miss Lily based on what you've seen in the blood cancer Community can you speak to the personal and financial effects on patients when they're deny coverage for life-saving care not because of medical judgment but because it's deemed too costly or Prof or not profitable yeah so I would say that this is unfortunately a call we often get to our information and referral center is hi I have insurance but they're saying they're not going to cover this particular service um unfortunately you know the US has led in biomedical research
▶ 0:52:24we have amazing cell and Gene Therapies and those therapies are probably the calls we get the most now is folks being unable to access these Services because they are so expensive I'll also add that this is one of the reasons why Medicaid is so important if we look at deian who was diagnosed with uh blood cancer many years ago she ended up on Medicaid because she could no longer work similar situation for Amanda who lives in Michigan many of our patients end up not being able to work not being able to maintain the coverage and then end
▶ 0:52:54up accessing the Medicaid Program because they are literally too sick to work thank you so unfortunately being denied life-saving care based on cost isn't an exception it's B into the system investigations have uncovered troubling practices by health plans and their corporate uh service providers to conduct arbitrary improper and mass denials of claims a prua investigation found that Signa built a system allowing doctors to instantly reject claims without opening the patient file another investigation
▶ 0:53:24founds how EV core a company contracted by insurers that cover over a 100 million Americans uses a secretive algorithm to drive up denial rates one employee described Executives directing staff to keep a closer eye on guidelines because we're not showing savings this since private insurers often have a duty to maximize profit for shareholders would you agree that a health system designed to maximize care and access for the public would help prevent these kinds of abusive denial practices and better protect patients
▶ 0:53:55I think it would and I think having that transparency that has really been a theme of this hearing so far around what algorithms are being used what are they based on are they being double checked is there a human actually reading the results and saying okay no this is this is all right this makes sense does that human have the right expertise are they if for my patients an oncologist or are they someone else yeah and I just just to say I think that this is exactly why we need universal healthcare
▶ 0:54:25we've spent decades trying to patch a broken system the Affordable Care Act expanded access and curbed some of the worst abuses but to be honest it was a compromise and since then both Democratic and Republican administrations have doubled down on market-based models that hand over more power and profit to corporate actors allowing private Equity firms and hospital conglomerates to tighten their grips on the Health Care system and where do these profits go straight into lobbying and political campaigns that block meaningful
▶ 0:54:55reform that's exactly why we know this Republican Congress this Administration and the billionaires and corporate Lackey won't support the policies working people actually need that's why instead of seeking to bolster our health system they're seeking to cut at least 800 million in funding for Medicaid a life-saving program for our most vulnerable populations including those who found themselves or find themselves recently unemployed we don't need more tweaks we need a system that treats Health Care as a human right not
▶ 0:55:25a job H one that prioritizes savings lives not share hle values we deserve Universal guaranteed health care for all I thank you all so much for your time today and I yield back the gentle lady yields back the chair next recognizes himself for five minutes you know we've been hearing a lot today about Medicaid that was not the purpose of this hearing but I'd like to uh Echo the sentiments of chairman Wahlberg um our Democrat colleagues insist on Miss and repeating their
▶ 0:55:56about Medicaid there are no Medicaid Cuts where do they get the $880 billion figure they keep repeating they get that because that's the total amount that the Energy and Commerce Committee is tasked with savings as we desperately attempt to get our federal budget deficit and debt under control not all of that savings will come of course from from the Medicaid Program much of it will come
▶ 0:56:26from the EV mandate and so on but even if even if $ 800 billion dollar uh came from savings from reforming Medicaid according to the CBO instead of Medicaid spending over the next decade increasing by 2.5 trillion doll it would increase by $1.7 trillion doar only in this city Only in Washington DC is a $1.7 trillion increase a cut but in many ways we there are many ways without cutting
▶ 0:56:57coverage that we can save money on the Medicaid Program and we do badly need to do so we can check eligibility that alone can save hundreds of billions of dollars work requirements can save over hundred billion dollars we know that Democrat states spend twice as much per capita on Medicaid as Republican states we could reform gimmicks used by states to juice their their take from the Medicaid dollar and we can we can
▶ 0:57:27and we can we can eliminate some of these gimmicks no there are no Medicaid Cuts but if we are to preserve Medicaid for the most needy and the most vulnerable we badly need to reform the Medicaid Program um Miss Strauss I appreciated your testimony in support of the self-insurance protection self-insurance allows employers to an offer an alternative to costly one-sized fits-all traditional insurance plans and ObamaCare
▶ 0:57:57plans it can produce long-term Financial savings for employers give flexibility to TA tailor coverage to the needs of their employees and invest in employee Wellness programs reinsurance or stoploss insurance which empowers self-insured employers to enter into these agreements is is critical reinsurance is a Financial Risk Management tool that protects self-insurance employer self-insured employers from catastrophic expens ens es we know that in
▶ 0:58:282022 103 million Americans relied on self-insurance for their health care coverage but since the Obama Administration this alternative has been under attack at the state and federal levels um so that is why this week of course I introduced the self-insurance protection act this bill will protect self-insurance by clarifying that fed Federal Regulators cannot Define stoploss insurance as traditional health insurance which Common Sense dictates
▶ 0:58:59it is not it also prohibits States from regulating stoploss insurance if those regulations make it inaccessible to employers essentially prevents the regulation of self-insurance out of business um Miss Strauss in your written testimony you mentioned that a two employee small business was able to save over $3,500 annually by transforming or transitioning to a level funded plan by purchasing stock loss Insurance um how does this work and
▶ 0:59:29how does this lead to cost savings yeah so um again through Innovation uh what we're seeing here is New Opportunities coming to the table and so when you look at the small group Market that self-funded space is a little different than it would be for these large employers that you know essentially are hundreds of um employees and so there are a lot more protections built around the small employer so then that way you know if for some reason and they come into a self-funded plan and let's say they do
▶ 0:59:59have situations where they have multiple employees dealing with cancer or chronic diseases that might increase those costs they still have protections so there's no runout there's nothing that's going to catch them on the back end so these have really been put together to make sure that it not only protects those employers and employees but it does Al also put them in the driver's seat for their health care so these plans typically what they can do is lower deductibles out of pocket maximums lower those cost shares for office visits um but it
▶ 1:00:29also again gives those employees the opportunity to drive their own health experience and their own health Journey when you have skin in the game and it directly impacts your paycheck you tend to be a little bit more engaged with what's going on so we are seeing you know things being diagnosed a lot sooner and uh better outcomes for employees in these situations well thank you m stuss i yield back um the chair recogniz his ranking member Scott of Virginia
▶ 1:00:59thank thank you Mr chairman uh Mr chairman we've heard a lot about um the deficit I just point out that the Republican budget increases the deficit and adds on to the debt as opposed it's uh compared to doing nothing and remind people that every Democratic president since um uh Kennedy has improved the improved the deficit that they handed that they inherited compared to what they handed over to the Republicans
▶ 1:01:30every Republican president since Nixon is handed over to the Democrats a worse deficit than the one they inherited all without exception and for fear mongering the cblo said you can't cut Energy and Commerce $880 billion programs under that committee without touching Medicaid if they want to end the fear Mar ring all they have to do is identify $880 billion within the jurisdiction of that committee um that does not include Medicaid
▶ 1:02:00and that would put an end to discussion um Miss Shield you indicated that under your plans uh you covered all of the essential benefits that were required under the Affordable Care Act is that right yes sir but that's not required for Associated Health Plans is that right we made a point of making sure that we were covering everything so that we wanted to be uh we wanted to be it was not required under Associated
▶ 1:02:30Health Plans um I honestly would have to uh defer that to my consultant so I I your it's not required under Associated health plans but you did voluntarily now um your plans were done before the before the American Rescue plan act eliminated the cliff at four times poverty that eliminated any subsidies after I guess about $660,000 income for
▶ 1:03:01um when we eliminated that Cliff what did that do to the competitive competitiveness of your plans um Congressman Scott I'm not sure that I have the information to be able to answer that what was the typical policy premium under your plan the typical again they had several plans that they could pick from so it might range um $1,200 a month um depending on if they were getting family added to it it it might add just
▶ 1:03:31a little bit more to it but I'm going to say average uh they were probably around a, to ,100 $1,200 depending on which plan they picked so that'd be over 10,000 12,000 a year it when we eliminated the cliff it meant that the maximum you would pay for family policy would be 8 and a half% of your income which at $100,000 would be which would be very difficult for you to compete with I think the problem we had was that Cliff which
▶ 1:04:02we eliminated in The American Rescue plan and extended in the uh inflation reduction act which um made U Insurance much more affordable for the people in the income range that um Realtors would probably find themselves in the 60 to 100,000 maybe a little more would be much more um much more affordable um Can could could businesses buy
▶ 1:04:32into the Affordable Care Act Miss Shield uh again I'm not familiar with uh the Affordable Care Act in as far as could businesses Buy in but I'm happy to get the information that you need and anybody on the panel answer that you just repeat it real quick so I can make sure I'm understanding it can businesses buy into small businesses by into the Affordable Care Act yes and how does that work because we understand
▶ 1:05:02most businesses don't take advantage of that so there was the shop Market um opportunity and it was not sustainable in most situations and so what was happening was employers were looking at that as an option and recognizing that they had better options outside of that um those those subsidies that have been increased um those some of these employe some of these people that have uh coming from employer plans to get into the marketplace with those subsidies are recognizing
▶ 1:05:32that in that case they actually have less access to providers in the marketplace so they're they're giving something up to get lower premiums the premiums have significantly increased from the very beginning um of the market of the marketplace um Mr chairman um we the Mr Shields indicated that um the benefits on essential benefits were not required and ask unanimous consent to to enter into the record
▶ 1:06:03a um Washington Post article entitled he had short-term health insurance his colonoscopy cost $7,000 because it was not uh included also a statement on behalf of members of a partnership Coalition of organizations um who are opposing um the association Health Plans the tele teleah health benefit expansion and the Self Insurance protection act for the record
▶ 1:06:33without objection so ordered the chair recognizes Mr McKenzie Pennsylvania thank you Mr chair for M Shields participants in your program had a choice to enter into these plans is that correct that's correct they would um do their research to determine if our plan fit them best or if they wanted to go to the ACA or anywhere else and what they experienced was lower premiums and deductibles in this option that's
▶ 1:07:03correct they they had um better prices lower deductibles and as pointed out earlier it may not be necessarily that the price was lower but they had a better plan that fit their needs and so what you're saying is that they were satisfied with their access to the care through these programs absolutely especially the fact that they were able to come in we covered the um previous existing conditions that they had or that um they were able to keep their doctors or for whatever
▶ 1:07:34the necessary reason was so what I'm hearing is that this is a choice that these individuals are choosing they were potentially able to get lower premiums and deductibles and they were satisfied with the care that they were receiving 100% our whole our whole point was to offer it as a benefit so that they had options um because many of them again were not insured and um didn't feel that they had anywhere that they could get the insurance that they needed so when you see that pattern it is astounding that people would
▶ 1:08:04be opposed to giving people a choice to get lower cost health care that they are satisfied with that is astounding to me that somebody would go on the record and say I want to take away Choice from people to get lowcost health care that meets their needs I'll just leave it right there uh so the next thing is uh I want to talk to Miz Strauss and ask about uh small businesses a particularly challenging environment for uh Healthcare
▶ 1:08:34and in our economy today is making sure that small businesses can offer Affordable Health Care to their individuals can you tell me about additional uh Innovative options that you're seeing in this space that meet those needs yeah so we we um routinely talk about the level funded which is the the self-funded plans in that small group Market um with most of our groups um so there there's a little bit more flexibility in that however there are things coming into the market
▶ 1:09:04uh around direct primary care that actually again puts those employees in the driver's seat so we have a program that we um can offer to employers at a a minimum um just a minimal fee on a monthly basis and employees have direct access to a provider team that they can call text email at any time this team not only only um advocates for them in situations where maybe a claim has been denied which agents do all the time and I just had one of those this week so um sometimes those
▶ 1:09:34denied claims are lack of documentation that needs to just be put together um but when we look at these things the whole experience which I think um uh Mr desier had mentioned the quality of care is very challenging a lot of times somebody might get diagnosed with something and just accessing um the next step is very difficult when you have these advocacy programs in place you actually have a team that is not only helping you to navigate that process a lot of times they
▶ 1:10:05have success in getting appointments sooner for these people um they have the ability to look at uh prescriptions and so they can look at a a wide variety of prescriptions in case somebody got prescribed something that's very expensive or not covered they can do that medical management with them um and they also just have a little bit more of a a person in their corner so they know that they can contact this provider team and that team already knows them they know their family members and it and they don't have to take the time out to go
▶ 1:10:35to a doctor that they might only see for 15 minutes to then be sent to a specialist or when you know just out into the Health Care system and so again these are providing that really high level of touch to the employees and it is bringing the claims cost down because these programs do not run them through the insurance program so for these um basic needs that they have those claims don't run through and so when you partner that with a level funded plan or high deductible Health Plan the out-of-pocket costs go down significantly for those members
▶ 1:11:05that are participating in that great well thank you for sharing that with me uh what I would like to close on is that we know we have a broken Health Care system in this country I think everybody up here agrees with that so the question is where do you go next and for me the clear answer is that we want people to innovate we want new options more options available for these individuals it could be Association Health Plans it could be self Insurance it could be teleah Health it could be direct Primary Care it could be anything that we are not even aware
▶ 1:11:35of at this time but the way that we are going to get those Solutions is by getting government out of the way instead of having a one siiz fits-all approach uh which is failing people in many instances I think we need to allow the free market to innovate allow these new options to come online and they can work in tandem with things like Medicare it's it's not or Medicaid it is not a one- siiz fits-all option I think we need an all of the above solution here and so I again uh thank you for your testimony today and these New Alternatives uh that
▶ 1:12:05you have presented that I think we should be in support of thank you and I yield back the gentleman yields now recognize Mr T our ranking member for his questions for five minutes thank you Mr chairman I hope we're still friends um and the comments that have been made by my colleagues about Medicaid I I welcome um we we can stop talking about it if we all have an agreement that what's in the Republican approved budget in terms of the number is not going to happen the way it's described in that um so
▶ 1:12:35I I think apologies are not the right word for my friend Mr Wahlberg I think there's a recognition um that the end product hopefully will be what we can all agree on much like the starting product was from the Senate and through the budget process uh until a certain point where we're reaching consensus um Miss Lily I am a survivor of stage four chronic lipos leukemia I like to tell my friends that I was perfectly healthy until I became a member of Congress when
▶ 1:13:05I was diagnosed with stage four cancer um and then I after that because of my decreased immune system um just running on the M I took a freak fall five years ago at the beginning of covid was rushed to George Washington uh and my doctors there told my kids when they flew out from California that I would die in the next 48 hours so I am have some expertise not because I chose to but because I'm a survivor of the American Health Care system and we do
▶ 1:13:36agree that the United States has we pay the most of any developed country for our Healthcare fifth of the economy looking at people who help pay for that and from a business perspective um clearly this is broken and we have the worst outcomes of any developed country I mean that's a simple state and if i r in a restaurant I was losing money um and I kept borrowing money to prop it up U I wouldn't be in business very long and also if I said I was going to cut my
▶ 1:14:06prices by 25% I was also going to cut a third of my kitchen staff I don't think people would believe me so Miss Lily denials first then I want to talk about the cuts at NIH and ACI uh I've got an example that's not an anomaly where gentleman and again as a consumer I could not have done this without help as you have said Mr Strauss and having been a small business member and I I was a member of nfib back when I
▶ 1:14:36was a republican many years ago um I can barely remember so having had trying to negotiate that so there's denials and as you alluded to there's this the denials before the denials just trying to negotiate the system which isn't just conspiracies or incompetence I had a friend who used to say I used to believe in conspiracies and I until I discovered incompetence in this instance I think it was a combination of both that you alluded to
▶ 1:15:06but in the case of denials one case that stands out to me is a gentleman named Tracy Pike from Illinois father of three had stomach cancer stage four he had all kinds of cases and preceden in in uh let's see Blue Shield of Illinois and Blue Cross of approving the operation and then when he was getting ready to go they denied his the approval he died because he was denied is that an anomal or is that what we're seeing more and more unfortunately it is not
▶ 1:15:36I think it's something that we're seeing more and more as the cost of healthcare is increasing and I'll add that you know I think we had a we testified before the Arisha Arisa advisory committee on this exact issue around denials recently and that's part of my written testimony so I'd refer everyone to that but I will say I think we don't know how many denials occur in employer sponsored insurance we don't have a lot of information and that transparency is kind of the first step in that direction um the office of Inspector General has looked at denials
▶ 1:16:07in both Medicaid managed care and in Medicare Advantage where they are incredibly High um folks don't know they can appeal denials I mean I think that the lack of consumer knowledge is also an incredibly important piece of this um Kaiser Family Foundation kff does sponsor a regular survey of Health and more than 50% of people had no idea they could appeal a denial I want to ask you about the cuts to NIH and ACA I as a survivor of leukemia I wouldn't be here if it wasn't for Investments
▶ 1:16:37over the last 70 years in research in the Department of Defense first off and NIH and ACI what is going to happen chronic CLL is the most common leukemia affects everyone doctor told me if I was diag noosed with this 15 years ago I'd be dead now I have a normal life expectancy times hundreds of thousands Americans what will these cuts that the administration's just done to the department and NIH how will that
▶ 1:17:07affect life expectancy half of cancer treatments in use today were developed by the N NCI the National Institute of cancer we need that research to advance the ball to make sure that we have new treatments and with cuts to that we don't know um America has led in biomedical research for decades and decades and that's why sir you're still alive with us today and I I don't know what will happen we are monitoring this very carefully and very concerned the pill I have in my
▶ 1:17:37pocket that I'll take at 3 in the afternoon was paid for for American taxpayers it's now covered by Johnson and Johnson they charge 500 bucks a pill in this country in Australia was 37 and the EU was 90 when the Biden Administration with us in leadership negotiated those prices it's now $90 so free Market's great but there's got to be some parameters to the free market we live in a mixed market thank you Mr chairman i y back gentleman yields and now I will recognize our
▶ 1:18:08former chairman and current chairman of the Rose committee uh Miss Fox for her questions thank you chairman um Miss truss we often talk of a RIS of preemption as being important for large employers to avoid the complexity of dealing with a patchwork of different insurance regulations across St state lines Why is the risk of preemption also important for small employers yeah that's a great question again it comes down to being treated
▶ 1:18:38equally so small employers are already at a disadvantage so offering them plans that um are regulated by irisa like the self-funded plans um those are just crucial it's just another option another opportunity for them again to be Innovative so we don't want regulations to get in the way when something's working which irisa has worked for a long time thank you very much M truss last Congress the house passed the lower cost more
▶ 1:19:08transparency act which among other things would have required hospitals and insurance companies to publicly list the prices they charge patients how would additional price transparency allow agents in the benefits industry like you to better assist employers and employees as they make Health Care coverage decisions transparency is vital I think we all can agree on that and right now the Health Care system has gotten so
▶ 1:19:38complicated that um it makes it very hard for people to actually be able to manage their health care journey and so um pbms continue to get brought up and I will tell you um it's not only pbms in the pharmacy space there's quite a few St holders that actually impact Pharmacy costs so we need to make sure that we're not only targeting one situation and asking for them to be transparent we need transparency across the board so when we look at things like site neutral payments
▶ 1:20:09um you know those are the things that we're looking at in that space as far as the hospitals and all of the consolidation that's happened um in the rural communities across the country you know it's intriguing to me that there is this battle not to have transparency price transparency obviously we must be on to something if if the um people who should be giving us transparency are not giving us transparency because it it
▶ 1:20:39it's the right thing to do miss Shields as you mentioned in your testimony you were responsible for setting up the association health plan for the Realtors can you discuss in more detail the participation in the ahp you set up and how did this participation compare to the participation in ACA plans thank you for that question um our members were participating in the ACA
▶ 1:21:09we had many that were not insured at all and then we had many members that were getting their insurance from their spouses um if that person happened to be working and of course we did have some on Medicare or Medicaid um when we offered the plan we had done many many surveys and this is something it was a benefit that our members had asked us to offer to them so when we set up the plan we didn't find that it took away necessarily from the ACA what
▶ 1:21:39we found is it was a choice that our members were able to look at to see if it was a benefit for them and their family and so we did have a lot that came to our program because they found that it was either saving the money it was a better deductible rate for them or they were able to have a pre-existing condition that was covered or they were able to keep their doctors or for any other number of reasons the problem that we found back to Mr Scott's point with the um
▶ 1:22:10ACA was that the ones that were in there with a realtor we were talking earlier about people that are unemployed well if you know a realtor they're going to tell you they're unemployed every day they have to get up every day and go find their work and with that you might have an average price or an average income that they make but it's not necessarily something they're going to keep year after year after year they don't get raises like an employee does so what happens is that their income is
▶ 1:22:40is fluctuated the subsidies we were being told is that they would take a subsidy maybe and then end up having to pay it back at the end of the year so they don't necessarily always qualify for those subsidies so it the the cost of the ACA did not always fit them with the the lower cost well thank you very much I think you've done a great job of describing that situation with Realtors from ones I've talked to uh Mr chairman I have a question for
▶ 1:23:10Mr Coleman that I'll enter into the record uh thank you the general yields back and now I'll call on Mr Kosar from Texas for his questions for five minutes thank you I want to focus my time today on something you won't hear much about from my Republican colleagues and frankly I don't think we're hearing enough about in the news but it is what I believe is Donald Trump's most dangerous attack on the rights of working people
▶ 1:23:40thus far last Thursday night president Trump signed an executive order that fundamentally undercuts Union and labor rights that Americans have counted on for a hundred years the exec itive order strips the rights to organize and to bargain away from 1 and a half million federal employees and that's just where he wants to start so for over a hundred years Americans have joined together in unions to fight
▶ 1:24:10to win everything from child labor laws to the minimum wage to the 40-hour work week for over a hundred years unions have Protected Their members and lifted up all American workers for more than a hundred years our unions have empowered Americans to stand up against the greedy and the ultra Rich that try to use our government to take away your money they have stood up against people like Elon Musk who think everyone else was put on Earth to just make them richer
▶ 1:24:41but again Donald Trump at the behest of the ultra Rich has signed this executive order robbing one and a half million Americans of the fundamental right to come together along their co-workers to fight for better wages and better working conditions and if the president is allowed to exploit a loophole in order to end the federal right to bargain that's not where he's going to stop he'll be coming for your right to bargain and to organize
▶ 1:25:12next this attack will not end with these federal workers unless we put a stop to it but let's discuss who Donald Trump is starting with by trying to take away their rights these federal workers are people dedicated to serving the public doctors at the VA food safety inspectors at the Department of Agriculture IRS employees who go after corporations who cheat on their taxes this includes our janitors Food Service workers administrative employees all losing the right to organize and bargain
▶ 1:25:42that workers have fought and bled for and marched for for over a hundred years this executive order is illegal full stop Trump does not have the authority to take bargaining rights away from the workers and it's already being challenged in court but the president is trying to see what he can get away with after stacking the Supreme Court with not just right-wing justices but justices picked by some of the richest people and biggest corporations in the country this committee should be talking about this it should really be the only
▶ 1:26:13thing that this committee on quote the workforce is discussing this week but right now instead we've had kind of a business as usual uh Committee hearing on Healthcare so let's talk about how Trump taking away collective bargaining of Rights impacts Healthcare federal employees will continue to be fired without due process because they don't have Union representation and they'll lose their health care CDC employees that are protecting us from the next pandemic can be fired without the
▶ 1:26:43security of a collective bargaining agreement justice department lawyers Prosecuting things like healthc care fraud can lose their jobs because they're not Trump's political lackies but they've lost protection s in collective bargaining these are real impacts and we should be talking about them so my question uh Mr chairman is whether we can hold a hearing on President Trump's executive order to strip bargaining rights away from 1.5
▶ 1:27:16Americans um this hearing is about employer health care plans uh uh we will take your your uh your question under consideration I appreciate that it would be good for us to talk about since we uh are the folks here that talk about education in the workforce one and a half million Americans losing their right to bargain I can't think of another moment in American history where in just one day that many Americans have lost that basic labor
▶ 1:27:47right so I would request that we have that hearing if we could have it at the next meeting or we could have a hearing about how a trump executive order has gotten rid of the minimum wage for federal contractors or the firing of equal employment opportunity Commissioners who are tasked with stopping discrimination in employment and so Mr chairman thank you for taking it under consideration uh and I will continue to bring up this issue if we don't have a hearing on the fact that one and a half million Americans
▶ 1:28:17just lost their bargaining rights I would be interested in whether the Republican majority is trying to take away bargaining rights from even more you un workers or whether they're thinking about giving those bargaining rights back but we know union members vote both Democratic and Republican as they always have and I just think it's really important for those union members to know whether the Republican majority and president Trump wants to take away their bargaining rights that they've had for over 100 Years thank you the gentleman yields and now
▶ 1:28:47I will uh let's see yeah okay uh so I now I'll call on Mr s for a closing statement yeah all right I want to thank the chairman and I really look forward to I'm happy to work with my colleagues clearly the system has worked um I think if we as people those of us who have own businesses really looked at this in private we could find a solution we could if we were driven by efficiency
▶ 1:29:17and as I said is very clear we pay the highest cost in terms of a percentage of GDP a fifth US GDP compared to the rest of develop world with worse outcomes life expectancy and that's in spite of these huge Investments we know there are inefficiencies we know that pbms no longer serve as any kind of efficient delivery of services we know that taking over hospitals and closing them so that we're restricting competition doesn't help with the quality of care if we want competition
▶ 1:29:47we've got to help incentivize to have that hard infrastructure we need to get young people to be able to go into the field so all of those things um I really have hope and on the Medicaid I I I take I I take my friends at their word however I have to say that in addition to CBO the Kaiser Foundation did an analysis of cbo's analysis and let me just read some of what they said this is from Kaiser Family Foundation a
▶ 1:30:17nonprofit probably the most respected nonprofit when it comes to Healthcare in the United States and I'm proud of the fact that Henry Kaiser started in in the East Bay of California as a major employer during World War II because he wanted he was really the starter of employer employee based Health Care um so Kaiser Family Foundation quote unquote the math is conclusive major cuts to Medicaid are the only way to meet The house's budget
▶ 1:30:49requirements the analysis goes on to say the CBO letter confirmed early expectations finding that over the next 10 years 93% of non-medicare spending in the Energy and Commerce jurisdiction is from the federal share of Medicaid spending 8.2 trillion out of 8.9 trillion an additional 200 billion of federal spunding comes from the children's health insurance program chip some of the committee's remaining
▶ 1:31:19spending in budget neutral and there is and therefore won't cut towards deficit reduction even if Energy and Commerce eliminated all non non-medicaid and ship spending the committee would need to cut federal spending on Medicaid and Ship by well over 700 billion do end quote Mr chairman I would like to ask unanimous consent to submit the Kaiser Family Foundation analysis for the record
▶ 1:31:49without objection and if I could continue just briefly um in terms of efficiencies as two people who met payrolls if we were interested in efficiencies I've often sat here and thought if we just on a bipartisan level followed the recommendations of the inspector generals how much more efficient would government be we pay for them they're experts they're bipartisan they've come in with great recommendations yet what did this Administration do is one of its first act it fired the inspector
▶ 1:32:19generals why wouldn't we just listen to them and act with the seriousness of implementing those plans the problem is not the analysis of the IG it's our failure to act the Congress on efficiencies Elon Musk I've known for a good deal of time I 20 years ago I was visiting the Palo Elta campus talking to the people who ran Tesla I thought it was a good idea I was a republican appointed by Governor Pete Wilson
▶ 1:32:50regulator in those days we wanted to improve under the Cali waiver the Clean Air Act signed by Richard Nixon and then the California Clean Air Act signed by Governor Ronald Reagan we wanted to incentivize this kind of delivery of services the original conception and the Brilliant Minds behind Tesla the computerized system in the battery was not Elon Musk if you want to read a good analysis of this read ludicrous it's a book about how Tesla got formed I've met with Mr musk he once asked me
▶ 1:33:20when I was a chair of the transportation Committee in the state senate he wanted to know why in California uh we couldn't be like Oregon not have a sales tax on cars that cost $100,000 so we could get more of it out at the time I was chair of the budget committee on Health and Human Services we were during the recession we were cutting our social safety net by billions of dollars Democrats with Republicans I told them it's a funny exchange I said I can't comprehend of writing
▶ 1:33:50a bill like that so I've had a relationships often on with the company uh the the plant is many of the people who work in Fremont work live in my district I've been there multiple times um there is a genius I suppose to what's happening there but you have to un look under the hood so to speak to the corporate culture and the corporate culture doesn't work the companies that are coming online internationally for GM were providing that product or
▶ 1:34:20doing it in a competitive way they were late and I wish they had had been earlier but in terms of efficiency just because somebody has a lot of money doesn't mean they are the messenger of efficiency particularly when you're coming from a business model like that to a completely different model and I am completely committed to working with my colleagues to look at efficiencies there's no no excuse for the federal government to have inefficient delivery services
▶ 1:34:50so with that Mr chairman uh for all of our differences uh for you and the chairman of the full committee and it's in our best interest to respect one another and I know we do even when we get heated about some of these things but I think we can fix this system in this subcommittee if we take that approach and the cuts to Medicaid uh putting it in the budget where responsibility goes event inevitably since you're
▶ 1:35:20in the majority what the final numbers are I will respect that division but I think it's completely accurate for us to bring the subject up aggressively because it's in the budget thank you Mr chairman and yo back I thank the ranking member and um uh again I agree with chairman wallberg I can't wait to shine a light on it and uh and show the people of this country uh where the where the money's going you know I served
▶ 1:35:50on the Healthy Future task force and and I ask all the experts to give me a breakdown of where every healthc care dollar is going they couldn't give it to me you know we talked about how complex healthc is they couldn't give it to me we spend $4 trillion in this country on health care and if you think about what Elon Musk said he said we're sending money out that we don't
▶ 1:36:21know that there's no charact there's no characterization on it it's what he calls it I call it code is okay what's this for and I'm talking about here we talk about B's and T's not Millions I'm talking about billions and also who actually approved this or appropriated this to be spent maybe that's the reason the inspector generals got fired uh maybe they weren't
▶ 1:36:51you know doing their job uh um you know uh I mean we've all we're all seeing the list of waste Fraud and Abuse uh that's coming out of this exercise we should be embarrassed about it not defend it I mean we're dealing I mean why a public company wouldn't get away with this their shareholders wouldn't wouldn't aren't the taxpayers shareholders in the federal government they've got stock they got ownership
▶ 1:37:21that's the reason they pay taxes is to be secure and to make sure that their uh dollars are being spent in a in a in a wise way uh which is is is frankly the only way we're going to survive like I said earlier we're running $2 trillion deficits after covid if we were at pre-co spending today we would have a balanced budget because like CBO said revenues would not increase under our tax and jobs
▶ 1:37:51act or revenues are up I dollar you grow the economy you grow revenues you grow GDP you grow revenues uh folks there's a way to do this and there's a way not to do it and somehow we've got to convince each other that okay this is how you get the job done and uh uh and I'm looking forward to that I really am we've learned a lot today uh you know one thing is small businesses need flexibility
▶ 1:38:21and as many tools as possible to combat years of rising health care costs to continue to offer high quality and affordable health care benefits to their employees you know a former president promis the American people if we pass this your premiums are going to go down what happened there should be alarm about that we're just sitting here paying the bill and guess who is paying the bill our children and our grandchildren and future
▶ 1:38:51Generations we should be ashamed came to that Democrats and Republicans share the goal of expanding access to Affordable and high quality Health Care to all Americans and there's a way to do it as we heard from our Witnesses doubling down on big government Health Care is the wrong approach because it takes away choices and increases health care costs for employers and employees the government is not the answer the people are the answer we give this to the people
▶ 1:39:22they'll fix it I look forward to continuing to work with all members of the committee on the Innovative free market Care Solutions we discuss today and with that uh this hearing is adjourned
▶ 1:39:53e