Everywhere you turn, health markets are nearing collapse. It’s an unfortunate and catastrophic reality of too much federal intervention in our health care. From soaring deductibles and skyrocketing premiums to fleeing insurers, it’s no wonder patients are paying more out of pocket each year under the so-called “Affordable Care Act.”
Today, the Energy and Commerce Committee’s Health Subcommittee will examine four legislative solutions to help deliver relief. Together, the bills will play an important role in being among the first bricks placed in the rebuilding of our health care system. Collectively, they will give patients relief from the law’s soaring costs, tighten enrollment gaps, and protect taxpayers.
Obamacare artificially restricted premiums for older Americans to no more than three times what is charged younger Americans in the individual market. This arbitrary cost shift flew in the face of the market where the cost of health care for older adults cost an average of 4.8 times that of healthier, younger patients. This one change dramatically increased the premiums for young people who in turn decided they were being forced to buy plans they couldn’t and probably wouldn’t use much. Pricing healthier adults out of the markets contributes to higher out-of-pocket costs for everyone.
Rather than settling for this arbitrary, actuarially unstable system, Rep. Larry Bucshon, a heart surgeon, introduced H.R. 708, the State Age Rating Flexibility Act of 2017, to return control to the states by allowing them to set the ratio for their unique populations or a standard 5:1, which better reflects the true costs of care. This flexibility will allow young, healthy patients to join the health insurance marketplace, which will, in turn, stabilize risk pools, allow insurers to offer patients more options, breed competition, and drive down costs for everyone.
Additionally, under current law and the rules implemented during the Obama administration, certain patients are allowed to enter HealthCare.gov and state exchanges outside of the defined Open Enrollment Period. Special Enrollment Periods (SEPs) are an important tool for patients who may lose health insurance outside of the traditional OEP or experience a life event — like moving, having or adopting a child, or getting married. Currently, the administration is required to verify documentation for individuals enrolling with SEPs. However, the administration allows for coverage without verification. H.R. 706, the Plan Verification and Fairness Act, authored by Rep. Blackburn, offers this simple solution and necessitates verification for individuals who wish to enroll under SEPs. This measure is another tool to help provide short-term stabilization of the individual insurance market while we work on additional, longer-term solutions to rebuild health markets.
When it comes to exchange plan enrollment, Obamacare ignored state laws and extended the grace period for premium delinquency to three months before any enrollee’s coverage ends. As a result, there’s mounting concern that a significant amount of people have gamed the system by signing up and receiving care, but never paying for the premium. Can you imagine what would happen if that were applied to auto insurance or homeowner’s insurance?
A growing population of exchange enrollees are using this provision as a loophole to game the system to get free health care while driving up costs for those who rightfully pay their monthly premiums. This abuse creates an imbalance in the risk pool which drives up the cost of coverage in the form of higher premiums for everyone else. H.R. 710, the Health Coverage State Flexibility Act of 2017, authored by Rep. Bill Flores, closes this loophole and provides premium relief for hardworking Americans by changing the length of the grace period back to state law, or one month.
Finally, we’ll consider legislation ensuring patients with pre-existing conditions are not denied coverage or care. This is about fairness. The Preexisting Conditions Protection and Continuous Coverage Incentive Act of 2017, authored by Chairman Greg Walden, will prioritize and protect patients with pre-existing conditions. For too long, patients with pre-existing conditions were turned away. As we move forward on legislative solutions, this provision will be a key component. It’s a necessary step in increasing the accessibility of quality, affordable health care that works all Americans. And it’s a longstanding Republican principle packaged into a range of alternative plans.
Today’s hearing is an important step in both the repeal of Obamacare and how we move toward a patient-first health care system. Critical work lies ahead, and today’s discussion will help piece together the solutions that families trust — knowing we are working for them.
Health care is a priority for this Congress and this committee, and we are committed to doing it right.
Reps. Larry Bucshon (R-Ind.), Marsha Blackburn (R-Tenn.), Bill Flores (R-Texas), and Greg Walden (R-Ore.) are members of the House Energy and Commerce Committee.
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