[Congressional Record Volume 164, Number 168 (Wednesday, October 10, 2018)]
[Senate]
[Pages S6749-S6750]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                              S.J. Res. 63

  Ms. MURKOWSKI. Mr. President, just a little bit ago, a few hours ago, 
we had a matter before the Senate relating to S.J. Res. 63. This was a 
resolution of disapproval, which would have worked to disapprove of the 
rule that was issued jointly by the Treasury, Labor, and Health and 
Human Services regarding these short-term, limited duration insurance 
plans.
  I had hoped, actually, to have an opportunity to speak to this prior 
to the vote but was not able to. I want to take just a couple of 
minutes this afternoon to weigh in on this issue from an Alaskan 
perspective. I think there have been some suggestions that with this 
rule in place, those of us who care about protecting those with 
preexisting conditions, somehow or another, are taking these 
protections away.
  I have weighed this carefully. In fairness, I think some of the 
arguments that have been made are, perhaps, not quite as clear cut as 
would be suggested and, perhaps, certainly, in a State like mine, where 
we still have the highest healthcare costs in the country and some of 
the highest costs for coverage in the country.
  I think Members here in the Senate know full well that while I have 
opposed many aspects of the Affordable Care Act, I have supported and 
have strongly supported certain parts of it as well. Again, one of 
those things that I feel very strongly about is the need to ensure that 
we protect those who have preexisting conditions. That is a debate 
that, I think, is ongoing in other places as well. Yet I want to make 
clear that, certainly, my vote this morning is in no way meant to erode 
or undermine where I am coming from when it comes to preexisting 
conditions.
  Back to the situation that we face in Alaska, as I mentioned, we are 
the highest in terms of the cost of care and the highest in terms of 
the cost of coverage, and we are still one of those States that has but 
one insurer on the exchange in Alaska. So our options are, really, 
pretty limited. As I am speaking to individuals about what they are 
hoping for when it comes to coverage, they are looking for additional 
options, but they are looking for affordable options as well.
  It is true--it is absolutely true--that these short-term plans do not 
offer as much or, certainly, may not offer as much in the way of 
coverage as those plans that are offered on the individual exchanges. I 
understand that, but I have had to come down on this issue on the side 
of more choice for consumers and more options being a good thing for 
consumers.
  In Alaska, our population, as one knows, is relatively small. We have 
about 720,000 people in the whole State, but we are talking about 
18,000 people, give or take, who are enrolled on the individual 
exchanges each year. The

[[Page S6750]]

universe here is 18,000 people when we are talking about the exchanges. 
In the year 2016, which was the most recent year about which the IRS 
can give us information, there were about 15,000 people who chose to 
pay the individual mandate penalty rather than to buy the insurance. 
Think about what that means. They are weighing this, and they are 
saying: I would rather pay a fine, pay that penalty. It is not that I 
don't want the insurance, but I cannot afford it.
  So you had 18,000 people on the individual exchanges, and 15,000 
people chose to pay the individual mandate penalty rather than buy the 
insurance. That is because, if an Alaskan does not get the subsidy--and 
a pretty heavy subsidy--the exchange plans just aren't affordable. Even 
though you want to have that coverage--you want that insurance--wanting 
it doesn't necessarily get it to you if you cannot afford it.
  The average premium for plan year 2018--this is according to CMS 
data--is $804 per month. What am I getting from constituents, from 
folks who are writing in to me and calling me? They are telling me what 
they are paying for their plans. For a family of four, the premium was 
over $2,000 a month, with a $7,500 deductible. Think about what that 
actually means for this family, for folks with those kinds of bills, 
who, basically, only have catastrophic coverage, as it is. Again, you 
think about the number of folks on the individual exchanges, and you 
think about those who choose not to pay the fines. You look at the 
numbers of those who receive the subsidies in the State of Alaska, 
which is quite considerable.
  We also have about 10,000 or so Alaskans--this is according to the 
State division of insurance--who have enrolled in healthcare sharing 
ministries. This is yet another option for people out there. A 
significant number has turned to these healthcare sharing ministries, 
and these folks have managed to avoid the penalty in prior years. In 
fairness, some of the ministry plans do not provide much in the way of 
coverage, but it is an indicator of what people feel they have to do in 
the face of just very, very high-cost plans.
  I understand where those who oppose this rule are coming from, and I 
have had good, long conversations about this. I guess I would ask that 
they turn to the realities that we are facing in a State like Alaska 
and just appreciate where people are coming from when you think about 
the 15,000 Alaskans who have chosen not to buy insurance over these 
past few years because it has been too expensive, but they want to have 
something they can afford. These short-term plans, while not ideal--I 
am not suggesting that they are--are an option for them to consider.
  What about the people who don't get subsidies and are paying over 
$50,000 per year before their insurance covers anything? That too is a 
situation in which they are looking for alternatives. So perhaps these 
short-term plans could be a viable option. For the 10,000-some-odd 
people who are currently using a sharing ministry, again, these types 
of plans could be an alternative. For the people who may choose to drop 
off the individual exchanges next year, these plans could be a path 
forward for some having some level of coverage.
  Again, I am not saying that this is perfect, and I am not saying that 
this is ideal. I am saying it offers a limited option in a place in 
which we have very few affordable options to turn to.
  Another reason these shorter term plans are helpful for us and why I 
have heard from so many Alaskans on this is that we are a State in 
which our employment base is very, very seasonal.
  You have a construction industry, but it is not like it is back here. 
Construction is, maybe, 6 months out of the year--longer in some parts 
of the State and shorter in other parts of the State. Yet you have a 
seasonal job.
  Our fishing industry is a great example. If you are working in the 
processing end of fishing, it may be 3 months. If you are working as a 
crabber, it may be 2\1/2\ months. If you are working on a tender up in 
Bristol Bay, it may be a very truncated 2 months.
  Then we have the tourist season. Again, we would like to think that 
we can entice you all to come up year round, but quite honestly, it too 
is very, very seasonal. So we need to have some level of flexibility 
for those many, many Alaskans who move between many of these seasonal 
employment opportunities.
  Under the prior rule, a short-term insurance plan could only last for 
3 months. That is not going to help out, say, those in the fishing or 
in the tourism industry or, again, in so many of these areas in which 
you need longer term coverage but you don't need a full year. So 
flexibility is something that people have been asking for as well. 
Where that sweet spot is, I am not sure. I am telling you that, for us, 
3 months doesn't make it. Maybe 3 years is too long. Maybe we do need 
to look at that. I happen to think that we do, but that is an area that 
is open for review.
  The last point I would make is that I think we have to have some 
trust in both our States as regulators and in individuals, the 
consumers. The rule that we were speaking about this morning really 
does allow States to have a great deal of leeway in regulating at the 
local level. We are seeing that among many of the States. I had a long 
conversation with our director of insurance up in the State of Alaska. 
We talked about where our State might take this and looked again at, 
perhaps, the length of these short-term, limited duration plans and how 
they might be regulated.
  Also, there is the transparency side of this, and this is something 
that concerns me. Some of the things we have heard are that people have 
bought these less expensive plans, these shorter term plans, and then, 
when they need them the most, they realize the coverage doesn't take 
care of them. That is also not a place we want anyone to be. Making 
sure that there is a level of transparency, that there is a level of 
disclosure that is real and not just the tiny boilerplate that nobody 
can understand--it has to be, again, transparent in that way.

  I think this is one of those areas where trusting in our laboratories 
of democracy, which are our States, to tailor plans that fit a State 
well should not be an action that we here in the Senate are so 
unwilling to take.
  As we look to how we do more in this Congress and how we do more to 
help those for whom healthcare--the cost of healthcare and access to 
healthcare--is still their No. 1 issue, still the No. 1 subject of 
discussion, I have come to speak on this particular issue today because 
there are maybe 25,000 people in my State who could see some benefit 
from these types of plans being available and also because I believe 
that trusting the regulators, certainly in my State, to handle the 
plans intelligently is an important part of how we move forward as 
well.
  I wanted to put that on the record today following the discussion 
from earlier this morning and the vote at noon.