[Congressional Record Volume 165, Number 164 (Thursday, October 17, 2019)]
[Senate]
[Pages S5899-S5900]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS ON JUNE 13, 2019

      By Ms. COLLINS (for herself and Mr. Manchin):
  S. 1868. A bill to provide support to States to establish invisible 
high-risk pool or reinsurance programs; to the Committee on Finance.
  Ms. COLLINS. Mr. President, rising health care costs are a major 
concern for millions of Americans--whether it's expensive health 
insurance premiums, high out-of-pocket expenses, or soaring 
prescription drug costs. In the individual market, where 11.5 million 
Americans who do not have employer-sponsored insurance have to go to 
buy their insurance--including the 78,000 individuals in Maine--
premiums continue to rise exponentially.
  With this in mind, I am introducing the Premium Reduction Act of 2019 
with my good friend and colleague, Senator Joe Manchin. Leading health 
care experts at Oliver Wyman indicate that our legislation would lower 
average health insurance premiums for consumers in the individual 
market by as much as 30 percent. In addition, more than a million more 
individuals would have health insurance that they now lack.
  Data from the Kaiser Family Foundation show premiums for the 
benchmark ``silver'' plans under the Affordable Care Act (ACA) are 
nearly 75 percent higher than they were when the ACA went ``live'' in 
2014. While individuals who are eligible for the ACA's premium tax 
credits are shielded from these increases, the price of these silver 
plans is out of reach for many who are not eligible for these tax 
credits. Even ``bronze plans''--the lowest cost individual market 
policies available through the ACA exchanges--have become unaffordable 
for those without subsidies. Bronze plan premiums have gone up so much 
that they now exceed those charged for silver plans in 2014, despite 
the fact that these bronze policies have far higher deductibles and 
out-of-pocket expenses.
  Individuals who make 400 percent or less of the federal poverty level 
get a federal tax credit to help defray the monthly premium cost. But 
individuals who make just one dollar over that level get no help at 
all, and must pay the full premium on their own. These premiums are 
simply unaffordable for middle-income families.
  The difference in premiums is shocking for many families. For 
example, in Aroostook County, Maine, a 60 year-old couple enrolled in a 
silver plan will pay about $6,500 for coverage if they earn 400 percent 
or less of the federal poverty level: in other words, as long as they 
earn less than roughly $66,000. But if they earn just a dollar more, 
they will lose their eligibility for a premium tax credit, and will 
have to pay the entire premium themselves--an incredible $36,500!
  One step Congress could take to help alleviate the rising cost of 
premiums in the individual health insurance markets is to provide 
States with additional flexibility and support to design State-based 
stabilization programs that would help offset the costs of covering 
consumers with high medical expenses. Once these costs are covered, the 
premiums needed to provide insurance to the rest of the population can 
be set at a much lower level. Thus far, seven states--Maine, Alaska, 
Maryland, Minnesota, New Jersey, Oregon, and Wisconsin--have 
established such programs. According to the health care experts at 
Avalere, the programs in these seven states have reduced premiums in 
the individual market by 20 percent compared to what they otherwise 
would have been, and saved the federal government nearly $1 billion in 
funding in the first year, which was returned to the states in the form 
of ``pass through'' funding.
  Under the Premium Reduction Act, $5 billion would be available 
annually over three years to support states that operate stabilization 
programs under section 1332 of the Affordable Care Act. In addition, 
$500 million is provided to assist states with planning the design of 
their own stabilization program, and there is a ``federal fallback'' 
for 2021 to give states time to apply for waivers under section 1332. 
It is important to note that our proposal does not change in any way 
the ACA's essential benefits requirements or its protections for 
individuals with pre-existing conditions.
  The bill provides three options for expedited review so that states 
could quickly stand-up their own programs using the existing waiver 
process under section 1332 of the Affordable Care Act:
  First, a state can demonstrate that their program is an ``invisible 
high-risk pool'' in keeping with the design pioneered by Maine early in 
this decade and used as a template by Alaska more recently;
  Second, a state can show that its program fits within the parameters 
of the ACA's transitional reinsurance program, which expired at the end 
of 2016; or
  Third, a state can submit what can be described as a ``copycat'' 
application based on another state's program that has already received 
approval.
  In lieu of these three expedited approval options, a state may seek 
approval of a program of their own design. Regardless of the option 
they select, all states operating qualifying stabilization programs 
would be eligible to receive an allocation from the funding provided by 
the bill. States may also add funds from other sources to the mix.
  In addition, in 2021, states that do not wish to establish their own 
stabilization program may instead receive funding through the ``federal 
fallback'' that I described a few moments ago.
  Finally, the bill would also extend the section 1332 ``feedback 
effect'' to states that receive funding through the federal fallback 
provision. This will ensure that the benefits of lower premiums are 
felt in all states as quickly as possible, giving states ample time to 
seek and obtain approval of their own programs under the waiver 
process.
  In a recent letter to me endorsing our bill, the National Association 
of Insurance Commissioners stressed that ``[alction must be taken to 
make coverage more affordable or we will see even higher uninsured 
rates, more people move to less regulated plans, and sicker individual 
market pools.'' The NAIC's letter goes on to note the success of 
stabilization programs at the state level, stating that such programs 
are ``a cost-effective way to significantly reduce individual market 
premiums'' that can expand coverage and make it more affordable 
unsubsidized individuals and families. The NAIC closed its letter with 
a call to implement such programs nationwide.
  Also, a consortium of health care providers, insurers, and 
stakeholders--joined by the U.S. Chamber of Commerce--circulated a 
letter recently to Senate and House leadership urging them to adopt a 
proposal like the one we are introducing as a ``commonsense solution to 
significantly lower premiums.'' In their letter, they stressed that 
premium reduction programs can ``help cover the costs of people with 
significant health care needs and improve the affordability of health 
care coverage,'' especially for those who are not eligible for 
subsidies.

[[Page S5900]]

  Mr. President, I ask that these letters be entered into the Record 
immediately after my remarks.
  Efforts at further reform of America's health care system have been 
the source of frustration and division in this chamber. At the same 
time, many members of both parties are committed to reducing health 
care costs and expanding access to quality, affordable coverage. The 
programs adopted by seven pioneering states have a proven track-record 
in reducing premiums for consumers and would make policies in the 
individual market more affordable. The bill Senator Manchin and I are 
introducing today would help extend and fund these successful models to 
every state that chooses to participate, helping to reduce premiums for 
the 11.5 million Americans who get their insurance in the individual 
market nationwide. I urge my colleagues to support our bill.

                                                     May 28, 2019.
       Dear Leaders McConnell and Schumer, Speaker Pelosi and 
     Leader McCarthy: As providers of health care and coverage to 
     hundreds of millions of Americans, we write to you to urge 
     prompt action to lower health insurance premiums. The 
     individual market is a critical source of coverage for 
     millions of Americans, helping them to access care. 
     Unfortunately, however, individual market premiums are often 
     unaffordable for many middle class families who do not 
     receive any financial assistance. With health insurers 
     finalizing their premium rates for 2020, the time is now for 
     Congress to establish a premium reduction/reinsurance program 
     to help cover the costs of people with significant health 
     care needs and improve the affordability of health care 
     coverage.
       A reinsurance program is a commonsense solution to 
     significantly lower premiums, which would greatly improve 
     access to coverage and care. Independent analyses, including 
     ones by Oliver Wyman and Avalere Health, show that a premium 
     reduction/reinsurance program could reduce premiums by up to 
     20% while preserving the comprehensiveness of coverage, 
     primarily helping those who are not subsidy eligible.
       We understand that there are numerous efforts in Congress 
     underway to establish a premium reduction/reinsurance 
     program, and we are happy to work with all parties towards a 
     final bill that will improve the individual market for 2020 
     and beyond.
       We urge you to deliver on the promise to reduce premiums 
     for millions of deserving Americans and their families so 
     they can access the care they need. We look forward to 
     working with you in support of this promise.
           Sincerely,
     America's Health Insurance Plans.
     American Academy of Family Physicians.
     American Benefits Council.
     American Hospital Association.
     American Medical Association.
     Blue Cross Blue Shield Association.
     Federation of American Hospitals.
     U.S. Chamber of Commerce.
                                  ____

         National Association of Insurance Commissioners and The 
           Center for Insurance Policy and Research,
                                                    June 12, 2019.
     Hon. Susan Collins,
     Senator, U.S. Senate,
     Washington, DC.
       Dear Senator Collins: On behalf of the members of the 
     National Association of Insurance Commissioners (NAIC) we 
     write to express our support for your continued efforts to 
     help improve the individual health insurance markets in our 
     states through the funding of state stabilization programs.
       While many states have seen more stable premium rates and 
     carrier participation over the past two years, the fact 
     remains that in all states premiums continue to be 
     significant for those who do not receive federal subsidies. 
     This has resulted in shrinking individual markets and less 
     stable risk pools. Action must be taken to make coverage more 
     affordable or we will see even higher uninsured rates, more 
     people move to less-regulated plans, and sicker individual 
     market pools.
       This is why commissioners from across the political 
     spectrum have contacted their congressional delegations, 
     testified before House and Senate committees, and urged 
     federal policymakers to take immediate action to stabilize 
     the individual health insurance market. In particular, we 
     support your proposal to provide federal funding for state 
     stabilization programs, as well as for grants to help states 
     develop innovative solutions through Section 1332 waivers. We 
     also support the creation of a federal program to assist 
     consumers in states unable to implement their own program 
     quickly.
       State reinsurance programs and invisible high-risk pools 
     have already proven their effectiveness. According to a 
     recent Avalere study, the seven states that have already 
     implemented a program through a Section 1332 waiver using 
     state funds have reduced premium by almost 20%. Additional 
     federal funding, as outlined in your bill, would provide even 
     more benefit to consumers, and extend the benefits to all 
     states.
       Creating a federal market stabilization program is a cost-
     effective way to significantly reduce individual market 
     premiums, thus making coverage more affordable to 
     unsubsidized individuals and families and growing the 
     individual market pool. We have seen it work in the handful 
     of states that have implemented such programs; it is time to 
     implement it nationwide.
           Sincerely,
     Eric A. Cioppa,
       NAIC President, Superintendent, Maine Bureau of Insurance.
     Raymond G. Farmer,
       NAIC President-Elect, Director, South Carolina Department 
     of Insurance.
     David Altmaier,
       NAIC Vice President, Commissioner, Florida Office of 
     Insurance.
     Dean L. Cameron,
       NAIC Secretary-Treasurer, Director, Regulation Idaho 
     Department of Insurance.

                          ____________________