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U.S. House Committee Considers Market Approaches to Lower Consumer Costs and Expand Access

March 06, 2019

The U.S. House Energy & Commerce Health Subcommittee reviewed a series of legislative proposals aimed at building on the successes of the current market-based approach to providing health insurance and improving efforts to expand access to coverage and lower consumer costs.

The hearing—Strengthening Our Health Care System:  Legislation to Lower Consumer Costs and Expand Access—focused on three specific pieces of legislation intended to strengthen the framework established by the Affordable Care Act (ACA) by reducing out-of-pocket costs for consumers, enhancing enrollment outreach efforts, and supporting state-based insurance marketplaces. Specifically, the subcommittee discussed the following bills:

  • H.R. 1425, the State Health Care Premium Reduction Act, would provide $10 billion annually to states to establish a state reinsurance program or use the funds to provide financial assistance to reduce out-of-pocket costs for individuals enrolled in qualified health plans. The bill also requires the Centers for Medicare & Medicaid Services to establish and implement a reinsurance program in states that do not apply for federal funding under the bill.
  • H.R.1386, the Expand Navigators’ Resources for Outreach, Learning, and Longevity (ENROLL) Act of 2019 would provide $100 million annually for the federally-facilitated marketplace navigator program. The bill would reinstate the requirement that there be at least two navigator entities in each state and would require the Department of Health and Human Services (HHS) to ensure that navigator grants are awarded to entities with demonstrated capacity to carry out the duties specified in the ACA. The bill would also prohibit HHS from considering whether a navigator entity has demonstrated how it will provide information to individuals relating to association health plans or short-term, limited-duration insurance plans.
  • H.R.1385, the State Allowance for a Variety of Exchanges (SAVE) Act, introduced by New Jersey Congressman Andy Kim and Pennsylvania Congressman Brian Fitzpatrick (R-PA01), would provide states with $200 million in federal funds to establish state-based marketplaces. Under current law, federal funds are no longer available for states to set up state-based marketplaces.

Testimony offered by Peter Lee, Executive Director of Covered California; Audrey Morse Gasteier, Chief of Policy for the Massachusetts Health Connector; and J.P. Wieske, Vice President, State Affairs, for the Council for Affordable Health Coverage spoke to successes and challenges in expanding access to coverage and addressing the affordability of health care. Each of the witnesses drew conclusions from state experiences in managing competitive marketplaces using tools such as reinsurance models and promoting enrollment in affordable coverage.

With intense interest by Congress and the Administration to address affordability, federal policymakers are poised to engage in ongoing policy discussions about the best approach to address coverage and cost. Much of the health care policy attention in the 115th Congress was focused on efforts to repeal and replace the ACA, including ultimately repealing the penalty enforcing the individual mandate, which required all Americans to maintain health insurance coverage. Additionally, many of the steps taken by the Administration over the last two years have undermined the ACA.

On the other end of the political spectrum and policy perspective, U.S. House Democrats and presidential hopefuls have in recent weeks initiated a policy conversation about a “Medicare-for-All,” single-payer framework.

Pennsylvania hospitals support efforts to ensure coverage for all individuals. The framework established under the ACA—which offers subsidized coverage through health care insurance exchanges reflecting the market in each state, combined with expanded access to Medicaid—is the most viable mechanism to expand coverage and reduce costs. 

HAP will be eager to engage with the Pennsylvania Congressional Delegation to inform policy conversations about the best approach to reducing the number of uninsured Pennsylvanians, promoting an affordable and stable insurance market, and continuing to drive toward reforms that improve quality and value for Pennsylvania patients.

If you have questions, please contact Laura Stevens Kent, HAP’s vice president, federal legislative advocacy, or Jeff Bechtel, HAP’s senior vice president, health economics and policy.

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