Despite some criticism of health insurance companies from the usual Senate suspects, an Affordable Care Act hearing focused less on partisan politics than it did on finding concrete solutions to stabilize the marketplaces.
Five governors from both sides of the aisle found common ground—and urged Congress to do the same in testimony before the Senate Health, Education, Labor and Pensions committee this morning.
On the Republican side, Massachusetts Gov. Charlie Baker, Tennessee Gov. Bill Haslam and Utah's Gary Herbert testified. Weighing in for the Democrats: Montana Gov. Steve Bullock and Colorado's John Hickenlooper.
"If you’re earnest about adding stability to system and individual markets, I do believe your efforts will reap political rewards on both sides,” Bullock told the Senate HELP committee. “Some might call me a dreamer, but it might even prove to be a model for further efforts.”
Bipartisan cooperation is essential to achieve affordable, high-quality coverage, said Baker, former CEO of Massachusetts’ Harvard Pilgrim Health Care. Health insurance is a shared commitment—not the sole responsibility of government, he added.
Several major themes emerged from the testimony, including these recommendations:
Fund cost sharing reduction payments
Like the state insurance commissioners who testified before the HELP committee yesterday, the governors spoke with once voice about funding cost-sharing reduction payments, with Baker and Hickenlooper among those calling for at least a two-year fix.
“Personally, I’m not a fan of CSR payments,” Herbert said. “Nevertheless, in the near-term individual insurance markets need predictability in order to price their products adequately.”
.@GovernorBullock in Montana, our largest insurer proposed a rate increase 10x higher b/c of uncertainty President and DC are creating.— FierceHealthPayer (@HealthPayer) September 7, 2017
“Nudge” younger, healthier people into the market
Keeping and enforcing individual mandates and encouraging continuous coverage by, for example, setting up special plans for those who let their insurance lapse, can help increase and stabilize insurance pools. Auto enrollment with opt-out could also nudge more people into the market, Baker said, adding that Congress should leave specifics up to states.
Lower premiums will also attract new, healthier people to marketplace, added Haslam.
Give states greater latitude
That means making it faster and easier for states to secure waivers. “Even in our state, it’s a challenge to adapt to the overly strict framework of ACA,” Baker said. The governors agreed states should be allowed to experiment as “labs of democracy,” and determine what works and what does not for their own residents.
Herbert said that in his state, that includes a focus on evidence-based care, eliminating duplicate tests and services, promoting managed-care organizations and empowering physicians to make more informed choices about care for their patients.
Most innovation does not come from the government, Herbert added. “It comes from the private sector.”
“We’re like startup companies,” Hickenlooper added. “We learn from mistakes. We tweak and constantly improve. Fine is never good enough. That’s part of being laboratories for Democracy.”
Address healthcare costs
That includes pharmaceutical costs. Baker called for safely expediting the FDA drug approval process, increasing competition by insuring the availability of generic drugs and giving public payers the power to negotiate drug prices.
Colorado is “home to some of the highest premiums in the country,” Hickenlooper said, and state insurance officials are predicting rate increases of up to 27%. A similar story is playing out in states across the nation.