Speeches & Floor Statements

Alexander: Congress Needs to Take Small, Balanced Step to Help 18 Million Americans Afford Health Insurance Next Year

Posted on September 6, 2017

This committee includes 23 senators—nearly a quarter of the members of the United States Senate. It includes senators with the widest divergence of views.  It has a Republican majority of only one.  

Yet, working together during the last two years, we have been able to agree on big steps on big issues about which we have big differences of opinion: Fixing No Child Left Behind, which President Obama called a Christmas Miracle; 21st Cures, which the Majority Leader said was the most important piece of legislation that Congress passed last year; the first overhaul of mental health laws in a decade; and in early August, after two years of work, we passed new agreements to help speed safe drugs and devices into medicine cabinets and provide $9 billion in funding for the Food and Drug Administration. 

I congratulate Sen. Murray and Democratic, as well as Republican, members for those accomplishments. This is the way Americans expect the United States Senate to work.  

Those were big steps. This hearing is about taking one small step, a small step on a big issue which has been locked in partisan political stalemate for 7 years: health insurance.  It is a step Congress needs to take by the end of this month.

This step is not so small to 18 million Americans—songwriters, the self-employed, farmers—those who do not get their health insurance from the government or on the job. These 18 million buy their health insurance in the individual market, and about half of them have zero government support to help buy that insurance. 

18 million is only 6 percent of those who have health insurance in America but each one is important. About half of these are lower income Americans have government subsidies to help pay for their insurance.  The other half--9 million Americans are those who get little or no government support to help pay for insurance. These Americans are the ones  hurt the most by the skyrocketing premiums, co pays and deductibles. 

Let’s take a hypothetical Tennessean – a thirty-five year old making $48,000 a year in Lynchburg, Tennessee, would receive no tax benefit to help cover her $7,147 per year in premiums.  She has an estimated take home pay of $39,185 after taxes, which means almost a fifth of her take home pay is spent on health insurance premiums – and this does not include deductibles or co-pays. 

Next year, the Tennessee Department of Insurance says premiums are going to go up by an average of 21 to 42 percent – that’s an increase for her of between $1,500 and $3,000 more in premiums next year, and that does not include increases in deductibles and co-pays. 

I’m arguing that she should not have to pay one fifth of her income for health insurance. 

Tennessee’s insurance commissioner –who is testifying here today--has described the state’s individual market as “very near collapse.” At the end of September last year Blue Cross—our largest insurer pulled out of the individual market in Knoxville, Nashville and Memphis, not just for Tennesseans with ACA subsidies for everybody. 

That could happen again at the end of THIS September—if Congress doesn’t act.  And if it happens again, up to 350,000 Tennesseans and millions of Americans could be literally left with zero options to buy insurance in the individual market. Last year, only 8% of American counties had one insurance company on the exchange. This year 33% have one insurer on the exchange. And for 2018, nearly/ almost one-half of the counties will have one insurer only on the exchange. In Tennessee, it's 78 of our 95 counties. 

If Congress does act, we can limit increases in premiums in 2018; continue support for co-pays and deductibles for many low-income families; make certain that health insurance is available in every market; and lay the groundwork for future premiums decreases. 

We can do this by taking just two actions: (1) Appropriate cost-sharing payments through the end of 2018 to help with copays and deductibles for many low-income Americans; (2) Amend the section 1332 waiver in the Affordable Care Act so states can have more flexibility to devise ways to provide coverage with more choices and lower costs.

On the first, cost-sharing payments are extra subsidies – or discounts, really – for many low-income individuals who receive premium subsidies under the law. They help these individuals pay for out of pocket costs like copays and deductibles, but their overall effect is to lower premiums in the individual market. 

On the second, the section 1332 waivers are already written into the Affordable Care Act. Under some circumstances, they allow a state flexibility from certain elements of the law, such as the essential health benefits – but they do not in any way reduce the patient protections most of us support, including protections for those with pre-existing conditions and ensuring those under 26 may remain on their parents’ insurance and have no annual or lifetime limits.

Right now 23 states have begun taking steps to apply, 7 states have applied, and 2 states have received the 1332 waivers so far.  

To get a result, Democrats will have to agree to something—more flexibility for states—that some may be reluctant to support. And Republicans will have to agree to something, additional funding through the Affordable Care Act, that some may be reluctant to support. 

That is called a compromise, a much smaller but similar agreement to the compromise that created this United States Senate in 1789. When the Founders created a senate with two members from each state and a House of Representatives based on population. This is a compromise we ought to be able to accept. Temporary Cost sharing payments were included in both the senate and House republican bills to repeal and replace major parts of the Affordable Care Act. The Section 1332 waiver already is in the Affordable Care Act, it just hasn’t been very appealing to states because it is a difficult tool to use. Only 2 states have actually received the waivers.

If we were able to take the big steps I mentioned—fixing No Child Left Behind and passing 21st Century Cures—we ought to be able to take this small, limited bipartisan step on health insurance. If we don’t, millions of Americans will be hurt.  

Timing is a challenge. So I propose that we come to a consensus by the end of next week when our hearings are complete so that Congress can act on it before the end of September. Otherwise we will not be able to affect insurance rates, and the availability of insurance, for next year.

This is because the Department of Health and Human Services requires insurance companies to submit their final rates by September 20, and the department plans to put those rates on healthcare.gov by September 27.   

I believe we can do it because we are plowing familiar ground here, our goal is a small step, and so many Americans will be hurt if we fail.

If we do not do this-- it will not be possible for Republicans to make political hay blaming Democrats, or Democrats to make hay blaming Republicans.  The blame will be on every one of us, and deservedly so.  

Now let me conclude with a word about process.

We will have 4 hearings. We are hearing from state insurance commissioners today, from 5 governors tomorrow, we will hear from various experts on state flexibility next Tuesday, and from a variety of helpful perspectives next Thursday, including representatives for doctors, hospitals, insurers, patients, and insurance commissioners. 

This committee has a clear jurisdiction over the rules that govern the individual insurance market, which we are discussing today. We have jurisdiction over private insurance, over the exchanges created by the Affordable Care Act, and over the cost-sharing reduction payments.

The purpose of these hearings is to provide a focus and create an environment for reaching a consensus that we can act on quickly. 

Note that we do not have jurisdiction over taxes—including the ACA tax credit subsidy—nor over Medicaid or Medicare. Those are the jurisdiction of the Finance committee.

There has been great interest in this effort by senators who are not members of our committee.  So Sen. Murray and I have invited senators who are not on the committee to join us at meetings with the witnesses before each of our hearings and to participate in this process. 

My goal is to get a result on a small, bipartisan and balanced stabilization bill. Where it makes sense, we will work with other committees and members to get that result. 

Health insurance has been a very partisan topic for a very long time, but the bottom line today is that 18 million Americans need our help, and I hope we can stay focused on getting a result.