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On March 6, 2019 the Health Subcommittee of the House Committee on Energy and Commerce held a legislative hearing entitled, “Strengthening Our Health Care System: Legislation to Lower Consumers Cost and Expand Access.” According to the House Committee on Energy and Commerce, the subjects of the hearing were the following three proposed bills:  

  1. State Health Care Premium Reduction Act” (H.R. 1425): This bill would provide $10 billion annually to states to establish a state reinsurance program to hedge against the costs of higher risk individuals. The funds could also be used to provide financial assistance to reduce out-of-pocket costs for individuals enrolled in qualified health plans, above and beyond the Affordable Care Act’s (ACA) subsidies. For states that do not apply for federal funding under the bill, it requires the Centers for Medicare and Medicaid Services (CMS) to establish and implement a reinsurance program.
  • According to Congresswoman Angie Craig, who introduced the bill alongside Congressman Scott Peters, the bill will lower health insurance premium costs for people in the individual market place by an estimated 10%. 
  • According to Energy and Commerce Chairman Frank Pallone, this bill is modeled after the reinsurance program that Republicans on the Health Subcommittee supported in the repeal bill last year. Part of the reason last year’s bill failed is because of partisan disagreement over inclusion of language pertaining to the Hyde Amendment, which blocks federal funding for abortion services. Republicans would not support a reinsurance bill without such language, while Democrats pushed back, arguing the inclusion would expand the Hyde Amendment to a new area of funding.  

2. “State Allowance for a Variety of Exchanges (Save) Act” (H.R. 1385):  This bill would provide states with $200 million in federal funds to establish state-based marketplaces (SBMs). Currently, federal funds are no longer available for states to set up SBMs.  

  • Federally Facilitated Marketplaces (FFMs) interested in tailoring their exchange and making health care more affordable might want to consider creating an SBM. A recent report released by Covered California, the Massachusetts Health Connector and the Washington Health Benefit Exchange – all SBMs – found that these three states fared much better than FFMs in gaining new enrollment and muting premium costs. Average benchmark premiums in the FFM are now 85% higher than they were in 2014, whereas the weighted average of those three states was 39%. From 2016 to 2018, the FFMs’ level of new enrollment dropped by 40%, whereas the three states had a drop of 6%.  
  • Audrey Morse Gasteier, Chief of Policy and Strategy at Massachusetts Health Connector, Massachusetts’ SBM, provided testimony at the hearing to show Congress how Massachusetts serves as a laboratory of effective health care experimentation. She stated, “The successes and lessons described above from the Massachusetts experience [an effective outreach apparatus, a state-wrap program, an approach to proactively ensuring market conditions that promote fair, stable, comprehensive coverage for all] would simply not be possible without a state-based marketplace. A state-based marketplace, reacting to local policy and market needs, working side-by-side, day-in-and-day-out with market participants, can successfully bring the promises of health reform and coverage expansion to life.” 
  • Peter V. Lee, Executive Director of Covered California, California’s SBM, also provided testimony to show how California serves as a laboratory of effective health care experimentation. He discussed the pivotal role of the funding in encouraging the states to set up an SBM: “The state-based marketplaces that are in existence today benefited from receiving federal ‘establishment funds’ to help start up in the early years of ACA implementation. Federal establishment funds expired, and today no state-based marketplace receives federal funds in order to operate. However, it is not clear that states would have made the early investments required to create the new state-based marketplaces that have taken shape over the past eight years, had it not been for early federal support.” 

3. “Expand Navigators’ Resources for Outreach, Learning, and Longevity (Enroll) Act” (H.R. 1386): This bill would provide $100 million annually for the FFM navigator program; reinstate the requirement that there be at least two navigator entities in each state; require the Department of Health and Human Services (HHS) to ensure that navigator grants are awarded to entities with the capacity to carry out specified duties; and 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.  

  • This bill appears in the face of the Trump administration having dramatically reduced funding for federal marketplace navigators. The administration cited greater public awareness of how to enroll in the marketplace and the limited effectiveness of navigators in facilitating enrollment, in comparison to brokers. CMS awarded $10 million for federal marketplace navigators in 2018 to 2019, which marked an 84% reduction to 2016’s award. 
  • Gasteier also referenced Massachusetts’ robust navigator program, which partners with a diverse group of sixteen organizations, as a key policy reason for the state’s relatively healthy risk pool, broad coverage expansion and high rates of renewal of coverage.  
  • She stated, “With respect to the Navigator proposal, the Health Connector’s experience suggests that a robust Navigator program is a vital component of ensuring access to coverage for the populations that need the most help getting into the ranks of the insured, and that the work they do contributes to the overall stability of the commercial market risk pool. In our program, we believe it is vital to work with organizations that are based in their communities, operate as non-profits, are expert in high-need populations, and are prepared to educate individuals about Qualified Health Plans and the importance of comprehensive coverage, as well as adapt to locally-identified emerging needs, like educating consumers about being on guard against scam health insurance products.” 

The Health Subcommittee could decide next to mark-up the bills and make changes prior to recommending them to the full committee. If the House Committee on Energy and Commerce then chooses not to do further studies or hearings, the Committee will vote on its recommendation to the House. After the vote, Chairman Pallone will instruct staff to prepare a written report of the bills, describing their intent, scope, impact, position of the executive branch and views of dissenting members. 



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