Sen. Lamar Alexander (R-TN), speaking at the Senate Committee on Health, Education, Labor and Pensions hearing this week -- which centered on insurance and what to do in the short term while those changes are worked out -- said about a dozen Democrats have written to him on the issue.
Among those who contacted him was Sen. Tim Kaine of Virginia, a member of the committee.
“Now, I’m not a naïve person, and I know that it’s not easy to move from Hatfields and McCoys to working together on this issue, but if there is one area where we ought to be able to do that, it’s with the individual market and the problems that we have with it,” the committee chairman said.
“I responded to him to say I’d like to do that,” Alexander said. “Because it’s a relatively small part of our health care system.”
Eighteen percent of Americans are provided with their health care under Medicare and “the discussions that we’re having ... we’re not talking about Medicare,” Alexander said.
And most of the conversations around Medicaid, he added, are “about more flexibility for states.” That can be discussed separately, Alexander said.
The committee heard from insurance industry representatives; from the former governor of Kentucky, Steve Beshear; and from Tennessee Department of Commerce and Insurance Commissioner Julie Mix McPeak.
Mix McPeak testified that Tennessee’s individual marketplace is struggling. In 73 of 95 counties, particularly in rural areas, Tennesseans only have one company they can buy insurance from.
“In short, Tennessee’s ACA individual market experience since 2014 has meant fewer marketplace carriers for Tennessee consumers, less competition across the state and higher priced premiums for available products,” Mix McPeak said. “In addition, we have seen existing carriers move toward narrower networks, further limiting consumers’ access to providers of their choosing.”
Marilyn Tavenner, president at America’s Health Insurance Plans, the industry’s largest trade group, told the committee that more insurers will leave the market next year, and those that remain will ask for price increases of up to 20 percent.
Janet Trautwein, CEO at the National Association of Health Underwriters, which represents insurance agents, brokers and consultants, said much of the problem in the market stems from people signing up during enrollment, then dropping the coverage -- so-called “adverse selection.”
But the act, which included individual responsibility requirements, has not been effective in preventing “adverse selection,” according to Trautwein.
“The individual responsibility requirement was intended to ensure that people were continuously covered and able to obtain preventive and other care they needed on a timely basis,” she said. “Unfortunately, while well-intended, the requirement did not provide an adequate incentive to maintain coverage continuously and has not been effective in preventing the adverse selection we see today.”
Ranking member of the committee, Democratic Sen. Patty Murray of Washington, said repealing the ACA with no plan to replace it “will create chaos throughout our health care system.”
“This isn’t just my view or Senate Democrats’ view,” Murray said. “It’s a view shared by the majority of independent policy experts, hospitals, insurers, including state leaders — from both parties — across the country.”
“No one is talking about repealing anything until there is a concrete alternative in its place,” Alexander said at the hearing.