May 3, 2019


In This Issue
Fast Facts
NAHU Promotes Private Health Choices as House Holds Medicare-for-All Hearing
State Spotlight: Washington Passes First “Public Option” Bill
House Holds Prescription Drug Hearing as CBO Releases Rebating Rule Analysis
One Week Remaining for Legislative Council Applications
Healthcare Happy Hour: Debriefing the Medicare-for-All Hearing
Register for This Month’s Webinar on Form 5500 Reporting
Register for the Catalyst for Payment Reform’s Virtual Event on May 17
HUPAC Roundup: Putting Congeniality Back in Congress
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NAHU Promotes Private Health Choices as House Holds Medicare-for-All Hearing
Congress held a first-ever hearing on Medicare for All in the House Rules Committee on Tuesday. The hearing’s purpose was to generally review key issues with the consideration of H.R. 1384, the House Medicare-for-All legislation introduced in February, and its companion introduced by Senator Bernie Sanders (I-VT) last month. NAHU strongly opposes Medicare-for-All and all forms of single-payer healthcare and is actively opposing efforts to implement such proposals through our coalition, the Partnership for America’s Health Care Future (PAHCF). As part of these efforts, NAHU submitted formal comments to the committee in advance of the hearing and joined the PAHCF and the Partnership for Employer-Sponsored Coverage in expressing our deep concerns that such proposals could have on existing coverage and choices for Americans.

Our comments stressed that the Medicare-for-All proposal would threaten the existing coverage of more than 180 million Americans, stripping them of their current private plans and replacing their insurance with less choice and control over doctors, treatments, and coverage, and higher taxes, longer wait times, and lower quality of care for patients. We further noted that existing healthcare choice would be threatened regardless if it is from incremental approaches such as a public option or Medicare or Medicaid buy-in, or a more sweeping federal takeover of the entire healthcare system to implement a single standardized government-run plan.

By the nature of Democrats controlling the chamber and a 9-4 majority within the committee, the seven-member panel included five Democratic witnesses, Ady Barkan, Dr. Dean Baker, Dr. Sara Collins, Dr. Doris Browne, Dr. Farzon Nahvi and two Republican witnesses, Grace-Marie Turner and Dr. Charles Blahous. Given this imbalance of both witnesses and committee members, the Democrats were more able to control the timing and line of questioning, and effectively used the hearing to promote their common goal of achieving universal coverage, regardless of whether it is through Medicare-for-All, a public option or similar program. This allowed the Democrats to satisfy each faction within their party without displaying the prominent divisions within their caucus over how best to move forward on achieving universal coverage.

The hearing began with Chairman Jim McGovern (D-MA) contrasting the Republican “repeal and no replace” efforts from 2017 and earlier that would have drastically increased the uninsured rate to that of the Democrats efforts to expand coverage. He noted that despite his support for the ACA, he never believed it would be last step and that with 44 million people underinsured and 29 million people uninsured, Medicare-for-All deserves to move forward. McGovern emphasized that this hearing is the first time Congress is holding a Medicare-for-All hearing and that Republicans didn’t hold a single hearing on their healthcare repeal plan.

Ranking Member Tom Cole (R-OK) countered McGovern’s remarks by questioning the purpose of holding the hearing in the Rules committee, given that it only has jurisdiction over one page of the 120-page House Medicare-for-All bill and urged other committees to hold hearings. Cole added that the proposal would completely change the healthcare system, requiring all Americans to pay more taxes, wait longer for care, threatening freedom of choice and put current Medicare recipients at risk, particularly those on Medicare Advantage plans.

Much of the questioning revolved around the total cost for implementing such a sweeping federal healthcare program, with a range of estimates on earlier legislation projecting roughly $32 trillion in new federal spending over ten years. The Congressional Budget Office has not released their own estimate of the current Medicare-for-All legislation, but did release a report this week on key considerations for establishing a single-payer system. Representative Cole referenced a Mercatus study that projected a total cost of $32 trillion and that Democrats have not revealed a plan to pay for these costs while suggesting that everyone’s taxes will more than double. NAHU has noted that this equates to an average annual tax increase of $24,000 per household, and despite the increase in taxes, these programs would provide lower quality of care than what American patients receive with long wait times for treatment and less access to medical specialists and experts.

Representative Donna Shalala (D-FL), who served as HHS Secretary for the duration of President Clinton’s administration, raised concerns of employers struggling to predict their healthcare costs for the future and the potential deterioration of the employer-based insurance system, while the government has repeatedly had to fill the gap where the private sector has fallen short. She noted her support of universal coverage and that she wouldn’t be afraid of transitioning the system because platforms like Medicare could fill the role. Representative Michael Burgess (R-TX) pointed out the irony that Democrats have bemoaned employer-sponsored coverage during today’s hearing while commending it as a cornerstone of the ACA.

Another consideration raised was that over reimbursement rates for providers and how setting them at Medicare/Medicaid levels would impact providers. The Republican witnesses noted that Medicare payment rates are 40% below private insurance rates, and it is unclear how providers would respond to this, but demand for services would dramatically increase. They further argued that hospitals may have to close down if physicians were to see payment cuts, particularly among rural areas. Shalala raised concerns on increasing prices in private insurance, and asked if there is a way to get better healthcare outcomes without integrated systems, to which Dr. Browne said no.

Following the hearing, House Ways and Means Committee Chairman Richard Neal (D-MA) confirmed that he would hold a hearing on Medicare-for-All. As with the hearing this week in the Rules Committee, the forthcoming hearing will cover all proposals of achieving universal coverage, and not those exclusively focused on Medicare-for-All. The hearing is expected to be scheduled after the House Budget Committee holds its hearing on single-payer options. These hearings satisfy pledges made by House Speaker Nancy Pelosi to hold hearings in the rules and budget committees this year; however, it remains unclear how much further the caucus is interested in advancing the legislation given opposition to the plan among a majority of Congressional Democrats.

NAHU will continue to closely monitor the developments in the Medicare-for-All debate and is working to shape the conversation with our coalition partners on the damaging impact that a Medicare-for-All proposal could have on private-market coverage. As a member of these coalitions, NAHU is actively advocating on behalf of your clients and the private health insurance market, and we will continue to promote the important role of health insurance agents, brokers, and consultants in providing valued guidance to understanding the choices available in the private market.
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