The Senate Finance Committee held a hearing October 20 titled “Health Insurance Coverage in America: Current and Future Role of Federal Programs”. The hearing featured a panel of witnesses that included Sens. Raphael Warnock (D-Ga.) and Rick Scott (R-Fla.) as well as several leaders of think tanks and advocacy organizations.
President Ron Wyden (D-Ore.) opened the hearing emphasizing the importance of insurance in promoting health care as a human right. He outlined Senate Democrats’ plans to increase access to coverage and close the coverage gap, noting that they are “on the cusp of introducing major legislation that will transform American health care, helping consumers to avoid getting beaten up at the pharmacy window, promoting innovation, and providing quality, cost-effective home and community services to seniors and people with disabilities.
Wyden also said the Democrats’ proposals to expand coverage would not impact the solvency of the Medicare trust fund. He did, however, acknowledge concerns about the impending solvency of the trust fund, saying that “strengthening the Medicare hospital insurance trust fund should be a bipartisan proposal to ensure that seniors continue to receive the benefits they have.” won”.
Ranking member Mike Crapo (R-Idaho) focused his opening statement on Medicare Part D and Medicare Advantage – calling their success “unprecedented” and suggesting that future healthcare reforms should “build on what works in our current system”. Crapo also pointed to bipartisan support for accelerating Medicare coverage for advanced devices, avoiding a telehealth access cliff, and capping out-of-pocket spending under Part D.
Witnesses discussed extensively what could be done to improve access to health care. Warnock shared the story of a Georgia woman who was ineligible for Medicaid and delayed seeking care for an illness that ultimately claimed her life. “There are real consequences for real people when we don’t do what we were sent here to do,” he said. In his opening statement, Scott emphasized that he believes more federal oversight is “never the answer” and hailed pricing transparency as essential to improving the healthcare system.
Sara R. Collins, PhD, vice president of healthcare coverage and access at the Commonwealth Fund noted that the Affordable Care Act (ACA, PL 111-148) “Extensions of coverage, market rules against underwriting, and mandates for employers to offer coverage have allowed millions of people previously [uninsured] people to be covered by comprehensive and affordable coverage,” but said more needed to be done. She pointed to several proposals to expand coverage and increase access, including addressing the “family issue,” making the American Rescue Plan Act of 2021 temporary (PL 117-2) permanent subsidy credits, ruling out deductibles and out-of-pocket costs, and developing an automatic enrollment mechanism to ensure people “enroll and stay enrolled in full coverage.”
Wyden asked Collins if a public option or additional Medicare Part B benefits would have a negative impact on the Medicare Part A trust fund. Collins replied that there would be no negative impact as these additional benefits would be financed from other sources of income. She said the ACA actually extended the solvency of the trust fund and increased the payroll tax. Wyden concluded the exchange by suggesting that he and Crapo team up to address solvency, as they did to address prescription drug pricing.
Douglas Holtz-Eakin, PhD, president of the vaunted American Action Forum the successes of Medicare Part D and Medicare Advantage, saying the programs are working well but could be even better with some reforms. For example, Holtz-Eakin suggested that “restructuring Medicare Part D benefit design to realign incentives around high-priced, high-discount drugs may be the best option to reduce overall program costs as well as drug prices in other countries. parts of the market. In an exchange with Crapo, Holtz-Eakin elaborated on this point, stressing that the Part D reforms would be a “great place to start” and “very bipartisan.”
Senator Elizabeth Warren (D-Mass.) closed the hearing by highlighting the potential positive impacts that the Build Back Better Act (HR 5376) could have on improving access to coverage. She said the Build Back Better Act presents a “historic opportunity to make a real difference in people’s lives and we should.”