The Senate Finance Committee held a hearing on Oct. 20 titled “Health Insurance Coverage in America: Current and Future Role of Federal Programs.” The hearing featured a witness panel that included Sens. Raphael Warnock (D-Ga.) and Rick Scott (R-Fla.) as well as several leaders from think tanks and advocacy organizations.
Chairman Ron Wyden (D-Ore.) opened the hearing by emphasizing the importance of insurance to promote 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 moving major legislation that will transform American health care, helping consumers get relief from getting clobbered at the pharmacy window, promoting innovations, and delivering quality, cost effective home- and community-based services to older people and people with disabilities.”
Wyden also stated that the Democrats’ proposals to expand coverage would not impact Medicare trust fund solvency. He acknowledged concerns with the impending solvency of the trust fund, however, stating that, “Shoring up the Medicare Hospital Insurance Trust Fund ought to be a bipartisan proposition in order to guarantee that seniors continue receiving the benefits they’ve earned.”
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 reforms to the health care system should “build on what works within our current system.” Crapo also remarked on bipartisan support for expediting Medicare coverage for cutting-edge devices, avoiding a telehealth access cliff, and capping out-of-pocket spending under Part D.
The witnesses largely discussed what could be done to improve access to health care. Warnock shared a story about a Georgia woman who did not qualify for Medicaid and delayed seeking care for a condition that ultimately took her life. “There are real consequences for real people when we fail to do what we were sent here to do,” he said. In his opening statement, Scott emphasized that he believes more federal control is “never the solution,” and praised price transparency as critical to improving the health care system.
Sara R. Collins, PhD, vice president of health care coverage and access at the Commonwealth Fund noted that the Affordable Care Act’s (ACA, P.L. 111-148) “coverage expansions, market rules against underwriting, and mandates for employers to offer coverage have enabled millions of previously [uninsured] people to get covered with comprehensive affordable coverage,” but stated that more must be done. She highlighted several proposals for expanding coverage and increasing access including fixing the “family glitch,” making the temporary American Rescue Plan Act of 2021 (P.L. 117-2) subsidy credits permanent, reigning in deductibles and out-of-pocket costs, and developing an auto-enrollment mechanism to ensure people “enroll and stay enrolled in comprehensive coverage.”
Wyden asked Collins if a public option or additional Medicare Part B benefits would negatively impact the Medicare Part A trust fund. Collins replied that there would be no negative impact as these additional benefits would be financed out of other revenue sources. She stated that the ACA actually extended solvency of the trust fund and increased the payroll tax. Wyden concluded the exchange by suggesting that he and Crapo team up on addressing solvency, as they have on addressing prescription drug pricing.
Douglas Holtz-Eakin, PhD, president of the American Action Forum touted the successes of Medicare Part D and Medicare Advantage, stating that the programs are working well but could be even better with some reforms. For example, Holtz-Eakin suggested that “restructuring the benefit design of Medicare Part D in a way that realigns incentives away from high-cost, high-rebate drugs may be the best option to reduce overall program costs as well as drug prices in other parts of the market.” In one exchange with Crapo, Holtz-Eakin elaborated on this point, emphasizing that reforms to Part D would be a “great starting point” and “very bipartisan.”
Sen. Elizabeth Warren (D-Mass.) closed the hearing by highlighting the potential positive impacts that the Build Back Better Act (H.R. 5376) could have on increasing access to coverage. She stated that the Build Back Better Act presents a “historic opportunity to make a real difference in people’s lives and we should do that.”