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The Health Care Choice Act Hearing Committee on Energy and Commerce House of Representatives THE HEALTH CARE CHOICE ACT HEARING BEFORE THE SUBCOMMITTEE ON HEALTH OF THE COMMITTEE ON ENERGY AND COMMERCE HOUSE OF REPRESENTATIVES ONE HUNDRED NINTH CONGRESS FIRST SESSION ON H.R. 2335 JUNE 28, 2005 Serial No. 109–23 Printed for the use of the Committee on Energy and Commerce ( Available via the World Wide Web: http://www.access.gpo.gov/congress/house U.S. GOVERNMENT PRINTING OFFICE 22–986PDF WASHINGTON : 2005 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2250 Mail: Stop SSOP, Washington, DC 20402–0001 VerDate 11-MAY-2000 11:23 Sep 16, 2005 Jkt 000000 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 22986.TXT HCOM1 PsN: HCOM1 COMMITTEE ON ENERGY AND COMMERCE JOE BARTON, Texas, Chairman RALPH M. HALL, Texas JOHN D. DINGELL, Michigan MICHAEL BILIRAKIS, Florida Ranking Member Vice Chairman HENRY A. WAXMAN, California FRED UPTON, Michigan EDWARD J. MARKEY, Massachusetts CLIFF STEARNS, Florida RICK BOUCHER, Virginia PAUL E. GILLMOR, Ohio EDOLPHUS TOWNS, New York NATHAN DEAL, Georgia FRANK PALLONE, Jr., New Jersey ED WHITFIELD, Kentucky SHERROD BROWN, Ohio CHARLIE NORWOOD, Georgia BART GORDON, Tennessee BARBARA CUBIN, Wyoming BOBBY L. RUSH, Illinois JOHN SHIMKUS, Illinois ANNA G. ESHOO, California HEATHER WILSON, New Mexico BART STUPAK, Michigan JOHN B. SHADEGG, Arizona ELIOT L. ENGEL, New York CHARLES W. ‘‘CHIP’’ PICKERING, ALBERT R. WYNN, Maryland Mississippi, Vice Chairman GENE GREEN, Texas VITO FOSSELLA, New York TED STRICKLAND, Ohio ROY BLUNT, Missouri DIANA DEGETTE, Colorado STEVE BUYER, Indiana LOIS CAPPS, California GEORGE RADANOVICH, California MIKE DOYLE, Pennsylvania CHARLES F. BASS, New Hampshire TOM ALLEN, Maine JOSEPH R. PITTS, Pennsylvania JIM DAVIS, Florida MARY BONO, California JAN SCHAKOWSKY, Illinois GREG WALDEN, Oregon HILDA L. SOLIS, California LEE TERRY, Nebraska CHARLES A. GONZALEZ, Texas MIKE FERGUSON, New Jersey JAY INSLEE, Washington MIKE ROGERS, Michigan TAMMY BALDWIN, Wisconsin C.L. ‘‘BUTCH’’ OTTER, Idaho MIKE ROSS, Arkansas SUE MYRICK, North Carolina JOHN SULLIVAN, Oklahoma TIM MURPHY, Pennsylvania MICHAEL C. BURGESS, Texas MARSHA BLACKBURN, Tennessee BUD ALBRIGHT, Staff Director DAVID CAVICKE, Deputy Staff Director and General Counsel REID P.F. STUNTZ, Minority Staff Director and Chief Counsel SUBCOMMITTEE ON HEALTH NATHAN DEAL, Georgia, Chairman RALPH M. HALL, Texas SHERROD BROWN, Ohio MICHAEL BILIRAKIS, Florida Ranking Member FRED UPTON, Michigan HENRY A. WAXMAN, California PAUL E. GILLMOR, Ohio EDOLPHUS TOWNS, New York CHARLIE NORWOOD, Georgia FRANK PALLONE, Jr., New Jersey BARBARA CUBIN, Wyoming BART GORDON, Tennessee JOHN SHIMKUS, Illinois BOBBY L. RUSH, Illinois JOHN B. SHADEGG, Arizona ANNA G. ESHOO, California CHARLES W. ‘‘CHIP’’ PICKERING, GENE GREEN, Texas Mississippi TED STRICKLAND, Ohio STEVE BUYER, Indiana DIANA DEGETTE, Colorado JOSEPH R. PITTS, Pennsylvania LOIS CAPPS, California MARY BONO, California TOM ALLEN, Maine MIKE FERGUSON, New Jersey JIM DAVIS, Florida MIKE ROGERS, Michigan TAMMY BALDWIN, Wisconsin SUE MYRICK, North Carolina JOHN D. DINGELL, Michigan, MICHAEL C. BURGESS, Texas (Ex Officio) JOE BARTON, Texas, (Ex Officio) (II) VerDate 11-MAY-2000 11:23 Sep 16, 2005 Jkt 000000 PO 00000 Frm 00002 Fmt 6011 Sfmt 0486 22986.TXT HCOM1 PsN: HCOM1 C O N T E N T S Page Testimony of: de Posada, Robert Garcia, Chairman/President, The Latino Coalition ....... 28 Gratzer, David, Senior Fellow, The Manhattan Institute ............................. 43 Kreidler, Mike, Washington State Insurance Commissioner, on Behalf of the National Association of Insurance Commissioners ......................... 31 Limbaugh, L. Hunter, Chair, Advocacy Committee, American Diabetes Association ..................................................................................................... 35 Matthews, Merrill, Jr., Director, Council for Affordable Health Insurance 14 Additional material submitted for the record: Kreidler, Mike, Washington State Insurance Commissioner, on Behalf of the National Association of Insurance Commissioners, response for the record ....................................................................................................... 68 Ness, Debra L., President, National Partnership for Women & Families, prepared statement of ................................................................................... 70 (III) VerDate 11-MAY-2000 11:23 Sep 16, 2005 Jkt 000000 PO 00000 Frm 00003 Fmt 0486 Sfmt 0486 22986.TXT HCOM1 PsN: HCOM1 VerDate 11-MAY-2000 11:23 Sep 16, 2005 Jkt 000000 PO 00000 Frm 00004 Fmt 0486 Sfmt 0486 22986.TXT HCOM1 PsN: HCOM1 THE HEALTH CARE CHOICE ACT TUESDAY, JUNE 28, 2005 HOUSE OF REPRESENTATIVES, COMMITTEE ON ENERGY AND COMMERCE, SUBCOMMITTEE ON HEALTH, Washington, DC. The subcommittee met, pursuant to notice, at 10:05 a.m., in room 2123, Rayburn House Office Building, Hon. Nathan Deal (chair- man) presiding. Members present: Representatives Deal, Hall, Gillmor, Norwood, Cubin, Shimkus, Shadegg, Buyer, Myrick, Burgess, Barton (ex offi- cio), Brown, Waxman, Pallone, Eshoo, Green, Baldwin, and Dingell (ex officio). Staff present: Chuck Clapton, chief health counsel; Bill O’Brien, legislative analyst; Eugenia Edwards, legislative clerk; Brandon Clark, Health policy coordinator; Bridgett Taylor, minority profes- sional staff; Amy Hall, minority professional staff; and Jessica McNiece, minority research assistant. Mr. DEAL. Good morning. I will call this hearing to order and welcome everyone here. We are pleased to have such a distinguished panel before us, and we look forward to hearing your testimony soon. If I talk fast enough and the other members talk fast enough, we will get to your testimony rather soon. But first of all, we have opening state- ments. Today, the subcommittee is here to examine H.R. 2355, the Health Care Choice Act of 2005. I want to thank Congressman Shadegg and his staff for their hard work, their cooperation, and their willingness to make some modifications to this initial legisla- tion to accommodate some of the issues that we will hear raised, I think, even today. I commend you, Mr. Shadegg, and your staff for your hard work on this issue. I would also like to thank our panel of witnesses for appearing before us. We know that any time you take time out of your sched- ules to be here that it is an inconvenience, but you have points of view that we do wish to hear from, and we appreciate your sharing those with us. But the reason we are here today is that we are told that some- time during this past year 45 million Americans, approximately, were without health insurance. For most of us, we think this is an unacceptable number. Today, we are here to explore one suggestion as to an innovative way to try to reduce that number of uninsured. Of course, covering (1) VerDate 11-MAY-2000 11:23 Sep 16, 2005 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 22986.TXT HCOM1 PsN: HCOM1 2 the uninsured is a complex issue, and probably no one simple an- swer is going to solve all the problems. It requires complex solu- tions as well. Perhaps today is a step in the right direction for find- ing some of those solutions. Again, I thank my colleagues for their work on this issue, and I know that there has been a cooperative effort within this sub- committee. With that, I will conclude my opening statement and call on my good friend, Mr. Brown, the ranking member, for his opening state- ment. Mr. BROWN. Thank you, Mr. Chairman. And thank you to our witnesses for joining us, especially the in- surance commissioner, Mike Kreidler, who was a member of, not this subcommittee, but the full committee back several Congresses ago. So, good to see all of you—especially you, Mike—thanks for coming. I want to thank Mr. Shadegg for contributing to the insurance debate. Although I cannot support the proposal he offers, we should commend him for focusing on this important issue. I see three basic arguments for this legislation, and I want to go through them one at a time. One, consumers need more choice, they should be able to pick the health plan that is best for them. This bill doesn’t give consumers more choice, it gives certain con- sumers more choice, the ones who are in perfect health. As far as for the consumers who don’t have a clean bill of health, maybe they can get on the waiting list for their State’s high-risk pool if their State has one. When you let insurers snake out from under consumer protec- tions, like guaranteed issue, coverage may be less expensive for some people; that is because it isn’t available at all to others. The whole notion of choice is anathema to the basic idea of insurance. When high-risk consumers can pick the health insurance that is best for them, it is called adverse selection. The plans that attract a bigger share of high-risk employees—of high-risk enrollees simply go out of business. When relatively low-risk enrollees can pick the insurance that is best for them, it is called favorable selection. Health plans that at- tract a bigger share of low-risk enrollees aren’t really insurers; they are more like bookies, the odds are always in their favor. Adverse selection destabilizes insurance markets and leaves the people most in need of coverage without coverage. The second premise is that it is burdensome for health insurers to comply with 50 different sets of regulations. I have no doubt that is burdensome. There is always a tradeoff between Federal and State regulation. But does that mean insurers should be able to canvass the 50 States, choose which set of regula- tions they like best, and comply only with those? H.R. 2355 doesn’t enhance flexibility, it makes the lowest State standard the de facto national standard. The third premise is that benefit mandates are bad because they make every enrollee pay for services that only a few people need. Insurance itself makes every enrollee pay for services that only a few people need. So let us talk about those evil benefit mandates.
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