S. HRG. 115–470 STABILIZING PREMIUMS AND HELPING INDIVID- UALS IN THE INDIVIDUAL INSURANCE MARKET FOR 2018: STATE INSURANCE COMMISSIONERS HEARING OF THE COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS UNITED STATES SENATE ONE HUNDRED FIFTEENTH CONGRESS FIRST SESSION ON EXAMINING STABILIZING PREMIUMS AND HELPING INDIVIDUALS ON THE INDIVIDUAL INSURANCE MARKET FOR 2018, FOCUSING ON STATE INSURANCE COMMISSIONERS SEPTEMBER 6, 2017 Printed for the use of the Committee on Health, Education, Labor, and Pensions ( Available via the World Wide Web: http://www.govinfo.gov U.S. GOVERNMENT PUBLISHING OFFICE 26–840 PDF WASHINGTON : 2019 VerDate Nov 24 2008 13:39 Mar 05, 2019 Jkt 000000 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 S:\DOCS\26840.TXT CAROL HELPN-004 with DISTILLER COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS LAMAR ALEXANDER, Tennessee, Chairman MICHAEL B. ENZI, Wyoming PATTY MURRAY, Washington RICHARD BURR, North Carolina BERNARD SANDERS (I), Vermont JOHNNY ISAKSON, Georgia ROBERT P. CASEY, JR., Pennsylvania RAND PAUL, Kentucky AL FRANKEN, Minnesota SUSAN M. COLLINS, Maine MICHAEL F. BENNET, Colorado BILL CASSIDY, M.D., Louisiana SHELDON WHITEHOUSE, Rhode Island TODD YOUNG, Indiana TAMMY BALDWIN, Wisconsin ORRIN G. HATCH, Utah CHRISTOPHER S. MURPHY, Connecticut PAT ROBERTS, Kansas ELIZABETH WARREN, Massachusetts LISA MURKOWSKI, Alaska TIM KAINE, Virginia TIM SCOTT, South Carolina MARGARET WOOD HASSAN, New Hampshire DAVID P. CLEARY, Republican Staff Director LINDSEY WARD SEIDMAN, Republican Deputy Staff Director EVAN SCHATZ, Democrat Staff Director JOHN RIGHTER, Democrat Deputy Staff Director (II) VerDate Nov 24 2008 13:39 Mar 05, 2019 Jkt 000000 PO 00000 Frm 00002 Fmt 5904 Sfmt 5904 S:\DOCS\26840.TXT CAROL HELPN-004 with DISTILLER CONTENTS STATEMENTS WEDNESDAY, SEPTEMBER 6, 2017 Page COMMITTEE MEMBERS Alexander, Hon. Lamar, Chairman, Committee on Health, Education, Labor, and Pensions, opening statement ....................................................................... 1 Murray, Hon. Patty, a U.S. Senator from the State of Washington, opening statement .............................................................................................................. 4 Murkowski, Hon. Lisa, a U.S. Senator from the State of Alaska ........................ 6 Casey, Hon. Robert P., Jr., a U.S. Senator from the State of Pennsylvania ...... 7 Enzi, Hon. Michael B., a U.S. Senator from the State of Wyoming .................... 38 Paul, Hon. Rand, a U.S. Senator from the State of Kentucky ............................. 41 Franken, Hon. Al, a U.S. Senator from the State of Minnesota .......................... 43 Collins, Hon. Susan M., a U.S. Senator from the State of Maine ....................... 45 Bennet, Hon. Michael F., a U.S. Senator from the State of Colorado ................. 47 Baldwin, Hon. Tammy, a U.S. Senator from the State of Wisconsin .................. 50 Cassidy, Hon. Bill, M.D., a U.S. Senator from the State of Louisiana ............... 52 Murphy, Hon. Christopher S., a U.S. Senator from the State of Connecticut .... 54 Burr, Hon. Richard, a U.S. Senator from the State of North Carolina ............... 56 Hassan, Hon. Margaret Wood, a U.S. Senator from the State of New Hamp- shire ....................................................................................................................... 58 Kaine, Hon. Tim, a U.S. Senator from the State of Virginia ............................... 62 Young, Hon. Todd, a U.S. Senator from the State of Indiana ............................. 65 Roberts, Hon. Pat, a U.S. Senator from the State of Kansas .............................. 69 Warren, Hon. Elizabeth, a U.S. Senator from the State of Massachusetts ........ 71 Whitehouse, Hon. Sheldon, a U.S. Senator from the State of Rhode Island ...... 73 WITNESSES McPeak, Julie, Mix, Commissioner, Tennessee Department of Commerce and Insurance, Nashville, TN ..................................................................................... 7 Prepared statement .......................................................................................... 9 Kreidler, Mike, O.D., Washington State Insurance Commissioner, Olympia, WA ......................................................................................................................... 13 Prepared statement .......................................................................................... 15 Wing-Heier, Lori K., Director, Alaska Division of Insurance, Anchorage, AK ... 19 Prepared statement .......................................................................................... 21 Miller, Teresa, J.D., Insurance Commissioner of Pennsylvania, Harrisburg, PA .......................................................................................................................... 25 Prepared statement .......................................................................................... 27 Doak, John, Commissioner, Oklahoma Department of Insurance, Tulsa, OK ... 33 Prepared statement .......................................................................................... 34 (III) VerDate Nov 24 2008 13:39 Mar 05, 2019 Jkt 000000 PO 00000 Frm 00003 Fmt 5904 Sfmt 5904 S:\DOCS\26840.TXT CAROL HELPN-004 with DISTILLER ADDITIONAL MATERIAL Statements, articles, publications, letters, etc. September 5, 2017, letter to Hon. Lamar Alexander and Hon. Patty Murray ........................................................................................................... 80 September 5, 2017, letter to Hon. Mitch McConnell, Hon. Chuck Schu- mer, Hon. Paul Ryan, and Hon. Nancy Pelosi ............................................ 81 September 1, 2017, letter from Mental Health Liaison Group ..................... 82 August 10, 2017, letter to Hon. Patty Murray ............................................... 84 Response by Mike Kreidler to questions of: Senator Alexander ............................................................................................ 87 Senator Burr ..................................................................................................... 87 Senator Young .................................................................................................. 87 Senator Roberts ................................................................................................ 88 Senator Whitehouse ......................................................................................... 88 Senator Franken ............................................................................................... 88 Response by Mike Kreidler to questions of Senator Whitehouse ................. 89 Response by Lori Wing-Heier to questions of Senator Alexander ................ 92 Response by Julie Mix McPeak to questions of Senator Whitehouse .......... 94 Response by Miller, Teresa, J.D. to questions of Senator Whitehouse ........ 95 (IV) VerDate Nov 24 2008 13:39 Mar 05, 2019 Jkt 000000 PO 00000 Frm 00004 Fmt 5904 Sfmt 5904 S:\DOCS\26840.TXT CAROL HELPN-004 with DISTILLER STABILIZING PREMIUMS AND HELPING INDI- VIDUALS ON THE INDIVIDUAL INSURANCE MARKET FOR 2018: STATE INSURANCE COM- MISSIONERS WEDNESDAY, SEPTEMBER, 6, 2017 U.S. SENATE, COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS, Washington, DC. The committee met, pursuant to notice, at 10:05 a.m. in room SH–216, Hart Senate Office Building, Hon. Lamar Alexander, chairman of the committee, presiding. Present: Senators Alexander, Murray, Enzi, Burr, Isakson, Paul, Collins, Cassidy, Young, Roberts, Murkowski, Scott, Sanders, Casey, Franken, Bennet, Whitehouse, Baldwin, Murphy, Warren, Kaine, and Hassan. OPENING STATEMENT OF SENATOR ALEXANDER The CHAIRMAN. The Senate Committee on Health, Education, Labor, and Pensions will please come to order. This morning, we are holding our first hearing on stabilizing pre- miums and ensuring access to insurance in the individual health insurance market for 2018. We have five State insurance commissioners. Thank you for com- ing from long distances, some of you, to be with us to give your tes- timony on how to enable the 18 million Americans in the individual insurance market. To give an idea of how many people are interested in this, Sen- ator Murray and I invited senators who were not on our com- mittee—which about a quarter of the senate is on this committee— to come to a coffee with the five commissioners that we have just completed for an hour. We had 31 senators there. That is a re- markable level of interest. Senator Murray and I will each have an opening statement and then we will introduce our five witnesses. After their testimony, senators will have an opportunity to ask witnesses questions and we will do it in 5 minute rounds. As I mentioned, this committee includes 23 United States sen- ators, nearly one-quarter of the members of the senate. It includes senators with the widest divergence of views. It has a republican majority of only one. Yet, working together during the last 2 years, we have been able to agree on big steps on big issues about which we have big dif- ferences of opinion such as fixing No Child Left Behind, which (1) VerDate Nov 24 2008 13:39 Mar 05, 2019 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 S:\DOCS\26840.TXT CAROL HELPN-004 with DISTILLER 2 President Obama called a Christmas miracle; 21st Century Cures Act, which Senator McConnell, the Majority Leader, said was the most important piece of legislation that passed Congress last year; the first overhaul of mental health laws in a decade; and in early August, after 2 years