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  • 4 days ago
During a House Education and Workforce Committee hearing prior to the congressional recess, Rep. Ryan Mackenzie (R-PA) spoke in support of offering new alternatives for accessing healthcare.

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00:00For Ms. Shields, participants in your program had a choice to enter into these plans, is that correct?
00:09That's correct. They would do their research to determine if our plan fit them best or if they wanted to go to the ACAA or anywhere else.
00:17And what they experienced was lower premiums and deductibles in this option.
00:22That's correct. They had better prices, lower deductibles. And as pointed out earlier, it may not be necessarily that the price was lower, but they had a better plan that fit their needs.
00:35And so what you're saying is that they were satisfied with their access to the care through these programs?
00:41Absolutely, especially the fact that they were able to come in.
00:44We covered the previous existing conditions that they had or that they were able to keep their doctors or for whatever the necessary reason was.
00:54So what I'm hearing is that this is a choice that these individuals are choosing.
00:59They were potentially able to get lower premiums and deductibles, and they were satisfied with the care that they were receiving.
01:05A hundred percent. Our whole point was to offer it as a benefit so that they had options, because many of them, again, were not insured.
01:14And didn't feel that they had anywhere that they could get the insurance that they needed.
01:18So when you see that pattern, it is astounding that people would be opposed to giving people a choice to get lower cost health care that they are satisfied with.
01:29That is astounding to me that somebody would go on the record and say, I want to take away choice from people to get low cost health care that meets their needs.
01:39I'll just leave it right there.
01:40All right. So the next thing is I want to talk to Ms. Strauss and ask about small businesses, a particularly challenging environment for health care in our economy today is making sure that small businesses can offer affordable health care to their individuals.
01:59Can you tell me about additional innovative options that you're seeing in this space that meet those needs?
02:06Yeah, so we routinely talk about the level funded, which is the self-funded plans in that small group market with most of our groups.
02:17So there's a little bit more flexibility in that.
02:20However, there are things coming into the market around direct primary care that actually, again, puts those employees in the driver's seat.
02:28So we have a program that we can offer to employers at a minimum, just a minimal fee on a monthly basis.
02:36And employees have direct access to a provider team that they can call, text, email at any time.
02:43This team not only advocates for them in situations where maybe a claim has been denied, which agents do all the time.
02:49And I just had one of those this week.
02:52So sometimes those denied claims are lack of documentation that needs to just be put together.
02:58But when we look at these things, the whole experience, which I think Mr. DeSolnier had mentioned, the quality of care is very challenging.
03:09A lot of times somebody might get diagnosed with something and just accessing the next step is very difficult.
03:15When you have these advocacy programs in place, you actually have a team that is not only helping you to navigate that process.
03:23A lot of times they have success in getting appointments sooner for these people.
03:27They have the ability to look at prescriptions.
03:30And so they can look at a wide variety of prescriptions in case somebody got prescribed something that's very expensive or not covered.
03:37They can do that medical management with them.
03:39And they also just have a little bit more of a person in their corner.
03:44So they know that they can contact this provider team.
03:48And that team already knows them.
03:50They know their family members.
03:51And they don't have to take the time out to go to a doctor that they might only see for 15 minutes to then be sent to a specialist or just out into the health care system.
04:01And so, again, these are providing that really high level of touch to the employees.
04:06And it is bringing the claims costs down because these programs do not run then through the insurance program.
04:13So for these basic needs that they have, those claims don't run through.
04:17And so when you partner that with a level funded plan or a high deductible health plan, the out-of-pocket costs go down significantly for those members that are participating in that.
04:25Great. Well, thank you for sharing that with me.
04:28What I would like to close on is that we know we have a broken health care system in this country.
04:33I think everybody up here agrees with that.
04:35So the question is, where do you go next?
04:37And for me, the clear answer is that we want people to innovate.
04:42We want new options, more options available for these individuals.
04:46It could be association health plans.
04:47It could be self-insurance.
04:48It could be telehealth.
04:49It could be direct primary care.
04:51It could be anything that we are not even aware of at this time.
04:55But the way that we are going to get those solutions is by getting government out of the way.
05:00Instead of having a one-size-fits-all approach, which is failing people in many instances, I think we need to allow the free market to innovate, allow these new options to come online.
05:10And they can work in tandem with things like Medicare or Medicaid.
05:15It is not a one-size-fits-all option.
05:17I think we need an all-of-the-above solution here.
05:19And so I, again, thank you for your testimony today and these new alternatives that you have presented that I think we should be in support of.
05:26Thank you, and I yield back.
05:28The gentleman yields.
05:29Now I recognize Mr. Sonier, our ranking member, for his questions for five minutes.
05:34Thank you, Mr. Chairman.
05:36I hope we're still friends.
05:37And the comments that have been made by my colleagues.
05:40Thank you, Mr. Thorpe.
05:55Thank you, Mr. Thorpe.
06:04Thank you, Mr. Thorpe.

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