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Kaiser Chief to Congress: You Have Just Days to Save Individual Health

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Bernard Tyson, the head of one of the biggest U.S. health insurers, told the Senate on Tuesday that Congress must act quickly if it wants to keep the individual health insurance market stable in 2018.

Congress has just days to provide meaningful relief for 2018, not weeks, Tyson said in written hearing testimony.

In oral testimony, Tyson said Congress and private industry players need to work together to shore up the individual market.

“We own the success or the failure of the American health care system together,” Tyson said. “It’s not about the government, or the marketplace, it’s about both of us working together.”

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Tyson is the chief executive officer of Oakland, California-based Kaiser Foundation Health Plan Inc.

4 Senate HELP Hearings

Tyson appeared at the third in a series of four hearings organized by the Senate Health, Education, Labor and Pensions Committee on stabilizing the individual health market.

The committee has streamed all of the hearings, including the third one, live on the web, and it has posted a video recording of the hearing, and the written versions of the witnesses’ testimony, here.

The first hearing featured state insurance commissioners, and the second hearing featured governors.

The fourth hearing, set for 10 a.m. Thursday, will feature a variety of “health care stakeholders,” including Raymond Farmer, South Carolina’s insurance commissioner, and Robert Ruiz-Moss, an Anthem individual health insurance unit executive.

The Tyson Plan

Tyson asked senators at the hearing on Tuesday to remember that, whatever faults the current Affordable Care Act system has, the system that existed before the ACA came along also had serious faults. 

“Before the ACA, many millions of Americans were unable to buy coverage or were priced out of coverage because of pre-existing medical conditions,” Tyson said in the written version of his testimony. “Virtually no one wants to go back to the way it worked before; we certainly don’t.”

Tyson encouraged senators to adopt changes that insurance commissioners and governors had backed in the Senate HELP hearings held last week:

  • Keeping up funding for the ACA cost-sharing reduction subsidy system, which helps low-income exchange plan users pay their deductibles, co-payments and coinsurance amounts.

  • Funding a reinsurance program, to buffer health insurers against the effects of insuring people with catastrophic claims.

  • Enforcing the ACA requirement that many individuals own what the government classifies as “minimum essential coverage,” or solid major medical coverage.

  • Support individual major medical insurance and ACA public health insurance exchange marketing and enrollment support efforts.

Brokers “have a significant role to play in helping to encourage enrollment,” Tyson said, but he said coverage issuers also need help from navigators and other nonprofit assisters with reaching some hard-to-reach populations, such as people who speak certain languages that few brokers speak.

Tammy Tomczyk (Photo: Senate HELP)

Tammy Tomczyk (Photo: Senate HELP)

Tyson also talked about the rules for states that want ACA Section 1332 waivers, or official waivers from some of the usual ACA requirements.

Like many Republican ACA opponents, Tyson called for speeding up the Section 1332 waiver review and approval process, especially for states basing their applications on waiver models already approved for other states.


Under former President Barack Obama, the U.S. Department of Health and Human Services set strict Section 1332 waiver program “guardrails,” or rules governing matters such as affordability, adherence to ACA minimum benefits standards and the ability of people with serious health problems to buy high-quality, affordable coverage.

Many Democratic policymakers want HHS to continue to apply the Obama administration guardrail standards.

Many Republican Section 1332 waiver program supporters want the federal government to loosen the guardrail standards.

Tyson said he wants to see the government keep the current guardrail standards.

“It is important to provide states with flexibility to respond to market conditions and come up with innovative solutions that can ultimately improve coverage nationwide,” Tyson said in his written testimony.

But the current guardrails “make sense, and need to be preserved in any expanded waiver authority made available to states,” Tyson said. “Divesting the HHS secretary of responsibility to verify validity of state waiver proposals would put consumers at a disadvantage. State flexibility is important, but so is the larger national goal of continuing to expand meaningful coverage for the American people.”

Tammy Tomczyk, an actuary with Oliver Wyman, said there are ways to make complying with the current guardail standards more practical.

HHS could let a state show that a waiver proposal would meet each guardrail standard in total for the market, and show that the proposal would have a neutral effect on federal spending over the lifetime of the waiver, rather than each year, Tomczyk testified.

Tomczyk suggested Congress should also give states more flexibility to increase enrollees’ out-of-pocket spending for low-value care while lowering out-of-pocket costs for high-value services, such as extra care for conditions such as diabetes that can lead to catastrophic health care costs. 

— Read Tavenner Asks Congress to Save 2018 Individual Health Market on ThinkAdvisor.

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