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October 21, 2021

Senate Finance Committee hearing on health insurance coverage

On October 20, the Senate Finance Committee held a hearing entitled, "Health Insurance Coverage in America: Current and Future Role of Federal Programs." Throughout the hearing, committee members and witnesses discussed health provisions contained within the Democratic "Build Back Better" proposal, primarily focusing on the permanent expansion of Affordable Care Act (ACA) premium tax credits (PTCs) advanced under the American Rescue Plan Act (ARPA); addressing the Medicaid "coverage gap" in non-expansion states; expanding Medicare benefits to include dental, vision, and hearing coverage; and, enhancing access to home- and community-based services (HCBS).

Chairman Ron Wyden (D-OR) said that expanding the ARPA provisions is "a no brainer" and also expressed support for the other coverage provisions, along with other Democrats on the committee and their witnesses. Sen Rafael Warnock (D-GA) spoke about the importance of closing the Medicaid coverage gap and said it is about "basic equity and fairness," noting that of the 275,000 Georgians in the Medicaid coverage gap, 47% are Black and 9% are Latino. Democrats also applauded the resiliency of the system during the pandemic and witnesses said that due to advancements under the ACA and provisions in the ARPA, it was the first time where the number of people who were uninsured did not increase during a recession, while also improving affordability and access. Others expressed the need to deliver critical dental, vision, and hearing coverage to seniors while also addressing the millions on waitlists for HCBS, among other priorities. Sen Elizabeth Warren (D-MA) said in closing the hearing that they have a "historic opportunity" to expand coverage, address gaps in care, and improve affordability.

Ranking Member Mike Crapo (R-ID) acknowledged that the health care system has "substantial room for improvement" but said that instead of the proposals offered by Democrats, "creative and market-based models provide a compelling blueprint for bipartisan reform." He also expressed support for bipartisan proposals to cap out-of-pocket (OOP) spending under Medicare Part D, expand access to telehealth, and expedite coverage for cutting-edge devices. In addition to fundamentally disagreeing with the expansion of government supports through the various proposals, Republicans expressed concern with the high cost of the package, including their negative impact on Medicare solvency and the deficit, also citing estimates from the Joint Committee on Taxation (JCT) that individuals below 400% of the federal poverty line (FPL) would see tax increases, despite promises made by the Biden administration. Sen. Chuck Grassley (D-IA), who worked to move bipartisan drug pricing legislation last Congress, also expressed concern around drug pricing proposals that he said will reduce access and disincentivize pharmaceutical innovation, stating he hopes that "common sense will prevail."

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Senate Finance hearing on health insurance coverage