Changing Health Insurance Market
Mr. Speaker, I thank my colleague from Florida, Mr. Haridopolos, so much. I rise today to discuss or to comment on what I see is the biggest fraud this body has ever put upon the American people. Let's go back to the beginning of the…
Mr. Speaker, I thank my colleague from Florida, Mr. Haridopolos, so much.
I rise today to discuss or to comment on what I see is the biggest fraud this body has ever put upon the American people.
Let's go back to the beginning of the unaffordable care act, ObamaCare. How was this sold to the American people? You can keep your doctor if you like them. You can keep your plan. Your insurance premiums are going to go down.
I will tell you, all of that--I will tell you; this is one time that both the Republicans and Democrats agree, that it did not deliver on that.
The Affordable Care Act, ObamaCare, has been one of the biggest drivers in increasing not just the cost of health insurance but the cost of healthcare.
To continue this deception, it was clear that this plan would not work. You don't have to be a Ph.D. in mathematics to understand why. As you start to add things--the essential health benefits that you added onto these policies, these required benefits, as you started to add things that had to be covered--and I am not saying whether those were good or bad. But if you add expenses, you can't make prices go down. It would be like saying if you went to a fast food restaurant and ordered a soda and the price is going to go down but they have to give you a free cheeseburger as well. It just doesn't make common sense. It doesn't make mathematical sense. So to further this deception, they realized that it only worked by subsidizing it. You had to levy a tax to subsidize it.
The architects on the other side of the aisle who put this together realized that the American people would rebel against this if they were given a tax to pay for it. How did they hide that? Well, let's just tax the payers, let's tax the insurance companies, and then they can pass those expenses down to the American people through higher premiums. That is exactly what happened.
Then let's look at another phenomenon. As these prices start going up, people start to question whether they are getting value for what they are paying for. For some folks, the answer was no. They didn't want to pay those higher rates, and so some folks came off.
As we see, the people who come off tend to be the people who least need services. So the healthy, younger people tend to be the ones that come off. As they do that, that concentrates the risk. That makes the prices go higher for the insurance companies, for the payers.
As that happens and you get into the next policy year, they have to raise the rates again. As they raise the rates again, you lose more subscribers to those policies. You further concentrate the risk. This is known as adverse selection.
What happens in adverse selection, every time you see that raise, those prices rise, you start to see more people come off. They look for alternatives like healthcare sharing ministries, they look for something else, or they go uninsured. You start this endless cycle of these prices going up.
There is another thing I want to point out. This is kind of economics 101. The more money you put into a system, the more expensive things get. We have seen that in so many different areas. We have seen that in subprime lending. We have seen that in student loans. You put money into a system, and it starts to push prices up.
One of the other contributors we have is not just adverse selection, which is concentrating the risk and making it more expensive for the insurance companies, but we put so much money in the system that we are seeing rises in actual healthcare.
It is important to make the distinction between the rising cost of healthcare and the related rising cost of health insurance. So we just come to this death spiral of this becoming more and more and more unaffordable. In my personal opinion, this entire system is going to collapse under its own weight, and you have got two solutions.
The other side thinks that we should just write a blank check from the Federal Government, no matter how big that check is going to be, so that we can hide the fact that this is failing.
Let's face it. This is seen as a landmark piece of legislation that the Democrats have pushed over the last couple of decades. It is important to them to protect this landmark legislation. I am sorry, but the emperor is not wearing clothes. In order to hide that, they are doing these smoke screens with these increased subsidies.
Now, let's look at the subsidies that have really gotten a lot of attention, these ObamaCare subsidies that we have been talking about that the Democrats brought in response to COVID. These are subsidies to folks who are on the individual market.
It is important to note that the individual market is a small percentage of the insureds. This is not the entire market. This is not a small group. This is not a large group. This is a small percentage of folks who are on the individual marketplace, who get their health insurance through healthcare.gov or through one of the exchanges. It is a very small part.
When the Democrats first put this, it was a reaction to the chaos during COVID, and it was, by their intent and by their architecture, a temporary solution for a temporary problem. So it was designed to expire. It had a sunset.
Then, when it was coming up to a sunset, when the Democrats still had control and had the ability to make this permanent, they still put an expiration date on it. These enhanced premium tax credits, or these ObamaCare credits, were designed to expire at the end of this year. Essentially, January 1 is when they were designed to expire.
It is entirely policy brought by the Democrats. This was not Republican policy, it was a smokescreen. There are estimates it will cost between $300 and $400 billion to pay for it over the next
10 years if they are expanded. Like I said, it is a smokescreen.
Folks are starting to talk about whether prices are going to go up or go down or what these subsidies will do. Let's talk about that for a second. These subsidies are a very small part of the increases that we are seeing in premiums because of what I have already talked about. It is because of rising costs of healthcare and because of rising costs of health insurance that are due to those healthcare increases as well as that adverse selection.
Let me just put this small percentage in perspective. In Montana, we have a number of payers, a number of insurance companies. The one with the largest increase on the individual market was about 25 percent. It is a high number, I agree, but that 25 percent was a single digit amount. About 9 percent of that, was attributed to the enhanced premium tax credits, the ObamaCare credits. Even without that, the prices are going up. Independent of these ObamaCare credits that we are discussing, it is going up in the small group, the large group, and it is going up in every other part of insurance.
That part without the enhanced premiums, as I said, that delta between 25 and 9, let's say that is 16 percent, everybody else is still seeing that. They are still seeing that increase.
One of the smallest increases we saw from our major payers was about 10, a little bit over 10 percent, and about 3 or 4 percent of that was attributed to the ObamaCare premiums.
The reason I am bringing this up is that it is a very small percentage of these overall costs. One thing that I want to point out is that if these tax credits are allowed to expire on the 31st, premiums are going up. If we extend them, premiums are going up. It is happening either way.
Just one thing I want to end on so that people understand how this process works. If this body decides to extend those premiums, let's say it is for 2 years or 3 years, an arbitrary amount, then what happens?
The way that insurance rates are filed is they go to the States, the payers, the insurance companies bring them to the States. They file, they are approved, they get filed with CMS, with the Centers for Medicare & Medicaid Services, and then the open enrollment period starts, which is usually mid-November to mid-December.
Mr. Speaker, during that open enrollment period is when you buy your policies for the following year. We just closed that open enrollment period a couple of weeks ago for the 2026 policy years. Those rates are already baked in. If we were to extend those credits, the rates are already baked in.
Unless we go to extraordinary measures of allowing the payers to, once again, refile their rates and then have another open enrollment period, which I guess would be March or April by the time we got all that through, then, what do we with that?
Do we make those rates ex post facto? Do we have them go back to the beginning of the year? Or do you allow it to go through its normal cycle, in which case those rates affect the 2027 year.
The point I am making is that by extending those ObamaCare subsidies, we are not affecting the 2026 rates without going to extraordinary measures to unroll everything that has already happened.
What will happen is those insurance companies that filed higher rates with the assumption of those premium tax credits staying in will get the benefit of having a higher rate plus having that tax credit.
Going back to how I started this, this fraud was put on to the American people to hide the taxes so that the American people weren't taxed directly. They taxed the insurance companies that are getting these tax credits to change those rates for the people. This is not going to affect what is happening right now without extraordinary measures.
In closing, what we need to do, and I thank the gentleman from Florida for yielding, we need to start looking at alternatives on what are the core drivers of the costs of health insurance.
How do we rate health insurance so that younger, healthier people are still willing to pay for it so we have spread risk there?
What are the things that we can look at for driving costs down to stopping this endless cycle of adverse selection so that people can actually, as was promised on this big fraud perpetrated on the American people, have the doctor they want, the plan they want, and have their rates going down?
This ObamaCare premium debacle is not the answer, but we do need to get to work and figure out how we can get to the root causes of these rising prices. That is because, as I said, this is either going to collapse under its own weight or we are going to be forced to write an unlimited check to the Federal Government which many of my colleagues and I are unwilling to do.