00:01 - Good afternoon and welcome to our final

00:05 - hearing

00:06 - of the first day.

00:09 - A budget here is.

00:11 - We've survived the first day it was great.

00:14 - And

00:15 - we're grateful

00:17 - to have the department of insurance here

00:20 - and penny here and have.

00:22 - A commissioner here

00:23 - with the whole team.

00:25 - We appreciate your flexibility

00:28 - with being with us.

00:29 - This afternoon.

00:31 - Before we begin

00:32 - chairman choosy any introductory comments yes thank you chairman Harris good

00:37 - afternoon everyone appreciate you being here and for being flexible.

00:41 - Just an opening remark if you will I think it's important to note unlike most

00:45 - agencies who are testifying during budget hearings this week the funding for the

00:49 - Pennsylvania insurance department is separate from general fund

00:52 - the agency is funded through the collection of fees from insurance providers

00:55 - deposited into the insurance regulation and oversight fund

00:59 - however

01:01 - p ID does have an impact on Pennsylvania's overall fiscal health because of it's

01:04 - oversight of large insurance marketplaces in Pennsylvania

01:08 - from auto to healthcare and beyond

01:10 - last year at this hearing we did discuss the role that we at the state level can play

01:13 - in keeping costs low and I expect will do the same today

01:16 - on emphasize from the outset there are a lot of reforms that house Republicans would

01:20 - like to see when it comes to health insurance cost

01:22 - but we also recognize that it can be complex to

01:25 - separate which aspects can be managed at the state level

01:28 - and what is in the purview of the federal government

01:30 - I look forward to hearing from from you

01:32 - and how we can work together to lower costs for Pennsylvania thank you.

01:38 - Thank the gentleman.

01:40 - Commissioner if you and your staff could please stand so we could swear you in.

01:49 - Go.

01:50 - Do you solemnly swear that the commit that the testimony you're about to give is the

01:54 - truth the whole truth so help you god.

01:56 - Thank you so much may be seated.

02:03 - Foolishly you have a

02:04 - do you or the executive director of any

02:06 - open

02:07 - introductory comments you want to jump right into.

02:10 - Good afternoon chairman Harris shares through

02:13 - share susie and members of the committee I am my cum freeze I serve as commissioner

02:17 - of Pennsylvania's insurance department

02:19 - with me today are the department's chief of staff Jody France

02:23 - budget director into

02:25 - a Patty eye

02:26 - and behind me are deputy commissioner Dave Bruno

02:28 - and Rayna workman p ID his deputy ledge director

02:32 - we always appreciate the opportunity to discuss who p ID is

02:35 - what we do and how we help Pennsylvania is

02:38 - as you may recall and

02:40 - the chairman just highlighted p ideas not funded through the general fund

02:44 - each year through our licensing fees and other revenue generating activities

02:48 - p ID not only generate that's enough money to support it's own operations

02:53 - we also provide funding to the general fund to support other commonwealth initiatives

02:58 - in the past three years our Iraq budget

03:01 - has hovered around forty million dollars while we have provided over sixty million

03:06 - dollars each year to the general fund.

03:09 - I'm proud to report that under governorship Euros leadership p ID has taken steps to

03:13 - more efficiently and effectively carry out it's duties

03:17 - these efficiencies include efforts to reduce paper

03:20 - like implementing a paperless process to annual statement filings

03:25 - providing templates that facilitate facilitate company compliance in eliminating

03:30 - unnecessary airy fees and hurdles to get a producer license

03:34 - in addition to implementing these efficiencies I'd

03:36 - like to highlight a few of our recent accomplishments.

03:39 - During twenty twenty five the bureau of consumer services

03:42 - engaged with approximately fifty four thousand consumers

03:46 - handling more than fourteen thousand complaints in recovering more than thirty

03:50 - eighteen million dollars for Pennsylvania consumers.

03:54 - P ID helped over seven thousand pennsylvanians.

03:58 - Obtain almost one hundred and forty million dollars in

04:01 - life insurance proceeds after the death of a loved one

04:04 - or producer licensing division received over eighty thousand individual licensee

04:09 - applications and process them in an average time of less than three days

04:14 - and our rates and forms filing team received about twelve to thirteen thousand

04:18 - thousand filings saving consumers over two

04:21 - hundred seventy seven million dollars in premium

04:24 - by blocking unjustified rate increase requests.

04:28 - In through p I d s bureau of public engagement I neglected to introduce Bethany

04:33 - blessing who's our director of public engagement

04:35 - we have made great strides in getting the

04:37 - word out about who who is and how we can help

04:40 - who pie ideas

04:42 - and we're not going to stop

04:43 - we'll continue our efforts to educate about insurance and hope that we can reach as

04:47 - many of your constituents is possible.

04:50 - Under governorship Euros leadership we will continue to build strong relationships

04:54 - with stakeholders in the general assembly

04:57 - while we continue our efforts to more iffy actively and

04:59 - efficiently perform our core regulatory responsibilities

05:03 - again thank you for the opportunity to be here today I

05:05 - look forward to working with all of you and your questions.

05:10 - An afternoon

05:10 - in

05:11 - Charlie the executive director of penny.

05:13 - Pennsylvania's official health insurance marketplace

05:16 - I appreciate this opportunity to share updates on penny

05:19 - and the status of coverage here in Pennsylvania after

05:21 - we've just come out of our recent open enrollment period.

05:25 - Last year

05:26 - when he reached record levels of enrollment

05:28 - due in large part to cop marriage that was more affordable than ever

05:31 - however this year penny enrollees faced unprecedented costs increases

05:35 - their health plan costs have doubled because congress

05:38 - did not extend the enhanced premium tax credits

05:41 - which for years

05:42 - helped lower costs and increase enrollment.

05:46 - The impact of higher costs was seen immediately

05:49 - with one only some premium tax credits remaining

05:51 - pennies hot one hundred and four thousand

05:54 - pennsylvanians make the difficult decision to end their coverage

05:59 - with twenty thousand and dropping in February alone.

06:02 - The numbers grow larger every day.

06:05 - Working pennsylvanians across the commonwealth shared what having coverage

06:09 - means to them.

06:10 - In

06:10 - Terms of both their health and financial well-being

06:13 - we hear it from the farmers who feed us

06:15 - the local store owners we buy from

06:17 - the barbers and salon owners who cut our hair

06:20 - from our family our friends and our neighbors

06:22 - but now more of our fellow pennsylvanians are going and

06:25 - without the peace of mind and protection of having coverage.

06:29 - Having more uninsured in Pennsylvania

06:31 - as we have now

06:32 - is a lose lose for everyone people don't stop

06:34 - getting sick just because they don't have coverage

06:37 - it weakens our healthcare system

06:39 - especially in rural areas

06:41 - when care that has been fully reimbursed is now uncompensated care.

06:46 - Our economy is weekend and people are too sick to work

06:49 - or small business viability is threatened.

06:52 - While the federal government saves money now

06:54 - a long term costs of the uninsured

06:56 - beg the question of whether we're not all ultimately paying more.

07:01 - Pennsylvania could mitigate some of these impacts

07:03 - act fifty four of twenty twenty four created a state affordability program

07:07 - to lower health plan costs a penny.

07:09 - This person is not currently funded but funding it now could

07:12 - allow tens of thousands of Pennsylvania to gain coverage

07:15 - improving the outlook for households

07:17 - local economies and the healthcare system overall.

07:20 - I look forward to share bring that data and stories a penny and Belize with you today

07:23 - and thank you for the opportunity.

07:25 - Thank you both

07:27 - will start with representative mais.

07:30 - Anki chair and happy black history month.

07:33 - Commissioner welcome thank you for being here today

07:36 - as just mentioned that.

07:39 - The catastrophic situation we are faced saying in this commonwealth and in our nation

07:44 - due to the failure

07:46 - to pass the enhance premium tax credits.

07:49 - Many pennsylvanians are going to suffer

07:52 - and we know that they'll be on the short end of trying to find coverage that may not

07:58 - meet their needs but they that they will not be able to afford.

08:02 - So how is the insurance department working to

08:05 - protect consumers from excessive or discriminatory.

08:08 - I rate hikers who are looking to take advantage of this moment and then the second

08:13 - part of that question is to thank you for your participation in the work of the

08:17 - Pennsylvania black maternal health caucus.

08:20 - Related to my first question as you did a survey about

08:23 - what are the essential coverages that are needed for women in this commonwealth

08:28 - and if you have results of the survey we'd love to hear some highlights or where you

08:32 - are with the status of the survey so

08:35 - what's going on

08:36 - with folks are going to face

08:38 - discriminatory rates

08:40 - which I would imagine will be

08:42 - the moms of this commonwealth as well

08:44 - and what are the results of the survey that you all instituted over the past year

08:48 - appreciate that representative and I think

08:50 - Devon highlighted some of the significant premium impact that people's

08:55 - when they came to penny saw for this year

08:58 - and an average of over one hundred percent

09:01 - once you take away way the enhance premium tax credits

09:04 - that congress still to this day as an opportunity to extend

09:07 - to make coverage immediately more affordable

09:10 - what p ids role is

09:12 - throughout last year around may of each year is when companies will submit their

09:16 - product filings for the following year

09:18 - so once those rates come in may fifteenth

09:21 - my team goes back back and forth with their

09:23 - company actuaries to make sure that we agree that

09:26 - the assumptions for the cost of coverage to deliver those benefits are in line with

09:32 - the expectations for what the premium and what the charge is going to be

09:36 - so we push back as much as we can through that process to make sure that

09:40 - the rates

09:41 - are

09:42 - any

09:43 - higher than what we think is justified by the

09:45 - potential claims payouts for the following year.

09:49 - Is that.

09:50 - We actually approved for for twenty twenty six

09:53 - premiums that were around twenty one and a half

09:55 - percent but obviously that was compounded by

09:58 - the federal government's inaction

10:00 - when people actually came to shop for cover.

10:03 - I think I'm on your second question representative

10:06 - thank you very much for inviting me

10:08 - to participate in those conversations that that event was great and I look forward to

10:12 - future collaborations

10:14 - with you

10:15 - we have

10:16 - to do moving paths

10:17 - when it comes to women's health maternity health.

10:21 - The first one is part of our

10:23 - form filing process

10:24 - last year we looked at

10:26 - several key benefit offerings and really wanted

10:28 - to get an understanding of what's in the market

10:31 - in in the end of December I think it was at

10:33 - the end of December published information on

10:36 - on what we found so people shopping for their coverage could understand that now

10:40 - because of the shapiro administrations.

10:43 - Encouragement

10:44 - all companies will cover is Iran alone the the fast acting

10:48 - oral treatment for postpartum depression

10:51 - beginning in two thousand and twenty six

10:53 - all will be covering ppd screenings in care

10:57 - of for the

10:58 - post year and pelvic floor therapy

11:01 - where I think there's a lot more work that can still be done.

11:05 - Do

11:05 - Coverage I think we have about one.

11:08 - Surrogacy coverage there are a couple of companies

11:11 - a brown breast milk storage is is getting better we're up at five

11:15 - donated milk

11:17 - that's up at three

11:18 - and so

11:19 - that was for last year those results are now public world be looking to see see what

11:24 - companies are projecting out for twenty twenty

11:26 - seven when those rates and forms come in

11:28 - may of this year and I think

11:30 - now that the companies know kind of from a benchmark perspective what we're looking at

11:34 - and we'll look to see coverage improvements I think for twenty twenty seven

11:38 - thank you

11:39 - thank you commissioner that the dual coverage is essential and it was one of the

11:43 - major pieces legislation our caucus is able to pass into law.

11:47 - Thank you for your continued support and we look

11:49 - forward to working with you too and just quickly for

11:51 - executive director

11:53 - tally trolley

11:54 - I wanted to ask you

11:56 - I work to enroll people in the affordable care act I know how important penny is

12:00 - to my district and the commonwealth

12:02 - one of the essential healthcare benefit fits

12:04 - his maternity and newborn care

12:07 - how are you seeing any demographic information about who's going off you mentioned

12:12 - twenty thousand and February are exiting penny are not able to afford it

12:16 - are you seeing any particular demographics around mom's dropping off of of penny or

12:21 - are women across this commonwealth.

12:24 - Yeah that's a great question we have not looked specifically and at that

12:28 - for determinations what I can say is that a

12:29 - lot of terminations have been older individuals

12:32 - who are not yet eligible for medicare

12:34 - and are young adults who

12:36 - you know are some of the first to drop coverage on costco

12:38 - because they're don't think they need it and the impact of that is that it hurts the

12:41 - rest pool and causes costs to go up for everyone

12:44 - and that we haven't looked at that specific question we can get back to you on that

12:46 - one yeah we definitely love to work with you on that thank

12:49 - you again share Harris thank you commissioner thank you

12:51 - executive director Charlie.

12:53 - Thank the gentle lady representative all summer.

12:57 - Thank you chairman Harris.

12:59 - Commissioner humphries

13:01 - and and everybody else thank you very much for

13:04 - being here and my first question and I have to

13:09 - do is regarding the public gestures

13:12 - and

13:13 - the house recently unanimously passed this bill

13:16 - reforming public adjuster licensing act.

13:20 - I appreciate the department being involved in this process

13:24 - along with my colleagues in the house

13:26 - can you please explain

13:28 - the.

13:30 - The importance of this legislation

13:33 - from the department's perspective

13:35 - that we we thought it was critically important in really appreciate you engaging the

13:39 - issue and in helping drive this issue forward it's

13:42 - it's one that after kind of a significant claims causing event

13:47 - it's one that we run into quite frequently from Dave's consumer side

13:51 - where there's instances that.

13:54 - A certain claim maybe hasn't been closed.

13:58 - Because there is a disagreement between the

14:01 - company and the policyholder often we find that.

14:04 - A public adjuster is is part of that conversation.

14:08 - So what we really thought sought out to do

14:11 - because a second piece that really has been challenging

14:13 - when Dave's team has gone out there is defined

14:16 - just exorbitant fees

14:18 - that were charged so I mean fees as high as almost forty percent

14:23 - so if I'm getting

14:24 - one hundred thousand dollars back to to repair my house thirty seven percent of that

14:29 - so thirty seven thousand dollars maybe is going to the public adjuster

14:33 - who helped negotiate that claim on my behalf

14:35 - leaving me in a position where I can't fully repair my house

14:38 - so

14:39 - In the in the bill we sought out and worked on putting a cap or reasonable cap on

14:44 - what public adjusters could charge as part of that process

14:47 - we also sought to

14:49 - do

14:49 - Prohibit a public adjuster from both being the public adjuster and the remediation

14:55 - entity as part of the same claim

14:58 - now you could still own two different businesses

15:00 - but because of the potential inherent conflict of interests you can't work

15:04 - on that same claim with two different hats.

15:08 - So really those are two who are the key points that we wanted to drive through.

15:13 - Last year and in really appreciate all members of the

15:15 - house for for advancing that with such a significant vote.

15:18 - We sincerely appreciate your input as well

15:21 - my next question quickly revolves around penny

15:25 - and the navigators and the sisters licensing

15:29 - as as a licensed insurance agent in the state of Pennsylvania

15:34 - licensed insurance agents in paz

15:37 - Pennsylvania must complete pre licensing education.

15:41 - Pass state exams

15:42 - carry errors and omissions coverage

15:45 - and meet continuing education requirements.

15:49 - Penny certify navigators and his sisters

15:52 - provide plan guidance to customers

15:55 - but are not required to hold insurance producer licenses

16:00 - can you explain why can't why the commonwealth

16:03 - believes this is a different regulatory standard.

16:07 - Why this different regulatory standard is sufficient

16:12 - and

16:13 - how it protects

16:14 - cut consumers

16:16 - and what safeguards are in place to ensure

16:19 - parity

16:20 - and accountability.

16:23 - So I'm happy to speak to that from how

16:25 - penny

16:26 - really uses both brokers and sisters to help people get coverage but there are some

16:30 - key differences so burgers as he mentioned

16:33 - because of their higher licensure and training they

16:36 - can do the full

16:38 - whole canon of consumer support they can help them apply for coverage get tax credits

16:42 - as and help get them choose a plan including all the different

16:46 - components of that and help make recommendations a clear differentiation between that

16:50 - and a sister's is that as sisters are not able to make plan recommendations

16:54 - they really thrive more and then we released the then help all the people who are

16:58 - next coverage with medicaid and penny across the family and they re the focus we see

17:03 - a lot more on complex eligibility cases and

17:07 - completing the application.

17:08 - So there are very distinct roles we train on those roles

17:11 - very clearly every year as part of our annual training

17:14 - of what the limitations of being a navigator and a sister are

17:17 - versus a broker

17:19 - and I'll just note we have fifty four percent of our enrollments are assisted by a

17:22 - broker ursa that broker activity is extremely

17:25 - supportive and strong and penny enrollments

17:28 - and our sisters play a key role they tend to be very supportive again of families who

17:32 - have complex eligibility especially when they're

17:34 - mixed coverage between medicate them honey

17:36 - do you know how many sisters and navigators there are in penny.

17:42 - Yet there are about I want to say a little bit under one thousand

17:46 - I'm sorry could you repeat that

17:47 - under a thousand toka

17:49 - and there are more than five thousand brokers

17:51 - okay.

17:53 - Thank you very much I appreciate your time this afternoon.

17:59 - Thank the gentleman representative Flemming.

18:04 - Thank you

18:04 - thank you mr chairman.

18:06 - Good afternoon

18:07 - and.

18:09 - Executive director trolley.

18:12 - Christopher humphrys really appreciate you being here

18:15 - and.

18:16 - I was

18:17 - very lucky growing up as a kid most of my life was spent without health insurance

18:22 - coverage and as far as I can remember I never got any major illness

18:28 - I just had to get stitches a few times which.

18:31 - Did not

18:31 - end up in severe medical debt for my

18:34 - parents or anything like that but

18:36 - that's you know health care costs.

18:39 - Since I was a kid have skyrocketed

18:43 - and in my district there are fifty nine percent

18:47 - of children in my district that are.

18:50 - On some sort of pub click health insurance

18:53 - which

18:54 - either medical assistance or on chip.

18:58 - That's a big number

18:59 - and I got that number from Pennsylvania partnerships for children who just released

19:03 - their fact sheet back in February

19:05 - or a little earlier this month

19:07 - and.

19:08 - Can we talk about the downstream effects

19:12 - of.

19:14 - How the healthcare system interacts with people who are not insured

19:19 - and why it's important to the extent possible for

19:23 - a government if it has to or other entities to make

19:27 - health insurance affordable

19:29 - not only for children but for adults as well

19:32 - and people need to get care

19:34 - people who require care are going to get it so.

19:38 - How does how does that work in terms of payment

19:41 - and in terms of the dollars and cents within our healthcare system.

19:44 - Sure representative you make a great point

19:47 - people don't stop getting sick because they don't have health insurance they don't

19:51 - stop getting injured because they don't have health insurance

19:54 - where you see kind of the

19:56 - I think global environmental impact is

19:59 - it

20:00 - At the provider level

20:01 - providers are still going to be providing these

20:04 - services and instead they'll be chasing bills

20:07 - so you'll see

20:08 - medical debt grow you'll see cash on hand at providers

20:11 - and hospitals many of whom are are already struggling.

20:15 - Having to to chase and collect

20:18 - info

20:18 - of

20:19 - Financial resources from people that.

20:22 - Don't necessarily have it available

20:24 - and that's that's for those that are uninsured isn't

20:27 - even negatively impacts those that that remain in short.

20:32 - Just for twenty twenty six I mentioned that the twenty plus per cent rate increase

20:36 - three and a half to four percent of that was the expectation for a worse risk pool

20:41 - because as Devin mentioned

20:43 - young and healthy individuals leave the Mark

20:46 - those that think they can forgo insurance are generally

20:49 - the first step pull out of having insurance coverage

20:52 - so

20:53 - The remaining pool tends to be.

20:56 - Less healthy than those that were in the pool prior so when

20:59 - a company is pricing it's product for the following year

21:03 - it has to assume that it'll pay more claims or at

21:05 - a higher rate than it would have otherwise paid

21:08 - so it impacts really the entirety of the healthcare ecosystem from

21:12 - the providers

21:14 - to those that remain in the insure

21:15 - space in a

21:16 - significantly negative way.

21:19 - Or you can just add one study looked at the number of people dropping coverage from

21:24 - that cost increases

21:25 - and they calculated after Pennsylvania alone because of the weakening of the

21:29 - healthcare system and the weakening of

21:31 - small business owners and other

21:32 - job creators here in Pennsylvania that that would cause the Pennsylvania gdp to go

21:36 - down by seven hundred and fifteen million dollars

21:39 - it would cause a loss of fifty one hundred jobs in Pennsylvania and it would mean

21:43 - forty nine million dollars in lost state revenue.

21:48 - Thank you for that and and

21:50 - at the end of the day and I know it doesn't make up for

21:54 - and

21:55 - the total cost but.

21:57 - Taxpayers are still on the hook for some of these costs

22:00 - for those who are uninsured and seek care right we do

22:03 - there's a funding there's a funding stream for uncompensated care

22:07 - too

22:08 - hospitals and health systems and other health providers healthcare providers so.

22:12 - I.

22:14 - You know

22:14 - it seems to me

22:16 - that

22:16 - if we as taxpayers are going to make an investment making the investment upfront

22:22 - to ensure that people do have health insurance

22:25 - and can and there's a payer for when they go go to the

22:29 - healthcare provider

22:30 - it seems to me that that would be

22:33 - a lot more wise in terms of spending

22:35 - than trying to pay for it on the back end with

22:37 - uncompensated care and then if we can't do that

22:40 - watching our

22:41 - health systems and providers close and shutter their doors.

22:46 - So.

22:47 - I dunno if you want to risk open to that but

22:49 - if not that's okay I think

22:50 - I think

22:51 - we agree with you wholeheartedly

22:53 - had had congress extended those tax subsidies

22:56 - I think you would have seen record enrollment.

22:59 - Through penny

23:00 - as an example new Mexico is able to fully back fill the enhance tax credits and they

23:05 - saw a fourteen percent enrollment

23:07 - increase for con Texas Pennsylvania saw a fourteen percent around the increase we'd

23:10 - be at five hundred and sixty five thousand

23:13 - insured but now we are about

23:15 - nearly one hundred thousand lower than that number of where we can have fun

23:19 - while it's certainly something to work toward thank you so much thank you mr chairman

23:23 - thank the gentleman representative krupa

23:26 - thank you mr chair and thank you to all the testifies for being here today it's no

23:30 - secret that they were in a mental health crisis here in Pennsylvania

23:33 - there's rising rates of anxiety depression and suicide

23:37 - yet more providers are leaving networks and it's creating a real access to care issue

23:44 - so the governor's budget narrative raised

23:47 - concerns about the fire financial impact a policyholder faces

23:51 - when their mental health providers no longer in an insurance network

23:55 - it seems the department's looking to create a more efficient process for the

23:58 - providers to enter into insurance networks

24:02 - I'm so my question

24:03 - and I'm and I'm

24:04 - a I've got multiple questions about this but

24:06 - I'll try to limit it can you provide more details

24:08 - about the legislation that's being proposed

24:11 - is there a trend that mental health providers are dropping

24:13 - out of insurance networks because of reimbursement rates

24:16 - if so how would this policy

24:18 - incentivize them

24:20 - to enter to join a network and ultimately then how

24:23 - does this all boil down to the consumer who's

24:26 - just trying to to maintain a qual medicare.

24:30 - Yeah I think it at it's base it should expand the availability of those mental health

24:35 - professionals to the consumer looking to

24:38 - seek service so

24:39 - it's ineffective any willing behavioral health

24:42 - practitioner.

24:44 - Draft legislation

24:45 - that would.

24:47 - Provide that any provider that that wants to and is willing to join a network

24:52 - at the terms that are suggested by the insurance

24:54 - company the insurance company cannot deny them

24:57 - from joining that network and must provide reimbursement to

25:01 - those providers at

25:02 - comparable levels to what it would otherwise pay

25:05 - other providers so.

25:07 - That we really put in end to what we hear today is.

25:11 - Our network is full.

25:14 - Meaning we already have reached a quote unquote adequate network we don't have to

25:18 - accept any additional providers we're not going to accept additional providers that's

25:24 - not going to be a thing of the future

25:26 - if we pass this any willing behavioral health provider legislation

25:30 - and

25:31 - the proposed policy my understanding is it only covers mental health providers

25:35 - are you seeing trends for other

25:37 - health providers with respected network access

25:40 - where we have a pretty robust network adequacy review process where each year is part

25:45 - of that rate and form filing process we also get their networks

25:49 - we run them through a system this year we actually went from instead of

25:52 - as the crow flies for disk since we measured actual turn by turn directions

25:57 - so that tight ended up a little bit more

25:59 - than where it was in the past in terms of

26:02 - how many providers need to be accessible based on

26:04 - where my place of residence or or employment is

26:08 - so

26:09 - In areas where we find that companies can be

26:12 - broader in their network in the past we have provided

26:15 - additional lists of of license providers that they could add

26:19 - we've had companies in the past because of the list that we've provided to them

26:23 - expand their network substantially because now they had

26:26 - an accessible list

26:28 - for providers that they could go out and outreach to.

26:31 - For those that don't meet

26:32 - the kind of

26:34 - what are qual city metrics tie it around ninety percent is what we would like to see

26:38 - in terms of ninety percent of that service area has

26:41 - sufficient access to this provider type

26:44 - we will follow up with them and

26:46 - request.

26:47 - Additional reporting on

26:49 - how they are going to fill the gaps that we have

26:52 - now there are some places that

26:54 - that a gap can't be filled right there there just aren't the number of providers in a

26:58 - certain area to fill out that network

27:01 - but in those cases

27:02 - where there is a willing provider that's acceptable

27:05 - and within a reasonable amount of time they're expected to be treating that provider

27:10 - as an in-network provider so a consumer doesn't get penalized

27:14 - on it's call I'll share

27:16 - from the deductible level in others.

27:18 - Just because there isn't a provider in that area

27:21 - that's in their network

27:23 - thank you very much.

27:25 - Thank Mr.

27:27 - Thanks generally representative Kincaid.

27:30 - Thank you mr chairman and thank you guys for being here today

27:33 - the governor's budget calls for.

27:37 - Legislation that would ensure that direct payments for prescription

27:41 - prescription medications count towards Pennsylvania and out of pocket maximum.

27:48 - Specifically noting that that ad

27:50 - folks who shop for more affordable medications can be penalised when insurance

27:54 - companies ignore what has already been paid

27:58 - on their behalf I

27:59 - wonder can you explain the problem that the administration is trying to solve with that

28:04 - sure we're we're actually

28:06 - been I think I think every way in this room knows that

28:08 - there's there's a challenge in transparency in healthcare

28:12 - right it's

28:12 - it's hard to know unlike when you're going to the convenience

28:16 - store or retail store and you can look at the prices

28:19 - that what you may purchase are going to cost you

28:22 - that's not really a thing

28:24 - as much

28:25 - on the healthcare side

28:26 - so the proposed legislature one

28:28 - would look at situations where an individual has found

28:32 - prescribed medication at a cost that's.

28:36 - Lower for that insured individual.

28:39 - It may not be at a network pharmacy it may be

28:42 - at one of these

28:43 - direct to consumer sites that that you see now coming up

28:47 - but when that individual dual pays that.

28:50 - Twelve dollars for a generic that

28:52 - otherwise maybe could have cost seventy dollars

28:55 - that that twelve dollars is actually counted towards the accumulator programs within

29:00 - the insurers so they have to count

29:02 - what somebody is actually spending on the drug within certain limits and we're

29:06 - working on getting that legislation out and

29:08 - and being able to socialize it with

29:10 - with all of you but it really

29:12 - seeks to benefit

29:13 - those individuals that are looking to

29:15 - to shop for

29:16 - for care

29:17 - looking to to shop for

29:18 - prescription medication that they can afford we don't think those individuals should

29:22 - be penalized and that's what the governor is saying and in proposing that legislation

29:27 - to make sure that those costs that paying

29:29 - get counted to their benefit and the insurance policy

29:32 - thank you and similarly

29:34 - I've introduced bipartisan legislation that that sort of a.

29:39 - In addition to that

29:41 - so would you agree that when

29:42 - a patient pays for their medication whether.

29:46 - On their own or via an assistance program or the the direct consumer.

29:52 - That the payment should count towards their out of pocket maximum so that insurance

29:57 - companies are not effectively receiving

30:00 - twice as much as they are entitled to on the backs

30:02 - of our sickest and lowest income Pennsylvania and

30:05 - that

30:05 - that's what this bill would do it's it's the cash pay or or credit pay it's the

30:11 - payment that the can sumer is making

30:13 - out of pocket

30:14 - for the drug would count towards

30:17 - that benefit now it's it's not necessarily an accumulator bill in the sense of

30:23 - there's some

30:24 - I think

30:25 - legal uncertainty right now and how the federal government is

30:29 - determined what companies need to count toward.

30:32 - An

30:33 - Accumulator programs the

30:36 - notice of benefit and payment parameters

30:38 - society has gone back and forth

30:41 - on what is required to be counted what doesn't have to be counted

30:44 - so it doesn't go that next step but it does go so far as to say

30:48 - those costs that a consumer are actually paying

30:51 - need to count towards thereby benefit

30:53 - thank you

30:54 - and we passed legislation

30:57 - last session to rein in pharmacy benefit managers

31:01 - and

31:02 - ads and wondering if you can speak to how the enforcement of that is is going

31:08 - sure it's it's really just beginning because of the the timeline of the legislation

31:13 - that the

31:14 - benefits came into play in large part one one of this year

31:18 - to apply to policies that were written this year and the individual and small group

31:22 - market there may have been some large group plans that

31:24 - that came into effect

31:26 - before this time but

31:27 - were we actually have a number of projects going right now

31:31 - the first is going to be the study that's required

31:34 - under the legislation we were required to look into

31:37 - spread pricing among pbms

31:40 - and what

31:41 - impact a ten dollar and I think fifty cents

31:44 - dispensing fee would have on kind of the overall market dynamics

31:48 - so we had contracted with a national consulting firm to do that study

31:53 - we expect to get it to you in the spring of this year.

31:56 - So hopefully within the next month six six weeks eight weeks

32:01 - to reveal that study at the same time

32:04 - we have reports that are now coming due under the legislation so

32:08 - in April pbms will have to be submitting to

32:10 - us their first ever network adequacy reports

32:13 - how their

32:14 - networks are are adequate and what they're doing in that space

32:17 - in July that's where the transparency reports come in

32:20 - how much they're paying

32:21 - affiliated pharmacies non affiliate

32:23 - aided pharmacies and others and

32:26 - so we're moving those pieces as well as

32:29 - Dave in in our team is coordinating with

32:32 - primarily independent pharmacies on a

32:35 - more streamlined pharmacy complaint form.

32:39 - That will address really any of the benefits that

32:41 - consumers are entitled to receive under the legislation

32:44 - in a single form

32:46 - so it could be related to

32:49 - the designation of a specialty drug but it could be

32:52 - clawback provision it could be.

32:55 - Charged provision so

32:57 - we are actually actively working with them

32:59 - as I speak on on

33:01 - how to how to make that form is

33:03 - as

33:04 - Positive as we can for the end users of it

33:07 - so as soon as we're able to to kind of work through

33:09 - that we'll have that on our website for an easier way to

33:13 - to get complaints to come in so

33:14 - so far we've gotten

33:16 - just shy of of eighty complaints I think

33:19 - in in large part because of the staggered

33:21 - implementation date a lot of those haven't been.

33:25 - Related to in effect policies a lot more of them

33:28 - are are really specifically related to glp one drugs

33:33 - and it's

33:34 - my insurance company doesn't cover it solely for weight loss purposes

33:38 - and that's that's generally true

33:40 - insurance companies will cover it when there's a comorbidity but

33:43 - not for weight loss purposes solely so.

33:46 - Complains that we've seen

33:47 - outside of what would otherwise be covered by act seventy eight but one that

33:51 - we're getting on premiums.

33:54 - That

33:54 - thank you mr Sharon.

33:56 - Thank the gentle lady representative Nelson.

33:59 - Thank mr chair

34:01 - commissioner great to have you here.

34:04 - I want to ask

34:05 - and talk a little bit

34:06 - about ducks and consumer protection issues related to insurance

34:10 - we

34:11 - Recently had a senior driver driving seminar and

34:15 - a family that was there was talking about a very difficult situation they were going

34:19 - through related to their homeowners insurance

34:21 - because they're apparently there

34:24 - their roof was identified through an AI

34:28 - data review that

34:30 - it was now getting older and they had x number of days in order to put a new roof on

34:35 - or else

34:36 - their insurance would be cancelled you know so for an older couple who said their

34:39 - roof was in a really good condition

34:41 - and they felt they had

34:43 - no ability to put she back against this prof process and is looking into it

34:47 - I guess it is a thing there's

34:49 - it's

34:50 - AI

34:50 - Targeted risk profiling

34:53 - of

34:54 - Homeowners

34:55 - and.

34:57 - Can you touch a little bit about your you know the

35:00 - the department's.

35:02 - Interaction with this I

35:03 - think

35:04 - you've done a great a job that helping maybe to prevent

35:07 - auto insurance increases.

35:10 - In going up but it seems like this new AI.

35:13 - Computer vision satellite imagery building history and analytics

35:18 - and then

35:19 - you know homeowner after homeowner are being.

35:22 - Really

35:23 - receding increase premiums

35:25 - what are we doing about this yeah yeah appreciate the

35:27 - question and I would I would add homeowners into though

35:31 - the department is doing a really

35:33 - strong job at pushing back

35:34 - we've actually saved policyholders

35:36 - seventy million dollars over the last three years and just pushing back on on rate asks

35:42 - now aside from that though.

35:44 - We are seeing some of those same challenges that that you describe.

35:48 - In

35:49 - Last I think it was last year at this point we did issue guidance on

35:53 - the use of aerial surveillance because we were hearing that companies were using it

35:56 - to cancel or non renew policies and in basically we went through and

36:01 - reminded companies of their responsibility to make that is information known to the

36:06 - policy holder give them an opportunity to correct.

36:09 - The change in and work with the policy holder where possible

36:13 - now I think some of what you're you're seeing though is is newer developments

36:18 - that we

36:19 - continue to do want to have further conversation about because we're seeing

36:24 - I think trends not only

36:25 - am from a

36:27 - a certain number of years where companies are now

36:29 - automatically assuming you need a new roof yes it seemed like

36:32 - and again I'm not a black belt in this area but both listening to.

36:37 - The family

36:38 - and then asking some questions that even though a person

36:42 - may buy a thirty year or pay for a forty year roof that

36:45 - now

36:46 - they're starting to at that ten

36:48 - what is it.

36:49 - Five to eleven years is considered middle aged

36:53 - in the eyes of the insurance company and

36:55 - they're starting to increase those percentages

36:57 - and

36:58 - legislatively do you

37:00 - do we need to put together a bipartisan package to

37:03 - you know.

37:04 - Create a way for homeowners to

37:07 - who've been

37:08 - identified through an AI review like they just

37:12 - they didn't seem

37:13 - to have a voice

37:15 - even to be able to dispute

37:17 - the assessment they could just or

37:19 - the insurance company was saying well you could exclude

37:21 - coverage or we're going to increase your deductible or

37:25 - you're going to get an as is roof so

37:27 - people are already paying more

37:29 - and it seems like this may be a way to buffer additional profits for some of our

37:33 - largest insurance carriers yet we'd be glad to talk to you more about how we can

37:38 - strengthen the consumer protection side of that conversation because I think one

37:42 - point that we'd also want to look at

37:44 - is part of that process is.

37:47 - Not necessary not only the potential replacement of roofs

37:50 - but that the coverage may change

37:53 - so maybe they will continue to

37:55 - underwrite you continue to offer you that homeowners coverage

37:59 - but

38:00 - it would turn into a situation where it's actual

38:02 - cash value instead of a replaced the value

38:06 - of policy that gives you the the full replacement for

38:09 - for that roof should you have a claim in the future so

38:12 - I think is your offices

38:14 - run into these issues for now

38:16 - it would help us to be able to kind of develop a complaint ledger on these issues so.

38:22 - Please feel free to reach out to my team and in Dave and in others

38:26 - so we can look at this on a one off basis

38:28 - while we have conversations about

38:30 - what a.

38:33 - Improved I think homeowner's policy could look like going

38:36 - forward in terms of the benefits that are required to be

38:40 - at least made available if not offered to consumers

38:43 - particularly related to to roofing but we would

38:46 - we would be very interested in seeing

38:48 - kind of those specific AI complaints

38:51 - looking at roof a age

38:53 - without looking at roof quality or sending

38:56 - somebody out to verify that the quality of the roof

38:59 - isn't what they say it is based on AI

39:02 - that's great I'm fortunate serve on the insurance committee so I will be

39:05 - following up thank you very much

39:07 - thank the gentleman representative Salisbury.

39:11 - Thank you chairman.

39:12 - I

39:14 - Stood

39:15 - at the same table and twenties twenty four

39:17 - and asked a question about

39:20 - how the department of insurance classify as autism

39:24 - and I was taught that autism as a mental illness

39:28 - and that is how the state of Pennsylvania has it

39:31 - classified.

39:32 - As the only openly autistic person who has ever chaired the state's

39:38 - autism caucus

39:39 - I have been very concerned about government on this information that

39:44 - comes out about when does not a mental illness but is a developmental disability or

39:50 - neuro developed mental disorder so in the wake of for example

39:55 - rfk juniors announcement related to autism

39:59 - and Tylenol

40:00 - last year and last month saw him entirely restructure the inter agency autism

40:06 - coordinating committee to include.

40:08 - People who believe that vaccines cause autism.

40:12 - I'm curious if you have changed in any way the.

40:16 - Manner in which you present autism to

40:19 - the people of Pennsylvania

40:21 - and whether this

40:23 - dis information campaign at the federal level

40:25 - has influenced the way that you speak about this

40:28 - neurodevelopmental disorder

40:30 - yeah I think the

40:32 - the misinformation campaign is a significant challenge to to all of us

40:36 - across

40:37 - only in the autism space in the vaccine space and in otherwise is

40:40 - as you mentioned

40:42 - and

40:42 - for us it's.

40:44 - We've been talking about it in a

40:47 - perspective of requiring

40:49 - parity and more robust coverage.

40:53 - For diagnoses of autism and four related services for those that are are insured.

41:01 - So it's

41:02 - it's less of a classification question in more of a

41:07 - requiring the most robust benefits.

41:11 - Possible

41:12 - it wasn't it wasn't

41:14 - us so much that that put it in a mental health bucket as

41:18 - do

41:19 - The.

41:21 - Dsm and other guidance that came out to put it in that

41:25 - bucket so we've we've talked about it less from a lens of.

41:29 - Where you would classify it and more from the lens of

41:33 - the benefits applicable to.

41:36 - Autism and to patients impacted by autism

41:39 - and

41:40 - I understand that and I definitely want everyone to get all the services to which

41:44 - they may be entitled I was not diagnosed until I was an adult and twenty twelve

41:49 - I was diagnosed with what was then called aspergers which is now I

41:53 - reframed as level one

41:55 - autism

41:57 - but

41:57 - I I remain concerned about the way in which we use terminology in Pennsylvania

42:03 - and how it may impact the health outcomes

42:06 - of

42:07 - Autistic children and adults

42:09 - because for example we do know that some people when they believe that their child

42:13 - has an illness called autism they will do horrific thing things like

42:17 - feed their children bleach or anti parasitic ce

42:21 - so I'm just curious in what way you may be

42:24 - trying to combat some of these unfortunate misunderstandings and outcomes.

42:30 - Yeah

42:30 - certainly we

42:31 - we would

42:32 - combat any suggestion that bleach is a good medical alternative

42:37 - someone on my Facebook page should encourage it she said it was a great idea

42:41 - I did blocker but yeah

42:44 - but

42:45 - the the way that we try to reference it it

42:47 - I mean it it cites to the dsm so

42:49 - it's not so much that we're going out there and saying it's a mental health condition

42:53 - it's just classified within the dsm that

42:56 - really guide mental health parity regulations

42:59 - as falling within

43:00 - coverage of mental health benefits

43:03 - so it's really the focus on

43:04 - the benefits that are required to be provided for individuals with coverage.

43:09 - As I said I certainly want to make sure that everyone is getting the coverage and

43:12 - services that they're entitled to

43:14 - but under the dsm five it does cl classify it

43:18 - as a nerd about

43:19 - neuro developmental disorder likewise the nih the

43:22 - national institute of mental health the CDC the w h o

43:28 - all classify it as not a psychiatric condition

43:31 - but rather a developmental disability

43:34 - and

43:34 - I just want to make sure that as we sat p policy and

43:39 - part of that policy is insurance benefits

43:41 - that we are not inadvertently contributing to any this information

43:47 - so I would appreciate anything that you could do going forward to try to clarify

43:52 - what autism is what it is not.

43:55 - In your capacity

43:56 - with working with insurance benefits

43:59 - appreciate that represented.

44:04 - The gentle lady representative braille

44:06 - thank you and thank you all for being here

44:09 - I'd like to follow up on a question

44:12 - that the the good

44:13 - lady from allegheny had asked about pbms

44:17 - and.

44:18 - Acts seventy seven of two thousand twenty four

44:21 - the Pennsylvania as pharmacy benefit reform act

44:25 - introduced greater oversight of pharmacy benefit

44:29 - managers and their role in drug pricing and reimbursement

44:33 - and a key provision

44:34 - of the law establishes a process for pharmacies to challenge

44:39 - the department's designation of a drug

44:41 - as a specialty drug.

44:44 - I have a small hometown pharmacy in my district in fact they're called hometown

44:50 - pharmacy and the governor visited them

44:53 - last August and had expressed.

44:56 - You know his concern and empathy for what they were going through

45:01 - and I have had an opportunity to follow up with these folks since the law

45:06 - came into place

45:08 - and

45:09 - Davis showed me that.

45:12 - Pharmacies are still losing a significant

45:14 - amount of money.

45:17 - Dispensing through managed care em CEOs namely express scripts

45:22 - cvs and care mark.

45:24 - Generic maximum allowable costs lists are unsustainable

45:29 - and they're paying penny margins to these small businesses.

45:33 - The pbm

45:34 - spread pricing still exists.

45:39 - Variable contract rate pricing is in effect where

45:42 - contract reimbursement rates constantly change.

45:46 - There are countless examples of where patients have unmet deductibles.

45:52 - The pharmacies get temporarily reimbursed higher

45:56 - to push.

45:57 - Their

45:58 - you know they're deductible but then once the

46:01 - deductible phases met the bottom drops out and.

46:06 - The reimbursements are much smaller.

46:09 - So.

46:11 - I'm very concerned

46:12 - about and.

46:15 - Businesses like this

46:16 - that are trying to exist

46:18 - in my community and I would just question

46:22 - and.

46:24 - Have we begun.

46:27 - Checking or challenging

46:29 - some of these processes

46:31 - your

46:32 - representative that's

46:33 - that's really where we are are now because a lot of

46:37 - those provisions didn't start until January of this year

46:41 - so I think I think hometown pharmacy is one that is part of the group of of

46:45 - independent pharmacies that we're talking to actively on

46:49 - and

46:49 - updating the complaint form to make it to make it work for that.

46:53 - So they have an easier way to to come through to us but starting this year

46:57 - is when all the reporting comes into us so we will actually be able to see

47:02 - what the spread looks like what

47:04 - additional transparency is excessive well to us

47:08 - in their different contracts and that's that's July

47:10 - of this year is when the transparency reports come in

47:13 - and then we'll be made

47:14 - a version of them will be made public

47:16 - for for everyone to consume so but when do we start taking action because to a small

47:21 - business like hometown this is detrimental as you can imagine

47:26 - and so so I understand we're going to be collecting all this data

47:30 - when are we actually going to start taking action

47:32 - your we're we're we're ready to take action

47:35 - as as complaints come in we're addressing them

47:38 - is

47:38 - As I mentioned

47:40 - I mean unfortunately so far

47:41 - of the eighty

47:43 - there's there's been a couple of dozen that were.

47:46 - Applicable and that we were able to work with them on

47:48 - but again many of those were were glp one complains but

47:53 - to be able to kind of really build that out we're looking to and this is part of why

47:58 - we've we've got this ongoing conversation going with the independent pharmacies

48:02 - is we need their experiences we need them to come to us to talk to us about

48:07 - kind of the the issues that we're running into because then we can

48:10 - have that direct line into the pbm to require a corrective behavior.

48:16 - Can you tell me what specific criteria.

48:20 - Your department applies when reviewing specialty

48:23 - drug challenges and how does it ensure consistency

48:26 - that we we actually haven't had one yet.

48:29 - So that's part of the the phone

48:31 - they can come into us today

48:34 - but we all are we plan to also make it easier through that form that I mentioned

48:39 - but as we look at it

48:41 - we we have a contract pbm from

48:43 - so we look at what companies suggests should be specialty

48:47 - drugs in addition to what's on the meta located list

48:51 - we pushback back based on what our pharmacists tell us give them an opportunity risk

48:55 - to respond and in many cases the company agrees to with us that it should not be a

49:00 - specialty drug so it does not go on the list

49:02 - sometimes it would go on the list but now is

49:05 - pharmacies if if a pharmacy is negatively impacted

49:08 - because a drug that they think that they could dispense

49:11 - is on the specialty list that they're not allowed to dispense

49:15 - under pbm policy

49:17 - that's something that we want to hear about because

49:19 - that's something we'll have direct access to

49:21 - our German

49:22 - and.

49:23 - I would just appreciate open dialogue with hometown pharmacy as we continue to try to

49:28 - deal with some of these

49:30 - ongoing ng issues

49:31 - absolutely thank you

49:33 - thank the gentle lady representative curry

49:35 - thank you chairman

49:36 - hello.

49:38 - Commissioner humphries thank you for being here today

49:41 - and I just want to thank you for your continued support of the pa black maternal

49:46 - health caucus and all things maternal health.

49:49 - Thank you for being at our events and.

49:52 - Really.

49:54 - Shining a light on many of the issues around insurance when it comes to maternal care

49:59 - so with that being said I am

50:01 - I want to ask you about the maternal health provider networks

50:06 - and

50:07 - Pennsylvania continues to experience a maternal health crisis as we all know

50:12 - unfortunately hospitals continue to close these services

50:15 - which leave many of our communities without nessa seri access.

50:20 - Which we call maternal health deserts.

50:24 - This often means that individuals need to go

50:26 - long distances to access this critical care.

50:29 - I have worked on several pieces of legislation

50:32 - that would address these access barriers including ways

50:36 - that midwives can work fully within

50:39 - top of their licensure.

50:41 - So I have a few questions I understand that the department of insurance monitors the

50:45 - provider networks of certain health

50:47 - insurance companies

50:49 - how do you ensure that providers like midwives are appropriately

50:53 - included in these networks

50:56 - what are your thoughts on encouraging the insurers

50:59 - to include providers like midwives in their networks

51:02 - so that individuals have the access to care they need

51:07 - and when insurers are not appropriately paying claims

51:11 - for services providers like these provide

51:15 - what do you recommend these individuals do to address this

51:19 - and before you answer I just you know want to make it known that

51:22 - one of the oldest

51:23 - birthing

51:25 - midwifery centers

51:26 - in Delaware county Montgomery county they're right there on the border

51:30 - is closing their doors next month

51:34 - they deliver six hundred babies

51:36 - a year and they're closing their doors so.

51:39 - Thank you.

51:41 - Yeah that

51:41 - that's a

51:42 - significant challenge and I think one that collectively

51:45 - we're working with dhs and others in in the health hub the quote unquote health hub

51:49 - and kind of rolling out a maternal health strategy

51:53 - and I know you've been a part of some of those conversations as well look forward to

51:57 - to continuing those conversations and in looking at

52:00 - more of what we can do

52:02 - and in some cases it could be encouraging coverage like like with saran alone

52:07 - it was us going out on behalf of the governor's office

52:09 - and saying look we need we need more robust coverage

52:12 - and in the the companies responded

52:14 - so I think sometimes it's

52:16 - it's just an additional conversation it's something that

52:19 - we could start looking

52:20 - specifically at

52:21 - midwifery

52:23 - is part of our our past template I I don't know that it was on.

52:27 - For this year so well while I was able to easily pull out

52:31 - and the the statistics on.

52:34 - Human breast milk

52:35 - doulas surrogacy

52:36 - I don't know that I have that off off the top

52:39 - of my fingers tips on.

52:41 - Midwifery

52:42 - but it's something that we can add as part of this process going forward so

52:46 - not only will it be something that that we could report out to you all into affected

52:51 - constituencies on on coverage but

52:53 - but one that insurance companies would know to look at like they're looking at these

52:57 - other issues that we identify throughout the filing pro process.

53:02 - More closely in terms of

53:04 - how they can

53:06 - potentially expand opportunities within their existing networks even

53:10 - now I would say

53:12 - when when someone has a complaint about

53:14 - their their reimbursement.

53:16 - I think a a strategy to come forward to the department

53:20 - it would be potentially

53:22 - in conjunction with

53:24 - the individual that that delivered the birth or whoever is the primary

53:28 - recipient of the payment whether it's the hospital the ob.

53:32 - Or in some cases the birthing center or others.

53:35 - Work with them bring the complaint to us and

53:37 - we're happy to engage the insurance companies

53:40 - to to develop kind of how this process worked because I think in

53:44 - in many cases and I know.

53:46 - I think the amd has a webinar coming up on.

53:50 - Maternity and birthing bundles

53:52 - it might be his

53:53 - his

53:54 - upcoming is next week or the week after that

53:56 - and changes that they're making to

53:59 - bundling codes

54:00 - but it may be something.

54:02 - That you could look at as part of that bundle because sometimes the bundle would go

54:06 - to the the quote unquote quarterback today and

54:09 - it's that individual's responsibility to pay

54:11 - the other individuals or participants or

54:15 - facilities

54:17 - subject to the terms of the contract that they have

54:19 - with those different groups and endeavor jewels

54:21 - so it's something that potentially could be built into

54:24 - maternity bundles in the future.

54:27 - Thank you so much

54:28 - commissioner you always have good

54:30 - suggestions and recommendations

54:33 - I just want to remind everybody that

54:35 - ninety three to ninety eight percent of all maternal deaths

54:38 - are preventable thank you commissioner and to your team thank you chairman

54:42 - thank the gentle lady representative maiko

54:45 - thank you mr chairman and

54:47 - commissioner for being here

54:48 - actually this was.

54:50 - Serendipitous I have a

54:52 - similar question I guess

54:54 - my question has to do with streamlining provider credentials

54:58 - and what the department's doing to do that.

55:02 - Especially when it comes to trying to get treatment for patients.

55:06 - Really in a rural communities

55:08 - and.

55:10 - I guess it's a problem in the city of the first class but in other counties as well

55:15 - you have to drive hours to get healthcare

55:17 - and trying to make it easier to get access would you know what's the department doing

55:21 - to help credential some of these insurers on the commercial level

55:24 - yeah we we've heard I think loud and clear

55:27 - challah inches and the credentialing space

55:29 - particularly in the

55:31 - the rural independent

55:33 - spaces

55:34 - because

55:34 - we think the vast majority of our providers use c a qh for credentialing already

55:39 - today every insurer I think that operates in

55:43 - Pennsylvania also uses ca qh for credentialing purposes

55:46 - it's really

55:47 - par two when it comes to

55:49 - the verification of data that comes in through

55:51 - the credentialing that I think has been.

55:54 - The most significant sticking point

55:56 - so we've actually going back a year in in secretary our cushion I really focused on

56:02 - credentialing is is what seems like

56:04 - an addressable issue.

56:06 - So we started the conversation patients and now

56:09 - Dave and my team and and I know the secretary's team has been able to participate

56:14 - we're meeting

56:15 - almost monthly

56:16 - I think with with all stakeholders so it's your

56:19 - hospital stakeholders it's the insurance companies

56:23 - to come up with a

56:24 - a single set of data

56:26 - and really this focuses

56:28 - on the

56:28 - provider directory piece but that's intricately linked to the credentialing process

56:34 - so we're trying to come up with that uniform set of data that can really make

56:39 - these processes better for for everyone in right now we have a lot of buyer.

56:45 - So I know I think

56:46 - I think we hear from from intro did stakeholders when when there's legislation it's

56:51 - it's hold off because the department's having really

56:53 - productive conversations with the payer and the provider side

56:56 - we are and there's there's a call tomorrow it's

56:58 - three hours I think is what they generally meet

57:01 - with when they're when they're meeting on these monthly basis and

57:04 - once we get that narrow data set

57:06 - I think credentialing becomes

57:08 - the next step on

57:10 - making this easier for for everyone in eliminating those pain points.

57:15 - For the providers today and in right now

57:18 - I'm cautiously optimistic that we're making good progress do you have like a

57:22 - guesstimate a timeline on how long that would would

57:25 - you guys are looking at for this turnaround on this

57:28 - info

57:29 - but.

57:29 - I would.

57:31 - Definite maybe

57:33 - a definite maybe is.

57:35 - I think tomorrow's call ironically

57:38 - is where we turn the corner to

57:41 - how the provider data.

57:44 - Links into their credentialing conversation so tomorrow's conversation I think will

57:50 - really inform what the new next steps look like and how readily accessible

57:54 - tackling the credentialing issue is

57:56 - and then there's nothing on or apart as far as

57:58 - legislation that you would need to move further with this

58:01 - there may be but right now the process I think is working and to the extent that they

58:06 - all agree on the same uniform set of data

58:09 - that both will inform the directory and creedence schilling

58:12 - I think we would have

58:14 - preempted the need for

58:15 - the legislation so we're working at it both from a

58:18 - delegated credentialing and a non delegated credentialing

58:21 - perspective

58:22 - so

58:23 - That would encourage those of your maybe constituents that have been impacted by this

58:27 - on the provider side

58:29 - engage their their associations or come directly

58:31 - to us asked to participate in these conversations

58:34 - and in the meantime we've handled a number of these issues on a one off basis

58:38 - so if if a particular provider is having a hard time

58:40 - getting into a network we're glad to work with them

58:43 - and the insurance company to see

58:45 - a why they're not in yet and kind of how we can maybe

58:48 - work okay

58:49 - yeah so just what I'm hearing is you guys are working on it

58:52 - it's a process

58:53 - don't know the timeline but got a call tomorrow that

58:56 - you'll.

58:57 - I guess hopefully work through some of these issues to get a

59:00 - better product in the near future.

59:02 - Much more succinct than me yes sir.

59:05 - We speak for a living I guess now I'm just sad.

59:08 - Take care thank you mr

59:09 - mr commissioner and as chairman.

59:12 - Thank the gentleman.

59:14 - Representative bellman.

59:25 - Thank you chair and thank you all for being here today.

59:28 - So I'm getting a lot of feedback from constituents that they are trying to do

59:32 - everything that they can to save money

59:35 - and they're cutting back on on going now they're cutting back on

59:41 - traveling but one

59:42 - do they also bring up a lot as auto insurance and I know that inflation has had a

59:46 - significant impact on the affordability of insurance

59:49 - policies

59:51 - including policies like personal auto insurance last year

59:54 - I saw that the Pennsylvania insurance department save consumers ninety one million

59:58 - 672 dollars on personal auto insurance premium increases

01:00 - 04.179 and two hundred and twenty seven million dollars in

01:00 - 06.922 property and casualty insurance increases in total

01:00 - 11.188 so other than inflation what are some other reasons that are contributing to the

01:00 - 16.642 continued increases for auto insurance representative it largely is inflation

01:00 - 18.622 the the u s department of labor

01:00 - 21.472 said that maintenance and repair costs

01:00 - 25.462 increased thirty four percent by between twenty twenty one

01:00 - 26.872 in twenty twenty four

01:00 - 29.680 the the rates that we've approved in twenty twenty

01:00 - 32.512 two would have been around fourteen per cent high

01:00 - 35.032 in two thousand and three thirteen percent still high

01:00 - 37.042 twenty four eight percent

01:00 - 40.162 and that's getting closer to where I'd like to see it

01:00 - 42.692 last year negative

01:00 - 44.068 the first time so it's

01:00 - 47.208 we've we've been in a position where I think we've

01:00 - 48.658 we've reached

01:00 - 51.362 kind of the the equilibrium that our our insurance

01:00 - 54.288 costs because we're really trying not to give insurers

01:00 - 57.228 any more rate than they absolutely need to keep

01:00 - 58.488 costs

01:00 - 59.788 keep in

01:01 - 01.248 keeping pace with

01:01 - 05.448 the costs of the products or services that that they're ensuring so

01:01 - 08.148 my team has been really really pushing

01:01 - 10.278 and we're proud to announce that

01:01 - 16.078 towards the end of last year we finally we we approved in and got some rate decreases

01:01 - 19.638 state farm had a decrease of over nine percent

01:01 - 23.148 impacting one point five million pennsylvanians travelers

01:01 - 26.898 had a four percent decrease impacting another one hundred and sixty thousand

01:01 - 30.208 I expect other companies will be coming in

01:01 - 36.834 with rates that are flatter or potentially even in negative territory and consumers

01:01 - 38.478 should finally be able to see this

01:01 - 41.208 so last year they were still feeling that

01:01 - 45.558 the eight percent or the thirteen percent that been approved over the prior two years

01:01 - 48.108 now that we're finally at that frat and stage

01:01 - 51.285 your next increase potentially could be much flatter

01:01 - 53.958 than than what we've seen in the last couple of years so

01:01 - 56.178 we are continuing to push that message

01:01 - 59.568 do you think there's anything that legislators can do to help this problem.

01:02 - 04.098 I actually think we have a very competitive auto the market

01:02 - 06.378 if you look at our neighboring states were

01:02 - 10.978 were lower average premium than new York new Jersey Maryland Delaware

01:02 - 15.504 so I think we're we're where we want to be but we need to continue to keep the

01:02 - 17.838 pressure on and then I think it becomes a

01:02 - 21.798 how insurers are treating their policy holders in making sure that

01:02 - 25.548 consumers are getting all the info nation that we feel like they need

01:02 - 28.908 and when they're having claims or when they're getting these increases

01:02 - 29.448 and

01:02 - 32.097 knowing that they have a place to go at the department

01:02 - 34.618 so when they come through you representative

01:02 - 34.998 and

01:02 - 39.388 bring them over to us we're glad to talk them through because they also have.

01:02 - 42.288 Potentially several hundred options

01:02 - 43.438 to choose from

01:02 - 48.108 not only do we have a more competitive market from a average rate perspective

01:02 - 52.764 but we have more insurers operating in Pennsylvania than a lot of our neighboring

01:02 - 55.218 states even some of the largest states in the country

01:02 - 00.358 would like to see the number of property and casualty insurers that we have here so.

01:03 - 03.233 There is competition if you're not happy with what

01:03 - 06.708 your rate looks like we'd encourage you to to shop and

01:03 - 08.268 into potentially

01:03 - 11.058 because I think one area that's a challenge

01:03 - 13.068 in in Pennsylvania is that

01:03 - 13.608 you

01:03 - 17.178 you can be cancelled within the first sixty days for for any reason

01:03 - 20.928 so when we say shop for coverage we also encourage pp people to keep.

01:03 - 24.078 Their policy for two months should something happen

01:03 - 27.528 and then they can retro cancel when when they've been clean for two months

01:03 - 30.078 and moved on to the policy that they're more happy with

01:03 - 30.738 or

01:03 - 32.938 Already thank you and thank you chair.

01:03 - 36.508 Thank the gentleman representative marceau.

01:03 - 39.858 Thank you mr chairman thank you very much for being here today

01:03 - 44.698 I had two questions that I wanted to talk about one relates to.

01:03 - 49.828 Providing consumer assistance in terms of people contacting your agency

01:03 - 53.058 much like when they contact our offices and they're looking for

01:03 - 55.608 us assistance they have questions for you

01:03 - 58.368 and they might have concerns about their insurance

01:03 - 59.688 so I was wondering

01:03 - 02.988 do you know approximately how many consumer interactions

01:04 - 05.208 your department has each year

01:04 - 08.158 and if you could provide

01:04 - 09.768 information about what is

01:04 - 14.758 what are the most frequent things that consumers might be reaching out here office.

01:04 - 17.818 Yeah I I have all of that.

01:04 - 18.958 It's.

01:04 - 23.088 We we had I think fifteen thousand ish

01:04 - 23.898 and

01:04 - 25.258 let's see we have it right here

01:04 - 26.058 so we had

01:04 - 28.128 fourteen thousand complaints

01:04 - 31.038 last year and I think that's pretty balanced across

01:04 - 32.938 auto and

01:04 - 35.778 health insurance our our most frequent complaints

01:04 - 39.318 I think often that is rates

01:04 - 41.868 and and how much they're increasing

01:04 - 45.002 on the health insurance side it's off it can be

01:04 - 48.348 kind of denial of care or the prior off process

01:04 - 50.898 may be accessible providers that

01:04 - 54.888 maybe are too far or the wait time is too long but we've kind of

01:04 - 00.288 steadily been in that mid teens thousands of complaints on a yearly basis

01:05 - 04.848 so it hasn't necessarily gone up or down that even consistently at around that range

01:05 - 08.754 should enact yeah it's been I mean it was just shy of fourteen thousand in two

01:05 - 11.298 thousand and three it was fifteen and a half last year

01:05 - 16.044 so we we actually I mean I think I'll be why one of the few cabinet members to tell

01:05 - 18.138 you like we would like more complaints

01:05 - 19.098 and

01:05 - 22.276 we it helps inform our processes when they

01:05 - 25.218 come in so we can understand what's happening

01:05 - 26.578 on the ground

01:05 - 28.738 so Dave's team we have.

01:05 - 31.555 Sophisticated ways of measuring our market right

01:05 - 34.368 every company is required to submit a market condo

01:05 - 35.488 annual statement

01:05 - 37.518 in through a series of kind of

01:05 - 40.618 statistical analyses we can identify

01:05 - 43.188 outliers within our market today

01:05 - 48.384 and we subject any outliers to kind of enhance review we may send them a list of

01:05 - 50.418 inner auditorium we expect you to answer

01:05 - 52.218 a b and c why are you

01:05 - 53.988 so far outside the

01:05 - 56.178 the norm in terms of

01:05 - 00.294 claims closed without payment within ninety days for instance is one of the

01:06 - 02.178 categories so we have a lot of data

01:06 - 04.858 that we can build on in that process

01:06 - 07.668 but like the the day to day consumer complaints

01:06 - 08.448 and

01:06 - 10.128 this this is how we learn

01:06 - 13.678 whether it's coming through the department coming through your offices

01:06 - 16.368 with concern ones about AI or I think that

01:06 - 19.293 the first time we found out about the aerial

01:06 - 22.218 imagery being used to to non renew or cancel

01:06 - 25.008 was was a consumer that sent us pictures

01:06 - 26.388 from their insurance company

01:06 - 29.115 from really frickin high up that it's hard to

01:06 - 32.178 tell the difference between a house and a tree

01:06 - 34.848 and yet the insurer is saying your roof is bad.

01:06 - 38.748 I mean Dave looks at the pictures we go back to the company and say

01:06 - 41.988 which roof are we talking about because this is a row home

01:06 - 45.588 there's four different roofs are looking at and they don't necessarily know so

01:06 - 46.608 I mean I think

01:06 - 51.048 just the the back and forth that we can have with your offices as consumers come in

01:06 - 52.668 we're glad to to

01:06 - 54.678 to engage any complaints and

01:06 - 58.944 we'd like to come into your area yeah and that's great to know and I'm sure that a

01:06 - 01.668 lot of our offices you might be getting more calls from us now.

01:07 - 05.328 After what you just said and so we appreciate your work there I had one

01:07 - 07.398 more question before my time is up.

01:07 - 10.341 Last year the fiscal code included a provision

01:07 - 13.558 that reorganized the joint underwriting association

01:07 - 15.234 I was wondering if you could provide

01:07 - 17.968 update on how that transition is going

01:07 - 22.914 and when the board might be meeting to talk about that the the board is is still

01:07 - 27.748 being structured so the the governor's made his appointments I think.

01:07 - 32.088 We have another representative topper I think made his appointment

01:07 - 35.068 so there are three still pending.

01:07 - 36.358 That we need

01:07 - 38.308 appointments to be made

01:07 - 39.048 but

01:07 - 42.282 the board will will commence I would think probably

01:07 - 44.928 in in the first quarter assuming we continue to

01:07 - 47.928 to get these appointments coming but now that we have a majority

01:07 - 50.238 I think they they could go ahead and meet there

01:07 - 50.928 and

01:07 - 54.198 obviously you you know they're not under p idea to

01:07 - 54.978 separate

01:07 - 58.318 into dependent agency or independent entity.

01:07 - 01.138 So is those continue to come in.

01:08 - 05.448 This year will actually start the quarterly reporting from j away to our department

01:08 - 08.988 on kind of claims information did you say q one in

01:08 - 11.238 most you one will be the first report we get

01:08 - 11.868 okay

01:08 - 14.038 thank you very much thank you.

01:08 - 19.372 Thank the gentle lady representative demands though.

01:08 - 25.068 Thank you chairman hairs

01:08 - 27.208 and commissioner humphries

01:08 - 28.918 and staff here

01:08 - 33.978 the department is self funded agency that returns excess dollars

01:08 - 38.118 every fiscal year from the insurance regulation of oversight fund the ira of.

01:08 - 41.098 Can you explain how this process works.

01:08 - 42.138 You want to

01:08 - 43.378 play guitar.

01:08 - 48.148 What happens is at the end of each budget here.

01:08 - 52.048 He amount of cash that we have on hand

01:08 - 54.618 is I reduce by

01:08 - 00.768 whatever is in excess of what our appropriated budget was for the prior year

01:09 - 03.568 we return to the general fund.

01:09 - 09.288 So for a sample in July of twenty twenty five for the prior fiscal of.

01:09 - 15.958 A year we return just over twenty four million dollars to the general fund.

01:09 - 17.838 In the reason I ask is

01:09 - 18.828 and

01:09 - 23.188 as you just stated and twenty four twenty five twenty three point seven.

01:09 - 27.768 However there's no dollar amount anticipated for twenty five twenty six can you

01:09 - 29.358 just give us a reason why

01:09 - 31.168 yeah that can.

01:09 - 34.777 Currently that next three months are when eighty

01:09 - 38.998 percent of our revenue comes then for p ID

01:09 - 44.668 and it was decided between us and gb out that.

01:09 - 48.208 We wouldn't guesstimate a number because

01:09 - 53.278 most of our revenue comes in after the governor's ex second object.

01:09 - 54.198 Is

01:09 - 56.148 To press okay

01:09 - 56.568 perfect

01:09 - 57.928 thank you.

01:10 - 04.518 Thank the gentleman representative

01:10 - 06.058 chairman druzy.

01:10 - 09.418 Yes thank you chairman.

01:10 - 13.228 Once again I appreciate you all being here today I know it's getting late.

01:10 - 14.358 Just a question though

01:10 - 15.828 you both mentioned

01:10 - 17.008 and you know.

01:10 - 19.098 It's hard for people to

01:10 - 22.958 afford insurance right now and so I think that behooves us

01:10 - 26.958 then to look at ways to reduce those costs if pasa apple

01:10 - 29.968 so I want to take a little step back and.

01:10 - 32.148 Association health care plans

01:10 - 34.668 those were a big thing

01:10 - 36.498 I'm going back to my chamber days

01:10 - 37.548 and

01:10 - 41.548 for small businesses to be able to afford health insurance

01:10 - 45.898 and they essentially if I'm correct went away here in Pennsylvania

01:10 - 47.248 after the patch

01:10 - 48.327 affordable care act

01:10 - 55.282 so what are your thoughts on bringing those back into an option for people here in

01:10 - 57.296 Pennsylvania for small businesses.

01:10 - 02.716 Yeah we we actually still there there are still association health plans

01:11 - 04.606 in in Pennsylvania and I think

01:11 - 09.076 one of the issues when we when we talk about hps and it's one that we.

01:11 - 12.946 Had discussed with an insurance committee staff of

01:11 - 14.446 several years ago

01:11 - 15.496 there's

01:11 - 17.186 there's two challenges

01:11 - 21.706 in in how it's been kind of brought forward in legislatively I think

01:11 - 27.776 the first is a letter that cms sent to the Virginia department of insurance.

01:11 - 32.576 In it because the legislature passed legislation to try to.

01:11 - 37.066 Authorize broad based hps that would be treated as one large group

01:11 - 38.426 cms said

01:11 - 39.976 no you can't do that

01:11 - 43.546 you have to look through to the size of the employer

01:11 - 45.766 to determine how to rate that

01:11 - 47.386 that association so

01:11 - 52.066 if my association had a sole proprietor in it a small group in a large group in it

01:11 - 56.116 each of those different employers would have to be rated based on

01:11 - 00.736 that the rating rules that apply lie to that particular market segment

01:12 - 01.396 so

01:12 - 03.706 If if we were able to

01:12 - 07.996 get over that hurdle in in cms may be more interested today

01:12 - 12.346 in in looking at how that would work versus kind of when they sent this letter

01:12 - 16.912 I think that the second piece that we ran into when when this body was discussing

01:12 - 18.646 this legislation a couple of years ago is

01:12 - 22.996 we fundamentally do not think that you should discriminate rate based on

01:12 - 26.307 two different employers in the same association so the

01:12 - 30.176 proposals that continued to come forward would have let.

01:12 - 32.956 Devin's employees pay

01:12 - 36.586 three to five times less than my employees because

01:12 - 40.216 maybe hers were healthier and in one of my the employees had cancer

01:12 - 43.486 so it would essentially set up this situation where

01:12 - 45.826 I'm ultimately priced out of the market

01:12 - 48.088 to the benefit of.

01:12 - 51.543 Devin's employee employees and others but what does that

01:12 - 54.496 do to the small group outside of the association plan

01:12 - 58.606 it means that everyone that would stay in the small group market would be

01:12 - 02.056 the bay bad risk that couldn't find an association to join

01:13 - 03.316 and was priced out

01:13 - 07.726 so if we were looking at an association plan that was

01:13 - 12.496 broader that would still provide the h b that was in underlying legislation that

01:13 - 14.686 wouldn't discriminate so it would be like

01:13 - 17.506 like the type of plan that a lot of us pick from right it's

01:13 - 21.436 employee employee plus spouse employee plus spouse independence

01:13 - 23.866 regardless of the employer

01:13 - 27.326 I think that's a fair conversation than.

01:13 - 28.216 Some of the

01:13 - 32.116 discriminatory rating practices that were in earlier conversations

01:13 - 36.536 so it is something we could have a discussion about and possibly

01:13 - 39.676 implement to help reduce some of these costs I think

01:13 - 42.046 we have to make those changes that you're suggesting

01:13 - 45.038 we could have additional conversations about what

01:13 - 47.476 what appropriate HP legislation could look like

01:13 - 48.196 okay

01:13 - 48.676 alright

01:13 - 50.066 thank you.

01:13 - 54.896 Commissioner I have a few questions

01:13 - 56.536 for for you and

01:13 - 58.436 the team here.

01:13 - 02.756 Could you tell me how many people were enrolled in penny in.

01:14 - 04.526 Twenty twenty five.

01:14 - 09.566 Choices we had a record number of enrollees at four hundred and ninety seven thousand.

01:14 - 13.996 And how many people are enrolled in penny

01:14 - 16.166 twenty twenty six

01:14 - 17.756 do we have.

01:14 - 20.306 And do we know why.

01:14 - 25.106 Cause I know we talked about a drop

01:14 - 28.456 what is that number currently and do we know why

01:14 - 31.886 these individuals have chosen not to enroll.

01:14 - 34.263 Here so currently as of today the numbers

01:14 - 38.066 about four hundred and seventy one thousand and

01:14 - 39.206 that

01:14 - 40.316 doesn't that covers

01:14 - 44.146 up at the number of people who dropped which is currently at one hundred and four

01:14 - 47.122 thousand and we did have some new unreleased come in during open enrollment that

01:14 - 48.976 offset some of that dropping we saw

01:14 - 51.383 but what we do now is that over one hundred

01:14 - 53.716 thousand people have dropped coverage and so

01:14 - 55.756 are concerns that we had around

01:14 - 59.032 the cost increases driving people out of coverage and what that meant for the

01:14 - 01.576 uninsured rate still exists because there are still

01:15 - 03.656 many more on insured

01:15 - 06.286 today than there were in two thousand and twenty five

01:15 - 10.276 and a lot of that is what we hear from people who say the costs just

01:15 - 12.196 aren't possible they are feeling

01:15 - 13.606 squeezed by

01:15 - 14.876 and.

01:15 - 18.556 Spreading their costs across a lot of different places we have even people who aren't

01:15 - 20.656 old fifth more than fifty percent

01:15 - 24.682 said that it doesn't fit within their budget and they had to move other household

01:15 - 28.126 essential items in order to make room for health coverage

01:15 - 30.629 what we hear from a lot of people is that who did

01:15 - 33.466 stay is that they have to make those changes because

01:15 - 36.046 having coverage is literally life or death for them

01:15 - 37.546 it's cancer treatments

01:15 - 40.586 it's medications to keep their seizure disorder

01:15 - 45.946 managed it's small business owners who feel like especially farmers we hear from

01:15 - 47.973 who have physical risk to their job and they feel

01:15 - 50.716 like they need to have insurance in order to stay

01:15 - 52.546 healthy enough to do their job

01:15 - 54.986 and that are really concerned about the health increased

01:15 - 56.596 that cost increases so

01:15 - 00.352 we've seen a tremendous number of people that's four times higher than the number of

01:16 - 02.176 people who drop coverage last year

01:16 - 05.686 it's all ca insistently the feedback we get is it's driven by costs

01:16 - 09.076 and even the people who stayed are feeling extremely stretched

01:16 - 10.816 and many of them picked plans with

01:16 - 13.426 deductibles that are tens that are thousands of dollars

01:16 - 14.026 more

01:16 - 17.116 so they are still stretched even when they said covered

01:16 - 20.636 and the increase in cost

01:16 - 22.676 is directly tied

01:16 - 23.846 to.

01:16 - 27.596 The lack of subsidies provided by the federal government.

01:16 - 29.876 Yes that's correct there were additional

01:16 - 34.036 premium tax credits that lower the cost of coverage available since twenty twenty one

01:16 - 36.468 the availability of those made coverage more affordable

01:16 - 39.716 than ever we saw enrollment increase by fifty percent

01:16 - 43.096 in rural areas in urban areas young adults

01:16 - 44.566 retirees

01:16 - 47.576 amongst farmers small business owners

01:16 - 50.266 across all those different aspects and those

01:16 - 54.412 extra tax credits expired at the end of twenty twenty five so that caused costs to go

01:16 - 55.846 up by one hundred and two percent

01:16 - 00.562 and some people lost tax credits altogether and we're looking at paying up to fifty

01:17 - 03.616 percent of their income just for the premium

01:17 - 06.146 even before the deductibles kicked in.

01:17 - 07.352 So you

01:17 - 11.026 said some folks have seen one hundred and two percent increase

01:17 - 13.676 because of the inaction in DC.

01:17 - 17.932 At an average cost went up by one hundred and two percent because congress did not

01:17 - 20.516 extend to the enhance premium tax credits.

01:17 - 21.776 So.

01:17 - 25.586 I think we we know so when uninsured people get sick.

01:17 - 26.946 We know they're going to get sick

01:17 - 29.186 everybody gets sick at some point in time.

01:17 - 34.306 Would you agree that even though they don't have healthcare they still seek coverage

01:17 - 35.536 the seats still seek

01:17 - 36.556 to be seen

01:17 - 39.236 with regards to whatever their sicknesses.

01:17 - 41.833 Yes and I think we know that to be true because

01:17 - 44.206 we used to see higher uncompensated care costs

01:17 - 47.446 since coverage has been expanded those costs have gone down but

01:17 - 49.611 as the uninsured rate increases we

01:17 - 51.533 expect to see those go back up and where do

01:17 - 54.476 those uninsured folks typically seek coverage.

01:17 - 59.812 What we know is that many uninsured wait until their conditions get significant and

01:17 - 01.576 so they go to the emergency rooms

01:18 - 05.446 and that has an impact on everybody because it

01:18 - 08.236 makes emergency rooms essentially primary care and

01:18 - 10.906 rates longer waits there and resource issues there

01:18 - 13.646 and it also creates strain on hospitals

01:18 - 14.446 so

01:18 - 15.376 Okay so

01:18 - 17.566 an uninsured person so okay

01:18 - 19.646 so let's go back.

01:18 - 23.546 Lot of folks have fallen off of healthcare because

01:18 - 25.376 subsidies weren't.

01:18 - 28.306 Extended at the federal level correct

01:18 - 29.486 correct.

01:18 - 31.556 We know that those folks.

01:18 - 32.816 Still get sick

01:18 - 33.226 and

01:18 - 35.956 it's your testimony that they typically wait

01:18 - 37.676 until they get sicker

01:18 - 39.956 before they seek treatment right

01:18 - 45.146 and that treatment is typically in the emergency room correct.

01:18 - 47.028 The commission let me ask you this

01:18 - 51.296 when those folks show up at the emergency room and they are treated.

01:18 - 52.766 Who pays for that.

01:18 - 53.806 That's

01:18 - 55.685 potentially a little bit of have a couple of

01:18 - 59.126 different buckets that could be uncompensated care.

01:18 - 59.506 That

01:18 - 00.643 impacts

01:19 - 01.796 all of us

01:19 - 02.326 in

01:19 - 05.036 Some of it becomes medical debt

01:19 - 06.836 that in the visuals

01:19 - 07.156 have

01:19 - 10.046 a hard time getting out from under.

01:19 - 11.186 So.

01:19 - 14.146 Medical debt that is

01:19 - 16.346 bore by all of us.

01:19 - 19.226 Also and then the hospitals

01:19 - 22.466 assume a lot of that that costs as well.

01:19 - 25.436 How does this affect.

01:19 - 27.806 Small health systems

01:19 - 29.576 or small hospitals

01:19 - 32.336 in those hospitals in rural Pennsylvania.

01:19 - 33.826 So

01:19 - 38.122 That is one of the highest concerns given that a lot of but the people who have

01:19 - 41.116 dropped coverage are more likely to live in rural counties

01:19 - 43.603 and so in talking with the hospital association

01:19 - 47.396 of Pennsylvania and they have identified the.

01:19 - 50.692 Terminations of coverage through penny because of the cost increases as a

01:19 - 52.966 contributing factor to their concern around

01:19 - 57.076 the viability of hospitals especially rural hospitals in Pennsylvania

01:19 - 59.213 just to add to the chairman.

01:19 - 03.510 They rely on the commercial market in the reimbursement

01:20 - 06.776 rates that they get from commercial insurers.

01:20 - 10.516 That that overpay medicare for example

01:20 - 14.536 and to to be able to make ends meet so when they

01:20 - 17.596 when they lose revenue from kind of these

01:20 - 18.716 higher.

01:20 - 19.756 Paying

01:20 - 21.916 insurers vs some of

01:20 - 22.219 the

01:20 - 26.266 other programs it puts them in a much harder position

01:20 - 28.696 and even even while they give

01:20 - 29.816 uncompensated care

01:20 - 33.442 and when you say villain one you're talking about hospital yes the providers is there

01:20 - 37.996 a likelihood that because of the uninsured population still seeking treatment

01:20 - 40.096 but hospitals not getting reimbursed

01:20 - 42.326 some of those hospitals could close.

01:20 - 43.036 I

01:20 - 46.363 Think it's something that hap cited as a significant

01:20 - 49.006 financial strain particularly among rural hospitals

01:20 - 50.056 so and

01:20 - 52.406 so particularly amongst rural hospitals.

01:20 - 57.798 Very possible that many of those hospitals in rural Pennsylvania

01:20 - 00.118 will close because.

01:21 - 03.120 Of the folks who continue to come and get service

01:21 - 05.298 but they're not getting reimbursed for those services

01:21 - 06.688 it.

01:21 - 10.614 He will certainly be negatively impacted from a

01:21 - 13.668 financial perspective by higher uninsured rates

01:21 - 16.408 and so when that hospital closes

01:21 - 20.398 or when that emergency room is overburdened in.

01:21 - 23.518 Rural Pennsylvania or even in urban Pennsylvania

01:21 - 25.248 an area even in urban areas

01:21 - 26.298 and

01:21 - 28.098 does data from affect

01:21 - 31.318 even those who may have commercial insurance.

01:21 - 35.118 Yeah it it impacts I think.

01:21 - 40.938 All of us in in a number of different ways and in representative Fleming's question

01:21 - 44.274 we we address a little bit earlier we all pay

01:21 - 47.448 more in insurance rates on the commercial side

01:21 - 50.815 and when fewer people are insured because the

01:21 - 53.898 makeup of the risk pool that we're ensuring

01:21 - 55.408 is generally

01:21 - 00.618 less healthy than when we have higher insurance rates you got stuck so

01:22 - 03.078 you gotta talk to me like I'm a second grader would that

01:22 - 05.425 make that make sense.

01:22 - 07.548 Like I was in second grade if

01:22 - 10.758 wet when there are more uninsured

01:22 - 12.708 the risk pool is worse worse

01:22 - 15.858 so insurers charge the rest of us more

01:22 - 18.228 than what we would have otherwise paid when

01:22 - 20.645 we had more people insured so that that means

01:22 - 23.868 that because the federal government did not extend

01:22 - 27.358 the tax credits for health care

01:22 - 31.798 and because of that we now have more uninsured people.

01:22 - 32.358 That

01:22 - 36.528 even those with commercial insurance are still going to have to pick up the tab

01:22 - 39.258 for those who are uninsured is that over say

01:22 - 42.885 yes in in addition to the statistics that Devin

01:22 - 46.098 had an impact to the overall Pennsylvania economy

01:22 - 47.118 and what

01:22 - 47.568 good

01:22 - 49.428 are going to two other pieces I think

01:22 - 50.118 and

01:22 - 53.268 we've heard from consumers in addition is that

01:22 - 54.448 and.

01:22 - 58.044 Some have said that if they lose coverage and they're not able to manage their

01:22 - 00.108 conditions then they are very likely to

01:23 - 01.488 become permanently disabled

01:23 - 03.590 and they have asked the question you know I'm

01:23 - 06.198 not able to work if I'm not able to manage my

01:23 - 07.458 condition so

01:23 - 09.678 sound we've had several consumers race to us

01:23 - 14.248 where's the logic here and that then I'll become more of a a drain on.

01:23 - 17.098 Other government programs that I am currently

01:23 - 19.037 working and being productive and I don't want

01:23 - 21.258 to eat there but without affordable coverage

01:23 - 25.158 that could happen and then one other thing that we hear a lot from consumers is

01:23 - 28.014 not that they're going to go to the emergency room and they get sick

01:23 - 30.461 but that in their words I guess I'll just die

01:23 - 32.928 is what we've heard from several consumers

01:23 - 36.744 because they've said I don't want to burden my family with the medical debt that

01:23 - 38.658 would come from going to the emergency room

01:23 - 40.578 when I get sick and so

01:23 - 42.994 I'm just not going to go we've heard those types of

01:23 - 45.198 things from consumers facing these higher costs as well

01:23 - 46.558 alright so

01:23 - 50.158 just to wrap this up then I want to make sure I got it all.

01:23 - 55.708 You're saying that there are more uninsured people here in Pennsylvania

01:23 - 57.778 because of the lack

01:23 - 58.978 of.

01:23 - 59.478 The

01:23 - 01.318 lack of continuation

01:24 - 03.408 of the subsidies that we see

01:24 - 07.248 coming from Washington DC correct yes congress failed

01:24 - 08.928 ensured Pennsylvania is in

01:24 - 13.188 Pennsylvania because the those people are uninsured but they still get sick

01:24 - 17.298 they're going to more than likely end up in an emergency room

01:24 - 22.228 worse off than they would have been if they saw their primary care doctor correct.

01:24 - 23.418 Yes

01:24 - 29.898 so those uninsured people who now go to the hospital and overburden our emergency rooms

01:24 - 32.898 those hospitals are still required to service them

01:24 - 35.898 even though those hospitals won't get reimbursed

01:24 - 36.708 correct

01:24 - 37.428 yes

01:24 - 40.188 that puts a financial strain on

01:24 - 44.958 those hospitals primarily hosp whittles in rural Pennsylvania correct

01:24 - 45.858 yes

01:24 - 51.448 does that mean and it is your opinion that those hospitals could possibly close

01:24 - 53.428 and create.

01:24 - 57.588 Healthcare deserts in many of those places in Pennsylvania correct

01:24 - 01.398 they are far worse off today than they were last year at this time

01:25 - 04.828 because of that and why when those folks are uninsured

01:25 - 06.138 seek treatment

01:25 - 08.428 go to the emergency room.

01:25 - 14.448 All of us even those in the commercial space end up paying more for health care

01:25 - 16.878 because insurance companies raise their rates

01:25 - 21.598 to compensate for the people who are uninsured is that correct that's right.

01:25 - 22.738 Thank you commissioner

01:25 - 24.108 would seem as though

01:25 - 29.988 it would make sense to ensure more people and not kick people off of healthcare

01:25 - 32.248 because when we do that.

01:25 - 35.038 We overburden our emergency rooms.

01:25 - 39.443 Many of our hospitals particularly in rural Pennsylvania cook clothes

01:25 - 42.078 and at the end of the day all of Pennsylvania

01:25 - 44.818 actually ends are paying more correct

01:25 - 45.438 yes

01:25 - 46.828 thank you so much

01:25 - 47.908 we appreciate

01:25 - 51.258 department of insurance and penny for being here with us

01:25 - 54.088 this afternoon and that will conclude.

01:25 - 57.708 Our budget hearing today with the department of insurance

01:25 - 59.611 and with penny.

01:26 - 08.288 It.