Democrats and Republicans on the House Ways & Means Health Subcommittee appeared to hold two different hearings Tuesday on improving healthcare — or at least it might have seemed that way to anyone watching the event.
Subcommittee Chair Rep. Vern Buchanan (R-Fla.) outlined what he saw as the hearing’s purpose. “I’m very excited to say that this committee is spearheading hearings and markups that will be helpful to lead toward better health results and outcomes of Americans throughout this country,” Buchanan said in his opening remarks at the hearing, which was entitled “Modernizing American Health Care: Creating Healthy Options and Better Incentives.”
Buchanan praised Robert F. Kennedy Jr., President Trump’s nominee to head HHS, for focusing on chronic disease prevention; he also urged Congress to help people take better care of themselves. “At the end of the day, we can be empowered to take charge of our own health,” said Buchanan. “Key flexibilities, including health savings accounts [HSAs], can make a difference.” HSAs are tax-advantaged accounts that workers can use to fund certain healthcare expenses.
No ‘Business as Usual’
But Rep. Lloyd Doggett (D-Texas), the committee’s ranking member, had an entirely different focus in mind. “My concern today is that under this new administration, it is the lifestyle of the very rich and famous that seems to be the only thing of concern,” he said. “The healthcare agenda that is being pursued outside of this hearing room represents the real skyrocketing crisis in this country. It’s one that will leave Americans less healthy, paying even higher prices, and suffering from preventable diseases. Today is not the time for business as usual when nothing usual is happening.”
Doggett was particularly concerned about several issues. “Republicans are preparing legislation this very week to cut significantly in healthcare,” he said. “The Trump administration continues to deny federal funds to innovative scientific researchers for developing treatments and cures that customers need. There is a delay in funds to community health clinics that treat vulnerable children and seniors. We’ve seen layoffs, hiring freezes, offers to buy out remaining workers, all worsening what was already a health workforce crisis.” He also mentioned the disappearance of “important public health data on topics ranging from youth mental health to vaccinations to contraception” from government websites.
Although Tuesday’s hearing was an important topic and “well-intentioned,” he said, “what will guarantee the worst health outcome is a lack of comprehensive, affordable coverage and inaccessible physicians and nurses. I’m eager to see progress on today’s topic and so many others, but first, we must stop the severe harm being done by the Trump/Musk duo” — a reference to Trump’s hiring of tech billionaire Elon Musk to run the extra-governmental Department of Government Efficiency.
Wellness Incentives Versus Medicaid Cuts
Once Buchanan and Doggett finished their opening remarks, the first witness to testify at the hearing was Brooks Tingle, CEO of the John Hancock life insurance company. Tingle pointed out that “life insurers have a vested interest in their customers living longer and healthier,” because the longer they live, the more premiums they pay, and the more money the life insurance company makes. Because of that vested interest, “it occurred to us how very odd it was that the life insurance industry had made virtually no effort to try to help its customers achieve better long-term health outcomes,” he said.
So, in 2015, the company introduced a program aimed at incentivizing customers and employees to pay more attention to health issues; the program gives participants points for developing good health habits like increased physical activity, preventive care visits, and buying fresh produce. The points earn participants a discount on their life insurance premiums, as well as discounts on healthy foods, fitness gear, and other items. In 2022, the company began offering a discounted rate on a test that screens for multiple types of cancer. “As a result, many of our customers have learned of a cancer diagnosis earlier than they otherwise would have, and hopefully will have better outcomes,” Tingle said.
Another witness was Leslie Dach, founder and chairman of a group called Protect Our Care, which says its goal is to make “high-quality, affordable, and equitable healthcare a right, and not a privilege, for everyone in America.” Although only 20% of Americans think that the government should spend less on healthcare, “the reconciliation proposals currently under consideration in Congress would increase healthcare costs and take away coverage for millions, including our neighbors in nursing homes, children, individuals with disabilities, and people who take care of their children or elderly parents. These cuts would devastate families in order to pay for tax breaks for billionaires and wealthy corporations, and line the pockets of big drug companies,” he said.
“If lowering the deficit is the rationale for these cuts, the simplest and most popular solution would be to rein in these massive tax breaks and not destroy our healthcare system,” he continued. “Proposals before Congress would cut over $2 trillion for Medicaid, which provides healthcare to over 72 million people, including six in 10 nursing home residents [and] 30 million children.”
Dach was speaking the day before the Republican-controlled House Budget Committee released its budget proposal, which includes plans to institute work requirements in Medicaid and reduce federal spending on the program by instituting “per-capita caps” that would restrict how much the federal government could spend on each Medicaid enrollee. In all, the proposed changes would cut an estimated $2.3 trillion — about one-third — from the Medicaid budget over 10 years, according to documents obtained by Politico.
Questions Along Party Lines
After the witnesses finished, the questioning was almost entirely along party lines, with the Democrats asking questions only of Dach, while the Republicans concentrated on the other witnesses. Rep. Brian Fitzpatrick (R-Pa.) asked Tingle what benefits had resulted from the John Hancock program.
“We have a great deal of data to support [the benefits] of engaging people, providing incentives and even rewards for undertaking greater levels of physical activity,” Tingle replied. “We’re not trying to turn all of our customers into marathon runners. It’s not about that. Let’s meet people where they are, [have them] take a few extra steps a day, be a bit more physically active.”
Rep. Adrian Smith (R-Neb.) asked another witness, Marcie Strouse, a benefits consultant for small businesses in Des Moines, Iowa, about HSAs. “I’m very concerned when patients tell me that they don’t feel the flexibility that they would like to have in terms of pursuing treatment, access, and care,” Smith said. “How important do you believe it is for them to have a variety of flexible options such as the HSA?”
Strouse said that HSAs are “extremely popular” but that the maximum contribution limit is “still extremely low. We probably see out-of-pocket maximums around $9,000 and right now you can only contribute $4,300 into your HSA. So we would love to see those limits increase to match out-of-pocket maximums.”
On the other side of the aisle, Rep. Dwight Evans (D-Pa.) noted that Republicans were discussing repeal of the Inflation Reduction Act, and asked Dach what the effect would be on Americans’ out-of-pocket health costs if that were to happen.
“There are many, and they’re expensive,” Dach said. “Let’s start with drugs, where the Inflation Reduction Act capped out-of-pocket [drug] expenses for seniors at $2,000 a year and allowed them to smooth those out over the course of the year so they pay what they could afford to pay. That would be gone.”
One moment of comity did occur when Rep. Steven Horsford (D-Nev.) reached out to Buchanan, the committee chair. “Mr. Chair, I look forward to us coming together,” said Horsford. “I know you and I have talked. We have more in common than we don’t. Let’s work together to address the healthcare needs of all of our constituents.” Buchanan responded, “You have my commitment.”
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