Governors Provide Plans To Fix Health Insurance Markets

Several governors were in Washington, D.C., to testify before the Senate health committee about their bipartisan plan to shore up the health insurance marketplace. NPR's Robert Siegel talks to Republican Gov. Gary Herbert of Utah and Democratic Gov. John Hickenlooper of Colorado.

ROBERT SIEGEL, HOST:

Now, two of the governors who testified before the Senate about health care today - John Hickenlooper, the Democratic governor of Colorado, and Gary Herbert, the Republican governor of Utah. Gentlemen, thanks for joining us today.

JOHN HICKENLOOPER: You bet. Our pleasure.

GARY HERBERT: Well, thank you for having us.

SIEGEL: And first I'd like each of you very briefly to tell us why a repaired Affordable Care Act is so urgent for your state. Governor Hickenlooper, let's start with you. What does Colorado need here?

HICKENLOOPER: So we have over 600,000 people covered with health insurance coverage now of some sort who did not have coverage before the Affordable Care Act. We feel a very great sense of urgency to make sure that these CSRs, these cost-sharing reductions, are in place and stay in place so that we can - in this private market we can create some stability.

SIEGEL: And Governor Herbert, what is so urgent in all this for Utah?

HERBERT: Well, ours is probably a little different position because we did not expand Medicaid like they did in Colorado. But we are concerned about the long-term sustainability aspects of the Affordable Care Act. We want to make sure in fact that insurance premiums are affordable as opposed to the double-digit increase we see taking place throughout the country. We in fact believe that there's opportunities for the states to have a larger role in developing policy.

And as we talk about in the Republican's side, repeal and replace, we understand that the Democrat's side is talking about modify and improve. And frankly those are very similar issues. And we think with the appropriate leadership and maybe a little nudge from the governors, we can come together and resolve some of the differences and have a better program going forward.

SIEGEL: You think there's enough overlap between those two sets of ideas that you could you could find some repair.

HERBERT: I think there absolutely is. I think with collaboration, you can actually come together on a final outcome. Now, it may not be perfect for everybody, and I expect that's the way it will be. But certainly we can get to a better place I think than where we currently are.

SIEGEL: I want to ask each of you about some of the ideas that have been embraced by a bipartisan group of governors. You're one of those governors, Governor Hickenlooper. When the plan that you and Republican Ohio Governor John Kasich designed spoke about making it easier for states to change the plan, would they be changing the core benefits that people receive from the plan? If not, what should you streamline in the way of change?

HICKENLOOPER: So we were not talking about changing in any way the essential benefits that people receive under these various plans, right? What we were suggesting was changing the actual process by which a state would seek to have a waiver that, again, wouldn't change the composition of a plan or what benefits someone got but would change some of the more detailed stuff about how you can move money from one part of the state government to another or how you would be able to create a reinsurance pool more successfully and more cost effectively.

SIEGEL: Governor Herbert, your state has very interesting demographics 'cause Utah's a very young state, which would mean you have a lot of very healthy, young adults who don't buy health insurance very often. The letter that Governor Kasich and Governor Hickenlooper wrote said - I believe one provision was, keep the individual mandate, a position that that wasn't easy for a lot of Republicans. Does it make sense to you? Do you need the individual mandate to make sure that young, healthy people just don't stay uninsured until they get sick?

HERBERT: Well, I think that is part of the philosophical debate - is, can you have a mandate versus just free choice? Clearly if we end up having pools where we only have the sick involved and not the healthy, then the cost for health care goes up, and hence the premiums are going up. So it's an issue we need to address.

In Utah, prior to the Affordable Care Act, we only had about 11 percent of our population which were not covered by insurance, and half of those could in fact afford it. They just chose for whatever reason not to buy it. And a lot of those, as you suggest, are the young invincibles. They think, well, I don't need that till I'm 40 or 50. Why get it now? And I'm not really convinced that we need to have a mandate. I think states can make that decision. I just don't think we should have a one-size-fits-all federal mandate.

SIEGEL: I'm just curious to hear from both of you, a Republican governor and a Democratic governor, upon your visit to Washington whether your sense of the Senate and the Congress right now is that Washington is in a problem-solving, un-ideological mood and ready to make big compromises to get a better health care bill or to repair the one that exists, or is it just a replay of the same arguments we've heard for the past year? Governor Hickenlooper, do you sense anything different today about Washington?

HICKENLOOPER: There are a couple of big differences, one being that Senator Lamar Alexander from Tennessee, who is chairing this committee that we both addressed, really has stressed narrowing the focus. And let's say - let's see what we can get done in the short term that is going to help stabilize these private markets that are so much at risk. And we had three Republican governors and two Democratic governors with widely divergent views on the world and from very different states, and yet we pretty much all agreed with some variation but on the importance of maintaining these CSRs, these cost-sharing reductions.

And the same thing with one of these reinsurance pools - we need to have some way of supporting states to allow them to have - instead of everyone getting - or at least all the expensive, high-cost cases getting consolidated in one pool - a way to spread that cost out to a larger number of people.

SIEGEL: Governor Hickenlooper sounds hopeful. Governor Herbert, are you hopeful that Washington's in a mood to fix things?

HERBERT: (Laughter) Well, I'm hopeful more on some days than others. Certainly today I'm hopeful. Again, I think that we started off in a - kind of a bad way with the Affordable Care Act, which passed on just partisan lines. That was a mistake. We should have worked harder to have a bipartisan product. But let's not make the same mistake on the other end now. I hope there's an attempt to have a bipartisan solution which will be lasting, that people can feel good on both sides of the aisle.

SIEGEL: Well, thanks to both of you for talking with us today. Republican Governor Gary Herbert of Utah and Democratic Governor of Colorado John Hickenlooper, thank you both very much.

HICKENLOOPER: Thank you.

HERBERT: Thank you so much.

(SOUNDBITE OF THE POLISH AMBASSADOR SONG, "TAKE WING")

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