HEARING - U.S. Senate Special Committee on Aging
HEARING - U.S. Senate Special Committee on Aging HEARING - U.S. Senate Special Committee on Aging
69 Mr. SHAPLAND. I am sorry that that statement was misleading. Now that we are engaged in this conversation, I can see that somebody could interpret it like that. But in the realm of the Medicare field of expenses, private coverage has provided catastrophic coverage to 70 percent, 12 percent are covered by Medicaid, about half of the remaining would be covered under Medicaid under Bowen's proposal because they have to spend $2,000 to get to the catastrophic that Bowen proposes, and by that time they would be in Medicaid anyway-so why spend money under Bowen's proposal to get Medicaid when they would just get the Medicaid anyway? And Bowen says that the remaining, the other people who do not have any coverage, who are another few percent, could buy his coverage. Well, they can buy coverage from us, too. Senator PRESSLER. Let me ask one final question, Mr. Chairman, and then I may have some for the record. I am trying to thoroughly understand this. On page 4 you state, "For the working population, studies of group employee benefit plans among commercial health insurance companies have shown trends toward adoption of plan features that will both help contain costs and improve the comprehensiveness of the plans." Then you say, "A higher percentage of employees today than ever before have larger maximum benefit levels, with nearly 80 percent having maximum benefits of $1 million or more.." Now, what does that mean, that 80 percent that have maximum benefits of $1 million, so they can get coverage-- Mr. SHAPLAND. We are saying that those employers that have bought group insurance for their employees, that 80 percent have full catastrophic coverage. Senator PRESSLER. Those companies that have coverage for their employees. Mr. SHAPLAND. Right, those that have chosen to buy group insurance for their employees. Senator PRESSLER. And of course, there are a lot of people-what percentage of Americans is that? Mr. SHAPLAND. I am sorry, but I do not have that number. Senator PRESSLER. OK. It is probably what, 20 percent maybe? Mr. SHAPLAND. Oh, no. We are talking about the vast majority of the employees. Where you do not have group insurance is where you have employees with minimum wages, and the employers just do not have the money to buy group insurance. Senator PRESSLER. What percentage of the people would that be? Who would that be? Mr. SHAPLAND. I do not. know. Maybe 10 percent. I am just guessing now. Senator PRESSLER. Can we get that for the record? Somebody is just now providing that to you. What percentage is it? Mr. SHAPLAND. I have just gotten a note that says there are 240 million who are, I guess, employees, and 172 million have group insurance-if I understand this note correctly. Senator PRESSLER. So it would be less than 50 percent, then, is that right?
70 Mr. SHAPLAND. Oh, no. There are 240 million Americans, and 172 million have insurance, The vast majority of that would be group insurance. Senator PRESSLER. There are how many million Americans? Mr. SHAPLAND. This says there are 240 million Americans, and 172 million have insurance. Senator PRESSLER. Of $1 million or more? Mr. SHAPLAND. No. It would be just how many have insurance, I think. Senator PRESSLER. OK. Mr. SHAPLAND. But 80 'percent of the 172 million would have $1 million or more. The insurance industry tries to sell catastrophic coverage, but some employers just do not have the financial means. They are working with minimum wage employees with high turnover, and they just are not going to come up with the money to have a group insurance program. Senator PRESSLER. Well, 1 thank you. I am going to have some more questions on some of these statistics. I think some of us who are trying to make these decisions have to understand this. It is terribly complicated. But somehow, some Americans are being left out. We heard from some of them today who are very hard-working middle-class people. As I go about my State, as I am about to begin to start a new project this year of visiting every county, I bet I will hear from someone who would like to have private health insurance, but who cannot get it for one reason or another. There will be somebody else who thought they had some kind of insurance, and they did not. Really, I guess that cannot all be thought to be your fault. Individuals have some responsibility, too, to inform themselves, and we cannot just expect people not to take some responsibility of their own. But there are people who slip through the slats, and we do have a problem out there. Mr. SHAPLAND. I might comment on one of the things you said about people who have a heart condition who cannot buy insurance because they are uninsurable. The Health Insurance Association has been very active for quite a few years, trying to get Congress to pass a law that supports State uninsurable risk pools. There are already at least 10 States that have such pools, so that those people do not fall through the cracks. And we ask you to support that legislation. Senator PRESSLER. Thank you very much. Chairman MELCHER. Senator Wilson. Senator WILSON. Thank you, Mr. Chairman. First of all, I do not want to dwell on this at great length, because there are many other questions I want to ask you, but why is that legislation necessary? Why can't the organizations do that voluntarily? Mr. SHAPL.AND. The States pass laws, these uninsurable risk pool laws? Senator WILSON. Yes. Mr. SHAPLAND. They can. We are asking for a law to be passed that allows what we call a fair distribution of the losses of those pools. Right now, the law precludes self-insurers from being charged for their fair share of those losses. We think there should
- Page 21 and 22: 18 Mrs. YEL.INECK. No. I started ou
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- Page 25 and 26: 22 Chairman MELCHER. Well, I am ple
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- Page 29 and 30: 26 STATEMENT BY SENATOR PETE WILSON
- Page 31 and 32: 28 Mrs. RIEGER. We have; we have wo
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- Page 37 and 38: 34 Senator HEINZ. So it is both a p
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- Page 45 and 46: 42 industry's role in providing cat
- Page 47 and 48: 44 Senator HEINZ. So things are wor
- Page 49 and 50: 46 Chairman MELCHER. In exactly the
- Page 51 and 52: 48 plement policy, what should that
- Page 53 and 54: 50 - 2 - I am Robert Shapland, Vice
- Page 55 and 56: 52 - 4 - CATASTRIPC PROTECTION IiDE
- Page 57 and 58: 54 -6- MiCIGAP INSJRANCE: A RPL1C/P
- Page 59 and 60: 56 To ensure that all of these cont
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- Page 63 and 64: 60 - 12 - Finally, given that Congr
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- Page 67 and 68: 64 Chairman MELCHER. Senator Heinz.
- Page 69 and 70: 66 Mr. SHAPLAND. I think we are in
- Page 71: 68 Those problems are real problems
- Page 75 and 76: 72 comprehension, and it is growing
- Page 77 and 78: 74 that educational process, and we
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- Page 81 and 82: 78 Mr. SHIAPLAND. How much would nu
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- Page 87 and 88: 84 Mr. Chairman and Members of the
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- Page 97 and 98: 94 Item 3 Testi~ony of GAIL SHEARER
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70<br />
Mr. SHAPLAND. Oh, no. There are 240 milli<strong>on</strong> Americans, and 172<br />
milli<strong>on</strong> have insurance, The vast majority of that would be group<br />
insurance.<br />
Senator PRESSLER. There are how many milli<strong>on</strong> Americans?<br />
Mr. SHAPLAND. This says there are 240 milli<strong>on</strong> Americans, and<br />
172 milli<strong>on</strong> have insurance.<br />
Senator PRESSLER. Of $1 milli<strong>on</strong> or more?<br />
Mr. SHAPLAND. No. It would be just how many have insurance, I<br />
think.<br />
Senator PRESSLER. OK.<br />
Mr. SHAPLAND. But 80 'percent of the 172 milli<strong>on</strong> would have $1<br />
milli<strong>on</strong> or more. The insurance industry tries to sell catastrophic<br />
coverage, but some employers just do not have the financial means.<br />
They are working with minimum wage employees with high turnover,<br />
and they just are not going to come up with the m<strong>on</strong>ey to<br />
have a group insurance program.<br />
Senator PRESSLER. Well, 1 thank you. I am going to have some<br />
more questi<strong>on</strong>s <strong>on</strong> some of these statistics. I think some of us who<br />
are trying to make these decisi<strong>on</strong>s have to understand this. It is<br />
terribly complicated. But somehow, some Americans are being left<br />
out. We heard from some of them today who are very hard-working<br />
middle-class people. As I go about my State, as I am about to begin<br />
to start a new project this year of visiting every county, I bet I will<br />
hear from some<strong>on</strong>e who would like to have private health insurance,<br />
but who cannot get it for <strong>on</strong>e reas<strong>on</strong> or another. There will<br />
be somebody else who thought they had some kind of insurance,<br />
and they did not. Really, I guess that cannot all be thought to be<br />
your fault. Individuals have some resp<strong>on</strong>sibility, too, to inform<br />
themselves, and we cannot just expect people not to take some resp<strong>on</strong>sibility<br />
of their own.<br />
But there are people who slip through the slats, and we do have<br />
a problem out there.<br />
Mr. SHAPLAND. I might comment <strong>on</strong> <strong>on</strong>e of the things you said<br />
about people who have a heart c<strong>on</strong>diti<strong>on</strong> who cannot buy insurance<br />
because they are uninsurable. The Health Insurance Associati<strong>on</strong><br />
has been very active for quite a few years, trying to get C<strong>on</strong>gress to<br />
pass a law that supports State uninsurable risk pools. There are already<br />
at least 10 States that have such pools, so that those people<br />
do not fall through the cracks. And we ask you to support that legislati<strong>on</strong>.<br />
Senator PRESSLER. Thank you very much.<br />
Chairman MELCHER. Senator Wils<strong>on</strong>.<br />
Senator WILSON. Thank you, Mr. Chairman.<br />
First of all, I do not want to dwell <strong>on</strong> this at great length, because<br />
there are many other questi<strong>on</strong>s I want to ask you, but why is<br />
that legislati<strong>on</strong> necessary? Why can't the organizati<strong>on</strong>s do that voluntarily?<br />
Mr. SHAPL.AND. The States pass laws, these uninsurable risk pool<br />
laws?<br />
Senator WILSON. Yes.<br />
Mr. SHAPLAND. They can. We are asking for a law to be passed<br />
that allows what we call a fair distributi<strong>on</strong> of the losses of those<br />
pools. Right now, the law precludes self-insurers from being<br />
charged for their fair share of those losses. We think there should
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