News & Commentary

Anthem Participates in Bipartisan HELP Committee Hearing on Stabilization of the Individual Market

September 14, 2017

On Thursday, September 14, Robert Ruiz-Moss, Vice President of Individual Business at Anthem, testified before the Senate Health, Education, Labor and Pensions (HELP) Committee as part of a series of four bipartisan Congressional hearings on the individual market. Below are his opening remarks outlining both short and long-term actions needed to stabilize the individual health insurance market, and the written testimony can be viewed here.


Chairman Alexander, Ranking Member Murray, and members of the Committee, I am Robert Ruiz-Moss, Vice President of Individual Business at Anthem.

It is a privilege to appear before you today to share Anthem’s recommendations on how we can work together to bring stability to the individual health insurance market and promote our common goal of making high quality, more affordable health care accessible for all.

Based on Anthem’s vast experience and expertise, we feel uniquely positioned to offer our perspective. For more than 75 years, we have been focused on caring for America’s health – a responsibility we take seriously – and today, we continue that focus through our service to 74 million Americans.

Anthem has participated in the ACA exchanges since their inception, and has continued to offer coverage even as many competitors have withdrawn. Unfortunately, the underlying lack of stability in the markets has led to difficult decisions regarding Anthem’s participation next year.

We must come together to address this challenge, and these hearings are a great step forward.

Our experience has shown us that three fundamental considerations are necessary to ensure a viable insurance market:

  • First: a balanced risk pool. Today, too few healthy individuals are enrolling in coverage, and many are doing so only when they require services, quickly dropping the coverage when it is no longer needed. Nearly 20 percent of Anthem individual market members maintained coverage for six months or less last year. 
  • Second: a predictable and stable regulatory environment.  The rules governing the individual market need to stabilize so consumers know what to expect, and so health plans, providers and consumers can plan effectively.
  • And third: predictable government financing.  To ensure the individual market provides affordable options for consumers, premium assistance and cost-sharing reduction funding must be predictable and reliable.

With open enrollment beginning November 1st, the need for swift action is clear. To improve the stability of the individual market in 2018, there are legislative and regulatory changes that, if made quickly, could improve the individual market environment for consumers next year.

  • The first step is funding certainty for CSR subsidies. CSRs play a pivotal role in ensuring more affordable access to health care for low-income consumers.  If CSRs are ended, the CBO predicts that premiums for silver exchange plans will jump nearly 20 percent, driving people to forgo coverage, and costing the federal government $2.3 billion more in fiscal year 2018.
  • The second step is repealing the health insurance tax. The moratorium on the health insurance tax ends at the close of 2017.  If reinstated, this tax will result in premium increases for consumers between three and five percent.
  • The third step is market stability funding. For the individual market to find its footing, it is critical that consumers have affordable options. Federal reinsurance would enhance coverage affordability for all, and maintain access for individuals with high-cost needs.
  • The fourth step is to ensure continuous coverage provisions. Sufficient measures must be in place – and enforced – to encourage healthy individuals to purchase and maintain coverage.

All of these steps will help address the short-term instability undermining individual health insurance markets.

However, these steps alone will not solve all the challenges facing the individual market. Given the layers of federal and state regulation covering the individual market, additional actions need to be taken to ensure long-term stability. My written testimony includes a number of recommendations, but I would highlight one in particular that Anthem encourages the committee to pursue: improving the Section 1332 waiver process, which enables states to implement innovative programs.

It’s also important to note that market instability is only a symptom of the disease facing our health care system, which is the rising cost of care.

The cost of health care is simply too expensive and continues to rise at an unsustainable rate, which is the true impediment to ensuring all Americans have access to high quality, affordable coverage. Anthem is committed to working with this Committee and other policymakers to advance solutions to this crisis and continue to bend the cost curve.

We stand at a challenging moment, but we are confident that our collective efforts can bring about meaningful improvements for health care consumers.

Thank you for the opportunity to testify today. I look forward to your questions.

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