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Summer Lee Slams Employer-Sponsored Healthcare: Tying Coverage ‘To A Paycheck Is Harmful’
Forbes Breaking News
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4/17/2025
During a House Education and Workforce Committee hearing prior to the congressional recess, Rep. Summer Lee (D-PA) spoke of her disapproval for employer-sponsored healthcare.
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00:00
The chair next recognizes Ms. Lee from Pennsylvania.
00:05
Thank you, Mr. Chair.
00:07
I think I might take just a slightly different route,
00:10
and I would like to start by saying that I don't think that we should have
00:13
health care that's tied to employment in the first place.
00:16
The United States has the largest economy on earth,
00:19
but we are one of the only wealthy countries where getting sick can bankrupt
00:23
you and your access to care depends on what kind of job you have
00:26
or whether you have one at all.
00:28
Our current health care system tells people that their worth and their health
00:30
depends on their specific employment status.
00:33
In the wake of the Trump administration and Doge's reckless mass firings
00:37
across the federal government, it's now clearer than ever
00:40
why tying something as essential as health care to a paycheck is harmful.
00:48
We're hearing heartbreaking stories after heartbreaking story
00:51
about the tens of thousands of people who are waking up one day suddenly unemployed
00:55
and also suddenly without health care.
00:58
A woman about to give birth to twins, a man in the middle of chemotherapy.
01:03
We've heard from a senior desperately needing hip surgery.
01:07
But let's also not forget, even those with employer-sponsored insurance
01:10
can still struggle with health care access and affordability.
01:13
Often I hear from working families who are underinsured,
01:17
burdened by high out-of-pocket costs, skipping appointments,
01:20
or drowning in debt for care that barely meets their needs.
01:24
If they even have coverage, it often doesn't go far enough.
01:28
And many are forced to choose between rent or groceries
01:30
or paying thousands for their life-saving medication.
01:35
Ms. Lilly, based on what you've seen in the blood cancer community,
01:38
can you speak to the personal and financial effects on patients
01:41
when they're denied coverage for life-saving care,
01:43
not because of medical judgment, but because it's deemed too costly or not profitable?
01:48
Yeah, so I would say that this is unfortunately a call we often get
01:53
to our information and referral center is,
01:56
hi, I have insurance, but they're saying they're not going to cover this particular service.
02:01
Unfortunately, you know, the U.S. has led in biomedical research.
02:05
We have amazing cell and gene therapies,
02:06
and those therapies are probably the calls we get the most now,
02:10
is folks being unable to access these services because they are so expensive.
02:14
I'll also add that this is one of the reasons why Medicaid is so important.
02:18
If we look at Deanne, who was diagnosed with blood cancer many years ago,
02:23
she ended up on Medicaid because she could no longer work.
02:26
Similar situation for Amanda, who lives in Michigan.
02:29
Many of our patients end up not being able to work,
02:32
not being able to maintain the coverage,
02:34
and then end up accessing the Medicaid program
02:36
because they are literally too sick to work.
02:40
So unfortunately, being denied life-saving care based on cost isn't an exception.
02:45
It's baked into the system.
02:46
Investigations have uncovered troubling practices by health plans
02:49
and their corporate service providers
02:51
to conduct arbitrary, improper, and mass denials of claims.
02:55
A ProPublica investigation found that Cigna built a system
02:59
allowing doctors to instantly reject claims without opening the patient's file.
03:04
Another investigation found how EVCore,
03:06
a company contracted by insurers that cover over 100 million Americans,
03:10
uses a secretive algorithm to drive up denial rates.
03:14
One employee described executives directing staff
03:17
to keep a closer eye on guidelines because we're not showing savings.
03:22
Ms. Lee, since private insurers often have a duty
03:24
to maximize profit for shareholders,
03:26
would you agree that a health system designed to maximize care
03:29
and access for the public would help prevent
03:31
these kinds of abusive denial practices and better protect patients?
03:34
I think it would.
03:36
And I think having that transparency
03:38
that has really been a theme of this hearing so far
03:41
around what algorithms are being used,
03:44
what are they based on, are they being double-checked,
03:46
is there a human actually reading the results and saying,
03:50
okay, no, this is all right, this makes sense.
03:53
Does that human have the right expertise?
03:55
Are they, for my patients, an oncologist,
03:58
or are they someone else?
03:59
And just to say, I think this is exactly why we need universal health care.
04:05
We've spent decades trying to patch a broken system.
04:08
The Affordable Care Act expanded access
04:10
and curbs some of the worst abuses.
04:12
But to be honest, it was a compromise.
04:15
And since then, both Democratic and Republican administrations
04:18
have doubled down on market-based models
04:20
that hand over more power and profit to corporate actors,
04:24
allowing private equity firms and hospital conglomerates
04:27
to tighten their grips on the health care system.
04:30
And where do these profits go?
04:32
Straight into lobbying and political campaigns
04:34
that block meaningful reform.
04:37
That's exactly why we know this Republican Congress,
04:39
this administration, and the billionaires and corporate lackeys
04:42
won't support the policies working people actually need.
04:46
That's why instead of seeking to bolster our health system,
04:49
they're seeking to cut at least $800 million in funding for Medicaid,
04:52
a life-saving program for our most vulnerable populations,
04:56
including those who found themselves or find themselves recently unemployed.
05:02
We don't need more tweaks.
05:03
We need a system that treats health care as a human right,
05:06
not a job perk, one that probably has a savings,
05:09
lives, not shareholder values.
05:10
We deserve universal, guaranteed health care for all.
05:13
I thank you all so much for your time today, and I yield back.
05:16
The gentle lady yields back.
05:19
The chair next recognizes himself for five minutes.
05:21
You know, we've been hearing a lot today about Medicaid.
05:25
That was not the purpose of this hearing,
05:27
but I'd like to echo the sentiments of Chairman Wahlberg.
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