Summer Lee Slams Employer-Sponsored Healthcare: Tying Coverage ‘To A Paycheck Is Harmful’

Forbes Breaking News

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.

Transcript

00:00The chair next recognizes Ms. Lee from Pennsylvania.

00:05Thank you, Mr. Chair.

00:07I think I might take just a slightly different route,

00:10and I would like to start by saying that I don't think that we should have

00:13health care that's tied to employment in the first place.

00:16The United States has the largest economy on earth,

00:19but we are one of the only wealthy countries where getting sick can bankrupt

00:23you and your access to care depends on what kind of job you have

00:26or whether you have one at all.

00:28Our current health care system tells people that their worth and their health

00:30depends on their specific employment status.

00:33In the wake of the Trump administration and Doge's reckless mass firings

00:37across the federal government, it's now clearer than ever

00:40why tying something as essential as health care to a paycheck is harmful.

00:48We're hearing heartbreaking stories after heartbreaking story

00:51about the tens of thousands of people who are waking up one day suddenly unemployed

00:55and also suddenly without health care.

00:58A woman about to give birth to twins, a man in the middle of chemotherapy.

01:03We've heard from a senior desperately needing hip surgery.

01:07But let's also not forget, even those with employer-sponsored insurance

01:10can still struggle with health care access and affordability.

01:13Often I hear from working families who are underinsured,

01:17burdened by high out-of-pocket costs, skipping appointments,

01:20or drowning in debt for care that barely meets their needs.

01:24If they even have coverage, it often doesn't go far enough.

01:28And many are forced to choose between rent or groceries

01:30or paying thousands for their life-saving medication.

01:35Ms. Lilly, based on what you've seen in the blood cancer community,

01:38can you speak to the personal and financial effects on patients

01:41when they're denied coverage for life-saving care,

01:43not because of medical judgment, but because it's deemed too costly or not profitable?

01:48Yeah, so I would say that this is unfortunately a call we often get

01:53to our information and referral center is,

01:56hi, I have insurance, but they're saying they're not going to cover this particular service.

02:01Unfortunately, you know, the U.S. has led in biomedical research.

02:05We have amazing cell and gene therapies,

02:06and those therapies are probably the calls we get the most now,

02:10is folks being unable to access these services because they are so expensive.

02:14I'll also add that this is one of the reasons why Medicaid is so important.

02:18If we look at Deanne, who was diagnosed with blood cancer many years ago,

02:23she ended up on Medicaid because she could no longer work.

02:26Similar situation for Amanda, who lives in Michigan.

02:29Many of our patients end up not being able to work,

02:32not being able to maintain the coverage,

02:34and then end up accessing the Medicaid program

02:36because they are literally too sick to work.

02:40So unfortunately, being denied life-saving care based on cost isn't an exception.

02:45It's baked into the system.

02:46Investigations have uncovered troubling practices by health plans

02:49and their corporate service providers

02:51to conduct arbitrary, improper, and mass denials of claims.

02:55A ProPublica investigation found that Cigna built a system

02:59allowing doctors to instantly reject claims without opening the patient's file.

03:04Another investigation found how EVCore,

03:06a company contracted by insurers that cover over 100 million Americans,

03:10uses a secretive algorithm to drive up denial rates.

03:14One employee described executives directing staff

03:17to keep a closer eye on guidelines because we're not showing savings.

03:22Ms. Lee, since private insurers often have a duty

03:24to maximize profit for shareholders,

03:26would you agree that a health system designed to maximize care

03:29and access for the public would help prevent

03:31these kinds of abusive denial practices and better protect patients?

03:34I think it would.

03:36And I think having that transparency

03:38that has really been a theme of this hearing so far

03:41around what algorithms are being used,

03:44what are they based on, are they being double-checked,

03:46is there a human actually reading the results and saying,

03:50okay, no, this is all right, this makes sense.

03:53Does that human have the right expertise?

03:55Are they, for my patients, an oncologist,

03:58or are they someone else?

03:59And just to say, I think this is exactly why we need universal health care.

04:05We've spent decades trying to patch a broken system.

04:08The Affordable Care Act expanded access

04:10and curbs some of the worst abuses.

04:12But to be honest, it was a compromise.

04:15And since then, both Democratic and Republican administrations

04:18have doubled down on market-based models

04:20that hand over more power and profit to corporate actors,

04:24allowing private equity firms and hospital conglomerates

04:27to tighten their grips on the health care system.

04:30And where do these profits go?

04:32Straight into lobbying and political campaigns

04:34that block meaningful reform.

04:37That's exactly why we know this Republican Congress,

04:39this administration, and the billionaires and corporate lackeys

04:42won't support the policies working people actually need.

04:46That's why instead of seeking to bolster our health system,

04:49they're seeking to cut at least $800 million in funding for Medicaid,

04:52a life-saving program for our most vulnerable populations,

04:56including those who found themselves or find themselves recently unemployed.

05:02We don't need more tweaks.

05:03We need a system that treats health care as a human right,

05:06not a job perk, one that probably has a savings,

05:09lives, not shareholder values.

05:10We deserve universal, guaranteed health care for all.

05:13I thank you all so much for your time today, and I yield back.

05:16The gentle lady yields back.

05:19The chair next recognizes himself for five minutes.

05:21You know, we've been hearing a lot today about Medicaid.

05:25That was not the purpose of this hearing,

05:27but I'd like to echo the sentiments of Chairman Wahlberg.

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