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Planning grants would be provided to states to create state or regional Gateways. Further encouragement for the state to proactively launch or participate in a Gateway lies in the stipulation that residents of the state would not be eligible for premium credits or an expanded Medicaid match until they adopted specified standards. If a state takes no action, the federal government would step in and operate that state’s program. Gateways would become financially self-sustaining through a surcharge on participating health plans. As envisioned, consumers would be able to purchase insurance either inside or outside of the Gateway and private or public entities would offer navigation assistance to help individuals and employers obtain affordable coverage. Quality standards for health plans offering essential health care benefits through the Gateway would be specified.

Policymakers have learned much by observing and studying the laboratory of Massachusetts and its successful health coverage experiment. Over the years, other states have adopted alternative health reform models. We are pleased that the Committee bill treats Puerto Rico and the other territories equally with the states with respect to the programs in its jurisdiction. We commend the Committee, especially the leadership of Senators Kennedy and Dodd, for recognizing that quality, affordable coverage should be available to all Americans wherever they reside. It is important to make certain that the insurance market rules are the same inside and outside of the Gateway.

In short, the proposal appears to embrace a reasonable and practical balance between federal policy direction and the reality of diverse insurance markets and state regulatory capabilities across the U.S.

Underwriting and Age Rating: In general, AARP supports community rating, where insurers do not charge higher rates or deny coverage based on age or pre-existing conditions. If age rating is not seriously constrained within national health reform, insurers will likely charge higher rates to older people to substitute for rating based on medical condition.

If any age differential is allowed, AARP believes it should be narrow – no greater than 2-to-1, as in the committee’s proposed legislation. Individuals living in states where no or narrow age rating is allowed today should not be disadvantaged as a result of national health reform. We strongly commend the Committee’s leadership in striving to limit age rating bands to a ratio of 2 to 1. We believe it is essential that health care reform result in providing affordable coverage to those who have the most difficulty obtaining it in today’s market and that is particularly true for older adults.

We have serious concerns about the adverse impact on AARP members of alternative proposals that allow insurers to charge older Americans up to five times or more premium rates. We question why age rating, especially as high as 5 to 1, is necessary when virtually all health reform proposals under consideration include risk adjustment to compensate for higher costs of enrollees who are sicker or older. Independent actuaries confirm that appropriate risk adjustment should mitigate the need for age rating.

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