Senator Elizabeth Warren’s Speech to the Health Action 2018 Conference

At the 23rd Annual Health Action Conference, ​Sen. Elizabeth Warren laid out a plan for addressing the high health care costs and high health insurance costs that cause pain to so many families. 

Here is the full text of the speech:

I grew up out in Oklahoma in a little house on a gravel road that was the last street in town. Behind us was nothing but open prairie for miles and miles. My three older brothers slept in a room that was a converted garage. My daddy had a lot of different jobs –he was a traveling salesman, he fixed cars.

When I was about 3 or 4, he got a steady job selling carpet for Montgomery Ward. Over the next few years, each of my three older brothers headed off to the military. Daddy worked steadily. My folks decided to move to Oklahoma City—a nicer house, an Oldsmobile station wagon. I felt safe.

And then it happened. My daddy had a heart attack.

I remember visiting him in the hospital. I remember how gray he looked. I remember the hushed way people talked and the casseroles they brought to the house. Scary stuff for a 12 year old kid.

After he got out of the hospital, he was home for a long time, long enough that we lost the family station wagon. Long enough that we nearly lost our home. I remember how my mother cried every night.

Eventually, we made it. My mom went to work at Sears. I babysat and waitressed. And Daddy went back to work. They paid off medical bills for years.

We weren’t rich, but we weren’t poor. We had been moving up a little in the world—a nicer house in the city, a station wagon with air conditioning, maybe a little savings. But one medical incident—one terrifying moment and trip to the hospital—and our lives were turned upside down. My daddy ended up as a maintenance man, my mom worked minimum wage. Eventually, they gave up the house and moved to an apartment, and they never rebuilt—no nicer home, no station wagon with air conditioning, no savings, no retirement.

And here’s the thing – We weren’t unusual. Shoot, compared with families that are dealing with babies with complex medical needs or chronic illnesses or high priced treatment for MS or cancer, we were lucky.

Starting back in the 1980s, as a law professor at the University of Houston, then at the University of Texas and later at Harvard, I did a lot of research on why hard working families—families like mine—go broke. My coauthors and I uncovered one of the key reasons: medical problems. In fact, we were the team that first identified medical bankruptcies, hundreds of thousands of families that were filing for bankruptcy in the aftermath of an illness or accident every single year.

It’s tough to be sick. Tough and scary. And despite how far we have come in recent years, the way people pay for health care in America still puts all but the richest among us at risk. I think that’s wrong, and that’s why I’m in this health care fight all the way.

For too long, giant health insurance companies have pretty much run the show when it comes to health care in America. They have squeezed the pocketbooks of hardworking people to pad their profits. I say it is time to flip the script. Health care in America should be about the well-being of families, not the wealth of insurance company CEOs.

Today I want to talk about how we get there.

Let me be absolutely clear: we will defend Medicaid and the Affordable Care Act with everything we have. But we have to do more than play defense. Millions of families are counting on us – and I believe it’s time to go on offense.

The Affordable Care Act made massive strides in expanding access to health insurance coverage. Even so, today, more than 28 million Americans are still uninsured. I endorsed Bernie Sanders’ Medicare for All bill because it lays out a way to give every single person in this country a guarantee of high-quality health care. Everybody is covered. Nobody goes broke because of a medical bill. No more fighting with insurance companies. This is a goal worth fighting for, and I’m in this fight all the way.

There are other approaches as well. We could give everyone the option to buy public coverage on the ACA exchanges, like Senator Whitehouse and others have proposed. We could let every person in the country choose Medicare, like Senators Bennet and Kaine have suggested. We could let families buy in to Medicaid, like the plan Senator Schatz has put forward. We could let employers buy in to the Medicare system to cover their employees.

I’m glad to see us put different ideas on the table.

Each of these proposals is about using public insurance to supplement private insurance, either temporarily or permanently. And so, of course, private insurance companies hate all of them. But consider what’s happening to the 216 million Americans who rely on private health insurance from an employer or purchased directly from an insurance company.

• Between 2005 and 2015, out-of-pocket costs for workers with employer coverage rose twice as fast as wages.
• Over the past decade, the average deductible in an employer plan has risen by 255%.
• One out of every five Americans says they have not filled a prescription for a medication they need because it’s too expensive.

When you take all these things together, it’s no wonder that three out of every ten American adults with health insurance say they’re having a hard time paying their medical bills.

“Hard time?” That’s an understatement. Medical bills today can stretch a family’s budget to the breaking point. A family’s security, built up for years, can be swept away by one bad diagnosis—just like my little family back in Oklahoma.

Why can’t middle class families get good coverage at an affordable price?

The reason is straightforward: profits. A private insurance company maximizes its profits by bringing in the most money possible from customers and paying out the least money possible for their health care.

And that’s exactly what many insurance companies do under the current rules.

Private insurance companies are failing the American people. We all know it. And whatever public alternatives you support, there is no reason on earth for us to continue allowing the health care of the American people to be held hostage by an industry that both attacks any new health care proposals AND, at the same time, refuses to do any better.

But here’s the good news: government sets the rules – and government can change the rules. Thanks to President Obama’s leadership, the Affordable Care Act made enormous strides in leveling the playing field for families. Protections like a ban on annual and lifetime coverage limits, guaranteed coverage for mental health and addiction services, and ending the discrimination that allowed insurers to charge women more for their insurance.

We need to build on that progress, and do more to hold America’s insurance companies accountable. I believe government should work for middle class families—not for the giant insurance companies. So long as private health insurance exists, we should require these companies to provide coverage that is at least as good and priced as reasonably as the coverage offered by our public health care programs. And that’s what I want to focus on today.

I have three straightforward proposals that would significantly improve access to healthcare for the 216 million Americans who are in private health insurance plans.

• First, don’t let private insurers cheat people.
• Second, require private insurers to be just as affordable as public insurers like Medicare and Medicaid.
• And third, when insurance companies howl that they can’t possibly be expected to do the first two things, call their bluff.

First. It’s time to end the tricks that private insurance companies pull to try to shift costs from themselves to their customers. There are lots of these, like drawing the boundaries of their networks so narrow that lots of people can’t actually see a doctor, dropping drugs from a plan in the middle of the year, ambushing people who rely on outdated provider directories, or junking plans and forcing people to go through the painful process of choosing a new one, year after year, even when they’re in the middle of a course of treatment.

Ask anyone with insurance whether it’s working for them. Ask, then stand back and listen as the horror stories come pouring out. The mom with a sick kid who needs to see an ear, nose, and throat specialist, but is told she’ll have to drive five hours to reach an in-network doctor. The patient with a rare disease who is terrified that she’ll log on to the marketplace next year and find zero plans that allow her to keep seeing her doctor. Or the worker who is in constant pain but too worried about unexpected costs to actually go visit the doctor—because even when he triple checks his policy, the insurance company always finds a way to slap him with a bill the size of a car payment.

These practices aren’t the exception – they’re the rule. And they should be outlawed. And to catch evolving scams, we should set up a program to compile consumer complaints about insurers and run down any new nonsense before it spreads.

So, stop the tricks.

Second. Let’s hold private insurance coverage to the same coverage standards that Medicare and Medicaid already meet. Look at the difference:

• Medicare premiums for most beneficiaries can’t grow faster than their Social Security checks – but premiums for plans on the ACA exchanges are subject to little or no oversight and they frequently grow by double digits.
• Medicare covers 84 cents of every dollar of health care costs, while private exchange plans might cover just 60 to 70 cents on the dollar.
• Medicare Advantage and contract Medicaid require insurance companies to prove that they have enough in-network doctors, while exchange plans have weaker standards.

The list goes on. These differences may seem small to someone who’s never encountered them, but they make a huge difference in the lives of millions of people. And every one of those differences is the result of policy choices – decisions made right here in Washington. So I say, let’s make different choices. Congress should require insurance companies to meet the same standards as Medicare and Medicaid on costs, on coverage, on doctor networks, and on profits. Period.

Stop the tricks and raise the coverage standards for insurance companies. Pretty simple ideas, but I guarantee – guarantee – that the mention of them will trigger immediate outrage from the private health insurance industry. They’ll claim that these basic protections and standards will put them out of business. They’ll stamp their feet and threaten to walk away from the health care exchanges. My response? Give me a break. The five big publicly-traded insurance companies in this country, together cover 125 million people, and they are raking in cash – more than $17 billion in profits the last year alone. Don’t tell me an industry that has $17 billion in profits to hand out to its investors in a single year can’t afford to do right by the American people.

And as we wrestle with insurance companies to get them to treat their customers a little better, keep in mind that taxpayers are directly responsible for a huge proportion of those giant profits. The top insurers in the U.S. pull in nearly 60 percent of their total revenue from Medicare and Medicaid. That’s more than $200 billion in 2016 revenues coming directly from American taxpayers. And there’s more.

• Through the tax code, the federal government subsidizes the cost of insurance to the tune of $260 billion per year.
• Through the Affordable Care Act, over the next decade, taxpayers will contribute more than half a trillion dollars to insurance companies.

Taxpayers have helped make insurance companies wildly profitable, and taxpayers can ask for fair treatment in return.

So here’s my third proposal – when the insurers complain that they just can’t accept these reforms, let’s call their bluff. If an insurer wants to bid on a Medicare Advantage contract or a state Medicaid contract, they should know that they could also be required to participate in that state’s health insurance exchanges.  In other words, if they want to bid on the really juicy federal health care contracts, they should have to offer a basic private insurance plan for individuals as well, even if those exchange plans aren’t quite as juicy for their investors.

And if some insurance companies really, truly aren’t willing to provide high-quality, affordable coverage in exchange for billions of dollars in federal subsidies and access to Medicare and Medicaid – if they really, truly want to pick up their toys and go home because their bazillion dollar profits aren’t high enough – then I say good riddance. If the insurance company walks, then we should replace their policies with public alternatives that we already know will provide better, more affordable coverage at a lower cost to taxpayers.

This isn’t pie-in-the-sky stuff. Massachusetts has the highest rate of health insurance coverage in the nation. We are the healthiest state in the nation.

That didn’t just happen because we woke up one morning and discovered that insurance companies had just started offering great coverage at a price everyone could afford.

We demanded that insurance companies live up to their side of the bargain. Every insurer participating in our exchange is required to offer plans with standard, easy-to-compare benefits and low up-front costs for families. Last year, we had the second-lowest premiums in the ACA market of any state in the country. Massachusetts insurers pay out 92% of the dollars they bring in through premiums to cover costs for beneficiaries – not to line their own pockets.

The rules are tough in Massachusetts, but the insurance companies have shown up and done the hard work of covering families in a responsible way. We have more than double the number of insurers participating on our exchanges, compared to the average across the country. They show up, they serve the people of Massachusetts, and they still make plenty of money.

Look, we still have plenty of work to do, particularly when it comes to bring down health spending, but we’re proud of the system we have built in Massachusetts, and I think it shows that good policies can have a real impact on the health and well-being of hard working people across the country.

The fight for access to health care has been a long fight—Franklin Roosevelt, Lyndon Johnson, Ted Kennedy, Barack Obama. And with more attacks on Obamacare and Medicaid and Medicare, the fights to preserve what we already have are tough.

But if this past year showed us anything, it’s that we are ready to take on the tough fights.

After Republicans laid out their cruel plans to repeal the Affordable Care Act, the American people fought back. In Congress, phones rang off the hook. Moms showed up at the Capitol with their little ones who used breathing tubes or had been born with holes in their hearts – and they simply refused to go away. Activists rolled their wheelchairs right into those hearing rooms and put their bodies on the line to protect Medicaid.

The Republicans did not succeed in repealing Obamacare. No. Democracy showed up to fight for health care in 2017, and democracy won.

And let me tell you something about these kinds of fights. I remember hearing people say, “Everyone’s just going to get tired and give up.” Well, here’s how I see it: You don’t get tired when you’re fighting for little kids who need breathing tubes. You don’t run out of steam when you’re fighting for moms, or brothers, or neighbors. You get stronger, and stronger, and stronger – until you win.

Even so, this is the time to move forward. It’s time to demand a health care system that works for all of us. America is ready for this fight. And there’s no one I would rather stand shoulder to shoulder with in this fight than all of you. Thank you for everything you did over the past year to save coverage for tens of millions of Americans, and for the work you are doing now to make our health care system work better for all Americans.