commissioner mcpeak: certainly. i do have a very specific information about that particular ghideance in my written testimony as well because it was distinct challenge for us in tennessee. as you mingsed, the carriers had already filed their service areas and the rates for 2016 when the guidance was issued. we have eight different service areas in tennessee and the guidance suggested that leaving one service area was going to be considered a market withdrawal and the carrier would be prohibited for five years from selling insurance in the state oftown tfpblet also a change in the plan. so moving from a p.p.o. to an e.p.o. plan was considered a market withdrawal. so insurers filed the rates. didn't have any idea this interpretation was outstanding. and then we received the guidance from h.h.s. in this regard. and for tennessee, that means that we would have lost five of our carriers for 2016 because of this guidance. we were very, very concerned. we had a lot of conversations with h.h.s. and finally h.h.s. agreed tha

mcpeak. >> good morning. thank you for inviting me to testify before the senate committee on the impact the affordable care act has had and thank you commerce and lack for your kind introduction. as mentioned and julie mcpeak. i've spent most of my career in insurance regulation and i have a strong affinity for the country state basis of insurance oversight. tennessee has a fabulous facilitative marketplace. the aca legislation would have significant impact in the respect is definitely cheap content. the aca introduced underwriting requirements to fundamentally reshape how health insurance is price, purchase and then mr. requirements make the policy a significant challenge. aca requirements that are cost iris and premium prices are well documented and include prohibition on create wasting condition exclusion from the guaranteed availability and essential health benchmark things that create a fuller or aca compliant plan benefits. aca impacted ensure flexibility to design plans to meet consume

mcpeak? >> thank you. good morning, chairman roskam ranking member lewis and members of the subcommittee. thank you for inviting me to testify before the subcommittee on the impact that the affordable care act has had on health insurance premiums, and thank you congressman black for your kind introduction. i've spent most of my career in insurance regulation and i have a strong affinity for the country's state-based system of insurance oversight. tennessee has a federally facilitated marketplace. and fmm for brevity. the aca legislation was intended to have significant impact, and in that respect, it has definitely achieved its intent. the aca introduced rating and swrurnd writing requirements that fundamentally reshaped how insurance is priced purchased and administered. they make a comparison of pre-aca policies to aca compliant policies, a significant challenge. aca requirements that are cost drivers are well-documented and include prohibitions on preexisting condition exclusions guarantee

mcpeak? >> they tell you, if it's not an emergency situation, go down to urgent care down the street and cost you a lot less and that's had a dramatic impact. >> commissioner? >> i would say higher. >> mr. chandler? >> the issue is that once you're in the emergency room they are a wild number of tests that will be performed. insurers aren't capable of exercising sensitive utilization review and as a result the costs can often be higher. >> it's amazing because i thought the purpose of aca really especially with subsidized insurance to reduce emergency room visits. again, that's what i'm seeing in ohio. commissioner mcpeak you mentioned that many insure earls made changes to provide thelimit the providers people can see. >> we are just now beginning to see very limited networks attached to rates and plans for the 2016 plan year. as i mentioned before, i do think that that is an attempt by the insure earls to moderate the rate increases requested and provide choice for consumers to have a skinn