ms. mcpeak. made the point of this is a very generalization made that the average american could save $2500 under the plan. if you like your doctor, you'll keep your doctor. we see pennsylvania as an example of the rate increase in western pennsylvania where my colleague is from 30 40% on average. networks are narrowing, not expanding. can you explain to me what is happening in the marketplace in the aftermath of those promises? are we seeing $2500 savings center people keeping doctors were networks getting narrower and are narrower networks a good thing? >> i think that assertion deserved every pinocchio data received. what you see is an entirely predictable result. community rated plans in most jurisdictions have been the object to severe adverse selection problems and i believe we are beginning to see precisely that with the rate increases we are seeing here. >> ms. mcpeak. >> i certainly don't hear from consumers. i hear quite the opposite from consumers calling my office. what i would sugges

ms. 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

ms. 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

ms. mcpeak, you said it changes requirements in health care plans. commissioner mcpeak: i alluded to those a moment ago. the essential health benefits platform i think does require citizens to purchase coverages they might not necessarily need and wouldn't choose to purchase on their own. what we hear frequently in tennessee is i am a 27-year-old male. i don't want maternity coverage. i have to have a plan that includes something like that. so i do think the inability to tailor products to the needs of your individual consumers has been affected by the affordable care act. the insurers can no longer tailor those plans to the distinct segment of the populations they are trying to soy. mrs. noem: could i buy a policy with fewer benefits? commissioner mcpeak: not unless it was compliant with the seengs health benefits. you can modify your cost sharing and your deductible amount. you can limit the providers that you would agree to see under the plan. the basic benefits have to be standized under the -- standardized. mrs. noem: the federal government is re