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Alexander Announces Bipartisan Bill to Stabilize Individual Health Insurance Market, Then Lower Premiums

Says bill will create more choices for health insurance, fund subsides that pay low-income Americans copays and deductibles

"Imagine yourself, a 45-year-old songwriter in Tennessee who loses her job, has three kids, and goes out into the individual market and finds out she can't buy health insurance because no company is offering it. If we do not act, this is the kind of consequence we are talking about."

WASHINGTON, October 17 -- Today, Senate health committee Chairman Lamar Alexander (R-Tenn.) announced he and Sen. Patty Murray (R-Wash.) have reached a short-term deal to offer bipartisan legislation to stabilize the individual health insurance market and begin to lower the costs of premiums, so all Americans have access to health insurance.

"Our legislation is based on the four bipartisan hearings and other meetings that our committee held last month and engaged nearly 60 senators," Alexander said. "According to witnesses at our hearings and according to the Congressional Budget Office, without these cost-sharing reduction payments, premiums will rise, the debt will increase by nearly $194 billion over ten years, and up to 16 million Americans may find themselves living in counties where no company sells insurance in the individual market."

Alexander continued: "Witnesses also testified that one way to lower costs for consumers is to give states more flexibility than the Affordable Care Act now allows to design health insurance plans give consumers more choices. We have purposely limited our proposal to these two things -- first, two years of temporary cost-sharing payments, and, second, amendments that would give states meaningful flexibility in using section 1332 innovation waiver that is already a part of the Affordable Care Act."

"Only about six percent of Americans get their insurance in the individual market. It's about 18 million people, but every single one of them finds their health insurance important, and every single one of them is terrified by the skyrocketing premiums and possibility that they may not able to buy insurance at all if we don't act. The best course is to take this limited bipartisan first step that to avoid the chaos that could occur during 2018 and 2019 if premiums continue to skyrocket and millions of Americans find themselves without a way to purchase health insurance."

"Imagine yourself, a 45-year-old songwriter in Tennessee who loses her job, has three kids, and goes out into the individual market and finds out she can't buy health insurance because no company is offering it. If we do not act, this is the kind of consequence we are talking about."

"Senator Murray and I hope that we can present this legislation to Senator McConnell and Senator Schumer, with the support of a significant number of senators. We hope that it will pass, the House of Representatives will agree to it, and the president will sign it. I have had encouraging discussions with President Trump, who called me on two different occasions encouraging me to work with Senator Murray to come to a bipartisan agreement. I'm grateful to him for that encouragement and I'm grateful to her."

A Douglas County jury has awarded $11.3 million in damages to an Omaha mother of 10, finding Farmers Insurance had acted in bad faith in refusing to make good on her husband's $350,000 life insurance policy.

The case — brought by Vaneza Ramos after her husband, Jose Gaytan, died of COVD-19 in 2020 — followed years of litigation and two jury trials.

At the first, in March, a jury found that Farmers had breached its insurance contract, rejecting the company's allegation of fraudulent misrepresentation.

At the second earlier this month in Omaha, a separate jury considered whether Farmers had acted in bad faith and, if so, the harm caused by its denial of the claim.

"Beyond the verdict amount, this is a compelling local story about a South Omaha family that lost a husband and father during the COVID-19 pandemic, the financial and personal challenges that followed, and the role of a jury in holding an insurance company accountable," said attorney Ross Pesek, who represented Ramos along with Alejandra Ayotitla.

According to the complaint, Gaytan had named his wife, Ramos, as the beneficiary. But after he died May 31, 2020, the company denied her claim, prompting the lawsuit.

In an answer, Farmers New World Life Insurance Co. acknowledged that they issued a policy to Gaytan on Nov. 28, 2018, listing Ramos as the sole primary beneficiary.

But the company's lawyer contended he had failed to disclose his history of a heart attack (specifically a myocardial infarction he'd had that August), denied the claim and sent Ramos a check for $17,360.87, to refund the premiums paid on the policy.

Ramos didn't cash it.

District Court Judge Katie Benson initially granted summary judgment in favor of Farmers. But in December 2024, the Nebraska Court of Appeals reversed and sent the case back to district court on the breach of contract and bad faith claims.

The appellate court said Farmers had failed to establish that Gayton had intended to deceive the company.

Gayton had texted his insurance agent about his hospitalization that August, and he answered "yes" on a medical questionnaire asking if he'd been treated, hospitalized or taken medication for a range of issues, including high blood pressure, high cholesterol or heart attack.

Viewing the evidence in a light most favorable to Ramos, the court said there were genuine issues of material fact for a jury.

At a three-day trial, Pesek told the jurors: "A promise to protect should not be broken."

He said that promise, and the consequences of breaking it, were at the heart of the case.

Pesek said Ramos and Gayton together raised a blended family of 10 children and operated a family business in Omaha. In May 2020, they'd had their youngest. Later that month, Gayton was hospitalized with COVID-19 and died of it May 31.

He said evidence at trial described the financial pressure that followed. Ramos had to borrow from family and her mother moved in to help care for the children. Gayton's truck got repossessed, and their son set aside his plans in order to take on substantial responsibilities in the family business.

Pesek compared Ramos' fight to the story of David and Goliath.

"There is one moment that even Goliath fears. It's this moment. It's accountability because of a jury," he told the jury, which returned its verdict Oct. 16.

Farmers' attorney, Quinn Eaton, didn't respond Tuesday to a request for comment.

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