The percentage of small firms providing health benefits has dropped to 30% today, from about 50% in 2000, Strouse said.

In addition to working as a broker and benefits consultant herself, Strouse is active at the National Association of Benefits and Insurance Professionals. She is the president of the NABIP Iowa chapter.

Strouse and other speakers at the hearing did not talk about proposals for repealing the Affordable Care Act.

Strouse and Republican lawmakers at the hearing called for expanding access to health savings accounts, making HSA rules more flexible and improving Affordable Care Act premium tax credit subsidy support for workers using individual coverage health reimbursement accounts, or ICHRAs, to pay for their own individual health coverage.

"To have an HSA plan, you have to have a high-deductible health plan," Strouse said. "Well, in my world today, guess what: Every single plan is a high-deductible health plan."

Strouse called for letting workers combine HSAs with any type of health coverage and for increasing the maximum HSA contribution limits to be in line with health plan annual out-of-pocket spending limits.

This year, the HSA contribution limits are $4,300 for individuals and $8,550 for families. That compares with group health plan annual out-of-pocket maximums of $9,200 for employee-only coverage and $18,400 for family coverage.

Strouse also called for making it easier for workers to combine employer ICHRA cash with ACA premium tax credit subsidies,

Related: Keeping ACA premium tax credits high may cut 2025 group health use

Leslie Dach, the chairman of Protect Our Care, a group trying to preserve the current, relatively high level of ACA premium tax credit subsidies adopted in response to the COVID-19 pandemic, and Democratic lawmakers at the hearing contended that Trump administration proposals and proposals by Republican lawmakers could reduce the percentage of people who have health coverage and hurt medical science.

If Congress lets the premium tax credit subsidies return to what they were in 2020, "over 20 million people will see their premiums go up an average of 90%, and 5 million people will lose their insurance," Dach said.

Rep. Leslie Sanchez, D-Calif., called for action to protect federal health science research funding.

She cited a Trump administration announcement that it's making $4 billion in biomedical research funding cuts.

"This funding pays for chronic disease research related to heart disease and diabetes, and all states could lose millions of dollars from these cuts," Sanchez said. "Just my home state of California alone could lose more than $800 million. Missouri could lose up to $131 million, and Texas could lose over $300 million."