Both the Senate Finance Committee and Health Education Labor and Pensions Committee held hearings this week on aspects of the Affordable Care Act. Here’s a quick summary of those hearings and other developments in Congress.
In the Senate Finance Committee hearing, Secretary Sebelius did a good job of responding to criticism of the ACA by some of the most vocal opponents of the law on the Senate side. They mainly rehashed criticism voiced during the enactment of the ACA and over the past year, complained about too many waivers being granted to mini-med plans and not enough waivers being granted to states that want to scale back coverage.
Senator Orrin Hatch (R-UT), the Senate Finance Committee’s most senior Republican, asked Secretary Sebelius to grant states waivers of the ACA stability protections or “maintenance of effort” (MOE) requirement. He claimed that a Congressional Research Service (CRS) analysis stated that HHS has the legal authority to allow states to lower their Medicaid income eligibility limits and tighten their enrollment procedures. According to CBPP’s Judy Solomon, this is an overstatement of the CRS analysis. The CRS report states that while the law could be interpreted to allow waivers of the MOE requirement, it also could be read to preclude waivers, according to Solomon. The report also states that whatever interpretation the Secretary adopts would receive substantial deference if challenged in court. As CCF’s resident waiver watcher Joan Alker has pointed out in previous blogs, waivers can only be granted to pilot or demonstration programs that “in the judgment of the Secretary, are likely to assist in promoting the objectives” of the Medicaid program.
Senator Hatch also questioned Secretary Sebelius about the length of time it is taking HHS to respond to requests for information. HHS has been inundated with requests for information on ACA from Members of Congress and outside groups. Sebelius took the high ground by responding that they would try harder when she was questioned on response times but didn’t mention the deluge of requests and efforts by some in Congress to cut the very staff that are needed to respond to such requests.
Both Hatch and Sebelius were also interviewed by Politico on the impending one year anniversary of the Affordable Care Act. The full video interviews are available online but the following quotes give you an idea of their views.
“I’m hoping that we’re going to start to talk about the future and not continue to revisit the last two years of what led up to the passage of the Affordable Care Act. Let’s figure out ways we can work together to make this law really work.”
Secretary Kathleen Sebelius
“The states already have let it be known that they can’t live with it. I think to allow it to be even partially implemented is a mistake. We should repeal it.”
Senator Orrin Hatch
Senator Hatch also reiterated his plan to introduce legislation to eliminate the maintenance-of-effort provisions.
The HELP Committee hearing focused on exchanges with a spirited debate on whether or not plans offered on exchanges should be required to offer an essential benefit package. The Kansas Insurance Commissioner Sandy Praeger and Secretary of Maryland’s Department of Health and Mental Hygene Dr. Sharfstein argued persuasively that without an essential benefit package, insurers would be allowed to cherry-pick healthier people causing adverse selection and undermining the community pricing benefits envisioned by exchanges. An essential benefit package also helps ensure that the exchange plans subsidized through the ACA will be of good quality. Utah State Representative David Clark argued that free market forces should be allowed free reign on the exchanges and described Utah’s exchange as an “online farmer’s market” where consumers can go to compare and purchase health care plans. Utah does not subsidize insurance plans offered on its exchange. He also pointed out that there should be a competitive marketplace outside of the exchange.
In other developments:
1099: The Senate postponed a vote on legislation to repeal the 1099 tax reporting provision until after March recess. The budgetary off-set for eliminating the 1099 reporting requirement would harm self-employed people, lower-income families and others with fluctuating income.
CR: Another short-term continuing resolution was approved avoiding a government shut-down for another three weeks. In a sign that pressure is mounting, a bipartisan group of sixty-four Senators sent a letter to the President urging him to collaborate with them on deficit reduction.
“Beyond FY2011 funding decisions, we urge you to engage in a broader discussion about a comprehensive deficit reduction package,” wrote the Senators. “Specifically, we hope that the discussion will include discretionary spending cuts, entitlement changes and tax reform. “
This debate may have new implications for children’s health care coverage so you can be assured that we’ll be tracking it closely as well as other developments.
