GOP pillories PPACA exchange implementation

Angry and posturing Republicans are lashing out at the health care exchange or marketplace implementation mandated by the Patient Protection and Affordable Care Act as it gets closer to going into effect, targeting what they expect to be soaring cost increases as well as the use of funds by Health and Human Services (HHS) Secretary Kathleen Sebelius. 

At a hearing today of the Subcommittee on Oversight and Investigations of the House Energy & Commerce Committee, House Republicans tried to pin down the director of the Center for Consumer Information and Insurance Oversight (CCIIO) under the Centers for Medicare & Medicaid Services (CMS) at HHS on whether costs would rise with the health care marketplaces. 

The hearing takes place during the consideration of the President’s fiscal 2014 budget, which seeks additional funding or implementation of PPACA. 

CCIIO Director Gary Cohen did not answer the question directly and demurred to the underlying cost of health care in general, as set by doctors and hospitals, as all manner of actuarial and costs analysis were bandied about and stories recounted of concern for a spike in health care costs. 

The house is also considering legislation to shut down what it sees as a slush fund or financing mechanism for the exchanges, at the expense of its intended use, to fill in a gap for people with pre-existing conditions. 

The fund, otherwise known as the Prevention and Public Health Fund, is being used to train exchange navigators and for a public awareness media and enrollment campaign. The fund has stopped taking new applicants. 

House Energy & Commerce leaders have criticized the $304 million cost of the enrollment campaign because it came from the prevention fund, as well as the $54 million used from the prevention fund to pay navigators – individuals and community groups – to sign people up for the exchanges. 

Rep. Gregg Harper, R-Miss., and others asked Cohen why HHS stopped enrollment in the fund. The money is “almost like a slush fund for her to use,” Harper said of Sebelius’ use of the fund. He said the money was to help people who are sick and with pre-existing conditions, that it is “unconscionable” to use for other purposes and “to deny care to those who are in the most need.”

Rep. Marsha Blackburn, R-Tenn., said the young adult population and families in her state are seeing 40 percent to 50 percent increases in their insurance costs. She asked if the increases would continue on the exchanges. 

Cohen advised families to shop the marketplace and “find the plan that is most affordable for their family. Healthcare costs had been going up year after year after year … before the health care law,” he said. 

Rep. Renee Ellmers, R-N.C., said that premium rates will go up by 61 percent for those whom she represents and asked for some relevant data.

“You are saying I am incredibly unclear as to what will happen to health care rates as of 2014,” Ellmers said to Cohen.

Oliver Wyman analysts have predicted that PPACA health insurance underwriting and pricing rules that are supposed to take effect in 2014 could increase the average premium for policyholders ages 21 to 29 by 29 percent. Cohen has said in earlier testimony that he believes the analyses about the effects of PPACA on the cost of commercial health insurance fail to reflect the effects of PPACA on the cost of the U.S. health care system as a whole.

In a testy exchange between Rep. Bill Johnson, R-Ohio, and Rep. Cory Gardner, R-Colo., and others demanding a definitive answer from Cohen on the prospect of costs going up or down next year, Cohen responded that it will depend on factors external to the PPACA. 

“If Rod Serling walked through that door, I wouldn’t be surprised… there is so much difference in interpretation,” responded Rep. Billy Long, R-Mo, who described the proceedings as “Twilight Zone-ish.” 

Cohen reminded the Congressman that Serling was deceased and he likely wouldn’t come through the door on those grounds.