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GOP pillories PPACA exchange implementation

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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. 

Long then doubled up on the imagery. 

Ranking Subcommittee Member Diana DeGette, D-Colo., intervened at one point to make sure Cohen was not put in a position to perjure himself. 

He and others publicly and privately invoked the image of a coming train wreck described last week by Senate Finance Committee Chairman Max Baucus, D-Mont., “who is not even running for re-election,” one Congressman noted. 

Gardner told Cohen that people are scared and concerned, and are asking him back in Colorado if they should lay off some of their employees to get under 50 people to avoid the exchange, and if they have to cut all their part-time employees to under 29 hours so they don’t have to give them insurance.

“People being forced out of plans they like into the exchanges,” Gardner said. He then quoted an article on on a bill that just passed in the Washington State Senate that would place low-wage, part time workers into the Washington State health insurance exchange.

Sen. Karen Fraser, D-Wash., reportedly told the newspaper that the precise benefits available under the exchanges are still unknown and that there is some “chance that some workers could not afford coverage and plunge their families into poverty,” as Gardner read.

For his part, Cohen said that CCIIO and the marketplace implementation is “on track,” and he is “optimistic and confident about where we are at this time.” 

Cohen reiterated that the exchanges – he referred to them as exchanges in some places and marketplaces in others, although the latter is the new term – will be ready to enroll on time. “We will have products on the shelves by Oct. 1,” he said. “Buying health insurance is not like buying a book on Amazon or shoes on Zappos,” Cohen said. 

Cohen championed the federal data hub and IT strides, said a call center will begin operating in June, and state offerings with rates should be available for public viewing by September. He later corrected a tally of the qualified health plans on board – around 140 thus far – in remarks to reporters. 

Cohen discussed the navigators’ role to be fair and impartial to help consumers select insurance and said that in order to do so they could not currently be in the service of a health insurance company. 

Cohen said that navigators will be getting their final training in August and be fully trained by Oct. 1. He said those applying to be navigators would be community members interested in helping their community. 

Murphy asked if those applying would be community members ”like ACORN,” referring to the Association of Community Organizations for Reform Now, the nation’s largest organized community of low-to-moderate income families, and a favorite rhetorical target of the GOP in recent years.

In answer to questions on the ravages of sequestration on air travel and furloughs for many others, Cohen noted that although his department had no furloughs, he cannot hire or replace those who leave. 

However, according to, CMS is hiring a few health insurance specialists. 

Gardner said later in a brief chat that he believes the implementation will start showing cracks in the fall. 


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