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PPACA spankings: House hearings

By Allison Bell

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House Republicans have been calling Obama administration officials over for a new round of hearings on the Patient Protection and Affordable Care Act (PPACA) commercial health insurance programs.

Republicans repeatedly blasted the administration officials over the recent announcement that HealthCare.gov sent customers about 800,000 inaccurate 1095-A coverage information notices.

Republicans also asked about the administration confession in September that the inclusion of 700,000 dental plan members in an enrollment press release had pushed the enrollment total over the 8 million benchmark.

Rep. Matt Cartwright, D-Pa., glared at Kevin Counihan, director of the Center for Consumer Information and Insurance Oversight (CCIIO), today at a PPACA hearing organized by the House Oversight & Government Reform health care subcommittee.

“We demand government transparency,” Cartwright said. “We demand accurate answers, and timely answers.”

Cartwright said that the plan enrollment correction made it look as if officials were trying to make the picture look rosier than it was. He told Counihan to commit to getting colleagues on the committee answers to their questions.

Counihan and Sylvia Matthews Burwell, secretary of the U.S. Department of Health and Human Services (HHS), who appeared at a separate House Energy & Commerce health subcommittee hearing, often responded to questions with carefully worded phrases.

When House Oversight members asked Counihan for information about matters such as the percentage of Americans who are, or were, uninsured, Counihan said he would get back to lawmakers with that information. He refused to provide any estimated numbers.

“I’ve learned with information that it’s important to be precise,” Counihan said.

For a look at some of what else went on at the hearings, read on.

counihan

1. Kevin Counihan

Counihan’s agency, CCIIO, runs the PPACA programs that affect the commercial health insurance market. CCIIO is a unit of the Centers for Medicare & Medicaid Services (CMS), which is, in turn, part of HHS. 

Counihan repeated earlier HHS estimates that the PPACA exchanges have received private plan selection information for 11.4 million people and will eventually get at least 9.1 million to pay for private plan coverage for 2015.

National health expenditures have been below 4.1 percent for five consecutive years, and those are the lowest rates the country has recorded since 1960, Counihan said.

The percentage of consumers who had access to three or more individual exchange medical plan issuers increased to 90 percent for 2015, from 74 percent for 2014, Counihan said.

Counihan noted that the widely reported 1095-A error simply affected the premium amount for the exchange program benchmark plan cost, the cost of the second lowest cost silver plan in a taxpayer’s county, on the form. “An incorrect form does not mean that a taxpayer’s advance tax credit was calculated incorrectly,” he said.

But Rep. Mark Meadows, R-N.C., slammed CCIIO and CMS for letting consumers auto-renew in exchange coverage, rather than having them return to HealthCare.gov to update eligibility information and compare plan costs. Because so many consumers auto renewed, “you know they’re going to get a surprise a year from now,” when they pay their taxes and learn about unexpected subsidy gaps, Meadows said. (Photo: YouTube)

Sylvia Mathews Burwell

2. Sylvia Mathews Burwell

Lawmaker attendance at the Counihan hearing may have been light because the House Energy & Commerce health subcommittee had Burwell in for a hearing on the fiscal year 2016 HHS budget at the same time.

Federal fiscal year 2016 starts Oct. 1.

HHS has asked for $83.8 billion in fiscal year 2016 budget authority, up from $79 billion for the current fiscal year. HHS is in charge of many programs other than PPACA commercial health insurance programs, including Medicare, Medicaid, medical research, and efforts to fight outbreaks of diseases such as Ebola.

See also: PPACA and the 2016 budget proposal

HHS wants to increase the budget for the National Institutes of Health (NIH) to $31.3 billion, from $30.3 billion this year, in part to help NIH increase funding on Alzheimer’s research to $638 million, from $577 million this year.

Burwell testified about PPACA that the law has helped 10 million uninsured Americans get coverage, and that premiums for group health coverage are $1,800 lower per family per year than they would have been if the cost increase trends prevailing before PPACA was enacted had continued.

Rep. Brett Guthrie, R-Ky., asked Burwell about HHS spending on the cost-sharing reduction program for PPACA exchange users. The program helps lower-income users of private exchange plans pay deductibles, co-payments and coinsurance amounts.

Guthrie asked Burwell what appropriations provision gives HHS the authority to fund the cost-sharing reduction program.

“We do believe we have the authorities to do the cost-sharing reduction program,” Burwell said. She said that the matter is under litigation, and that she would let lawyers at the Justice Department answer questions about the topic.

Guthrie said the Obama administration asked for cost-sharing reduction spending authority for 2014. “That didn’t happen, for whatever reason, but we’re spending the money,” Guthrie said. “We’re just asking where the authority comes from.”

J. Russell George

3. J. Russell George

The House Appropriations financial services subcommittee brought in J. Russell George, the Treasury inspector general for tax administration (TIGTA), for a hearing on the Internet Revenue Service (IRS) Wednesday. Much of his testimony focused on how the IRS will handle PPACA tax provisions.

Agency inspectors general are responsible for auditing government operations, and George gave some specific examples of the kinds of problems the IRS will face when it implements PPACA.

PPACA lets many consumers use a complicated tax credit program to pay for exchange plan coverage.

When the IRS detects a math error in a return, or some basic kinds of problems, such as missing Social Security numbers, acting on the error costs just $1.50 per return.

Auditing a return to address other types of problems costs an average of $278 per pre-refund audit.

Because the IRS has no authority to use PPACA exchange data to handle PPACA tax credit errors, it will have to use expensive audits to deal with conflicts between exchange information and tax return information, George testified.

See also: 3 things you CAN’T know about IRS PPACA problems