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Life Health > Health Insurance > Health Insurance

Democrats, heal thy opaque selves

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Members of the Senate Finance Committee have run several probing but cordial health agency nomination hearings this winter.

Fair warning: I’m about to be a little mean here.

Sen. Ron Wyden, D-Ore., seems to be a senator who takes the time to try to understand public and commercial health insurance policy issues. It would obviously be great for everyone, including health insurance agents and your Medicare plan clients, if he could get Seema Verma to talk a little, candidly, about what she thinks of Medicare.

Related: Democrat asks for CMS pick’s views on Medicare

Verma, the Indiana consultant who’s on track to become President Donald Trump’s Centers for Medicare & Medicaid Services administration, would probably have controversial, thought-provoking things to say about Medicare — if she were not on her best, cabinet secretary nominee behavior.

Wyden has a moral and civic obligation to try to get Verma to talk, and Verma has a practical obligation to keep her mouth shut.

And I think that, even from the perspective of people who hate the Affordable Care Act and want it dead-dead-dead, the ACA’s enemies are really mean to it and its implementers.

Everyone wants to do what’s best for sick people, and to keep healthy people healthy, whether that’s through eliminating government bureaucracy or setting up fine new public programs. Health policy is really hard. Since the days of the Truman administration, Republican policymakers have been working about as hard as Democratic policymakers to come up with some kind of politically feasible health care program for working-age people.

The Obama administration managed to get something passed. Maybe it was, from the perspective of its critics, ugly, poorly thought out, arrogant and unsustainable. But a lot of people at the Obama administration’s CMS, and the parent of the U.S. Department of Health and Human Services, engaged in a heroic, epic struggle to set up the ACA programs and protect the ACA programs from ACA stranglers.

On the other hand: It was hilarious to watch Wyden complaining about the answers Verma gave to Democratic senators’ written questions about Medicare.

“We have not been asking gotcha questions,” Wyden said. “The answers to the written questions were worse than what we got at the hearing. There’s just no content there.”

Did Wyden ever make any kind of serious effort to find out what was up with those ACA programs?

If so, and he actually got reasonably clear, detailed, well-formatted data on how the ACA programs worked, how they changed over time, and how they did at meeting the original ACA goals, could he perhaps send that stuff to me? If he wants to charge me: I’ll try to work that out with my bosses.

I think I’ve probably at least skimmed every report HHS, CMS, the HHS inspector general’s office, the Internal Revenue Service, the U.S. Government Accountability Office, most of the state-based exchanges, and a number of independent research organizations have put out since 2013. I’ve also looked at many of the regulatory and paperwork impact analyses hidden deep inside PDFs inside confusing Office of Management and Budget websites. I’ve looked inside long and short versions of federal budget proposals and appropriations bills.

While many state-based health insurance exchanges released helpful data to the public, federal agencies have been less forthcoming with their ACA statistics. (Photo: iStock)Many state-based health insurance exchanges released helpful data to the public, but federal agencies have been less forthcoming with their ACA statistics. (Photo: iStock)

HHS put out pretty good ACA individual public exchange plan signup data, some exchange plan user demographic data, and awe-inspiring health plan rate databases

The state-based public exchanges in places like California, Colorado and the District of Columbia put out wonderful, clear, fascinating reports on public exchange program budgets, marketing plans and enrollment.

But, the truth is, generally, CMS and HHS themselves barely put out any data on anything other than exchange plan signup activity and plan prices.

Republican-led House committees seemed to make plea after plea for information, about matters such as whether would work, and barely get anything substantive back.

Obama administration officials could blame that stonewalling on the proposition that the Republican lawmakers were nasty ACA stranglers, but I’m a nice person who just wants to know how the ACA story turned out.

I want clear information about how many people signed up for the “managed Medicaid for all” Basic Health Plan coverage, and what happened to those people. How did the BHP issuers do? Are they happier with the BHP contracts than with their individual exchange plan efforts?

I want to know what exactly happened to the Multi-State Plan Program. Where were the MSP plans actually available? Who bought them? What happened with the claims for those? For the insurers, were those really any different to set up or run than offering a comparable collection of single-state plans?

I want to know how many employers, workers and dependents got into small-group health plans.

I want to see a clear financial statement, similar to the one that the Colorado exchange puts out, that shows how much spends, how much revenue it generates, and how its financial performance is changing over time.

Now, the Obama administration veterans can’t even get into the data files to answer the questions. The Trump administration officials in charge of the programs may not care enough to try to generate those kinds of reports. If they do try to generate the reports, they may skew the data to make the programs look as bad as possible. No one will ever know how friends of the ACA programs would have collected and reported the data if they had had some interest in transparency.

I’m like a soap opera fan left desolate by the cancellation of my show.

So now, finally, Wyden has an interest in getting federal health policy answers.

Where was he when Obama administration officials were hiding all of the answers that would have resolved the ACA show cliffhangers?

The only proper punishment may be illegally cruel, but here it is: The officials who hid the data should be banned from ever learning how “Game of Thrones” turns out. Ever. They should leave this world still not knowing what’s up with Jon Snow, just as the rest of us have no idea what really happened with Small Business Health Options Program use.


Video: ACA hearing witness says Congress is ‘under literal siege’

Chaffetz accuses HHS of resisting CO-OP document subpoena

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