Their opinion: Making the health care law work better
Bennington Banner, Nov. 1, 2013
When House Republicans direct their opposition to Obamacare toward aggressive oversight rather than apocalyptic budget shenanigans, they can do themselves and the country a lot of good.
That was obvious when the House Ways and Means Committee posed some smart, tough questions about HealthCare.gov to Marilyn Tavenner, who, as the administrator of the Centers for Medicare and Medicaid Services, is perhaps the person most directly responsible for the fiasco. Yes, there were a few "gotcha" questions meant to showcase individual representatives' hatred of the health care law. But for the most part, the queries seemed designed to find a path toward more competent management of the Patient Protection and Affordable Care Act.
Many of them went unanswered, unfortunately, but here are some important questions they should press again:
(asterisk) What happened to President Barack Obama's promise that Americans would be able to keep their doctors and their insurance plans?
Tavenner failed to even acknowledge the frustration felt by people whose plans are now being canceled, and whose insurers are blaming it on the law. She said the government can't stop doctors from leaving a given insurer or insurers from changing their plans. In that case, the president had no business making the pledge in the first place.
(asterisk) How big is the gap between current enrollment and the level that's needed to make the exchanges work?
Republicans pressed Tavenner not only to provide the raw numbers but also to say how many of those who sign up are eligible for Medicaid, how many are young and healthy, and how many are in fact covered by their employers, making them ineligible. To be transparent, CMS will have to include that data in its first enrollment report next month. If it does, Republicans can share some of the credit.
(asterisk) How can the administration prevent a premium spike for exchange-based plans in 2015 if too few young and healthy people sign up this year?
That's a concern not just for the 13 million Americans projected to buy exchange plans in 2015 but also for all taxpayers, who will be on the hook for higher subsidies if coverage under the exchanges gets more expensive. Tavenner deflected the question, noting only that 2014 premiums for exchange plans were lower than originally projected -- a fact that has no bearing on 2015.
(asterisk) If HealthCare.gov isn't fixed by the Nov. 30 target date, what happens to the people whose current plans expire at the end of the year?
The administration has already announced that Americans now will have until the end of March to buy coverage without having to pay a tax penalty. But that doesn't provide health insurance starting Jan. 1 for the increasing number of citizens whose current plans are being canceled on that date. Tavenner said those people could use the call centers to buy insurance on the exchanges. But with 2 million people already being told they can't keep their coverage, it's unclear how many in that group the call centers can handle.
(asterisk) How will the government prevent people from inadvertently getting subsidies they're not entitled to?
Tavenner suggested that the responsibility for presenting accurate information about subsidy eligibility will rest with those who apply, but it's easy enough to imagine people being confused or uninformed about the coverage offered by their employer or a parent's plan. CMS needs a strategy to help people avoid making a mistake, thereby risking a tax penalty.
(asterisk) Can CMS claw back some of the money it has paid to the contractors most responsible for the website's problems?
Tavenner said only that she would provide information after the hearing, not that she intended to get some of the government's money back.
Asking hard, practical questions aimed at steering Obamacare back on course may not be as satisfying as endlessly voting to repeal the law, or obsessing over what the president knew and when he knew it. But it's far more enlightening, and it may end up making the health care law work better.
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