Democrats who supported President Obama’s healthcare law grilled a top Health and Human Services official Thursday over what they see as holes in the implementation effort and the White House’s political bargaining.
Gary Cohen, the director of the HHS office overseeing the bulk of the healthcare law’s implementation, fielded tough questions from several Democrats.
Sen. Bill Nelson (D-Fla.) hammered HHS for inviting Congress to cut funding for a new nonprofit insurance model. Funding for healthcare co-ops was eliminated in the year-end tax deal, and Nelson said officials offered up the program as a place Congress could cut.
“Why was that negotiated away at the 11th hour?” Nelson asked.
Cohen didn’t have an answer.
“I want somebody to be accountable for this, and if it was a mistake, for somebody to own up to it,” Nelson said.
Cohen also took hits from Sen. Maria Cantwell (D-Wash.), who criticized the administration for delaying implementation of the Basic Health Program — an option for states to provide cost-efficient health coverage outside of Medicaid and the law’s new insurance exchanges.
HHS has said it will not have the Basic Health Program ready until 2015 — a year behind schedule. State officials have balked, and Cantwell echoed their criticisms Thursday during the Senate Finance Committee hearing on the status of the implementation effort.
“We’re very concerned about the approach by the agency in trying to thwart this effort,” she said. “Are you artificially raising the cost to all taxpayers by trying to lure them onto the exchange?”
Cantwell warned that many members of the Finance Committee are familiar with state-based cost-control efforts and would not look kindly on HHS subverting them. She said the department has sidelined the Basic Health Plan in order to focus on the exchanges — which will provide subsidies from the federal government.
“What I’m very concerned about is the agency seems to think the technology of the exchange is the holy grail, and you’re trying to lure states” into the exchanges, she said.
Cohen said the Basic Health Plan has simply had to take a backseat to other priorities.
“I don’t think we’re trying to lure people into the exchange,” he said.
Finance Chairman Max Baucus (D-Mont.) was also skeptical about both the co-ops and HHS’ work on exchanges — specifically, integrating the complex and often outdated computer systems of the multiple federal agencies that will have a role in providing or assessing health coverage.
And Sen. Ron Wyden (D-Ore.) criticized the administration for not extending the law’s definition of “affordable” coverage to family plans.
The health law makes subsidies available to people who cannot buy affordable coverage from an employer, and defines an affordable plan as one that costs less than 9.5 percent of the employee’s salary. But that standard only applies to an individual policy.
So if an employee could insure herself for less than 9.5 percent of her income, but couldn’t afford to cover her whole family through her employer’s plan, she wouldn’t be eligible for subsidies and healthcare would remain unaffordable.