Health reform implementation

A House hearing Thursday pitted businessman against businessman as lawmakers argued over the law's winners and losers.

In one corner, a representative for small employers with generous coverage touted the law's tax credits and health insurance exchanges that will give small business owners more bargaining power. In the other, a proxy for the U.S. Chamber of Commerce warned that many larger employers will face rising costs because the law requires them to provide generous coverage or pay a fine.

The two businessmen were clearly well-briefed by outside forces in advance of the partisan and predictable hearing of the Committee on Education and the Workforce's Health subcommittee. A New York bowling alley executive acknowledged that he was testifying on behalf of the U.S. Chamber; in the other corner, the owner of a nine-employee auto shop in Portland is a member of the left-leaning Main Street Alliance — and was a guest of President Obama at the State of the Union address, which mentioned him by name.

Rep. Dennis Kucinich (D-Ohio), a top Democrat on the subpanel, started off by asking the auto shop owner how much negotiating power he had with his insurance company before the law.

"None," Jim Houser answered. "All we can do is wait for our broker to tell us what we'll be paying."

Others offered a gloomier assessment of the law.

A House Republican is pushing a new bill that would allow individuals to get a waiver from major provisions of the new healthcare reform law, including the so-called individual mandate.

Pointing out that the Obama administration has granted more than 1,000 waivers to organizations for a provision of the law, Rep. Mike Rogers (R-Mich.) said everyone should have the opportunity.

"It’s a matter of fairness," said Rogers, a member of the Energy and Commerce Committee's Health subpanel. "Every American and employer deserves the opportunity to receive a waiver from the new healthcare law if it’s driving up costs and limiting services, not just the politically connected."

The administration says the one-year waivers are a temporary measure to allow low-value insurance plans to operate until new state-based health insurance exchanges open in 2014. The idea, the administration says, is that limited insurance is better than no insurance at all, and consumers will be able to shop for better and more affordable coverage on the exchanges. 

The health department also gave a waiver this week to Maine insurers allowing them a temporary exemption from a requirement to spend at least 80 percent of premium dollars on healthcare services. 

This story was updated at 12 p.m. to specify that besides the Maine waiver, the administration has granted more than 1,000 waivers for just one provision of the law.

Taking a new approach for halting healthcare reform funds, House Republicans on Wednesday slammed the law for including at least $105 billion in mandatory spending over the next few years.

Republicans on the Energy and Commerce health subcommittee, rebuffed so far in their efforts to repeal and defund the law, targeted five provisions of the sweeping reform law they want to subject to the annual appropriation process.

Tea Party Caucus leader Rep. Michele Bachmann (R-Minn.) and other conservatives this week have seized on the long-term mandatory spending included in the reform law. They say that the spending was hidden in the law and was just recently uncovered, though the Congressional Research Service disclosed $105 billion in mandatory spending in an October report. 

Subpanel Chairman Joe Pitts (R-Pa.) called the mandatory spending a “slush fund” for the Health and Human Services secretary, and vowed to introduce legislation to classify the spending as discretionary for the five provisions.

“By eliminating this fund, we are not cutting any specific program or activity,” Pitts said. “We are reclaiming our oversight role of how federal taxpayer dollars should be used.”

House lawmakers are stepping up their pressure on the Senate to complete work this week on a repeal of the 1099 provision included in the healthcare law despite a dispute over how the $22 billion cost is covered. 

House Ways and Means Chairman Dave Camp (R-Mich.) said the House-passed measure, which received support from 76 Democrats, and now appears to have Democratic leadership support in the upper chamber, could be sent to President Obama this week. 

The Senate isn't expected to bring up the measure this week, a senior aide told The Hill. 

A House Democrat on Tuesday said that President Obama should sign a 1099 repeal measure even it includes a controversial offset. 

Rep. John Dingell (D-Mich.) told reporters, "I don't think the president will waste his time vetoing a bill on which the House has already spoken so clearly."

"There are fights that it pays to make and there are fights that it doesn't."

Republicans on a second House panel are investigating healthcare waivers awarded to more than a thousand organizations.

State gets first Medical Loss Ratio waiver: Maine health insurers found out Tuesday that they are getting a temporary exemption from the healthcare reform law's requirement that they spend at least 80 percent of premiums on care (85 percent in the large group market). Maine insurers will continue to follow the existing 65 percent medical loss ratio threshold. The Hill's Julian Pecquet has the story.

Panel looks at new defunding approach: Energy and Commerce Committee Republicans, taking a new tack for defunding healthcare reform, on Wednesday will look at five provisions of the law they want to subject to annual appropriations. The GOP lawmakers are targeting: grants for state-based health insurance exchanges; the Prevention and Public Health Fund ($17.75 billion); construction and capital cost fund for school-based health centers ($200 million); state grants for sex ed and other "personal responsibility education" ($75 million); and grants to establish or expand primary care residency programs in teaching health centers ($230 million).

Former rep. says defunding not easy: Former Rep. Ernest Istook (R-Okla.) will tell the House panel on Wednesday that defunding healthcare reform is not as easy as blocking funds in the long-term continuing resolution. Istook, a fellow with the Heritage Foundation, wrote Tuesday that the law includes $105 billion "in direct implementation spending that bypasses Congress’s normal appropriations process."

"The challenge is not as simple as denying future funding for ObamaCare because you have all these postdated checks that have already been written by the previous Congress," Istook told The Hill. "The simplest analogy is you're promising not to write any more checks, but you haven't canceled the checks already written."

Senate Majority Leader Harry Reid (D-Nev.) suggested Tuesday that he prefers the pay-for included in the House version of a 1099 repeal that many House Democrats oppose. 

"The 1099 is something we're going to look at," Reid told reporters Tuesday. "Me, personally, I like the House pay-for better than ours, so we'll have to see."

The debate isn't whether to repeal the provision, which requires businesses to file 1099 forms to the IRS for any vendor purchases of $600 or more, it's how to pay for it. 

It's the first state to get a temporary waiver from the requirement insurers spend at least 80 percent on care.

Embattled Medicare chief Don Berwick said that the White House has supported him throughout a partisan battle over his future at the Centers for Medicare and Medicaid Services.

Berwick's future at the agency is in doubt now that the overwhelming majority of Republican senators have called on the administration to withdraw his nomination.

Last week, 42 Republicans senators called on President Obama to scrap Berwick's nomination, saying his past statements about healthcare rationing and his “lack of experience” managing an organization of CMS’s size disqualify him.

Obama recess appointed Berwick to lead CMS in July 2010.

On Tuesday, Berwick said that the administration has sufficiently gone to bat for him as Republicans make him a central political target for their opposition to the healthcare reform law enacted last year.

“You may have seen a response from the White House a few days ago,” Berwick told reporters after a speech at an America’s Health Insurance Plans conference. “It was positive. I’m very grateful for that response.”

After the Senators sent the letter, White House spokesman Reid Cherlin said the administration would not withdraw Berwick’s nomination.