Hatch released his exchange with Lew on Monday, a day ahead of the committee's vote on Lew's nomination.
Lew also reiterated the administration's opposition to proposed Medicaid savings that it had previously endorsed. The White House had proposed changing the way federal Medicaid payments are calculated, in a way that would have shifted more costs to the states.
But White House advisers and the Health and Human Services Department have publicly rebuked that policy since the Supreme Court's healthcare ruling. The court's decision allowed states to opt out of the Medicaid expansion in Obama's signature healthcare law, and the White House is trying to make clear to states that they can rely on full federal funding for the expansion if they choose to accept it.
"The Supreme Court decision has made the higher matching rates available in the Affordable Care Act for the new groups covered even more important to incentivize states to expand Medicaid coverage," Lew wrote. "We continue to seek efficiencies and identify opportunities to reduce waste, fraud and abuse in Medicaid, and want to work with Congress, states, and other stakeholders to achieve these goals while expanding access to affordable healthcare."
In his role as director of the White House budget office, Lew has gained a reputation as a fierce defender of Medicaid. He helped insulate the program during budget-cutting talks, and other White House officials have also said Medicaid will be a higher priority than Medicare in future negotiations.
Lew punted on Hatch's questions about other proposed entitlement reforms, deferring answers until the release of the administration's budget proposal for 2014. He also did not provide any new information about how the administration is implementing the Affordable Care Act.