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House Subcommittee on Obamacare Implementation Issues

By    |   Wednesday, 02 January 2013 02:29 PM

The House Committee on Energy and Commerce’s Health Subcommittee held a hearing recently titled the “State of Uncertainty: Implementation of PPACA's Exchanges and Medicaid Expansion” regarding the implementation of the provisions of Obamacare that provide for the establishment of health insurance exchanges and for the expansion of state Medicaid programs.

A panel of seven witnesses representing federal and state health care administrators presented diverse views on how the program is progressing toward its scheduled deadline of Oct. 1, 2013, for beginning to enroll beneficiaries. With Chairman Joe Pitts, R-Penn, absent due to illness, Rep. Michael Burgess, R-Texas, presided.

In his opening statement, Burgess criticized the administration for failing to provide critical information that Congress, the states and health plans need in order to plan for the implementation of the new law, also known as the Patient Protection and Affordable Care Act. Burgess complained that there is still no information as to how data will be exchanged among agencies involved in administering the Act — the Treasury, Health and Human Services and Department of Human Services — and that despite the release of 13,000 pages of regulations, key questions remain regarding the basic ground rules states will be expected to follow. This will pose problems for states that only meet for a limited time and for the Texas legislature, which meets every other year.

Rep. Frank Pallone, D-N.J., accused Republicans of following a playbook that calls for obstructing implementation of the Act now that they have failed to defeat it, to repeal it and to have it declared unconstitutional by the Supreme Court.

Rep. Phil Gingrey, R-Ga., retorted that the Act would cost $1.7 trillion and would increase healthcare costs, not reduce them, as proponents claim.

Two witnesses, Gary Cohen, director of the Center for Consumer Information and Insurance Oversight, and Cindy Mann, deputy administrator/director of the Centers for Medicare and Medicaid Services’ Center for Medicaid and CHIP Services, touted the acceptance of exchange implementation by 34 states, which have received $2 billion in federal funding for it, and noted that 48 states have received some implementation funding.

The other five witnesses represented states in various stages of implementation of the Act and with widely divergent views on the merits. Dennis Smith, secretary of Wisconsin’s Department of Health Services, stated that Wisconsin had 90 percent of the work in place to establish coverage, but he expressed apprehension that the rules would lead to divergent outcomes among similarly situated applicants, and that whether the program ultimately proves to be affordable will depend on decisions to be made by people, not by the provisions of the Act.

Bruce Greenstein, secretary of the Department of Health & Hospitals in Louisiana, and Gary Alexander, secretary of Pennsylvania’s Department of Public Welfare, bitterly denounced the Act as extremely costly and difficult to implement.

Greenstein predicted that Louisianans would pay $2,000 more for single and $4,500 for family coverage over the next 10 years.

Alexander charged that there has never been a statute “so vast with such demands on resources and lack of federal guidance.” He listed a number of specific complaints from among “the hundreds of mandates and procedural requirements that have escaped public attention but which we must by law obey.”

The remaining two witnesses, Dr. Joshua Sharfstein, secretary of the Office of the Secretary Department of Health & Mental Hygiene in Maryland, and Andrew Allison, director of the Division of Medical Services in Arkansas, presented more positive views of the Act.

Sharfstein, especially, was so effusive in his support that one would find it difficult to believe that he and Alexander were both talking about the same law. Sharfstein cited a study by the state university predicting that the Act would add billions of dollars and thousands of jobs to the economy.

Allison testified that Arkansas still has to decide whether to adopt the Medicaid extension, which requires a 75 percent supermajority of the legislature. The state projects that the program will raise $700 million over 10 years, thanks to redistribution of funds from other states.

It would appear that better and more objective data will be needed in order to sort out the competing claims as Obamacare takes effect.

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The House Committee on Energy and Commerce’s Health Subcommittee held a hearing recently titled the “State of Uncertainty: Implementation of PPACA's Exchanges and Medicaid Expansion.”
Wednesday, 02 January 2013 02:29 PM
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