House committee members spar among themselves, but CMS chief Marilyn Tavenner manages to stay mostly above the fray as she takes questions about the Patient Protection and Affordable Care Act.
A composed Marilyn Tavenner, head of the Centers for Medicare & Medicaid Services, faced the full House Energy & Commerce Committee during a two-hour session last Thursday that was billed as an opportunity for the members to take the pulse of the Patient Protection and Affordable Care Act.
The tone was often conciliatory, but frequently combative as committee members quizzed the administrator of the Centers for Medicare & Medicaid Services on a wide range of topics related to healthcare reform, including the readiness of health insurance marketplaces, the process for income verification and self-attestation, premium costs, and even Tavenner's willingness to enroll in an exchange health plan herself. [She said she would be willing.]
At times Tavenner's presence seemed almost incidental as committee members sparred among themselves along party lines.
After Rep. Henry Waxman (D-CA) spoke about the support for healthcare reform in his district, Rep. Joe Barton (R-TX) remarked that he must "live in a parallel universe" from Waxman. "When I am out in my district I don't have anyone coming to me saying they can't wait for the Affordable Care Act to be implemented or for this great day when they can get all these benefits. I hear just the opposite."
Rep. Diane DeGette (D-CO) challenged her colleagues from both sides of the aisle "to work on educating constituents on how to make this new law work, for individuals, families, and businesses." She compared healthcare reform to the passage of Medicare Part D. "Democrats didn't like it. But we all went out to our districts and we worked with our constituents to let them know how they could enroll. Why? Because this would help our constituents. Now Medicare Part D has become very, very popular."
For her part, Tavenner managed to stay somewhat above the fray as she addressed the concerns of House Republicans.
Here are the hearing highlights:
Timeline
Tavenner pushed back against suggestions that a delay in the employer mandate signaled that the entire program was off-track. She clicked off a number of upcoming deadlines that will be met, including the selection of so called "navigators" to help consumers enroll in the health exchanges, successful end-to-end testing of the exchange enrollment system, and the opening of the health insurance exchanges themselves on Oct. 1.
Tavenner added that end-to-end testing will include all the agencies necessary to confirm applicant information, including the IRS and the Social Security Administration, and that vulnerabilities will be corrected as they are identified.
Income verification and self attestation
Tavenner assured House members that there will be a "100% check" against IRS records to confirm income eligibility for premium subsidies on the exchanges. Equifax, which has the CMS contract for income verification, will also be part of the process.
She explained that when IRS and Equifax records match the application process proceeds. If not, an applicant will need to produce pay stubs or other records as proof of income and go through the self attestation process. That was sticking point for several committee members.
Rep. Marsha Blackburn (R-TN) recounted the difficulties experienced by Tennessee when it used self-attestation to qualify low-income members for its TennCare program. Tavenner explained that CMS would verify every self-attestation within 90 days, although individuals will be allowed to enroll in a health plan pending the review.
"If someone is committing fraud how quickly will you remove them?" asked Blackburn. "Immediately," Tavenner replied.
Cost containment
Tavenner provided data based on 11 state exchanges as evidence that the exchanges will lower the cost of individual insurance "by encouraging plans to compete for consumer." She noted that in Oregon and Washington, DC insurers requested permission to amend their bids after a public release showed competitors coming in at lower rates. She also pointed to California, where she said some rates submitted to the state exchange are as much as 29% below the average premiums paid for small plans in 2013.
However, several committee members cited reports of large premium increases in their districts and states. Rep. Phil Gingrey (R-GA) referred to a 198% premium increase anticipated by some individuals in Georgia. "This is not what we are seeing across the country," replied Tavenner. "We have many stories where rates have come in lower than expected. That's why competition and transparency are so important."
Gingrey countered that Aetna and Coventry have announced that they will not participate in the Georgia exchange and in some areas Blue Cross Blue Shield will be the only option. "That's not competition."
"We have always said this process will require several years and more companies will get interested in the exchanges as we go along," Tavenner responded.
The trials of small employers
In perhaps her only slip of the two-hour session, Tavenner drew a sharp rebuke from Republicans when she characterized stories about employers reducing employee hours as "isolated incidents." Rep. Tim Murphy (R-PA) said it was "phenomenal" that Tavenner was unaware of the number of people who being adversely affected by the Affordable Care Act. "I think that's a problem."
"It seems like you are living in some sort of a cocoon," added Rep. Steve Scalise (R-LA).
Tavenner defended her stand. "I am out there. I am listening." She noted that she has criss-crossed the country meeting with small and large group employers. "There are stories with good and bad examples. That will continue to be the case."
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
