When Health and Human Services Secretary (HSS)
Kathleen Sebelius announced her pending resignation earlier this
year, President Obama nominated Sylvia Matthews Burwell, who
currently serves as the head of the White House Office of
Management and Budget (OMB), to be her replacement. A big part of
the HHS job is working on the Affordable Care Act—a.k.a.
Obamacare—and throughout her tenure, Sebelius has served as the
public face of the president’s health law.
Naturally, a lot of the questions surrounding Burwell’s
nomination, which is widely
expected to make it through the Senate confirmation process,
have focused on how she would continue implementation of the
controversial health care overhaul.
We got some idea of how she’ll answer those questions in
Senate hearing on her nomination earlier this month. Today we
got some additional sense from a paper follow up.
Following the hearing, Republican Sens. Mike Lee (Utah) and Ted
Cruz (Texas) sent Burwell a list of pointed questions about the
health care law and how Burwell would handle some of its most
controversial provisions. Charging that Burwell had been “less than
forthcoming” in her original testimony, Sens. Lee and Cruz asked
about the law’s potentially bailout-like risk-mitigation
provisions, the details and current status of the administration’s
enrollment data, the role of the Independent Payment Advisory Board
(IPAB), and the administration’s legal authority to change the
law.
Burwell offers some sort of response to all of the questions,
but I doubt many people will find her follow-up answers much more
forthcoming than her initial hearing responses. Burwell is often
vague and doesn’t directly address every query. Instead, she sticks
pretty closely to the administration’s standard line on every
question and doesn’t tell us much we don’t already know.
Here’s a brief summary of the question topics and Burwell’s
responses, followed by the original
document with Burwell’s full answers.
On Obamacare enrollment data—duplicates, non-payments,
and the expansion of health coverage: Burwell cites
statements from health insurers saying that 80-90 percent of
sign-ups under the law have paid their premiums, but doesn’t
provide any additional data, saying that final information is not
available yet. She does promise to make available “accurate and
reliable data regarding premium payments” once federal health
officials have it. She says duplicates are a non-issue, but also
that HHS is still removing some from its lists. And she cites
survey data from RAND and Gallup to suggest that Obamacare is
helping to reduce the number of uninsured.
On the risk corridor program that has been dubbed a
potential bailout for health insurers: Using language that
is very similar to what appeared in a recent regulation, Burwell
reiterates the administration’s position that the risk corridors
will be revenue neutral over the next three years. But she also
says that, if they are not, then the HHS secretary is bound to make
payments to insurers, and that HHS will do what is necessary to
find another source of funding, if appropriations are
available.
On the legal authority OMB relied on this year to make
Obamacare’s insurance subsidies not subject to the sequester—even
though a previous OMB report said they should be: Burwell
says that OMB decided to make the law’s subsidies payable out of a
different fund than initially planned, one that’s not subject to
sequester cuts.
On how she would handle IPAB—Obamacare’s independent
cost-containment board—as HHS secretary: Burwell does not
respond directly to the letter’s question about whether she’ll
commit to repealing the provision, but she says she share’s IPAB’s
goal of protecting against excessive cost growth in Medicare and
will work with Congress to make Medicare more efficient and
sustainable.
On the administration’s repeated delays of Obamacare’s
employer mandate, and whether she agrees with Hillary Clinton’s
1993 statement that without the provision, many employers would
cease offering coverage: Burwell doesn’t really address
the specific questions asked here, but instead restates the
administration’s vague commitments to “common sense”
implementation, to making sure that “companies have clarity” about
the law, and that “individuals who face hardships…have the
flexibility and support they need.”
On whether HHS will provide Congress with a list of
Obamacare-participating health insurers who offer abortion
coverage, and whether she thinks Americans “should be informed”
about a plan’s abortion coverage provisions prior to
purchase: Burwell’s answer here is extremely vague and
doesn’t address the questions directly. She says that
Healthcare.gov already provides information to consumers, that
plans have to provide an official benefits summary, and that if
confirmed, she’ll work to make sure consumers “have information
regarding the coverage” they get under Obamacare.
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