As ACA Approaches 1st Birthday, Legislative Activity Heats Up – Say Ahhh! A Children’s Health Policy Blog

Both the Senate Finance Committee and Health Education
Labor and Pensions Committee held hearings this week on aspects of the
Affordable Care Act.  Here’s a
quick summary of those hearings and other developments in Congress.

In the Senate Finance Committee hearing, Secretary
Sebelius did a good job of responding to criticism of the ACA by some of the
most vocal opponents of the law on the Senate side.  They mainly rehashed criticism voiced during the enactment
of the ACA and over the past year, complained about too many waivers being
granted to mini-med plans and not enough waivers being granted to states that
want to scale back coverage.

Senator Orrin Hatch (R-UT), the Senate Finance
Committee’s most senior Republican, asked  Secretary Sebelius to grant states
waivers of the ACA stability protections or “maintenance of effort” (MOE) requirement.  He claimed that a Congressional
Research Service (CRS) analysis stated that HHS has the legal authority to
allow states to lower their Medicaid income eligibility limits and tighten
their enrollment procedures.  According to CBPP’s Judy Solomon, this is an
overstatement of the CRS 
analysis.  The CRS report states that while the law could be
interpreted to allow waivers of the MOE requirement, it also could be read to
preclude waivers, according to Solomon.  The report also states that whatever interpretation the Secretary adopts would
receive substantial deference if challenged in court.  As CCF’s resident waiver watcher Joan Alker has pointed out in previous blogs, waivers can only be granted to pilot or demonstration programs that “in the judgment of the Secretary, are likely to assist in promoting the objectives” of the Medicaid program. 

Senator Hatch also questioned Secretary Sebelius about
the length of time it is taking HHS to respond to requests for
information.  HHS has been
inundated with requests for information on ACA from Members of Congress and outside
groups.  Sebelius took the high
ground by responding that they would try harder when she was questioned on
response times but didn’t mention the deluge of requests and efforts by some in
Congress to cut the very staff that are needed to respond to such requests. 

Both Hatch and Sebelius were also interviewed by Politico
on the impending one year anniversary of the Affordable Care Act. The full video interviews are available online but the following quotes give you an idea of their views.

“I’m hoping that we’re going to start to
talk about the future and not continue to revisit the last two years of what
led up to the passage of the Affordable Care Act. Let’s figure out ways we can
work together to make this law really work.”

Secretary Kathleen Sebelius

“The states already have let it be
known that they can’t live with it. I think to allow it to be even partially
implemented is a mistake. We should repeal it.”

Senator Orrin Hatch

Senator Hatch also reiterated his plan to introduce legislation to eliminate the maintenance-of-effort provisions. 

The HELP Committee hearing focused on exchanges with a
spirited debate on whether or not plans offered on exchanges should be required
to offer an essential benefit package. 
The Kansas Insurance Commissioner Sandy Praeger and Secretary of
Maryland’s Department of Health and Mental Hygene Dr. Sharfstein argued
persuasively that without an essential benefit package, insurers would be
allowed to cherry-pick healthier people causing adverse selection and undermining
the community pricing benefits envisioned by exchanges. An essential benefit package also helps ensure that the exchange plans subsidized through the ACA will be of good quality. Utah State Representative David Clark argued that free market forces should be allowed free reign on the exchanges and described Utah’s exchange as an “online farmer’s market” where consumers
can go to compare and purchase health care plans.  Utah does not subsidize insurance plans offered on its exchange. He also pointed out that there should be a competitive
marketplace outside of the exchange.

In other developments:

1099: The Senate postponed a vote on legislation to
repeal the 1099 tax reporting provision until after March recess.  The budgetary off-set for
eliminating the 1099 reporting requirement would harm
self-employed people, lower-income families and others with fluctuating

CR: Another short-term continuing resolution was approved
avoiding a government shut-down for another three weeks. In a sign that
pressure is mounting, a bipartisan group of sixty-four Senators sent a letter
to the President urging him to collaborate with them on deficit reduction.  

“Beyond FY2011 funding decisions, we urge you to engage
in a broader discussion about a comprehensive deficit reduction package,” wrote the Senators. “Specifically, we hope that the discussion will include discretionary spending
cuts, entitlement changes and tax reform. “

This debate may have new implications for children’s
health care coverage so you can be assured that we’ll be tracking it closely as well as other developments. 

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