Casey Submits Questions to HHS Secretary Sebelius on Health Care Implementation

Washington, DC- U.S. Senator Bob Casey (D-PA) submitted a written statement questioning Kathleen Sebelius, Secretary of the Department of Health and Human Services (HHS), on the online enrollment problems in the federal health insurance marketplace.

“The implementation of this part of the Affordable Care Act has been inadequate,” Senator Casey said. “Pennsylvanians are eager to access affordable health insurance but that won’t happen if implementation isn’t done right. These hearings will play an important role in holding HHS accountable for implementation. I’ll continue to push the Administration to get this right so Pennsylvanians can access the benefits of this law.”

Statement as submitted for the record is below. 

Note: Senator Casey was unable to attend today's Finance Committee hearing because his wife, Terese, had surgery yesterday to repair a heart valve. While the procedure itself is very common, the recovery may take several weeks. He is expected to be with her most of this week. We will advise any additional changes to his schedule as appropriate.

Statement for the Record

Chairman Baucus, thank you for convening this important oversight hearing into the implementation of the Affordable Care Act.  I appreciate your leadership in overseeing the implementation of this law.  I would also like to thank Secretary Sebelius for coming to the Finance Committee today.  I look forward to hearing from you.

I am disappointed that the opening of the health insurance marketplaces on healthcare.gov has been so fraught with problems.  I do not believe these problems are indicative of flaws in the law, but I do think that they are indicative of flaws in implementation.

Thus, as the Secretary of Health and Human Services, I am particularly interested in hearing from you about how we ended up in this situation and what is being done to remedy the problems that have been identified.

Administrator Tavenner testified before the Committee on Health, Education, Labor, and Pensions yesterday that many of the initial problems individuals encountered when attempting to access healthcare.gov have been resolved.  However, it is apparent that there are still “back end” problems that are being addressed.

I hope that you will be able to provide insight on the relationships between HHS and the contractors that were hired to develop healthcare.gov, including more details about HHS’s oversight and accountability standards for the contractors.

As I said yesterday, too many people have experienced problems with healthcare.gov since October 1, and these problems are unacceptable.  Pennsylvania is one of the 36 states with a federally-facilitated marketplace, that is, one being run by the federal government.  These states are entirely dependent on the federally-created infrastructure; individuals in those states must use healthcare.gov from start to finish if they wish to be able to see and compare all the available plans in their area.

Unfortunately, Pennsylvania is also one of a number of states with a large number of individuals who have received notices from their insurers that their plans are ending.  Many of these plans include features banned under the Affordable Care Act, like riders that prohibit coverage of pre-existing conditions for 12 months, and the people currently enrolled in those plans will now have access to plans that provide comprehensive coverage without exclusions or discriminatory premiums.

However, the insurers have done little to calm the anxiety they are creating.  Their notices may fail to explain the new benefits and consumer protections, or omit or obfuscate mentions of healthcare.gov as a method for individuals to compare all their options under the Affordable Care Act.  I believe that HHS should be playing a more active role in ensuring that these individuals are made aware of their options under the law.

I do want to note that we have heard some success stories.  When healthcare.gov works, for many people it works well.  A recent story in the Philadelphia Business Journal highlights the experience of Doug Wohl, a small business owner, who has been uninsured for several years. He was deterred from purchasing health insurance because of pre-existing conditions and because he is a smoker.  While he experienced some initial difficulties with healthcare.gov, he came back later and was able to successfully create an account, browse his options, and select a plan for $355 per month, about a third of what he had been asked to pay the last time he tried to buy insurance.  Mr. Wohl is even looking forward to getting a colonoscopy, a recommended and fully-covered preventive service under the law.

Several news outlets also told the story of Gail Roach, from Pittsburgh.  Gail has Type 2 diabetes, and qualified for a tax credit and a cost-sharing subsidy.  Her total monthly premium is going to be $1.11.  She doesn’t have to worry about an insurer turning her down, or dropping her from coverage if she ends up in the hospital.  These success stories are important, because they highlight the improvements in the individual health insurance market that are occurring as a result of the Affordable Care Act.

I have never claimed that the Affordable Care Act is perfect, and I am open to reasonable improvements to the law.  However, it is the law, and it has been upheld by the Supreme Court.  Millions of Americans are eagerly awaiting its benefits: health insurance that doesn’t cost more because you’re a woman, or that excludes treatment for a preexisting condition, or charges outrageous rates without any guarantee of renewability at the end of the year.  October 1 was an eagerly-awaited date, but January 1, 2014 is even more eagerly awaited by so many people who have struggled for many years to access the health insurance they need to get the health care they need for themselves and their families.

Secretary Sebelius, thank you again for appearing before the Committee today.  I hope that your testimony will be helpful, and that we will be able to work together to ensure that the Affordable Care Act is a success.

Questions for the Record

1. What measures does HHS have in place to ensure appropriate oversight and accountability of the contractors hired to develop pieces of healthcare.gov?  I am particularly interested in knowing how HHS is measuring the performance of these contractors post-October 1.
2. Please describe for us the efforts HHS is undertaking to ensure that consumers have the most accurate information about open enrollment, what is changing and what is not changing, and how individuals can enroll in health insurance through healthcare.gov (including non-internet based methods such as the call center).  I would like to know how HHS intends to engage with individuals who may have begun but not completed the enrollment process and individuals who may have become discourages from even attempting to enroll because of the website problems.
3. I would also like to know what steps HHS is taking to mitigate the concerns of individuals who have been sent letters from their insurers saying that their plans are ending at the end of December.  Many of these individuals did not previously realize that they would have to switch health insurance plans, and it seems that many of them were blindsided.  Given that many of these individuals may have had so-called “junk plans” and are now eligible for both better coverage and, potentially, tax credits, I hope that your outreach includes a specific plan for this group of people.
4. In what way did the decisions by 36 states, including Pennsylvania, to forego establishing their own state-based insurance marketplaces affect HHS’s implementation plans?  Did this have a significant impact on the readiness of healthcare.gov on October 1?
5. I am disturbed by a recent report from the Pennsylvania Partnerships for Children noting that one in twenty Pennsylvania children remain uninsured, and that there are about 274,000 uninsured parents, of whom nearly half would qualify for Medicaid if Pennsylvania were to expand coverage.  We know that children of uninsured parents are more likely to be uninsured than children with insured parents.  Does HHS have a strategy to educate these families and encourage them to enroll in coverage?

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