Some of those alarm bells were raised by Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee and a key architect of the Patient Protection and Affordable Care Act. Baucus, who confirmed Tuesday that he would not seek another term, told Sebelius last week that he is worried the administration is headed for a “train wreck” with the launch of the exchanges.
During Wednesday's House hearing, Rep. Michael Burgess (R-Texas) questioned whether HHS' assurances are credible given problems and delays already encountered with some provisions of the law. For example, he cited the recent decision by HHS to delay by a year allowing employee choice within the Small Business Health Insurance Options Program, known as SHOP exchanges, as well as a decision in February to stop enrolling people in the Pre-Existing Condition Insurance Plan because of funding issues.
Ranking member Rep. Henry Waxman (D-Calif.) characterized the criticisms of his Republican colleagues on the committee as opportunistic. “Republicans are suddenly concerned with about those with pre-existing conditions and want to make sure it has enough money for the rest of the year,” he said. “I question how sincere they are wanting to help those” with pre-existing conditions considering their longstanding opposition to the Affordable Care Act.
Cohen was also queried about “navigators,” the tens of thousands of people who will be hired in every state to assist consumers in applying for coverage through exchanges. Chairman Rep. Tim Murphy (R-Penn.) questioned why agents and brokers, who have to be licensed and have years of experience, can't become navigators if they get paid by insurance companies, while people who will get brief training on exchanges can.
Murphy also asked what measures are in place to prevent people who may be involved in political groups from using information and data gained from enrollees for improper purposes. Cohen responded that navigators will be trained on privacy and security, and will face criminal penalties if they engage in such behavior.
The possibility of premium spikes is another matter generating considerable interest as the administration gears up to get millions of Americans to enroll in the coverage.
The Society of Actuaries issued a report in March predicting that premiums in the individual market will rise significantly along with healthcare claims costs as a result of the ACA. On Tuesday, Maryland posted the rates that insurers requested for 2014, and some of them show steep increases. CareFirst Blue Cross and Blue Shield, the state's dominant insurer, requested a 25% increase in premiums for its individual plans. The insurer's CEO, Chet Burrell, told the Baltimore Business Journal that the rate request is largely driven by new requirements under the reform law.
Responding to questions from lawmakers about premiums, Cohen responded that they will be less “relative to where it would have been to without the law” in place. After the hearing, Cohen told reporters that elements of the reform law would mitigate cost increases to consumers.
“One of the things you need to look at when (the Society of Actuaries) is estimating is, are you taking into consideration the whole picture,” he said. The actuaries' analysis, he said, may not have accounted for tax subsidies and reduced cost sharing. “What's meaningful is not just the premium a person has to pay, but the total burden that healthcare costs has for that person. There are a lot of things in the law that are going to make that burden less.”
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