CMS Administrator Seema Verma on Wednesday defended the Trump administration's actions on healthcare, telling the U.S. House of Representatives' Energy and Commerce Committee that her agency is trying to provide greater access to care in the face of rising healthcare costs.
Verma touted the CMS' efforts on a range of healthcare issues from health IT interoperability to opioid abuse throughout her testimony, but the committee's Democratic members met her with fierce criticism. They said that under the Trump administration, the healthcare system is heading in the wrong direction and that the Affordable Care Act is succeeding "despite" the administration's best efforts to undermine it.
The Democrats were especially concerned about the CMS' expansion of short-term, limited-duration insurance, a recent drop in the number of people with insurance, waivers for Medicaid work requirements and the administration's unwillingness to share information about what it'll do if a court throws out the ACA.
The CMS loosened restrictions on short-term, limited-duration insurance last year to provide more affordable coverage options to consumers who don't have employer-sponsored insurance but earn too much to receive subsidies for plans offered through ACA exchanges or qualify for federal programs like Medicaid. Unlike plans sold on the exchanges, they don't have to meet the ACA's mandates.
Critics, including the committee's Democratic members, argue that these plans are affordable because they don't cover as much as ACA-approved plans that have caps of cost-sharing and require payers to cover people with pre-existing conditions. Throughout the hearing, several committee members called them "junk" health plans. And the representatives repeatedly confronted Verma on the lack of ACA protections for consumers.
"What are people with these junk plans supposed to do when they need vital healthcare services that are not covered by these junk plans?" said Rep. Paul Tonko (D-N.Y.).
Verma responded that when the other plans available to people are unaffordable, the short-term plans are "better than no insurance at all."
"If there were more affordable options available under Obamacare, people wouldn't have to make compromises," Verma said.
Several committee members also took aim at the Trump administration for a recent falloff in the number of people who have health insurance. Nearly 2 million more people lacked health insurance in 2018 compared with the year before, according to a report from the U.S. Census Bureau. The report showed that a dropoff in Medicaid coverage caused most of the decline.
"Under this administration, thousands of children and families have lost coverage of basic health services … the numbers just don't lie," said Rep. Diana DeGette (D-Colo.).
But the worries about Medicaid weren't limited to Democrats; Republicans had concerns too.
"How do we ensure that the populations, some of the most vulnerable in our communities, are actually getting the care that we have promised to them?" said Rep. Cathy McMorris Rodgers (R-Wash.).
Committee Democrats also brought up the administration's approval of Medicaid work requirement waivers, which seem increasingly likely to get struck down by the courts because of HHS' failure to consider their effects on coverage. Low-income, working-age adults in Arkansas were less likely to have health insurance, work or participate in community engagement activities after the state's work requirement went into effect, according to a recent study in the New England Journal of Medicine. That's despite Arkansas' unemployment rate declining over that period.
"Can you point me to one study that says a work requirement makes people healthier?" asked Rep. Joe Kennedy III (D-Mass.). "Healthier people might work, but working doesn't necessarily make people healthier."
Several members of the committee also wanted to know what the administration would do if the 5th U.S. Circuit Court of Appeals were to uphold a lower court ruling that would invalidate the ACA entirely. They were especially frustrated that HHS had "stonewalled" them on their requests for documents about the administration's contingency plans, especially those related to likely coverage losses and protections for pre-existing conditions.
Committee members also wanted to know why the administration didn't ask the courts to safeguard the parts of the law that the administration says it supports. They asked about protections for pre-existing conditions or allowing kids to stay on their parents' health insurance until they are 26 years old.
"Did the administration file some kind of a motion in the Texas case to say that the pre-existing conditions should be maintained?" DeGette asked.
"We will maintain what works and we will try to address the problems that we're having with the ACA," Verma replied.
She added that people with pre-existing conditions "don't have the protections today" if they can't afford the coverage.
"Where is the plan?" asked Rep. Jan Schakowsky (D-Ill.).
An analysis by the left-leaning Urban Institute estimates that roughly 20 million people will lose coverage if the courts toss out Obamacare altogether.