From President Barack Obama’s proclamation that Obamacare is a settled matter to Nevada Sen. Harry Reid’s charge that Obamacare “horror stories” are fabrications to the constant refusal to respond to congressional queries, the Obama administration’s modus operandi has been to conceal and spin the full reality of the law’s impact.
That is why the Department of Health and Human Services Secretary Sylvia Burwell’s recent statements indicating a new approach based on transparency and candor are so refreshing. The department seems to be taking a more conciliatory and cooperative approach to working across the aisle on addressing the very real problems with the health care overhaul.
This May 14, 2014 file photo shows then-Health and Human Service Secretary nominee Sylvia Mathews Burwell testifying on Capitol Hill in Washington. The Obama administration has been struggling to clear up data discrepancies that could potentially jeopardize coverage for millions under the health overhaul, the government’s health care fraud watchdog reported Tuesday. The Health and Human Services inspector general said the administration was not able to resolve 2.6 million so-called “inconsistencies” out of a total of 2.9 million such problems in the federal insurance exchange from October through December, 2013. (AP Photo/J. Scott Applewhite, File)
Burwell also stated a goal of responding to letters from members of Congress within 30 days. While this news inspired new letters to the secretary, the top three questions that Burwell should answer right away have already been asked of her.
On May 16, in a letter to then-nominee Burwell, Sens. Mike Lee (R-Ariz.) and Ted Cruz (R-Texas) asked questions regarding the number of paid enrollees, the number of previously uninsured enrollees and whether taxpayers will be on the hook for an insurance industry bailout.
Question 1: Who Has Paid?
Instead of counting people who have actually paid for a plan, the administration has continuously counted anyone who put a plan in their shopping cart, but has not necessarily paid, as being enrolled. In addition to not revealing the number of people actually covered, there is reason to believe that the number of covered individuals might already be on a sharp decline.
Aetna, which is the nation’s third-largest insurer, is estimating that 30 percent of the “enrollees” either never paid their first month’s premium or will have stopped paying by year’s end. Florida’s insurance commissioner has reported a 22 percent decline in the state’s number of enrollees from what was originally reported by the HHS.
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While some of this attrition could be due to the normal market churn (obtaining coverage through a new job or relocating to another state), this high attrition rate likely reflects duplicate enrollments originally reported by the government, individuals never paying their first month’s premium and people who have since decided to drop coverage.
Question 2: How Many Were Previously Uninsured?
Not only did the federal government originally project about 14 million health insurance exchange enrollments in 2014, only to be revised to 7 million in September 2013, but these projections also assumed that the vast majority of these exchange enrollments would be previously uninsured individuals.
But many of the reported “enrollees” were likely previously insured – moving into the exchange as a direct result of policy cancellations resulting from Obamacare regulations or dropping their previous coverage to enroll.
The extent to which the law shuffled previously insured individuals between coverage compared to its original enrollment goal of providing health insurance coverage to the previously uninsured needs to be fully disclosed.
Question 3: Will Taxpayers be on the Hook for Insurance Industry Bailouts?
The law includes provisions to pay insurers for their financial losses in the health insurance exchanges. Instead of being budget neutral as promised – meaning that money would be pooled from each insurer and added to tax revenue from a new tax on health insurance plans – new regulations could put taxpayers on the hook for a blank check to insurers.
So here’s the question: Will Burwell abide by the original promise that payments to insurers remain budget neutral or will she bend to insurance industry pressure and force American taxpayers to foot an even larger bill for the law’s shortcomings?
A draft copy of the 21-page of a Health and Human Services Department form proposed for use to apply for low-cost insurance from Medicaid or the Children's Health Insurance Program is photographed in Washington, Tuesday March 12, 2013. (AP Photo/J. David Ake)
Burwell’s statement indicating a new approach based on candor and transparency is not only welcome news, but it is also a stark departure from the agency’s previous approach. While a skeptic might see this as an attempt to merrily skip past a discussion of Obamacare accountability, Burwell does have an important opportunity to demonstrate her earnestness.
The administration is now gearing up for its second open enrollment period in just two short months. But before that begins, the American public deserves the opportunity to evaluate – based on complete data and information – the promises that were originally made.
Naomi Lopez Bauman is the director of health policy at the Illinois Policy Institute (www.illinoispolicy.org). You can follow her on Twitter at @LopezBauman.
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