Jan. 11, 2019
Dive
Brief:
- Top
Democrats in the House and Senate stepped up their oversight into the
Trump administration's healthcare regulatory agenda this week in letters
seeking answers from administration officials about their handling of the
Center for Medicare and Medicaid Innovation and the Affordable Care Act.
- The newly
minted House Democratic chairman of the House Ways and Means Committee,
along with his Republican counterpart, wrote to CMS Administrator Seema
Verma on Wednesday to urge CMS to increase transparency at its model
testing and innovation arm CMMI, asking her to "reform its processes
to incorporate greater opportunity for public input."
- Also Wednesday, Democrats on the
House committees on Energy and Commerce, Ways and Means and Education and
Labor, along with the Senate committees on Health, Education, Labor, and
Pensions and Finance, wrote HHS Secretary Alex Azar and Verma to request
"detailed information" on how HHS and CMS are spending state
user fees intended to support the ACA exchanges.
Dive
Insight:
The
two letters are the opening sally in a newly emboldened and more Democratic
Congress. Notably, on the House side, the top Republican joined his colleague
in the gambit for increased oversight.
"Significant
policy changes made unilaterally by the executive branch without sufficient
transparency could yield unintended negative consequences for beneficiaries and
the health care community," read the Ways and Means letter signed by
Chairman Richard Neal, D-Mass., and Republican ranking member Kevin Brady
of Texas.
The
lawmakers took issue with CMMI's opacity in recent years, especially in its
rulemaking focused heavily on mandatory models. They asked Verma to supply the
committee with information on what models CMMI is considering, with the
estimated timeline for each, the public comment period that will be provided
before model finalization, the financial repercussions of the models and what
experts CMMI consulted when crafting it.
Ways
and Means also asked for a description of additional activities the government
will take to "promote transparency and engage Congress, stakeholders,
Medicare beneficiaries and the public" by the deadline of Jan. 23.
Top
Democrats in House and Senate committees looped in Azar to inquire how the
Trump administration is spending money when it comes to the federal ACA
marketplace.
"The
Administration's record of undermining enrollment in the Marketplaces, including
by cutting funding for vital functions such as marketing and outreach, as well
as spending agency funds on 'repeal and replace' propaganda, raises questions
about whether the dedicated funding is being spent effectively, legally, and
appropriately," reads the letter, signed by Chairmen Frank Pallone,
D-N.J., of Energy and Commerce, Neal of Ways and Means and Bobby Scott,
D-Va., of Education and Labor; along with Senate ranking members Patty
Murray, D-Wash., of Health, Education, Labor, and Pensions and Ron Wyden,
D-Ore., of Finance.
The
joint letter cited CMS cutting funding for ACA marketing and consumer
assistance by 90% and navigator funding by 40% in
2017, cuts the Government Accountability Office described as
"problematic" and supported by "unreliable" data.
The
top Congressional Democrats also took issue with other the administration's
2018 actions around the ACA, noting that (among other efforts) further slashed funding and
the promotion of association and
short-term health plans undermined the law ahead of the 2019
enrollment period.
The
2019 exchanges saw lower interest than any year since
2014 so far. Eleven states and D.C. have yet to be tallied.
"Given
the agency's clear intent to undermine enrollment in the Marketplaces by
reducing funding for vitally important Marketplace functions, it is unclear why
CMS continues to charge states that use the federal platform a 3.5 percent user
fee," the report notes — or why CMS recently raised the fee on
state-based marketplaces that use the federal platform from 2% to 3%.
The
five Democrats requested a breakdown of how user fees were spent in 2017 and
2018, along with outreach and marketing expenditures. They're also interested
in details on how the Trump administration invested funds to improve the
marketplace and what contracts currently exist with outside companies around
the ACA's functioning.
Azar
and Verma have until Jan. 24 to provide the information.
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