MICHAEL BRADY October 23, 2019
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.
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