The New York Times by Robert Pear –
February 14, 2013:
An Obama administration official told Congress on Thursday that the government would be ready to enroll millions of people in private health insurance plans this fall, but senators of both parties expressed doubts.
The skepticism voiced by four Democratic members of the Senate Finance Committee was striking because they had been deeply involved in writing the health care legislation that President Obama signed in March 2010.
Gary M. Cohen, the federal official in charge of setting up health insurance marketplaces, or exchanges, told the committee: “We are making great progress. We are on track. We will be ready for people all across the country to receive high-quality affordable health insurance starting Oct. 1.”
But after listening to Mr. Cohen for more than an hour, the committee chairman, Senator Max Baucus, Democrat of Montana, demanded a detailed work plan and timetable for specific tasks, showing how the White House would meet the Oct. 1 deadline.
“We’ve got to get moving here,” said Mr. Baucus, the chief author of the 2010 law.
Several senators said they feared a repetition of the turmoil and confusion that occurred when Medicare was expanded with the addition of a prescription drug benefit, offered through private insurance plans, in 2006.
Mr. Baucus said he was particularly concerned that federal agencies would not have the computer systems needed to communicate with one another, with state agencies and with insurance companies. Those systems will be needed to verify consumers’ income and citizenship status, to enroll them in health plans and to pay subsidies to insurers.
Under the law, most Americans must have health insurance by Jan. 1, or they may be subject to tax penalties. Congress had assumed that each state would set up its own exchange, where people could shop for insurance. But many states balked, so the federal government will have the main responsibility for running exchanges in more than half the states.
Senator Ron Wyden, Democrat of Oregon, criticized a decision by the administration to define affordable health insurance by reference to the cost of coverage for an individual worker, without regard to the cost of family coverage, which is often much higher.
“In January 2014,” Mr. Wyden said, “we are going to have millions of families really pinched — in a no man’s land, where they are unable to afford family coverage offered through their employers and ineligible for subsidies that could be used by dependents on the exchange.”
Senator Orrin G. Hatch of Utah, the senior Republican on the Finance Committee, said, “I have a hard time understanding how the administration expects to have exchanges up and running by Oct. 1, especially since we have no details on how the exchanges will work in over half the states.”
Mr. Cohen, director of the federal Center for Consumer Information and Insurance Oversight, assured the senators that the administration had “a contingency plan for every eventuality.”
Under current plans, Mr. Cohen said, insurers will submit proposals to the federal exchange in April, and federal officials will decide by July which insurance policies can be sold in the federal marketplace.
Senator Maria Cantwell, Democrat of Washington, said the administration appeared to be “trying to lure people into the exchange” and thwarting alternatives. Ms. Cantwell expressed dismay that the administration had ignored a provision of the law that allows states to establish “basic health plans” for low-income people who will not be eligible for Medicaid.
Some officials in Washington, Minnesota and several other states want to use this option. But Mr. Cohen said it would not be available until 2015, a year later than Congress intended.
Senator Bill Nelson, Democrat of Florida, complained that the administration had torpedoed efforts to establish nonprofit health insurance cooperatives in about half the states, including Florida.
The administration has offered low-interest loans to co-ops in 24 states. But it agreed to eliminate money for co-ops in other states as part of a deal on taxes and spending at the end of last year. Mr. Nelson said the administration had suggested the co-op program as a source of savings.
“Why was that negotiated away at the 11th hour?” Mr. Nelson asked.
Mr. Cohen said, “I don’t have an answer.”