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Haslam Sends Letter of Concern to Obama Over Unaccompanied Minors

Letter to U.S. President Barack Obama  from Tennessee Gov. Bill Haslam; July 25, 2014:

The Honorable Barack Obama
The White House
1600 Pennsylvania Ave NW
Washington, D.C. 20500

Dear President Obama:

I write to you to express my concern about the number of unaccompanied immigrant children entering this country and the failure of the federal government to notify states in which children are being released.

On July 13, the nation’s governors met with Health and Human Services (HHS) Secretary Sylvia Burwell during the annual National Governors Association meeting, which I hosted in Nashville this year. We spent a significant amount of time in that meeting discussing the issue of unaccompanied immigrant children. Although this is a complex issue and one that ultimately must be solved at the federal government level, governors are rightly concerned about the impact on states. We emphasized to
Secretary Burwell the need to be informed of any children being relocated to our states.

It is unacceptable that we became aware via a posting on the HHS website that 760 unaccompanied children have been released by the Office of Refugee Resettlement to sponsors in Tennessee without my administration’s knowledge. Not only was our state not informed prior to any of the children being brought here, I still have not been contacted and have no information about these individuals or their sponsors other than what was posted on the HHS website and subsequently reported by media.

Although solving the border crisis is a federal responsibility, this influx of immigrant children could have a significant impact on state and local governments. Therefore, we strongly believe that the state needs to be informed prior to any additional unaccompanied immigrant children being released in Tennessee, and we also need immediate answers to the following questions:

1. What was the process for determining that these children should be released to sponsors in Tennessee?
2. How did you locate and evaluate the fitness of their sponsors?
3. What medical screenings were the children given prior to their release in Tennessee?
4. What is the official immigration status of these children and their sponsors?
5. In what localities are these children now residing?
6. What are the legal requirements concerning the provision of services for these children while they are in the state?
7. What additional information is available on these children, such as age and health status?
8. How long will these children be in Tennessee?

Tennessee is a diverse and welcoming state, and we also understand that this is a complicated issue. However, an influx of unaccompanied immigrant children to the state, with little information being made available to the public or to state leaders, creates confusion and could be very problematic. The start of school is approaching for many districts across the state, and the federal government’s actions have caused great uncertainty around this issue.

I appreciate your attention to this matter and look forward to receiving a response to these urgent questions.

Sincerely,

Bill Haslam
Governor

cc: The Honorable Sylvia Burwell, Secretary, HHS

Haslam: Medicaid Expansion Talks Didn’t Get Down-and-Dirty with New HHS Top

Tennessee’s Republican governor, Bill Haslam, said he had a “great conversation” with Sylvia Mathews Burwell when she was in Nashville a little over a week ago for the for the National Governors Association summit.

But Gov. Haslam said he and Burwell, the Obama administration’s new U.S. Health and Human Services Secretary, didn’t get into particulars with respect to working out a deal that might enable the state to draw down Affordable Care Act money from Washington earmarked for expanding the number of people in Tennessee eligible for government-finance health insurance.

“It wasn’t that kind of specific conversation in terms of where we are in the issues,” Haslam told TNReport in Winchester Monday. The governor was visiting the Franklin County seat to announce he was handing out half a million dollars in taxpayer-funded grants for city-center revitalization and regional recreation upgrades, like renovations to campsites and trails in Tims Ford State Park, and new lights at a local ball field.

“I do think we continue to make progress,” the governor said of the meeting with Burwell. “We had a good conversation about that, as well as numerous — you know, HHS obviously encompasses a lot of areas for the federal government, so we had a pretty broad range of conversation.”

Haslam said part of his talk with Burwell was a process of  “just getting to know each other.” He added that the two discussed “the history of where we are, and then both the financial and political realities that we’re dealing with in Tennessee.”

“I was very impressed by her,” Haslam said.

About two weeks ago, Haslam told TNReport at another grant announcement in Southeast Tennessee that he was hoping t0 find some middle-ground for facilitating Obamacare’s Medicaid-expansion provision in the Volunteer State when she stopped off in Middle Tennessee for the NGA festivities.

Haslam noted that although he’d met Burwell previously when she was filling a different role in the Obama administration, he was looking forward to talking with her for the first time since she’d taken charge at HHS. Haslam said that he hoped new blood at HHS could mean getting “some of the logs unjammed.”

Haslam told the Chattanooga Times Free Press following the NGA meeting that while his conversation with Burwell was upbeat, there were several “bright lines” that divided the state and the feds policy-wise. Some of those divisions include what’s covered and how to incentivize better health choices — which includes Haslam’s desire to use co-payments for the expansion.

In related news, the federal government has kicked off a new $100 million initiative program — developed with input from the National Governor’s Health Care Sustainability Task Force, and praised by Haslam — intended to help states improve their Medicaid programs.

TNHDC: Haslam Letter to HHS Latest ‘Farce’ in ‘Continued Obstruction’ to TennCare Expansion

Press release from the Tennessee House Democratic Caucus; December 10, 2013:

Haslam Letter to Sebelius a Farce
The time to act is now on the Medicaid expansion.

NASHVILLE, Tenn. – Late yesterday, Governor Haslam released a letter to Health & Human Services Secretary Kathleen Sebelius regarding his continued obstruction of Medicaid expansion in Tennessee.

“The Governor’s letter is simply the latest in a series of farces,” said House Democratic Leader Craig Fitzhugh. “It’s more of the same hand-wringing, ducking and dodging we’ve come to expect from this administration, all in an attempt to absolve themselves of the worst moral and mathematical failure in a generation—denying health care to 330,000 working Tennesseans.”

Governor Haslam’s letter offers no specific proposals, instead laying out a series of complaints and concerns about the overall Affordable Care Act. It offers no details about the so-called “Tennessee Plan,” which the Governor has yet to provide either to the federal government or state legislators.

“Governor Haslam is seeking to offer lower quality care to fewer people and still collect all the money allocated in the Medicaid expansion – that is not something that Secretary Sebelius has the power to authorize, and he knows that,” said House Democratic Caucus Chairman Mike Turner. “If Governor Haslam is going to negotiate seriously with CMS on creating a ‘Tennessee Plan,’ it needs to be done in a way that both conforms to federal law and appreciates the economic, fiscal and moral blunder that would result from a decision not to expand Medicaid.”

A hybrid Medicaid expansion plan has already passed the Arkansas legislature and been approved by the federal government. The Arkansas Plan includes cost-sharing components and addresses questions about defining “medically frail” through a questionnaire developed by the state.

“Expanding Medicaid in Tennessee is not an impossible task, but Governor Haslam is doing everything he can to make it one,” said Leader Fitzhugh. “All of the serious questions about creating a hybrid plan have been addressed in the Arkansas Medicaid waiver. Tennesseans don’t have time for the Governor to wait for political cover. The time to act is now.”

The Tennessee General Assembly returns to session on January 14, 2014. Speakers Harwell and Ramsey have pledged to move the session along as quickly as possible, meaning the Governor may only have a few months left before legislators will be gone for the rest of the year. If we do not act by January 1, 2014, Tennessee will begin to lose $2.5 million per day in federal funding.

Carr Claims Credit for Alexander’s Reversal on Sebelius Resignation

Press release from the Joe Carr Campaign for U.S. Senate; October 29, 2013:

Under fire from Conservative Joe Carr, Lamar flip-flops on Sebelius

Nashville, TN –Just one day after Conservative Senate candidate Joe Carr criticized Senator Alexander for his refusal to call for Secretary Sebelius’s dismissal, Senator Alexander dramatically reversed his position.

“I’m glad that Senator Alexander has reversed his position and now admits I was right. But its unfortunate he only did the right thing after political pressure. Unlike Senator Alexander, I’ll fight for our conservatives principles from day one.”

Last week, Senator Alexander gave an interview to Fox News in which he was asked if Sebelius should be fired. Alexander responded: “Well, that’s up to the President. I think he should make that decision.”

On Monday, Carr released the following statement:

“ObamaCare is a disaster and the implementation is even worse. It’s time for Kathleen Sebelius to be held accountable for the debacle she helped create. Senator Alexander’s refusal to call for her ouster is further proof he is well to the left of the conservative mainstream,” said Carr.

Today, Lamar reversed his position.

Alexander Wants HHS Secretary Sebelius to Explain ‘Technical Problems’ with Obamacare Exchanges

Press release from the Office of U.S. Sen. Lamar Alexander; October 10, 2013:

Senate, House committee leaders ask Secretary Sebelius to explain the technical failures, administration plans to fix them, and whether the administration went live knowing there were problems with the site
***
“We are concerned by recent comments to the media that the system suffers from architectural problems that need design changes. We seek information about these problems as well as whether you still expect individuals to suffer a tax penalty if they do not purchase government-approved health insurance.” – Letter to HHS Secretary Sebelius

WASHINGTON, Oct. 10 – The senior Republican on the Senate health committee and the Chairman of the House oversight committee today called on the Obama administration to provide details on the technical problems that have prevented many Americans from enrolling in the federal government’s health insurance exchange, and to explain whether individuals will still suffer tax penalties for not purchasing insurance.

Senator Lamar Alexander (R-Tenn.), the Ranking Member of the Senate Health, Education, Labor and Pensions Committee, and Rep. Darrell Issa (R-Calif.), the Chairman of the House Committee on Oversight and Government Reform, sent a letter to Secretary of Health and Human Services Kathleen Sebelius requesting information “to help us evaluate the extent of the problems with ObamaCare’s rollout and for us to better determine whether any corrective legislative actions are necessary.”

Alexander and Issa write: “HHS launched healthcare.gov on October 1, 2013, as required by law. From day one, however, healthcare.gov has been plagued by what Administration officials initially referred to as technical glitches. After six days the Administration finally admitted the glitches were ‘design and software problems that have kept customers from applying online for coverage.’ News reports detailed stories of people waiting as long as 36 hours to enroll for insurance, many waiting for hours only to give up. As many as 99 of every 100 applications are not able to be processed, and experts are concerned that ‘federal officials could face a situation in January in which relatively large numbers of people believe they have coverage starting that month, but whose enrollment applications have not been processed.’

They continue: “Among the many problems that have been identified in the media: many tens of thousands of people have started the application process but been unable to create accounts; the system that determines whether people are eligible for federal subsidies or Medicaid has made inaccurate determinations; the exchange will not be able to communicate with state Medicaid agencies until November; drop down tools and identity checking systems have not properly functioned; the website bottlenecks at the account creation stage; insurers are receiving incomplete or corrupted applications; and insufficient capacity has been allocated for the website. The website was shut down for periods on October 5th, October 6th, and on October 8th in order for HHS to attempt to make changes.

Alexander and Issa ask for information including how many people have successfully enrolled in the exchange; details on all technical problems preventing enrollment and the anticipated cost of fixing those problems; whether HHS decided to go live with healthcare.gov knowing there were problems with transmitting data to insurers; and whether individuals who attempted to enroll in insurance through the federal exchange but who were ultimately unsuccessful due to the system’s failures still face a tax penalty if they do not enroll for 2014.

“According to some reports,” they write, “the Administration was repeatedly warned that the federal exchange had significant problems. Insurers complained that during tests of the exchange there were difficulties with transmissions to insurers, with insurers not receiving all necessary data about individuals enrolling in plans during tests. Did HHS go live with healthcare.gov knowing there were problems with transmitting data to insurers? If those problems were resolved during testing, how were they resolved?”

The text of the letter is below:

October 10, 2013

The Honorable Kathleen Sebelius
Secretary
U.S. Department of Health and Human Services
330 Independence Avenue, SW
Washington, DC 20201

Dear Secretary Sebelius:

We are writing to seek information about the federal health insurance exchanges established by the Department of Health and Human Services (HHS). We are concerned by recent comments to the media that the system suffers from architectural problems that need design changes. We seek information about these problems as well as whether you still expect individuals to suffer a tax penalty if they do not purchase government-approved health insurance.

ObamaCare requires millions of individuals to enroll in government-mandated insurance or else face a tax penalty. The law required an online exchange be available by October 1, 2013, for individuals to compare plans and rates. For the 36 states that are not operating their own exchange websites, HHS established healthcare.gov for individuals to shop for insurance that would meet the law’s mandated insurance coverage requirements. A Government Accountability Office report from June detailed that HHS spent almost $394 million over three years in contracts to establish the exchange and its related functions.[1]

Two top HHS officials, Marilyn Tavenner, the Administrator of the Centers for Medicare and Medicaid Services (CMS), and Gary Cohen, the Director for the Center for Consumer Information and Insurance Oversight, provided testimony to the House Committee on Oversight and Government Reform within the past few months suggesting that HHS would be ready for implementation on October 1, 2013. On July 17, 2013, Ms. Tavenner testified that she was “feeling pretty comfortable about the ability [of CMS] to be ready on October 1st.”[2] She further stated that “I want to assure you that [on] October 1, 2013, the health insurance marketplace will be open for business. Consumers will be able to log onto healthcare.gov, fill out an application and find out what coverage and benefits they qualify for.”[3] At a hearing on May 21, 2013, Mr. Cohen testified “I think we are very much on schedule; we are moving forward. We are going to be ready October 1st for open enrollment to begin.”[4] Mr. Cohen also testified that there would not be “any problems with [the] massive amount of data sharing.”[5]

HHS launched healthcare.gov on October 1, 2013, as required by law. From day one, however, healthcare.gov has been plagued by what Administration officials initially referred to as technical glitches. After six days the Administration finally admitted the glitches were “design and software problems that have kept customers from applying online for coverage.”[6] News reports detailed stories of people waiting as long as 36 hours to enroll for insurance, many waiting for hours only to give up.[7] As many as 99 of every 100 applications are not able to be processed, and experts are concerned that “federal officials could face a situation in January in which relatively large numbers of people believe they have coverage starting that month, but whose enrollment applications have not been processed.” [8]

Among the many problems that have been identified in the media: many tens of thousands of people have started the application process but been unable to create accounts;[9] the system that determines whether people are eligible for federal subsidies or Medicaid has made inaccurate determinations;[10] the exchange will not be able to communicate with state Medicaid agencies until November;[11] drop down tools and identity checking systems have not properly functioned;[12] the website bottlenecks at the account creation stage;[13] insurers are receiving incomplete or corrupted applications;[14] and insufficient capacity has been allocated for the website.[15] The website was shut down for periods on October 5th, October 6th, and on October 8th in order for HHS to attempt to make changes.

To help us evaluate the extent of the problems with ObamaCare’s rollout and for us to better determine whether any corrective legislative actions are necessary, please provide the Committees with the following information by October 24, 2013:

  • As of October 9, 2013, at midnight, how many people had successfully enrolled for insurance through the federal exchange? How many people attempted to submit applications?
  • Please describe, in detail, all technical problems (including software and design defects) that are preventing people from successfully creating accounts, applying for insurance, and enrolling in plans. Please describe in detail the administration’s plans to address those problems and what has already been done to fix them. Please include which contractors were involved in the design and operation of those aspects of the exchange and which contractors are involved in correcting the problems.
  • How much has it already cost and will it cost to address the technical problems with the exchange? Does HHS need additional appropriations to solve the technical problems and if not, how will HHS pay for the changes? Please list specific appropriations accounts used.
  • According to several news reports,[16] the system that determines when people are eligible for subsidies to buy insurance or Medicaid appears to be malfunctioning, and thus many people may not be eligible for plans in which they are enrolled. What is your timeline for determining when people may have received inaccurate information about eligibility and for notifying affected individuals? How will individuals be notified?
  • According to a USA Todayinterview with HHS’s Chief Technology Officer Todd Park, the Administration has said it hopes as many as 7 million people will eventually sign up for health insurance through the federal exchange. Yet, the administration only designed healthcare.gov to handle 50,000 to 60,000 simultaneous users.
    1. Why did the Administration build the site to accommodate so few people at a time when it expected many more to apply for insurance?
    2. How much load testing of the exchange was done? What is the maximum number of simultaneous users the exchange was tested to accommodate?
  • According to some reports,[17]the Administration was repeatedly warned that the federal exchange had significant problems. Insurers complained that during tests of the exchange there were difficulties with transmissions to insurers, with insurers not receiving all necessary data about individuals enrolling in plans during tests.
    1. Did HHS go live with healthcare.gov knowing there were problems with transmitting data to insurers?
    2. If those problems were resolved during testing, how were they resolved?
  • For the first five days of open enrollment, the administration insisted enrollment problems were a matter of unexpected volume. In an on the record interview with USA Today published October 6, Todd Park said “These bugs were functions of volume[.] Take away the volume and it works.” On the same day, the Administration admitted to The Wall Street Journalthat capacity was not the only problem, but the exchange suffered from design problems as well.
    1. When did HHS first learn of the design and software problems with the exchange?
    2. Please provide all documents, including emails, referring or relating to the design, software, and capacity problems with the exchange.
  • Will individuals who attempted to enroll in insurance through the federal exchange but who ultimately were unsuccessful due to the system’s failures still face a tax penalty if they do not enroll for 2014? What about individuals who believe they successfully enrolled but later find out they were ineligible?
  • Please provide all documents referring or relating to the testing of the exchange and the federal data hub, including but not limited to contractual terms, reports or other data that were submitted by contractors, internal testing, internal emails, memos, power point presentations, and any communications from third parties such as insurers or other stakeholders on the performance of the exchange.

The Committee on Oversight and Government Reform is the principal oversight committee of the House of Representatives and may at “any time” investigate “any matter” as set forth in House Rule X. An attachment to this letter provides additional information about responding to the Committee’s request.

In preparing your answers to these questions, please answer each question individually and include the text of each question in your response. When producing documents to the Committee on Oversight and Government Reform, please deliver production sets to the Majority Staff in Room 2157 of the Rayburn House Office Building and the Minority Staff in Room 2471 of the Rayburn House Office Building. The Committee prefers to receive documents in electronic format.

If you have any questions about this request, please have your staff contact Stacy Cline of the Senate Health, Education, Labor and Pensions Committee Staff or Brian Blase of the House Committee on Oversight and Government Reform Staff. Thank you for your attention to this matter.

Sincerely,

Sen. Lamar Alexander                        Rep. Darrell Issa

Ranking Member                                 Chairman

Senate Health, Education,                   House Committee on Oversight

Labor and Pensions Committee          and Government Reform

 

Enclosure

cc: The Honorable Tom Harkin, Chairman, Senate Committee on Health, Education, Labor and Pensions

The Honorable Elijah Cummings, Ranking Minority Member, Committee on Oversight and Government Reform

——————————————————–

[1] John E. Dicken, Patient Protection and Affordable Care Act: Status of CMS Efforts to Establish Federally Facilitated Health Insurance Exchanges, GAO Report to Congressional Requesters (June 2013).

[2] Evaluating Privacy, Security, and Fraud Concerns with ObamaCare’s Information Sharing Apparatus, Joint Hearing Before the H. Comm. on Oversight and Government Reform, Subcomm. on Energy Policy, Health Care, and Entitlements, and H. Comm. On Homeland Security Sucbomm. on Cybersecurity, Infrastructure Protection, and Security Technologies, 113th Cong. 20-21 (2013)

[3] Id.

[4] Examining The Concerns About the ObamaCare Outreach Campaign, Hearing Before the H. Comm. on Oversight and Government Reform, Subcomm. on Energy Policy, Health Care, and Entitlements, and Subcomm. on Economic Growth, Job Creation and Regulatory Affairs, 113th Cong. 20-21 (2013)

[5] Id.

[6] Christopher Weaver, et al., Software, Design Defects Cripple Health-Care Website, Wall St. J. (Oct. 6, 2013).

[7] Sarah Kliff, For Some Shoppers, Buying Obamacare is Turning Into a Marathon, Wash. Post Wonkblog (Oct. 4, 2013).

[8] Dan Mangan, 99% of Obamacare Applications Hit a Wall, CNBC (Oct. 4, 2013).

[9] Supra note 6.

[10] Id.

[11] Phil Galewitz, Federal Insurance Marketplace Can’t Yet ‘Talk’ to State Medicaid Agencies, Wash. Post (Oct. 4, 2013).

[12] Supra note 6.

[13] Michael D. Shear, et al., Health Exchange Delays Tied to Software Crash in Early Rush, N.Y. Times (Oct. 7, 2013).

[14] See, e.g., Drew Armstrong, et al., Insurers Getting Faulty Data from U.S. Health Exchanges, Bloomberg (Oct.8, 2013).

[15] Tim Mullaney, Obama Adviser: Demand Overwhelmed HealthCare.gov, USA Today (Oct. 6, 2013).

[16] Supra notes 6 and 11.

[17]See, e.g., Juliet Eilperin, et al., Many Remain Locked Out of Federal Health-Care Web Site, Wash. Post (Oct. 8, 2013).