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Haslam Optimistic New HHS Head Will Work With TN on Medicaid Expansion

Tennessee Gov. Bill Haslam said he expects discussions about Medicaid expansion in the Volunteer State will come up this week at the National Governors Association meeting in Nashville.

Sylvia Burwell, the new U.S. Department of Health and Human Services secretary, is expected to attend the NGA meeting, Haslam told reporters following a grant announcement in Dunlap Tuesday. She was appointed to the post June 9.

Despite the fact that it’s been about a year and a half since Haslam said he wanted to develop a special “Tennessee Plan” for accessing Affordable Care Act money to expand government-financed health insurance for the state’s lower income residents, there’s been little visible movement toward a compromise.

In the meantime, the Legislature has passed a law requiring that the General Assembly sign off on any agreement the Haslam administration reaches with Washington for it to take effect. Republicans dominate in the statehouse, and many have indicated they’re in no way whatsoever interested in facilitating any aspect of Obamacare.

Still, the governor said, new blood at HHS may mean novel approaches will be considered by those administering the ACA at the federal level.

“We’ve always had hope that there’s something to work out, or we would have just quit a long time ago,” Haslam said. “But I think obviously whenever you introduce somebody new into the process, you hope it’ll be somebody who can help get some of the logs unjammed.”

Haslam said he’s met Burwell previously when she was in a different position, but this week’s meeting in Nashville would be the first chance he’s had to speak with her since she was appointed head of the department that oversees the execution of Obamacare policies.

Former HHS Secretary Kathleen Sebelius, Obama’s first appointment to that role, resigned on April 11, in the wake of months of criticism over the problematic roll out of the Affordable Care Act federal health care exchange.

According to the Affordable Care Act, if Tennessee agrees to expand TennCare, the federal government will pick up the tab for the coverage through 2016, and provide part of the cost after that.

Haslam initially held out for a waiver from HHS that would allow him to establish a “third way,” and use federal money to subsidize private insurance to extend coverage to 175,000 uninsured Tennesseans.

An agreement was never reached between Sebelius and Haslam, but Haslam has continued to say that he is still working on finding a way to reach a middle ground between the Obama administration and Tennessee’s Republican super-majority in the General Assembly.

The Tennessee House Democratic Caucus sent out a press release last week referencing a recent report by the White House Council of Economic Advisors that “lays out the fiscal, economic and moral failure caused by the Haslam administration’s refusal to expand Medicaid in Tennessee.”

But there is concern among those opposed to expanding the state’s poverty health care program about whether the federal government can afford to do that, as well as what the state should do in the case that the money for the program is not forthcoming from federal officials.

Back in the mid-2000s, under Democratic Gov. Phil Bredesen, Tennessee had to remove more than 300,000 from TennCare coverage, due to rising costs and lack of funding, a problematic time that is often pointed to by opponents of Medicaid expansion.

Haslam was in Dunlap to award a transportation grant of $591,141 to the city for them to help connect nearby residential areas with the downtown education centers and business district.

The NGA meeting begins Thursday, July 10, in Nashville, and runs through July 13.

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.

Kelsey Protests Sebelius’ Memphis Visit

Press release from the Tennessee Senate Republican Caucus; November 1, 2013:

(NASHVILLE, Tenn.), November 1, 2013 — State Senator Brian Kelsey (R-Germantown) announced today that he will appear at the Benjamin L. Hooks Central Library in his district at 1:00 p.m. in protest of the visit of the Department of Health & Human Services Secretary Kathleen Sebelius. Senator Kelsey will also voice his opposition to Medicaid Expansion in Tennessee.

“Given the failure of Secretary Sebelius in designing the healthcare.gov website, I am 100% opposed to her designing an Obamacare Medicaid expansion plan for Tennessee.”

Sen. Kelsey is the sponsor of Senate Bill 804, filed to block Medicaid expansion in Tennessee. 15 of the 33 state Senators are signed on the bill as co-sponsors. The bill is scheduled to be heard in January at the first meeting of the Senate Finance Committee.

Sen. Kelsey represents Cordova, East Memphis, and Germantown. He serves as chairman of the Senate Judiciary Committee.

Alexander: Sebelius ‘Always Welcome’ in TN, Time ‘Better Spent’ Fixing Exchanges Though

Press release from U.S. Senator Lamar Alexander; October 31, 2013:

WASHINGTON, Oct. 31 – U.S. Senator Lamar Alexander (R-Tenn.) today released the following statement on Health and Human Services Secretary Sebelius’s planned visit to Memphis tomorrow:

“The secretary is always welcome in Tennessee, but her time would be better spent in Washington fixing the Obamacare website so that millions of Americans won’t find themselves without health insurance starting January 1st. But while she’s in Memphis, I hope she’s able to meet with some of the thousands of Tennesseans who are being informed that they won’t be able to keep the health insurance the president promised they’d be able to keep.”

On Monday, Alexander called on President Obama to ask Sebelius to resign, saying, “Expecting this secretary to be able to fix in a few weeks what she has not been able to fix during the last three and one half years is unrealistic. It is throwing good money after bad … No private sector chief executive officer would escape accountability after such a poor performance.”

Last week, Alexander introduced legislation that would require the administration to provide weekly reports on the Obamacare exchanges, saying, “Before the Internet, RCA knew how many records Elvis was selling every day. Before the Internet, Ford knew how many cars they were selling every day. Before the Internet, McDonald’s could tell you how many hamburgers it had sold each day. Yet the Obama administration cannot tell us how many Americans have tried to sign up for Obamacare.” Senate Democrats on Tuesday rejected his request to unanimously pass the legislation.

And today, Alexander announced his support of a subpoena issued by House Oversight Committee Chairman Darrell Issa (R-Calif.) for Obamacare exchange documents requested by Alexander and Issa.

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 Calls for HHS Secretary’s Resignation

Press release from the Office of U.S. Sen. Lamar Alexander; October 29, 2013:

Says “no private sector CEO would escape accountability after such a poor performance”

***

WASHINGTON, Oct. 29 – The senior Republican on the Senate health committee today (Video HERE) called for President Obama to ask Health and Human Services Secretary Kathleen Sebelius to resign.

Senator Lamar Alexander (R-Tenn.) said: “Expecting this secretary to be able to fix in a few weeks what she has not been able to fix during the last three and one half years is unrealistic. It is throwing good money after bad.”

Alexander pointed to at least 1.5 million Americans who are losing health care coverage starting on January 1 because their policies are not legal under Obamacare.

“If the exchange is not working, they will not be able to choose another policy through that exchange. At some point there has to be accountability,” Alexander said. “Taxpayers have spent $400 million to create exchanges that, after three and one half years, still don’t work.”

He continued: “No private sector chief executive officer would escape accountability after such a poor performance. And the principle of accountability is not foreign to the public sector. Admiral Hyman Rickover, father of the nuclear navy, told his submarine captains that they were not only accountable for their ships, but they were also accountable for the nuclear reactor on their ships. If anything went wrong with the reactor, their career in the Navy was over, the Admiral said. As a result of that dose of accountability, since the 1950’s there never has been a death as a result of a problem with a naval submarine reactor.”

“Americans deserve that kind of accountability in the implementation of the new health care law,” he said.

Alexander added: “Instead, the Secretary appears not even to have told the President about known problems with the Obamacare website in the months and days leading up to the launch. Despite repeated requests, she has refused to tell Congress or the public the reasons the Obamacare website continues to fail while insisting on more time and an undisclosed amount of money to fix it.”

“It is time for the President to ask the Secretary of Health and Human Services to resign.”

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).