This article was published by Kaiser Health News.
By Aimee Miles
President Obama's top health official stuck to familiar talking points in a congressional hearing Thursday, defending the president's agenda from attacks by a GOP-led House subcommittee that focused on the administration’s budget request and implementation of the health care law.
Panel members asked Kathleen Sebelius, secretary of the Department of Health and Human Services, how much flexibility cash-strapped states will have in redesigning their Medicaid programs, and how HHS was dealing with the possibility that court rulings against the law might hamper its implementation. The questions echoed the simmering frustrations of state officials who say they’re unsure of whether, or how, to move forward on the health law.
"What we see in front of us, Madam Secretary, seems to be a confused process," said Rep. Marsha Blackburn, R-Tenn. "Our states are frustrated—we've heard from state legislators, from governors, they're all beginning to agree…this is something that would bankrupt states."
State governors, especially Republicans, have complained that the health law doesn’t give them the flexibility they need to restructure their Medicaid programs to work within their depleted budgets. Many would like to pare Medicaid costs by restricting eligibility, but the health law's "maintenance of effort" provision requires states to maintain their current levels of coverage.
"If states are instead forced to impose steep reductions in payments to providers, they will likely drive more doctors…out of the Medicaid program," said Rep. Fred Upton, R-Mich., chairman of the House Energy and Commerce Committee.
Pressed by Upton and Pennsylvania Rep. Joseph Pitts, chairman of the Commerce panel’s health subcommittee, on whether she would support repealing the maintenance of effort requirements needs, Sebelius said the department is working with states on a case-by-case basis to try to accommodate their requests for flexibility. She also said the president directed her to work with governors on their proposals for an alternative to the requirements.
Rep. Michael Burgess, R-Texas, was unsparing in his criticism of the health law and of Sebelius' decision to issue rules that he says hadn’t undergone adequate public comment. "At no other time in our history has so much power gone to one federal agency. Can you understand why the American people are understandably concerned by what has happened to them?" he asked Sebelius.
"I think the American public should be alarmed that we are paying taxpayer dollars to any provider…which doesn't have a quality system in place," Sebelius responded flatly.
Democrats preferred to shift their focus to the GOP's plans to sharply cut federal spending.
"I'm much more focused on the threats from the continuing resolution passed by the House,” said Rep. Henry Waxman, D-Calif. He told Sebelius that the cuts in the resolution would be "just devastating to the mission of your department."
Several Democrats pointed out that the GOP’s continuing resolution includes a 23 percent cut in funding for the Centers for Medicare and Medicaid Services, eliminates $1 billion from the community health centers program and cuts $1.6 billion from the National Institutes of Health.
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