“Woefully sloppy and willfully ignorant” is how Chairman Tim Murphy (R-PA) described the oversight of the state-run health insurance exchanges at an Energy & Commerce oversight hearing Tuesday.
Andy Slavitt, Acting Administrator for the Centers for Medicare & Medicaid Services (CMS), testified before the subcommittee on the use of federal funds provided to establish state-based marketplaces under the Affordable Care Act.
CMS doled out more than $5.5 billion in grant money to construct exchanges in 17 states, but lawmakers now question whether this money has been used properly. Chairman Murphy noted that every single state exchange faces significant budget shortfalls. For example, $733 million was given to establish state exchanges in Hawaii, Nevada, New Mexico, and Oregon. All four exchanges failed to become self-sustaining and were forced to transition consumers to the federal marketplace. It is increasingly unclear whether or not the money will be recouped.
Congresswoman Marsha Blackburn (R-TN) questioned Slavitt about a recent report from the Government Accountability Office which revealed that some state exchanges’ information technology systems were still functioning improperly. The report found that CMS “did not always clearly document, define, or communicate its oversight roles and responsibilities to states as called for by best practices for project management.” State administrators say communication with CMS has been poor, which “adversely affected states’ deadlines, increased uncertainty, and required additional work.”
CMS is charged with reviewing states’ funding requests and conducting audits to ensure all money is being spent legally. After January 1, 2015, states were not allowed to spend grant money on operation expenses such as rent, utilities, telecommunications, or software maintenance. Chairman Murphy cited a report from the Office of Inspector General revealing that Washington state may have used its grant money for operational costs, contrary to law.
Slavitt contended all current state marketplaces are sustainable despite these compelling challenges. When asked by Congressman David McKinley (R-WV) whether anyone has lost their job for giving erroneous advice to the state exchanges, Slavitt was unable to provide a single name.
Tuesday’s hearing was the second Energy & Commerce oversight hearing to address the tumultuous problems within the state marketplaces in an effort to ensure that taxpayer dollars are being spent wisely and in accordance with the law.
The Pacific Legal Foundation filed an appeal Monday asking the Supreme Court to hear a new challenge to the Affordable Care Act which argues that the ACA’s taxes are unconstitutional because they originated in a bill written by the Senate.
Under the Constitution’s Origination Clause, all bills that levy and raise taxes must begin in the House of Representatives. Contrary to this provision, the text of the ACA was written by the Senate and later adopted by the House. Senate Majority Leader Harry Reid gutted an unrelated House bill, leaving only the bill number, and in its place, he inserted the 2,076 pages of the ACA.
The PLF contends that the ACA’s taxes were therefore unconstitutionally created in a bill written by the Senate.
In 2012, the Supreme Court decided in NFIB v. Sebelius that the individual mandate, a requirement in the ACA forcing Americans to purchase health insurance or else pay a penalty, is indeed a tax. The Supreme Court did not however address the implications of the Origination Clause on this conclusion.
PLF’s lawsuit, Sissel v. U.S. Department of Health & Human Services, specifically targets the individual mandate to prove that all of the ACA’s taxes are unconstitutional under the Origination Clause.
“Beyond its assault on healthcare freedom, Obamacare represents an attack on some core constitutional principles and protections for taxpayers,” according to PLF’s Principal Attorney Timothy Sandefur. “Obamacare raises taxes by hundreds of billions of dollars, but it was enacted in violation of the Origination Clause, which was designed to safeguard against arbitrary and reckless taxation.”
Four of the nine justices must vote to hear the case before it is placed on the court’s docket.
View PLF’s petition for writ of certiorari here.
Lackluster enrollment numbers, technology issues, and high maintenance costs are among the challenges plaguing ObamaCare state exchanges that were reviewed by the House Energy and Commerce Oversight Subcommittee at a hearing Tuesday.
“CMS has seemed more focused on doling out taxpayer dollars rather than overseeing how those dollars are spent,” Chairman Tim Murphy (R-PA) said of the lack of oversight.
Executives from six state exchanges—Oregon, Massachusetts, Hawaii, California, Minnesota, and Connecticut—provided testimony. So far, Oregon and Hawaii’s exchanges have both proven to be unsustainable, closing down and migrating consumers to HealthCare.gov’s federal marketplace with others likely to follow.
Chairman Murphy emphasized in his opening statement the sufficient amount of taxpayer money that was poured into creating these now-failing exchanges: “The Centers for Medicaid and Medicare Services has awarded $5.51 billion dollars to the States to help them establish their exchanges. Let me repeat that. The States received $5.51 billion in federal taxpayer dollars to set up their own exchanges. Yet, the ACA had no specific definition of what a state exchange was supposed to do, or more importantly, what it was not supposed to do.”
Grant money used to fund the exchanges was cut off in 2015 when states were expected to start bringing in enough money to continue operation on their own. Of the 17 states that chose to establish their own exchanges, nearly half face financial difficulties.
The committee hopes to find out why exchanges have struggled to become self-sustaining and whether or not any grant money will be recouped from states where exchanges have been shut down. For instance, Oregon spent $305 million of taxpayer dollars to establish its failed exchange, while Hawaii spent $205 million.
As Americans for Tax Reform points out, Tuesday’s hearing is a vital first step to addressing the urgent problems within the state exchanges—before they spread to all 17.