Complaints for the sake of complaining

By Steve Benen

The House Energy and Commerce Committee just started the first of several congressional hearings on the Affordable Care Act’s website, but this will not be a normal discussion between lawmakers and Obama administration officials...this is one of Congress’ key functions, and even those who champion “Obamacare” have no reason to complain about lawmakers checking up on the administration and demanding the best possible performance.

But therein lies the rub: that’s not quite what Republicans have in mind today. Alec MacGillis had a good piece on this the other day.

Generally, holding a hearing demanding to know why a new program isn’t functioning better implies that … you want it to function. Until now, Republicans have managed to oppose Obamacare totally, to undermine its implementation left and right while casting symbolic votes for repeal and, just recently, engaging in an immensely costly charade to press for the “defunding” of the law.

But now that the law is actually going into effect, seizing on its deficiencies takes on a different aspect: It means, at some basic level, accepting the goals of the law as worth achieving

Theoretically, that’s exactly right. The ostensible point of today’s hearing – the first of several such panels that will all make the same point – is that Congress is dissatisfied with the well-publicized website glitches and wants the administration to do much better...the trouble is, Republicans are crying what Matt Miller aptly described as “crocodile tears.”

To listen to Republican laments about Healthcare.gov’s terrible launch, you’d think the GOP was deeply concerned that people who need affordable health insurance are being denied this essential protection thanks to the administration’s incompetence.

But of course nothing could be further from the truth. What conservative officials, pundits and advocates are screaming is closer to the following: How dare you totally screw up something that we think shouldn’t exist!

I’ve watched Congress for quite a while, and I’ve been to more congressional hearings than I can count, and I honestly can’t think of anything similar to the charade we’ll see today. The Republican majority is complaining about the functionality of a website that they’d just as soon destroy. They’re furious Americans are struggling to sign up for benefits that Republicans don’t want them to have. They’re demanding better performance of a system they’ve spent years deliberately trying to sabotage, and have no intention of trying to help fix...those responsible for calling the hearing – the one who’ll complain the loudest – don’t want improvements at all. Their stated preference would be that the website that doesn’t work as it should to stay that way indefinitely...so what is, exactly, the point of the exercise? Part of this is simply an excuse to grandstand. Republicans took a beating when they shut down the government, and so they’ll take advantage of the opportunity today to release some frustration and go on the offensive by shouting at Obama administration officials for a few hours. I’m sure it’ll be quite cathartic.

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http://www.msnbc.com/rachel-maddow-show/complaints-the-sake-complaining

IT Contractor: HealthCare.gov Was The First Of Its Kind

At the House Energy and Commerce Committee's oversight hearing Thursday on HealthCare.gov's troubled launch, an executive for one of the project's top software companies stressed to members that the insurance marketplace was a first-of-its-kind technological endeavor.

"The federal exchange ... is not a standard consumer website," Cheryl Campbell, senior vice president at CGI Federal, a lead contractor for the site, told the committee. "Rather, it is a sophisticated technology platform that for the first time in history combines the processes of selecting and enrolling in insurance and determining eligibility for government subsidies all in one place and in real-time."

"Some consumers were able to enroll on October 1, but we acknowledge that issues arising in the federal exchange make the enrollment process difficult for too many Americans," she continued. "Consequently, CGI Federal's focus shifted to solving consumer access and navigation problems on the exchange."

http://talkingpointsmemo.com/livewire/it-contractor-healthcare-gov-was-the-first-of-its-kind

Under Bush, Republicans Vigorously Defended Health Care Reform Despite Serious Glitches

By Igor Volsky

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This sounds like the familiar story of the last few days of the Obama administration’s rollout of the exchanges. But, actually, those quotes, and that scenario, are taken from the Bush administration’s efforts to implement the Medicare prescription drug benefit in 2005 and 2006.

Not only was Bush’s rollout “anything but smooth,” but administration officials had “some trouble getting the [online] tool up and running” and had to delay its debut for weeks. What’s more, computer glitches caused low-income beneficiaries to go without needed medications and sent pharmacies the wrong drug information. Before it was all resolved, Dr. Mark McClellan, Bush’s head of the Center for Medicare & Medicaid Services (CMS), appeared at hearings before the House Committee On Energy And Commerce, laying out the flaws in the law’s implementation and detailing how the administration would address them.

As the House Energy and Commerce Committee holds its first hearing on the implementation of the the Affordable Care Act on Thursday, it’s worth noting that some of the very same Republicans who are lashing out against Obamacare, arguing that the botched rollout is proof that the government cannot implement effectively and should repeal the law entirely, gave the Bush administration a pass and urged Americans not to pre-judge such a complicated process. At least four of the Republicans still on the committee had argued that early implementation hurdles should not taint the entirety of reform:

REP. JOE BARTON (R-TX): “This is a huge undertaking and there are going to be glitches. My goal is the same as yours: Get rid of the glitches. The committee will work closely with yourself and Dr. Mark McClellan at CMS to get problems noticed and solved.” (Barton Statement via Archive.org, 2/15/2006)

REP. TIM MURPHY (R-PA): “Any time something is new, there is going to be some glitches. All of us, when our children were new, well, we knew as parents we didn’t exactly know everything we were doing and we had a foul-up or two, but we persevered and our children turned out well. No matter what one does in life, when it is something new in learning the ropes of it, it is going to take a little adjustment.” (Murphy Floor Speech via Congressional Record, 4/6/2006)

REP. MICHAEL BURGESS (R-TX): “We can’t undo the past, but certainly they can make the argument that we are having this hearing a month late and perhaps we are, but the reality is the prescription drug benefit is 40 years late and seniors who signed up for Medicare those first days back in 1965 when they were 65 years of age are now 106 years of age waiting for that prescription drug benefit, so I hope it doesn’t take us that long to get this right and I don’t believe that it will. And I do believe that fundamentally it is a good plan.” (“Medicare Part D: Implementation of the New Drug Benefit,” 3/1/2006)

REP. PHIL GINGREY (R-GA): “I delivered 5,200 babies, but this may be the best delivery that I have ever been a part of, Mr. Speaker, and that is delivering, as I say, on a promise made by former Congresses and other Presidents over the 45-year history of the Medicare program, which was introduced in 1965 with no prescription drug benefit. And what we have done here is add part D, the ‘D’ for ‘drug’ or, if you want, the ‘delivery’ that we have finally provided to our American seniors.” (Gingrey Floor Speech via Congressional Record, 4/6/06)

Ultimately, the Bush administration fixed the law’s technical glitches, but more than half of the beneficiaries who ended up signing up for insurance didn’t do so until after the first of the year. Significantly, they signed up for coverage despite the Bush administration’s well-publicized initial glitches in extending coverage to low-income beneficiaries. Whereas only 21 percent of seniors had a favorable impression of the law and 66 percent didn’t know what was in it in April of 2005, by November of 2006, “half of the seniors polled said the program was working well or that just minor changes were needed.”

http://thinkprogress.org/health/2013/10/24/2828261/hearing-post/

Long before this Supreme Court decision, through the Affordable Care Act, seniors began to see positive changes in their prescription drug costs, access to preventive health care, and more. Thanks to the Supreme Court’s decision the following provisions will continue to be provided to seniors:

Medicare Improvements

The ACA contains several important improvements to the Medicare program, many of which are already helping seniors today.

1) Closing the donut hole

a. Medicare Part D covers the cost of medications up to a certain point. Between that point, and a catastrophic coverage threshold, the older adult must pay out of pocket for medication (this gap in coverage is often called the Part D “donut hole”). One in four beneficiaries fall in this gap, and end up paying an average of $3,610 out of pocket on drug expenses.

b. The ACA requires drug manufacturers to reduce prices for Medicare enrollees in the donut hole. Beginning in 2011, brand‐name drug manufacturers must provide a 50% discount on brand‐name and biologic drugs for Part D enrollees in the donut hole. By 2013, Medicare will begin to provide an additional discount on brand‐name and biologic drugs for enrollees in the donut hole. By 2020, Part D enrollees will be responsible for only 25% of donut hole drug costs.

c. This is a benefit seniors are getting now, and will continue to get as a result of this decision.

2) Improving senior’s access to preventive medical services

a. Prior to the ACA, Medicare beneficiaries were required to pay a deductible and 20% copay for many preventive health services.

b. The ACA eliminated cost‐sharing for many preventive services and introduced an annual wellness visit for beneficiaries.

c. The ACA also eliminated cost‐sharing for screening services, like mammograms, Pap smears, bone mass measurements, depression screening, diabetes screening, HIV screening and obesity screenings.

d. This is a benefit seniors are getting now, and will continue to get as a result of this decision.

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Medicaid Long Term Services and Supports Improvements
Several provisions in the ACA will make it easier for seniors to get long‐term services and supports at home and in the community. Medicaid provides funding for long‐term care services in institutions, such as nursing homes and in the community. Seniors prefer to receive care in their homes, and it is generally less expensive, however, most states spend their Medicaid primarily on institutional care. The ACA includes incentives to encourage states to shift Medicaid spending from institutions to the community, so that individuals who require long‐term care services may receive care in least‐restrictive environment. These incentives are not directly impacted by the Court’s decision to limit the Medicaid expansion. Elements of the ACA that enhance home and community long‐term care include:

1) Community First Choice Option (CFCO) provides participating states with a six percentage point increase in federal Medicaid matching funds for providing community‐based attendant services and supports to individuals who would otherwise be confined to a nursing home or other institution.

2) Balancing Incentive Payment Program targets increased federal matching funds to states that spend less than half of their Medicaid long‐term care expenditures on community‐based care. This spring, six states received grants to improve their community‐based care.

3) Extending Medicaid’s spousal impoverishment protection provisions to spouses of individuals who seek long‐term care in the community. This rule goes into effect in 2014.

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http://www.ncpssm.org/Portals/0/pdf/aca-analysis.pdf