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HHS Secretary Burwell Is Grilled About Health Law Contingency Plans

Mary Agnes Carey speaks with Melissa Attias of CQ- Roll Call about Health and Human Services Secretary Sylvia Burwell’s visit to Capitol Hill, where she faced a torrent of questions about the pending Supreme Court case concerning health law subsidies and the impact the ruling might have on the millions of people who have subsidized coverage.

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MARY AGNES CAREY: Welcome to Health on the Hill, I’m Mary Agnes Carey.  Department of Health and Human Services Secretary Sylvia Burwell faced some tough questioning today on Capitol Hill about the upcoming Supreme Court arguments concerning health law subsidies that help millions of people afford coverage. With us now is Melissa Attias, who was at that House hearing and covers health care for CQ-Roll Call. Thanks for joining us.

MELISSA ATTIAS, CQ-ROLL CALL: Thanks for having me.

MARY AGNES CAREY: As expected, several Republicans on the House Energy and Commerce Health Subcommittee asked Sec. Burwell about how the administration intends to respond if the court rules that people in about three dozen exchanges that are run by the federal government are no longer entitled to get subsidies to help purchase coverage. But subcommittee Chairman Joe Pitts asked the secretary about an alleged 100-page HHS document detailing potential actions that the agency could take if the court rules that the subsidies can’t exist in federal exchanges. What was her response?

MELISSA ATTIAS: Pitts asked about this document. He said he had heard from a source within HHS that it exists, and Burwell said she was not aware of the document. She instead cited a letter that she sent out to Republican offices on Capitol Hill Tuesday that said her department doesn’t know of any administrative action that could undo the damage that would happen if the court ruled against the government and that therefore they don’t have a plan that could accomplish that kind of action. And she also reiterated that she thinks the Obama administration is going to prevail in the court case. The Supreme Court is going to hold oral arguments next week, March 4, and a ruling is expected by the end of June.

HHS Sec. Sylvia Mathews Burwell testifies during her confirmation hearing before the Senate Health Committee in May. (Photo by Alex Wong/Getty Images)

HHS Sec. Sylvia Mathews Burwell. (Photo by Alex Wong/Getty Images)

MARY AGNES CAREY: Hasn’t the administration acted before in the sense of changing requirements on the employer mandate – is one that comes to mind – or the special enrollment period they just created for people who find out they owe a penalty this year because they didn’t have health coverage? Why doesn’t that power extend to having an answer on the subsidy issue?

MELISSA ATTIAS: The administration has already taken a number of actions administratively to smooth implementation of the law, you named the employer mandate; that’s a great example, so I think it would surprise many people if the administration isn’t making some sort of contingency plan, because most would expect that the administration is going to do anything they can to soften the blow if the subsidies are taken away from the federal exchange.

MARY AGNES CAREY: While Republicans focus their questions today on the upcoming Supreme Court case, Democrats looked into a different area. Can you tell us about that?

MELISSA ATTIAS: Sure, Democrats were asking Burwell, whether she was aware of any Republican plans that provide comparable coverage to the Health Care law and they repeatedly tried to hammer home that point one after another. Congressman Eliot Engle who is a New York Democrat urged lawmakers to pass legislation if the court rules against the administration to make sure that people can continue to get affordable coverage through the health exchange. He said that’s what Democrats intended and congressman Kurt Schrader of Oregon also said he thinks its ironic that Republicans keep asking for the administration’s contingency plans for the case, but he thinks it Congress’ responsibility and noted that the Republicans control both chambers of Congress right now.  Democrats also pointed out that Republicans are the ones supporting the lawsuit. Chairman Pitts of the health subcommittee for example is one of those who has signed on to a friend of the court brief in support of the challenge.

MARY AGNES CAREY:  Chairman Pitts also asked about an issue in California that deals with health insurers and abortion coverage. What’s happening there?

MELISSA ATTIAS:  Pitts said he was deeply concerned about a lack of HHS action in California, where there is a new policy for health plans to cover abortion. And Pitts said that policy is in violation of the Weldon amendment; that refers to an amendment that’s attached to annual spending bills and it bars funding for a federal agency or state or local government and I’m going to quote here and the quote is that : “Subjects any institutional or individual health entity to discrimination on the basis that the health care entity does not provide, pay for, provide coverage of or refer for abortion,.“ So Burwell said they have opened an investigation within the office for civil rights and that they take the issue seriously. The issue also came up at a house appropriations sub-committee hearing yesterday.

MARY AGNES CAREY: I want to ask you about another item that came up at the hearing I know it’s on your radar screen. We’ve talked about it before.  This is the sustainable growth rate; the way Medicare pays physicians. The current formula expires at the end of March. What’s new there?

MELISSA ATTIAS: Lawmakers came up with a bipartisan compromise on the policy last year. But they weren’t able to find a way to pay for it, so they went with a patch as you mentioned which as you mentioned expires at the end of March.  The cost of the policy proposal recently went up by $30.5 billion earlier this month because the Congressional Budget Office added another year to the budget window compared to an estimate the Congressional Budget Office released in November. And the latest estimate is that the cost $174.5 billion from fiscal 2015 to 2025.  At the hearing Congressman Michael Burgess, who’s a Texas republican, said he’s looking at the Medicare changes President Obama proposes his budget for offsets.

MARY AGNES CAREY: Thank you Melissa Attias of CQ-Roll Call

MELISSA ATTIAS: Thanks for having me.

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