When Health and Human Services Secretary (HSS) Kathleen Sebelius announced her pending resignation earlier this year, President Obama nominated Sylvia Matthews Burwell, who currently serves as the head of the White House Office of Management and Budget (OMB), to be her replacement. A big part of the HHS job is working on the Affordable Care Act—a.k.a. Obamacare—and throughout her tenure, Sebelius has served as the public face of the president's health law.
Naturally, a lot of the questions surrounding Burwell's nomination, which recently passed a Senate Finance Committee vote and is widely expected to make it through the Senate confirmation process with relative ease, have focused on how she would continue implementation of the controversial health care overhaul.
We got some idea of how she'll answer those questions in a Senate hearing on her nomination earlier this month. We also got some additional sense of how she'll approach those issues from a on-paper follow up.
Following the hearing, Republican Sens. Mike Lee (Utah) and Ted Cruz (Texas) sent Burwell a list of pointed questions about the health care law and how Burwell would handle some of its most controversial provisions. Charging that Burwell had been "less than forthcoming" in her original testimony, Sens. Lee and Cruz asked about the law's potentially bailout-like risk-mitigation provisions, the details and current status of the administration's enrollment data, the role of the Independent Payment Advisory Board (IPAB), and the administration's legal authority to change the law.
Burwell offers some sort of response to all of the questions, but I doubt many people will find her follow-up answers much more forthcoming than her initial hearing responses. Burwell is often vague and doesn't directly address every query. Instead, she sticks pretty closely to the administration's standard line on every question and doesn't tell us much we don't already know.
Here's a brief summary of the question topics and Burwell's responses, followed by the original document with Burwell's full answers.
On Obamacare enrollment data—duplicates, non-payments, and the expansion of health coverage: Burwell cites statements from health insurers saying that 80-90 percent of sign-ups under the law have paid their premiums, but doesn't provide any additional data, saying that final information is not available yet. She does promise to make available "accurate and reliable data regarding premium payments" once federal health officials have it. She says duplicates are a non-issue, but also that HHS is still removing some from its lists. And she cites survey data from RAND and Gallup to suggest that Obamacare is helping to reduce the number of uninsured.
On the risk corridor program that has been dubbed a potential bailout for health insurers: Using language that is very similar to what appeared in a recent regulation, Burwell reiterates the administration's position that the risk corridors will be revenue neutral over the next three years. But she also says that, if they are not, then the HHS secretary is bound to make payments to insurers, and that HHS will do what is necessary to find another source of funding, if appropriations are available.
On the legal authority OMB relied on this year to make Obamacare's insurance subsidies not subject to the sequester—even though a previous OMB report said they should be: Burwell says that OMB decided to make the law's subsidies payable out of a different fund than initially planned, one that's not subject to sequester cuts.
On how she would handle IPAB—Obamacare's independent cost-containment board—as HHS secretary: Burwell does not respond directly to the letter's question about whether she'll commit to repealing the provision, but she says she share's IPAB's goal of protecting against excessive cost growth in Medicare and will work with Congress to make Medicare more efficient and sustainable.
On the administration's repeated delays of Obamacare's employer mandate, and whether she agrees with Hillary Clinton's 1993 statement that without the provision, many employers would cease offering coverage: Burwell doesn't really address the specific questions asked here, but instead restates the administration's vague commitments to "common sense" implementation, to making sure that "companies have clarity" about the law, and that "individuals who face hardships…have the flexibility and support they need."
On whether HHS will provide Congress with a list of Obamacare-participating health insurers who offer abortion coverage, and whether she thinks Americans "should be informed" about a plan's abortion coverage provisions prior to purchase: Burwell's answer here is extremely vague and doesn't address the questions directly. She says that Healthcare.gov already provides information to consumers, that plans have to provide an official benefits summary, and that if confirmed, she'll work to make sure consumers "have information regarding the coverage" they get under Obamacare.