[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
EXAMINING THE CONCERNS ABOUT OBAMACARE OUTREACH CAMPAIGN
=======================================================================
JOINT HEARING
before the
SUBCOMMITTEE ON ENERGY POLICY,
HEALTH CARE AND ENTITLEMENTS
and the
SUBCOMMITTEE ON ECONOMIC GROWTH,
JOB CREATION AND REGULATORY AFFAIRS
of the
COMMITTEE ON OVERSIGHT
AND GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
FIRST SESSION
__________
MAY 21, 2013
__________
Serial No. 113-39
__________
Printed for the use of the Committee on Oversight and Government Reform
Available via the World Wide Web: http://www.fdsys.gov
http://www.house.gov/reform
U.S. GOVERNMENT PRINTING OFFICE
82-107 WASHINGTON : 2013
-----------------------------------------------------------------------
For sale by the Superintendent of Documents, U.S. Government Printing
Office Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; DC
area (202) 512-1800 Fax: (202) 512-2104 Mail: Stop IDCC, Washington, DC
20402-0001
COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM
DARRELL E. ISSA, California, Chairman
JOHN L. MICA, Florida ELIJAH E. CUMMINGS, Maryland,
MICHAEL R. TURNER, Ohio Ranking Minority Member
JOHN J. DUNCAN, JR., Tennessee CAROLYN B. MALONEY, New York
PATRICK T. McHENRY, North Carolina ELEANOR HOLMES NORTON, District of
JIM JORDAN, Ohio Columbia
JASON CHAFFETZ, Utah JOHN F. TIERNEY, Massachusetts
TIM WALBERG, Michigan WM. LACY CLAY, Missouri
JAMES LANKFORD, Oklahoma STEPHEN F. LYNCH, Massachusetts
JUSTIN AMASH, Michigan JIM COOPER, Tennessee
PAUL A. GOSAR, Arizona GERALD E. CONNOLLY, Virginia
PATRICK MEEHAN, Pennsylvania JACKIE SPEIER, California
SCOTT DesJARLAIS, Tennessee MATTHEW A. CARTWRIGHT,
TREY GOWDY, South Carolina Pennsylvania
BLAKE FARENTHOLD, Texas MARK POCAN, Wisconsin
DOC HASTINGS, Washington TAMMY DUCKWORTH, Illinois
CYNTHIA M. LUMMIS, Wyoming ROBIN L. KELLY, Illinois
ROB WOODALL, Georgia DANNY K. DAVIS, Illinois
THOMAS MASSIE, Kentucky PETER WELCH, Vermont
DOUG COLLINS, Georgia TONY CARDENAS, California
MARK MEADOWS, North Carolina STEVEN A. HORSFORD, Nevada
KERRY L. BENTIVOLIO, Michigan MICHELLE LUJAN GRISHAM, New Mexico
RON DeSANTIS, Florida
Lawrence J. Brady, Staff Director
John D. Cuaderes, Deputy Staff Director
Stephen Castor, General Counsel
Linda A. Good, Chief Clerk
David Rapallo, Minority Staff Director
Subcommittee on Energy Policy, Health Care and Entitlements
JAMES LANKFORD, Oklahoma, Chairman
PATRICK T. McHENRY, North Carolina JACKIE SPEIER, California, Ranking
PAUL GOSAR, Arizona Minority Member
JIM JORDAN, Ohio ELEANOR HOLMES NORTON, District of
JASON CHAFFETZ, Utah Columbia
TIM WALBERG, Michigan JIM COOPER, Tennessee
PATRICK MEEHAN, Pennsylvania MATTHEW CARTWRIGHT, Pennsylvania
SCOTT DesJARLAIS, Tennessee TAMMY DUCKWORTH, Illinois
BLAKE FARENTHOLD, Texas DANNY K. DAVIS, Illinois
DOC HASTINGS, Washington TONY CARDENAS, California
ROB WOODALL, Georgia STEVEN A. HORSFORD, Nevada
THOMAS MASSIE, Kentucky MICHELLE LUJAN GRISHAM, New Mexico
Subcommittee on Economic Growth, Job Creation and Regulatory Affairs
JIM JORDAN, Ohio, Chairman
JOHN DUNCAN, Tennessee MATTHEW A. CARTWRIGHT,
PATRICK T. McHENRY, North Carolina Pennsylvania, Ranking Minority
PAUL GOSAR, Arizona Member
PATRICK MEEHAN, Pennsylvania TAMMY DUCKWORTH, Illinois
SCOTT DesJARLAIS, Tennessee GERALD E. CONNOLLY, Virginia
DOC HASTINGS, Washington MARK POCAN, Wisconsin
CYNTHIA LUMMIS, Wyoming DANNY K. DAVIS, Illinois
DOUG COLLINS, Georgia STEVEN A. HORSFORD, Nevada
MARK MEADOWS, North Carolina
KERRY BENTIVOLIO, Michigan
RON DeSantis Florida
C O N T E N T S
----------
Page
Hearing held on May 21, 2013..................................... 1
WITNESS
Mr. Gary Cohen, Deputy Administrator and Director, Center for
Consumer Information and Insurance Oversight, Centers for
Medicare and Medicaid Services
Oral Statement............................................... 7
Written Statement............................................ 9
APPENDIX
Questions for Mr. Gary Cohen from Chairmen James Lankford and Jim
Jordan......................................................... 58
EXAMINING THE CONCERNS ABOUT OBAMACARE OUTREACH CAMPAIGN
----------
Tuesday, May 21, 2013,
House of Representatives,
Subcommittee on Energy Policy, Health Care &
Entitlements, joint with the Subcommittee on
Economic Growth, Job Creation and Regulatory
Affairs
Committee on Oversight and Government Reform,
Washington, D.C.
The subcommittees met, pursuant to call, at 10:09 a.m., in
Room 2154, Rayburn House Office Building, Hon. Jim Jordan
[chairman of the Subcommittee on Economic Growth, Job Creation
and Regulatory Affairs] presiding.
Present from Subcommittee on Energy Policy, Health Care &
Entitlements: Representatives Lankford, Gosar, McHenry, Jordan,
Walberg, DesJarlais, Woodall, Speier, Norton, Cartwright,
Duckworth, Cardenas, Lujan Grisham, and Horsford.
Present from Subcommittee on Economic Growth, Job Creation
and Regulatory Affairs: Representatives Jordan, DeSantis,
Duncan, McHenry, Gosar, DesJarlais, Collins, Meadows,
Bentivolio, Cartwright, Duckworth, Connolly, Pocan, Kelly, and
Horsford.
Also Present: Representative Cummings.
Staff Present: Ali Ahmad, Majority Communications Advisor;
Alexia Ardolina, Majority Assistant Clerk; Brian Blase,
Majority Senior Professional Staff Member; Molly Boyl, Majority
Parliamentarian; Caitlin Carroll, Majority Deputy Press
Secretary; Katelyn E. Christ, Majority Professional Staff
Member; Drew Colliatie, Majority Professional Staff Member;
Gwen D'Luzansky, Majority Professional Staff Member; Adam P.
Fromm, Majority Director of Member Services and Committee
Operations; Linda Good, Majority Chief Clerk; Meinan Goto,
Majority Professional Staff Member; Tyler Grimm, Majority
Professional Staff Member; Mark D. Marin, Majority Director of
Oversight; Emily Martin, Majority Professional Staff Member;
Tegan Millspaw, Majority Professional Staff Member; Scott
Schmidt, Majority Deputy Director of Digital Strategy; Sharon
Meredith Utz, Majority Professional Staff Member; Jaron Bourke,
Minority Director of Administration; Yvette Cravens, Minority
Counsel; Devon Hill, Minority Research Assistant; Jennifer
Hoffman, Minority Press Secretary; Nicholas Kamau, Minority
Counsel; Una Lee, Minority Counsel; Jason Powell, Minority
Senior Counsel; Brian Quinn, Minority Counsel; and Rory
Sheehan, Minority New Media Press Secretary.
Mr. Jordan. The committee will come to order. We want to
welcome folks today.
Mr. Cohen, we will get to you in just a second, but you
know how it works: you have to listen to us first, then we get
to you. So we will do our opening statements.
And Mr. Lankford is on his way and Mr. Cartwright is on his
way, but, in the interest of time, we will get started.
There is a lot we don't know about Obamacare, but the more
we learn, the worse the law seems. We know that Obamacare
remains unpopular. We know that it has sparked considerable
confusion and certainly uncertainty. Frankly, I spoke to
business people yesterday in our district and this was one of
the main topics we talked about. We know that many businesses
are refusing to hire and expand because of the law.
Now the Administration wants to spend billions of dollars
promoting the law, money that would be much better spent on
patient care or something else. If it is so good, why does the
Administration have to spend so much money in advertising?
Because of Obamacare's complicated mix of regulation, taxes,
subsidies, and mandates, premiums for relatively young and
healthy people are projected to spike next year. For millions
of these individuals, premiums will increase by 50 percent or
more, and, of course, lots of these young people are currently
paying lower rates, the very groups of individuals that the
Administration, through navigators and assisters, most wants to
enroll in the exchanges.
The increased premiums will make millions of Americans
worse off. Other individuals will only be applying for
insurance and exchanges because of Obamacare's expensive
subsidies, which will greatly exacerbate Federal deficits
beginning next year.
CBO estimates that the law will cost $1.8 trillion over the
next 10 years, a price tag that seems to rise each year.
We know that there is a major problem in California. The
California State legislature decided to conceal spending on all
of its exchange contracts, including funding for the State's
Assisters Program. This means Federal taxpayers won't have
knowledge of how California is spending hundreds of millions of
their dollars.
In addition to all the funding, training, and oversight
concerns about navigators and assisters, the overreach of the
Administration in its overall implementation efforts is also
stunning. For example, Congress has denied Health and Human
Services Secretary Kathleen Sebelius several additional
requests for pouring more taxpayer money into the law, so the
Secretary has taken money, in many cases, without clear legal
authority from different sources to fund Obamacare.
HHS officials admitted to this committee that the Secretary
lacks legal authority for this Assisters Program, a program
created solely to get around Obamacare's explicit prohibition
on using State-established grants to fund navigators in
exchanges established by those States.
The Secretary has failed to respond to an April 19th, 2013,
letter from the committee relating to the Secretary's
transferring of funds for Obamacare implementation. More
recently, however, is the Secretary's brazen fundraising push,
despite Federal ethics regulations forbidding any department
official from fundraising in a professional capacity.
Recent reports indicate that the Secretary has placed
multiple phone calls to help insurance, pharmaceutical, and
hospital executives over the past three months, asking them to
contribute money to nonprofits leading Obamacare outreach
efforts. One such organization, Enroll America, a spinoff of
Families USA, which lobbied strongly for the passage of the
law, HHS actions to elicit donations on behalf of organizations
connected to the Administration are even more troubling.
Finally, in light of the revelation of IRS's targeting of
conservative groups applying for tax-exempt status, it is
crucial for the American people to understand that Obamacare
tasks the IRS with enforcing nearly 20 new tax laws. It is
amazing to me. The very organization who is charged with
enforcing Obamacare was systematically targeting conservative
groups who came into existence because they opposed Obamacare,
and it was targeting them for over a two year time period.
It is also important to remember that the IRS is building
the largest personal information data hub the Federal
Government has ever attempted. The IRS has a central role in
Obamacare's very complicated subsidy scheme. According to
Treasury's own analysts, many taxpayers who do everything right
will still face significant harm from the scheme. According to
the Taxpayer Advocate, taxpayers who did not update their
household information during the year, such as income, marital
status, change in family size, or receipt of employer-sponsored
insurance, may find that they owe a significant amount of money
at the end of the year, money they likely do not have.
In fact, the IRSs role in enforcing Obamacare is tied with
the Navigator and Assister Program. If navigators and assisters
incorrectly fill out people's health insurance applications and
individuals receive subsidies to which they were not entitled,
then the IRS will go after the individuals for the overpayment.
The insurance companies who receive the overpayment and the
navigators or assisters who provided the bad advice won't face
any harm.
With less than four months to go before the launch of the
health care insurance exchanges, we must focus on what can be
done to save our health care system from the huge train wreck
that Obamacare implementation has become.
I hope, Mr. Cohen, that you can tell us that the Health and
Human Services has given much greater thought to the navigator
and assister rule, and will issue a final rule that is
consistent with statutory authority which protects consumers
and which increases standards for navigators.
With that, I would yield to the gentlelady from the
District of Columbia, Ms. Norton.
Ms. Norton. Thank you very much, Mr. Chairman. I must take
exception to your attempt to link the Affordable Health Care
Act with the present investigation of IRS. To say that is a
stretch is to give you too much credit.
I thank the members and our witnesses, Mr. Cohen, who is
before us now.
Until recently, I had thought that one of the major
differences between the Banana Republics and other pseudo-
democracies was that in this Country, once a law was passed or
once the Supreme Court has spoken, the law was the law and the
law was carried out. This has been always, until now, a Country
where respect for law and the rule of law was unquestioned,
even when our side lost a particular bout or a particular round
and a law came forward with which we disagreed. The nature of
democracy is you implement the law that has been passed by the
majority.
Now, last summer, the Supreme Court ruled, and on this
question the Supreme Court is the law of the land, and they
ruled that the Affordable Health Care Act was constitutional,
and there was no question that this was the law of the land. Of
course, that is very good news for millions of Americans who
don't have health insurance and every day are getting access to
health insurance.
But the Republican majority is still fighting the
Affordable Health Care Act as if it were not the law of the
land and if they had not taken an oath to uphold the law of the
land, whatever that law was. Just last week, I am not sure
whether it is because they have no agenda whatsoever for the
113th Congress and they needed something to fill the time, but
they passed, once again, the 37th repeal of the Affordable
Health Care Act, to giggles and scorns throughout the United
States.
You keep that up, and more and more no one takes you
seriously as a legislature.
Like that vote, today's hearing is merely an attempt to
obstruct the law and the rights of American citizens to health
insurance. It is time to assure that the law of the land is
carried out effectively and efficiently, instead of trying to
undermine the law of the land as if this were not a democracy.
Congress intended that consumers receive assistance and
information in the process of enrolling in the new health care
options. After all, this is a new law, an unprecedented law.
Accordingly, the Navigator Program was created by Congress to
serve as a tool to help educate and enroll citizens. The reason
for the Navigator Program is simple: reducing health care
costs, which I had assumed everyone wanted to do, requires that
everyone be covered; that everyone be in the insurance pool.
Navigators are helping people to get health care coverage, some
for the first time in their lives, and in the process lower
health care costs for everyone in the Nation. The more people
in the pool, the less health care costs everybody in the United
States.
Furthermore, the model for the enrollment efforts of the
Affordable Care Act is very well established. Much the same
model was used more than two decades ago to implement the State
Children's Health Insurance Program. In some States an
enrollment assister, as she is called, helped consumers enroll,
just like Congress intended for the health exchanges created
through the Affordable Health Care Act.
As of today, not a single grant application for the
Navigator Program has been reviewed and no grants have been
awarded as of yet. It is, therefore, premature to say much of
anything about what the program is doing. I hope that we can
avoid speculating about the worst case scenarios that haven't
happened and will sincerely work toward the efficient and
effective implementation of health care that lowers health care
costs for us all.
That is within our reach if we will fulfill what Congress
intended in passing the Affordable Health Care Act and, I might
add, what the law now demands for everyone who took the oath to
uphold the law as a member of the United States Congress, and I
yield back.
Mr. Jordan. I thank the gentlelady.
We now turn to the chairman of the committee, and let me
just say I am sure, on behalf of the whole committee, we are
certainly thinking about the folks in Oklahoma, in your
district and surrounding areas, and praying for all that they
have to deal with and what you are dealing with as a member.
So we now recognize the chairman, Mr. Lankford.
Mr. Lankford. Thanks, Jim.
And thank you, so many people that have prayed for us for
what is going on in Oklahoma right now. These are incredibly
difficult days for a lot of families there.
Last month, my subcommittee held a hearing on key problems
in America's health care system. We heard testimony about the
lack of transparency in competition in health care markets,
about widespread medical errors, and about rising health care
costs. Four years ago, Congress created the Affordable Care Act
to attempt to resolve these issues. I strongly believe that the
Affordable Care Act actually creates more problems than it
solves, and I want to do everything that I can to protect the
people in my district from the harmful effects of this law.
But it is the law of the land and the implementation is
beginning. Congress has an important oversight role to ensure
the Administration follows the law during its implementation
efforts and that implementation harms as few people as
possible.
Obamacare requires that exchanges make grants to at least
two organizations in each State with a Federal exchange to
serve as a so-called navigator, an entity responsible for
finding people without insurance and encouraging them to sign
up. However, Obamacare explicitly prohibited State-based
exchanges from using Federal grants for navigators.
Now we understand that a twin program, called In-Person
Assisters, has been created by HHS funded with Federal grants.
In fact, during a briefing last month, HHS officials confessed
to Republican and Democratic staff that there is no statutory
authority for the Assisters Program.
On April 19th and May the 6th, Chairman Issa, Chairman
Jordan, and myself sent letters to Secretary Sebelius outlining
many of our significant concerns with the agency's plans for
these outreach programs. We still have many unanswered
questions. Our letter still has not been responded to.
Has HHS mandated a criteria for individuals who can be
navigators or assisters? For instance, could felons,
individuals convicted of identity theft, high school dropouts
be navigators and handle sensitive and personal information?
Is there an expectation that a navigator or an assister
applicant will have any prior knowledge about the functioning
of health insurance markets? Currently, the training for
navigators and assisters will only be 20 to 30 hours of online
training and will contain tests after each module that can be
taken an unlimited number of times.
Has HHS developed an oversight plan? For instance, are
there plans to check with individual navigators or assisters to
evaluate their job performance? What if there are reports of
misconduct and wrongdoing of individual navigators or
assisters?
There are conflicting reports if the State requirements for
licensing will apply to navigators. It is also uncertain if
they will have to carry errors and omissions insurance. It is
even uncertain if navigators will face any consequences if they
give wrong tax or insurance advice, since they will be dealing
with specific tax references that will apply to their next
year's tax.
There are also media reports that the director of HHS has
made calls to solicit health insurance executives,
pharmaceutical executives, and hospitals to donate large sums
to nonprofits responsible for the Obamacare outreach efforts.
According to The New York Times, several executives said they
were uncomfortable with the discussions because the Federal
Government has the power to approve or reject the health plans
they want to sell in insurance markets that will be run by the
Federal officials in more than 30 States. These actions unduly
pressure private companies to financially support
implementation and promotion efforts, fearing retribution from
the Department of Health and Human Services if they do not
contribute to organizations like Enroll America.
With the October 1 enrollment period looming, these
problems must be addressed now. The Administration must assure
us that individuals facing financial security will be protected
and that taxpayer dollars will not be abused during the
implementation of this law, and the Secretary must stop using
unethical, if maybe not illegal, we don't know yet, methods to
fund the law's implementation.
I look forward to hearing from our witnesses and further
discussing our concerns.
Thank you, Chairman Jordan.
Mr. Jordan. I thank the chairman.
All right, Mr. Cohen, you are up. Mr. Cohen is Deputy
Administrator and Director for the Center of Consumer
Information and Insurance Oversight at the Centers for Medicare
and Medicaid Services. Just like government to have that long
title there, Mr. Cohen. We appreciate you being here. We swear
folks in at this committee, so if you will stand up, raise your
right hand.
Do you solemnly swear or affirm that the testimony you are
about to give will be the truth, the whole truth, and nothing
but the truth, so help you, God?
[Witness responds in the affirmative.]
Mr. Jordan. Let the record show the gentleman answered in
the affirmative.
You are now recognized for five minutes. You know how this
works. You have the lighting system in front of you. Make sure
you pull the mic close and fire away.
WITNESS STATEMENT
STATEMENT OF GARY COHEN
Mr. Cohen. Thank you, Chairman Jordan, Chairman Lankford.
On behalf of everyone at CMS, Mr. Lankford, we certainly send
our thoughts to the people in Oklahoma at this difficult time
and certainly will do anything that we can to help out in that
difficult situation.
Thank you for the opportunity to discuss the CMS Navigator
Program today. Before I begin, I want to note that we have
received the letter from the chairs of the subcommittees and
are working to provide you and your staff with the information
you have requested as quickly as possible.
Over 40 million of our fellow citizens and neighbors live
daily with the insecurity of not knowing how they will pay for
the medical care which they and their families need. The
uninsured are one diagnosis away from medical bankruptcy. They
often do not receive the preventive care and early diagnosis
and treatment that are associated with better outcomes and
lower costs. When the uninsured do seek treatment, it is all
too often at the emergency room, and every American business
and taxpayer helps pay for the uncompensated care that is
provided there.
The new health insurance marketplaces will fundamentally
change that reality for these Americans. The marketplaces are
precisely what the name describes: a place where consumers and
businesses can find health coverage options. Consumers will be
able to compare costs, benefits, and cost-sharing in order to
choose a plan that is right for them, their families, and their
employees. If eligible, consumers and businesses will be able
to receive help in paying the premiums through premium tax
credits that lower the cost of premiums right away, cost-
sharing reductions, or a small business health care tax credit.
Ensuring that consumers and businesses participate in the
marketplaces requires, of course, that they learn about the
benefits that these marketplaces have to offer and that they
get the help they need in order to take advantage of those
benefits. This is a significant undertaking.
We know quite a bit about the uninsured Americans we need
to reach. Many currently do not have health insurance, so the
transaction of selecting, applying, and enrolling in health
coverage may be unfamiliar to them.
Twenty percent of the uninsured have not completed high
school and nearly 10 percent live in a household that does not
have an English-speaking adult. To inform these people about
their new health insurance options, information must be
provided by people connected to the community in a way that
they can understand.
The existing insurance market clearly has not served these
millions of Americans well. So while we know that more
traditional ways of reaching them, such as the marketing
efforts that insurance companies and agents and brokers will be
doing will be important, we also know that we need members of
the community to speak neighbor to neighbor to get the word
out.
For that reason, the Affordable Care Act authorizes, and
CMS is implementing, a variety of ways to provide outreach,
education, and enrollment assistance to the uninsured. The
Navigator and In-Person Assistance Programs will help Americans
enroll in affordable, high-quality coverage beginning on
October 1. These programs provide funding for trained helpers
who must maintain expertise in eligibility enrollment and
program specifics; raise public awareness about the
marketplace; provide consumer-focused information and services
in an easy to understand, fair, accurate, and impartial manner;
and help people enroll in a qualified health plan through the
marketplace.
On October 9, CMS published a funding opportunity
announcement that uses cooperative agreements to fund
navigators in federally-facilitated or State partnership
marketplaces. Applications are due on June 7. I am pleased to
report that we have received over 830 optional letters of
intent from a variety of organizations. We expect to receive a
similarly robust number of applications for the Navigator
cooperative agreements by the June due date. This high level of
interest and the competitive application process will ensure
that only the most qualified individuals and organizations will
be selected to participate as navigators.
The application process to become a navigator is rigorous
and extensive. Applicants must provide detailed information
about how they plan to perform the navigator duties, their
estimated budget, their track record and accomplishments, and
the expertise of their personnel. Applications will be scored
by an expert objective review panel and screened by our grant
managers to ensure that applicants have the business management
capability to successfully perform these duties, and that their
proposed budget is allowable and reasonable.
Once the successful applicants are chosen, navigators must
complete a 20-to 30-hour long training program and must pass an
exam prior to beginning to help consumers. Grantees will be
monitored by CMS based on their quarterly financial and
progress reports to make sure they are meeting the program's
goals, as well as its terms and conditions. CMS may terminate
any award for violation of the terms and conditions of the
award, including failure to perform award activities in a
satisfactory manner; improper management or use of award funds;
or fraud, waste, abuse, management or criminal activity.
HHS awards grants for more than 300 programs, including
consumer outreach and education programs, such as the State
Health Insurance Assistance Program for Medicare beneficiaries,
the nationwide Senior Medicare Patrols Program, and the
Connecting Kids to Coverage Program. The Navigator Program
follows this tradition of responsible grant-making for consumer
education for newly developed marketplaces. We are confident
that the Navigator and State-based In-Person Assistance
Programs will provide consumers with the high quality help they
need as they consider their health coverage options.
I appreciate the subcommittees' interest in this program
and would be happy to answer your questions.
[Prepared statement of Mr. Cohen follows:]
[GRAPHIC] [TIFF OMITTED] 82107.001
[GRAPHIC] [TIFF OMITTED] 82107.002
[GRAPHIC] [TIFF OMITTED] 82107.003
[GRAPHIC] [TIFF OMITTED] 82107.004
[GRAPHIC] [TIFF OMITTED] 82107.005
[GRAPHIC] [TIFF OMITTED] 82107.006
[GRAPHIC] [TIFF OMITTED] 82107.007
[GRAPHIC] [TIFF OMITTED] 82107.008
[GRAPHIC] [TIFF OMITTED] 82107.009
[GRAPHIC] [TIFF OMITTED] 82107.010
[GRAPHIC] [TIFF OMITTED] 82107.011
Mr. Jordan. Thank you, Mr. Cohen. Forty seconds to spare.
We appreciate that.
The gentleman from Oklahoma is recognized for five minutes.
Mr. Lankford. Mr. Cohen, thank you for being here, and this
is a brand new program, so we will have additional questions as
you are pulling this together, and the CMS team and HHS, and
for us, as well, as we are trying to oversee it and understand
it a little bit more.
What is the difference between a navigator and an assister?
Mr. Cohen. The functions are essentially the same. The
difference is that we really responded to requests from a
number of States, recognizing that they have to have a
Navigator Program that cannot be funded from Federal grant
funds.
Mr. Lankford. Right.
Mr. Cohen. But in the first year of the program they also
have an obligation, that is in the statute, to provide outreach
and assistance to help people get enrolled, and in the first
year of the program they don't have a funding source, which
will come into place through user fees and so forth once the
program is operational.
Mr. Lankford. So is there a statutory authority, then, to
create this State-based Navigator Program?
Mr. Cohen. The statutory authority is the requirement in
the Affordable Care Act that State-based exchanges and all
exchanges provide outreach and education and enrollment
assistance to people.
Mr. Lankford. So you make an assumption that because the
law says you need to have this, even though the law
specifically states that only navigators go to Federal
exchanges, you just assume they wrote the bill wrong and they
meant you should also have this other program? Because I am
trying to figure out the statutory authority to it. And I hear
the assumption that you assume they are going to do it, and
States like California, Colorado, this past week came up and
said, hey, we don't have near enough money to be able to do
this, asked for another $14 million just for their Assister and
Navigator Programs; say we were promised enough, this is not
enough. I get their frustration in trying to implement the law,
I am just trying to figure out the statutory authority of
creating a program that the law specifically says you just do
this.
Mr. Cohen. Well, the In-Person Assister Program is a
program that is separate from the Navigator Program, it is a
transitional program.
Mr. Lankford. But it is pretty much the same.
Mr. Cohen. The function that the people will be performing
is very much the same.
Mr. Lankford. So is there a reason you wouldn't call it
State navigators and Federal navigators, just use the same
term; these are State-funded navigators or these are Federal-
funded navigators?
Mr. Cohen. Well, State-based marketplaces are required to
have a Navigator Program that they fund. But as a transitional
program during the establishment of the exchanges, only in the
first year and before they are financially sustainable, States
came to us and said----
Mr. Lankford. We don't have enough money.
Mr. Cohen. That is right.
Mr. Lankford. Okay. We will have some follow-up on that.
You mentioned in your opening statement about only the most
qualified will be the individuals in there. I assume that you
are requiring some basic background checks, that you are
requiring some of the things to be able to prove these are only
the most qualified. These will be folks that will have some
familiarity with health care in the background or insurance in
the background; they have gone through a background check; they
have gone through a fingerprinting, you know that? Is that my
assumption as well?
Mr. Cohen. So I think if you look at the funding
opportunity announcement you will see that the successful
applicants will demonstrate both a past history of knowledge
and expertise in this area and a track record of working in the
community successfully in this area, as well as----
Mr. Lankford. So a background in health care or a
background in insurance, as well as a connection with the
community?
Mr. Cohen. One of the requirements that will be scored in
the grant selection process is showing expertise in the private
health insurance market----
Mr. Lankford. I am sorry, Mr. Cohen, I don't mean to
interrupt. That is for the organization. What about for the
individuals that are actually going to be the navigators on the
ground? Will there be a background check; will there be a
requirement of competence beyond the 20 or 30 hours of online
training?
Mr. Cohen. We have left the States' flexibility to
determine what specific checks need to be made on the
individuals who will be performing this function.
Mr. Lankford. So can the State, then, require to have a
licensing as well?
Mr. Cohen. What we have said is that State licensing is
permitted. The only thing that is not permitted is requiring an
agent broker license.
Mr. Lankford. Would they be required like many States, my
State included, that they have errors and omissions insurance
if you are handling insurance information? So if they give
someone bad advice, for instance, if they are going to advise
them, say, here is how much your subsidy is, but if they
punched it in wrong, next year that individual is going to get
a huge tax bill. So this person is giving tax advice at their
door, basically, as well as health care advice. Will there be
some errors and omissions insurance required; will that be
allowed by States as well?
Mr. Cohen. So I actually don't think that navigators are
going to be giving tax advice, Congressman. I think that is
really kind of a misconception of their role.
Mr. Lankford. Will they help determine are you eligible for
the subsidy?
Mr. Cohen. No, they will not. That will be determined
through the application process that each person will have to
go through, where they enter certain information about their
financial situation, and the navigator will help them to do
that, but the navigator is not going to be giving them tax
advice.
Mr. Lankford. Can I ask just a quick question, as well, on
the background? Would you assume that the individuals that are
navigators that have access to Social Security numbers, private
health care information as far as their insurance companies and
such, they would have the same standards as census workers, for
instance, that are doing a headcount in the house? They are
going to walk away with an awful lot of private information
when they walk away from this door, so would they have the same
standards as a census worker?
Mr. Cohen. So I would make two points. First of all, they
won't walk away with any private information. The private
information will be entered through the application process,
but the navigators are specifically going to be trained and
directed not to retain any private information.
Mr. Lankford. So is there any way to verify that? I get
that is the desire, but there has to be a verification that
they are not walking away with a pretty big database of that
community.
Mr. Cohen. Sure. And we will be doing an oversight process
and it is punishable by a fine of up to $25,000 if you steal
somebody's personal information, so it is a pretty significant
thing. But the other thing I would say, Congressman, is I think
that these folks are going to be comparable to what we have
seen for many, many years in the State Medicare programs, where
they have had people who have assisted in getting folks
enrolled. It has been extremely successful in the CHIP program,
where they have had people who have helped getting people
enrolled, and I am not aware of any problems that have occurred
in those programs in terms of the kind of thing that you are
mentioning, so I don't expect we will see them here.
Mr. Lankford. Well, I am going to yield back, but I can say
in my State there is already some questions about licensing and
brokers, errors and omissions insurance, and all those things
that we assume are going to be a part of this that are in our
State law that now we feel like we are getting some push-back
on to say, no, you will have your group and we will have our
group, and though they are handling insurance they really are
not handling insurance. So there will be some questions and we
have to figure out the process on that. The letter that we sent
to you a while back, some of those details will actually help
us to be able to get some of the information as well.
I yield back.
Mr. Jordan. I thank the gentleman.
The gentlelady from the District of Columbia is recognized.
Ms. Norton. Thank you, Mr. Chairman.
I would like, Mr. Cohen, to see if we can put what you are
doing in some context. One would think this is an unprecedented
program, but you just mentioned some of the programs that
required outreach in the past. Many of us are familiar, of
course, with the Children's Health Insurance Program, Medicare
Part C and Part D. Were these in any way models for Navigator?
Is there something different between the outreach that was used
for Medicare C and D or S-CHIP and what you are doing now?
Mr. Cohen. I think we definitely tried to learn lessons
from those previous programs and, as you know, since TRIPA was
enacted, for example, CMS has given out grants to over 100
grantees, including schools, community organizations, provider
groups, faith-based organizations, tribal entities, and so
forth, to help kids get enrolled in that program. The same
thing is true of the State programs to help people get enrolled
in Medicare. And we looked at all those different programs. I
actually think that what we are doing with the Navigator is at
least as rigorous, or more, of an application process and a
review process has been true in those programs.
Ms. Norton. Well, out of those programs, since these
programs go back some years, have there been a set of best
practices that have informed how you have created the Navigator
Program?
Mr. Cohen. Exactly. That is right. And we know that
community-based application assistance itself is a best
practice when it comes to helping people to get enrolled in
programs such as Medicaid and in CHIP and in Medicare. Person-
to-person assistance delivered by trusted individuals is really
the best way. So this is not a bunch of people from Washington
flying in to tell people this is what you ought to do; this is
people in the community who have a history in the community,
are trusted in the community, who are going to be providing
this assistance.
Ms. Norton. But apparently there are two entities who are
navigators in each marketplace, one is consumer-based off a
nonprofit. Would you tell us about this two-layered approach?
What is the difference between the navigators?
Mr. Cohen. I think that what the statute contemplates is
that at least one of the two navigators that is required to be
in each State be a nonprofit consumer group and then the other
can be something else.
Ms. Norton. For example?
Mr. Cohen. It could be a hospital; it could be a labor
union; it could be a Native American tribe. There are a variety
of different types of organizations that serve the community
that would qualify.
Ms. Norton. So the two-layered approach is necessary for
what reason?
Mr. Cohen. I think it is just to ensure that we have a
variety of different types of organizations. Of course, anyone
serving as a navigator may not have any sort of conflict of
interest or financial benefit from the insurance industry, so
that applies across the board. But I think the idea was to make
sure that there would be at least one group that had a history
of serving consumers in that community.
Ms. Norton. Well, that, I applaud you for. Instead of using
only, pardon the pejorative, bureaucrats, you are also using
people from the community, training them and sending them into
the community with the right kind of best practices background.
Thank you very much, and I yield back.
Mr. Jordan. I thank the gentlelady.
Now recognize the gentleman from Florida, Mr. DeSantis.
Mr. DeSantis. Thank you, Mr. Chairman.
Thank you, Mr. Cohen. Just to go back to the gentleman from
Oklahoma, when he asked you about statutory authority for the
assisters, was your answer that, yes, there is statutory
authority or no, there is not explicit statutory authority?
Mr. Cohen. There is statutory authority because the statute
requires that exchanges provide outreach education and
enrollment assistance to consumers. That is the statutory
authority. That is the function that has to be performed by the
exchanges.
Mr. DeSantis. So when the HHS folks briefed the committee
staff and they said there was not statutory authority, they
were incorrect?
Mr. Cohen. Well, I wasn't there, so I can't speak to what
they said or didn't say, or what folks heard or didn't hear.
But I'm telling you_
Mr. DeSantis. Well, if they said that, I am asking you if
they said that, they would have just been mistaken and not
understood the law, correct?
Mr. Cohen. We have statutory authority for the In-Person
Assister Program, yes.
Mr. DeSantis. Okay, now, in terms of the goal, as I read
the statute, that these navigators are supposed to provide
fair, impartial, and accurate information about this program,
correct?
Mr. Cohen. Yes.
Mr. DeSantis. And so, for example, California, they are now
trying to develop a system where they are paying these
navigators per enrollment, and they say the reason for that is
they want to incentivize enrollment. But if there is a conflict
between incentivizing enrollment and providing fair and
accurate information, the navigator would have to provide fair
information, even if it may lead somebody to not enroll,
correct?
Mr. Cohen. They have to provide fair and accurate and
impartial information, yes, regardless of what the decision is.
Mr. DeSantis. Right. So, for example, the way the law is
structured, you have this tax or mandate that applies to folks
who do not get insurance, but then you also have a must-issue
provision so that if people do develop a condition, they still
will get insurance issued to them. And I think the cost for an
individual is about $95 in 2014 for those who choose not to get
insurance.
So my question for you is will navigators be required to
inform applicants that their failure to purchase insurance will
lead, in some instances, to a penalty that is actually cheaper
than the cost out of pocket to them to maintain insurance?
Mr. Cohen. Navigators would be required to provide
accurate, fair, impartial, and truthful information with
respect to all aspects of this, including the potential
penalties.
Mr. DeSantis. So they would have a duty to affirmatively
provide this information.
Mr. Cohen. Well, ordinarily, people that navigators will be
dealing with are going to be people who want health insurance
coverage; that is why they are going to find their way to a
navigator. So I don't know that they are going to say to every
person who comes in the door, well, if you don't get health
insurance, you might have to pay a penalty of $95. But if they
are asked a question, they will give a truthful, accurate
answer to the question.
Mr. DeSantis. Well, in California they are doing this to
try to incentivize it, so they must feel that there will be
some folks that they are trying to reach who are not going to
be actively seeking it. So will navigators be required to tell
individuals that they can wait until they develop a condition
or get sick to purchase insurance without facing a financial
penalty?
Mr. Cohen. Well, that would be inaccurate because the
people will only be able to sign up for insurance during an
open enrollment period, just as is true of the market today.
Mr. DeSantis. Well, how does that work? So if I have a job
and I have insurance, and I have a preexisting condition and I
lose my insurance or I find myself developing a condition
through no fault of my own, I would actually have to wait? I
thought this law provided for coverage for preexisting
conditions? That was one of the main things that I heard. So
there may be people, through no fault of their own, who are
having to wait until an enrollment period, which could be six,
eight, ten months.
Mr. Cohen. Well, I think you have confused a couple
different things. There are circumstances in which what is
called a special enrollment period. This is the same as in the
market today, nothing different. If you lose your job, for
example, and you lose your coverage through your employer, then
you would have an opportunity to get enrolled and coverage on
an individual basis.
But normally, without some event happening that allows you
to have a special enrollment period, the open enrollment period
for the first year will run from October through March, and
then there will be an open enrollment period in subsequent
years, just as there is today. And you are right that when you
go to enroll in coverage, the law says that insurers may not
decline to give you coverage because you have a preexisting
condition, but that doesn't mean that you can wait until you
get sick and then sign up. You are taking a risk if you don't
sign up during an open enrollment period that you may get sick
and may not be able to sign up until the next open enrollment
period.
Mr. DeSantis. Or if you don't qualify for one of the
special enrollment, even if you are not trying to game the
system.
Mr. Cohen. That is true.
Mr. DeSantis. You would be in a tough situation there.
Okay, well, thank you, Mr. Cohen.
I yield back the balance of my time.
Mr. Jordan. I thank the gentleman.
I now recognize the ranking member, Mr. Cartwright.
Mr. Cartwright. Thank you, Mr. Chairman.
And thank you, Mr. Cohen, for coming here today and sharing
your thoughts with us. I think by now everybody understands the
way insurance works. The more people who are in the pool, the
more diversified the pool, the lower the costs are for
everybody. And the same basic principle applies to health
insurance; the more people who are enrolled in health
exchanges, the lower the cost is going to be for health care
for everybody. Is that a fair statement, Mr. Cohen?
Mr. Cohen. It is a fair statement. And I would add one more
thing. Because, if people show up at an emergency room without
health coverage, they may get treated anyway, and so there is a
lot of uncompensated care. So we have an additional problem in
addition to the one that you have identified. We have an
additional problem that we are paying for a lot of this
uncompensated care today that isn't covered by insurance.
Mr. Cartwright. So the more successful the Navigator
Program is, the more people are going to be enrolled and the
lower the cost of health care is going to be for everybody in
the Nation. Isn't it true that the navigators are going to help
assist people who might otherwise not know about how to enroll
in the health exchanges?
Mr. Cohen. Exactly right.
Mr. Cartwright. Now, isn't it also true that more people
are going to enroll in the health exchanges due to the work of
the navigators than would otherwise enroll if Congress had not
created the navigator function, Mr. Cohen?
Mr. Cohen. That is true. And we know that particularly from
our experience with Medicare and Medicaid and CHIP that that is
true.
Mr. Cartwright. That is they don't know about the program,
they are just not going to enroll in it.
Mr. Cohen. Right.
Mr. Cartwright. And we are talking about people, a majority
of whom were previously uninsured, is that correct?
Mr. Cohen. Yes.
Mr. Cartwright. So these are people that kind of could use
some guidance on how to sign up for health insurance, right?
Mr. Cohen. That is right.
Mr. Cartwright. Now, Mr. Chairman, I think it is pretty
obvious that what is happening here at this hearing is by going
after this Navigator Program, the majority is really attacking
both the new access to health insurance coverage for millions
of previously uninsured Americans thanks to the Affordable Care
Act and lower health insurance costs that everybody is going to
enjoy in this Nation once the health exchanges extend coverage
to everybody eligible under the law.
Now, Mr. Cohen, I want to ask you a study by the Kaiser
Family Foundation estimated that 65 percent of the people
enrolling through an exchange will have been previously
uninsured. Is that correct?
Mr. Cohen. Yes, I am familiar with that.
Mr. Cartwright. Have you seen that figure?
Mr. Cohen. I have.
Mr. Cartwright. And many individuals who are now eligible
for health insurance are unaware of what a health exchange is
and how it can benefit them. For these individuals, how
important is it that we do outreach and education activities?
Mr. Cohen. I think it is extremely important, and I think
it is important that we do it in a variety of different ways
that reflect the great diversity of this Country and the
different kinds of people who live in it, and that we make sure
we target as carefully as possible so that we reach as many as
possible.
Mr. Cartwright. Now, is it safe to say that many of these
previously uninsured individuals who will now have access to
health care coverage are unfamiliar with the terms and options
that they will need to get through when seeking coverage?
Mr. Cohen. I think that is true.
Mr. Cartwright. And some of these consumers may have other
individual limitations which make it particularly difficult for
them to make informed health plan choices. Would that be
correct as well?
Mr. Cohen. Yes.
Mr. Cartwright. Given these prior barriers to coverage, how
critical will navigators be in helping Americans gain access to
the health care benefits available to them?
Mr. Cohen. Navigators are very critical in particular, as
you mention, in helping people who do have barriers such as
disabilities, limited English language proficiency, and other
obstacles.
Mr. Cartwright. Now, Mr. Cohen, in your testimony you
stated that ensuring that consumers and businesses participate
in the marketplaces requires that they learn about the benefits
that these marketplaces have to offer and that they get the
help they need in order to take advantage of the benefits. How
are the navigators going to assist small businesses
participating in health insurance exchanges and what kind of
help is available to small businesses participating in the
health insurance exchanges?
Mr. Cohen. Small businesses are eligible if they have 25 or
fewer employees and they are otherwise eligible for a small
business tax credit, and navigators will be able to help small
business owners understand their eligibility for the tax credit
and also help them in selecting a plan that is good for their
employees and for their business.
Mr. Cartwright. Well, thank you, Mr. Cohen, for helping
explain how the navigators assist making our new health care
law work, and I yield back, Mr. Chairman.
Mr. Jordan. I thank the gentleman.
I now recognize the vice chair, Mr. Gosar.
Mr. Gosar. Thank you, Mr. Cohen.
Thank you, Mr. Chairman.
I am confused. I am very confused from what I have been
hearing from my colleague from Florida and the gentleman just
before me. I want you to describe this navigator, so I am going
to ask you a number of questions. Yes or no would be a great
answer.
So you would require a high school diploma, yes or no?
Mr. Cohen. It is really not a question I can answer yes or
no.
Mr. Gosar. That makes my point. This is getting
complicated. So let me ask you, they have to have insurance
knowledge, yes or no?
Mr. Cohen. The grantee recipient has to demonstrate, as
part of the process for applying, insurance knowledge and also
it has to maintain that knowledge through the course of
informing.
Mr. Gosar. I am glad you did that. So what is the checks
and balances in that educational process? Is somebody coming
and visiting with that navigator or is it done online?
Mr. Cohen. In terms of the course that they are taking?
Mr. Gosar. Absolutely.
Mr. Cohen. The course that they are taking is going to be
an online course, just as it is for agents and brokers in many
States today.
Mr. Gosar. And there is no other checks and balance?
Mr. Cohen. No. So there is a very rigorous grant oversight
process that we follow that is the same type of process that we
follow in all of the grants that CMS administers and HHS
administers. There will be quarterly and annually reports,
there will be financial review, and there can be site visits as
well.
Mr. Gosar. I understand. I have a limited amount of time.
The gentleman that you had a conversation with that there
are special needs so that you are going to have to be very
aware of special needs. That does not describe to me somebody
that has a very simple objective or a basic education, does it
not? Oh, by the way, I have been doing this for 25 years; I am
a dentist. So I have dealt with insurance. It is not an easy
issue and it is not what 20 and 30 hours can actually oversee.
When you are talking about special needs people, it takes
an awful lot of compassion and actually have walked in their
moccasins, as we say in Arizona, a long time to understand how
that application means. So when you look at 20 to 30 hours,
that is inadequate, absolutely inadequate.
Let me ask you the next question. How can you guarantee for
me that a convicted felon wouldn't utilize this information and
be actually able to participate as a navigator?
Mr. Cohen. I don't see that, really. If you look at the
process of what organizations and people are going to have to
go through to get these grants, and you look at the history
that we have had of doing similar types of programs in Medicare
and Medicaid and CHIP, where I am not aware of any of those
kinds of problems, so we can speculate----
Mr. Gosar. No, no, no, no, no. I am glad you brought that
up. So there is no fraud and deceit within some of these
programs like Medicaid? In fact, I want you to go back to what
we have seen here over the last year with deceitful actions in
regards to applications of processes in Medicaid and Medicare.
So let's not go there.
Mr. Cohen. But that is not what I said. What I said is I am
not aware, and would be happy to hear, about problems with
application assisters helping people and committing some kind
of fraud.
Mr. Gosar. Well, I guess what I am getting at, this isn't a
simple process, and what you are belaboring here is that this
is a simple process and that this person can be pretty much
anybody looking at both health care, as well as insurance. And
then the second part is we are only going to be dealing with,
for the most part, people like my colleague from Florida said,
actually looking for health care. Wouldn't it be behooving
people to sign up because we want a bigger pool, like the
gentleman that just spoke prior to me in regards said, the
bigger the pool, the better insurance rates? So you are going
to be engaging people who you are engaging on door-to-door
knocking, could it be not?
Mr. Cohen. Outreach and letting people know about the
benefits of getting health insurance coverage can provide for
them is part of the function of a navigator, yes.
Mr. Gosar. So we are going to come back to this. So we do
have some minimum requirements for this navigator or assister,
do we not?
Mr. Cohen. Yes.
Mr. Gosar. And what are those?
Mr. Cohen. Well, in order to get a grant, they have to
demonstrate a track record of work in the community, expertise
of the personnel who are going to be doing the work, and a plan
for how they are going to perform the work and a budget.
Mr. Gosar. And I want to go back to that working in the
community. You said that there is no worry about this
information. Well, when you give somebody your Social Security
number and give tax records, which they will be able to access,
right?
Mr. Cohen. The navigator will not be receiving people's
information; the information will be submitted through an
application that the navigator can assist with, but the
navigator is not collecting this information. And again I would
point out application assisters in Medicaid and Medicare and
CHIP do the same thing, and Social Security numbers are
required in those programs as well.
Mr. Gosar. Thank you. I am out of time.
Mr. Jordan. I thank the gentleman.
Now recognize the gentlelady from New Mexico, Ms. Lujan
Grisham.
Ms. Lujan Grisham. Thank you, Mr. Chairman.
And thank you for being here today, Mr. Cohen. I want to do
maybe a couple of things in reaffirming there are many public
programs where we have not only required, but, because we
didn't require it up front, had limited enrollment and
misinformation about a variety of health care programs from
veterans' benefits to Medicare to senior citizens programs and
Medicaid. So I will get back to that in a second.
And I appreciate that, that we want navigators or assisters
to be accountable and effective so that people get the best
information, but I am stymied that so far in this hearing we
are more concerned about background checks and those
qualifications for people who would be navigators and outreach
specialists, than we are for people who would, today, buy a
firearm. And I want to point out that we have incredible
success with outreach and health care benefits programs. For
example, when we did Medicare Part D, in spite of the fact that
we had a national hotline and a variety of nationally-based
information programs, most States had to provide additional
supportive information because it was too hard to make the
decisions about the independent prescription drug insurance
benefits that were available.
For at least 20 years, that I am aware of, States have
operated in their aging programs health insurance and benefits
assistance corps. Most States don't require fingerprinting or
background checks, they don't require that folks have to have a
high school education, maybe a GED; but that they work on is
have those folks gone through a rigorous training program, do
they understand the benefits and the complexities between the
health care delivery system, private insurance, and the social
programs or social insurance programs like veterans' Medicare
and Medicaid, so that you can help someone navigate those
complexities.
And I would also submit that the high back program was one
of the most effective programs at identifying fraud and waste,
which created then the Operation Restore Trust Program. I am
going to highlight also, and I am going to ask if you are
familiar with those, that this program was a very successful
program for both veterans, Medicaid recipients, and Medicare
Part D enrollees.
So we will start there. Are you familiar with the high-back
program and related programs by States?
Mr. Cohen. I am actually not. I am familiar with State
health insurance and assistance programs and a number of States
that have provided in-person assistance for people to help them
get enrolled in Medicare and Part D.
Ms. Lujan Grisham. Are you aware that in many States,
including New Mexico, we have looked at, for the high-risk
pools, because, again, it is also, even though it is a very
finite eligibility context for those programs, both State high-
risk pools and Federal high-risk pools, the States have
incentivized agents and brokers to understand the difference
between the Federal pool, the State pool, Medicaid, Medicare,
Medigap. Because what you want, people who have Medicaid have
far better coverage than people in a traditional insurance plan
through the pools.
Mr. Cohen. Yes.
Ms. Lujan Grisham. And are you aware of the significant
fraud or privacy protection problems for any of those States,
including New Mexico, my home State, who are engaged in those
operations?
Mr. Cohen. I am not.
Ms. Lujan Grisham. My last context here for questioning,
and I agree with the statements that have been made before,
that if you don't do this outreach, people don't know. People
on Medicare cannot describe to you their benefits. People on
private insurance cannot adequately describe their co-pays,
their benefits, their authorizations, their referrals. They
have difficulty navigating for their own taxes today what was
their health care costs or tax deductibles that are out-of-
pocket versus those that are not. It is complicated. We all
understand that.
Are you engaging in specific efforts for a State like New
Mexico--and I realize I am leaving you very little time--to use
navigators in places like the Navajo Nation, with 21, if you
don't count the Navajo Nation, independent, with independent
languages, tribes, a large Asian-American and Hispanic
community? What are we doing to make navigators successful in
that context?
Mr. Cohen. Thank you. As you know, we have an obligation
under the Affordable Care Act to do tribal consultation, which
we do on a regular basis, and we are working very closely with
the tribes to make sure that Native Americans are aware of the
benefits of the Affordable Care Act and some benefits of the
Affordable Care Act that are particular to Indians that are
even better than are true for the rest of the population. We
very much encourage tribes to apply to be navigators because we
think that would be one very effective way that they can reach
their community. So that is an area that we definitely have put
some very particular focus on.
Ms. Lujan Grisham. I have a few seconds left, Mr. Chairman,
before I yield back. I would point out that--maybe I am doing
the opposite clock now, I just saw that. But if I might just
finish that, Mr. Chairman.
Mr. Jordan. You are fine.
Ms. Lujan Grisham. I might argue with you that the benefits
under the Affordable Care Act are not more robust for a Native
American community, but notwithstanding the fact that they are
sorely under-insured in an Indian health service, and
notwithstanding frontier and rural access, it is a huge
problem; and for my State, where we have a more than 21 percent
under-insured, with one of the poorest and sickest populations
in the Country, we are going to need navigators and assisters
and outreach and education efforts to facilitate, which is
required under the Act, to facilitate enrollment to the highest
degree.
Thank you. No further questions. I yield back.
Mr. Cohen. And I was just referring, really, to the
provisions on cost-sharing, which are a little bit different
for Indians.
Ms. Lujan Grisham. Fair enough.
Mr. Jordan. I thank the gentlelady.
Mr. Cohen, Senator Baucus has said implementation of the
Affordable Care Act is a huge train wreck. Is he right? And let
me just say this. He wrote the bill; he has a distinguished
career in the Senate. He was intricately involved in writing
the bill over there. He is a guy who comes with some expertise,
a number of years serving in Congress. So when he says
something, it means something. Is he accurate?
Mr. Cohen. I don't agree with Senator Baucus' statement. I
think we are very much on schedule; we are moving forward. We
are going to be ready October 1st for open enrollment to begin.
Mr. Jordan. So Senator Baucus is wrong?
Mr. Cohen. Well, I am not sure exactly what he is referring
to or what he meant.
Mr. Jordan. He said implementation of the Affordable Care
Act is a huge train wreck. He didn't say it is complicated; he
didn't say what you said in your opening statement. You said
this is a significant undertaking. He could have used that kind
of language. He didn't choose to use that language, he said it
is a huge train wreck. So I am asking is he accurate in his
assessment of what is coming to the American people.
Mr. Cohen. I disagree with Senator Baucus' statement.
Mr. Jordan. So the guy who helped write the bill in the
Senate is wrong. You are saying maybe he is 71 years old, he is
losing it, he doesn't have it anymore? What are you saying?
Mr. Cohen. I disagree with Senator Baucus' statement. We
are doing very well; we are moving forward. We just recently
completed receiving submissions----
Mr. Jordan. Do you think you can do it? Do you think you
can get ready?
Mr. Cohen. Yes. We will be ready.
Mr. Jordan. Here is my understanding. You don't start
training these navigators. They get these navigators,
assisters, and the confusion that exists around this. What I do
know is the money goes out like August 15th, is that right,
this year?
Mr. Cohen. Yes.
Mr. Jordan. And then, a few weeks later, they are supposed
to be out there signing people up. I mean, normally, when you
have a new product, you don't need people out there telling
folks they have to do it; people find out, well, if it is a
good product, I will sign up on my own. So August 15th this all
starts, and then the enrollment runs through what, October 1st
through March, is that right?
Mr. Cohen. Correct.
Mr. Jordan. And you think you can get it all up and running
in that time, even though the guy who helped write the bill,
who was intricately involved, has a distinguished career in the
Senate, calls it a huge train wreck?
Mr. Cohen. It will be up and running, and it will be ready.
And I would like to point out navigators are not the only way
that people are going to learn about this law and are going to
get help.
Mr. Jordan. They are learning now. I talk to business guys.
They are learning now, trust me. We know what is coming. Go
ahead, I am sorry. I just talked to a bunch of business guys
yesterday.
Mr. Cohen. Agents and brokers are going to be out there
helping people get enrolled; the insurance industry itself,
obviously, has a tremendous interest in getting people
enrolled.
Mr. Jordan. Let me ask another question, another thing that
is on people's minds. The American people have heard what
Senator Baucus called the implementation of this bill. I think
they understand what train wreck means versus a significant
undertaking. But let me ask you this, because in my opening
statement I referenced the situation with the Internal Revenue
Service, and Ms. Norton said that that was a stretch to tie
that in, but I just want to know, isn't it true that the
Internal Revenue Service is intricately involved with
implementing and enforcing the Affordable Care Act?
Mr. Cohen. The Internal Revenue Service has a significant
role in overseeing tax provisions insofar as they are
implicated in the Affordable Care Act, not everything about the
Affordable Care Act.
Mr. Jordan. You just answered Mr. Cartwright's question
that one of the things these navigators are going to be out
doing is, when they talk with small businesses, they are going
to be giving them tax advice. So there is that component as
well. So the IRS is involved, significantly, you said, correct?
Mr. Cohen. The IRS is involved, yes.
Mr. Jordan. And I just want to know since they are involved
and since you are intricately involved in all this, does it
trouble you what is going on with the Internal Revenue Service,
this scandal that has been uncovered? Does that trouble you as
an American, that someone who is involved in putting together
the implementation of the Affordable Care Act?
Mr. Cohen. You know, it is not my job to oversee what the
IRS does. I don't see a connection between what I have read in
the newspaper and what we are doing.
Mr. Jordan. Has HHS transferred any Federal tax dollars to
the Internal Revenue Service for the significant portion that
they are involved with in enforcing Obamacare? And, if so, how
much money?
Mr. Cohen. I don't believe HHS has transferred money to the
IRS. I don't know the answer, frankly.
Mr. Jordan. My understanding is it is hundreds of millions
of dollars that have moved to the Internal Revenue Service for
the enforcement of this.
Mr. Cohen. Well, the Internal Revenue Service certainly has
gotten funding for its part of implementing its role in
connection with the Affordable Care Act. Whether that money
came from Health and Human Services, I don't know the answer to
that.
Mr. Jordan. And as someone who is so involved in this
issue, do you find it troubling at all that the agency who has
a significant role in enforcing the Affordable Care Act was
systematically targeting groups who came into existence because
they initially opposed the Affordable Care Act? And the date
that the targeting started, according to the inspector
general's report, the date that the targeting started was the
very month that the Affordable Care Act passed, March of 2010.
Do you find that at all troubling, as an American citizen?
First Amendment rights were obviously violated in this thing.
Do you find that as cause for concern?
Mr. Cohen. Congressman, I would be happy to have a beer
with you and talk about what I think as an American citizen,
but, sitting here right now, I don't have a position on what I
have read in the newspapers about the IRS. I don't see a
connection between what I have read in the newspapers and what
we are doing.
Mr. Jordan. You don't see a connection at all?
Mr. Cohen. I don't.
Mr. Jordan. And you don't think we need to delay the
implementation of this, even though the guy in the Senate who
was so involved in putting it together, has said it is a huge
train wreck? You don't think we need to delay, a suspension, a
hold?
Mr. Cohen. Absolutely not.
Mr. Jordan. Okay.
Mr. Cartwright. Mr. Chairman, would you yield for a point
of information?
Mr. Jordan. I would be happy to yield to the ranking
member.
Mr. Cartwright. I would just like to point out that what
Senator Baucus said was if the Obamacare is not implemented
properly, it will be a train wreck.
Mr. Cohen, when the chairman asked you that question, did
he put the question in that context?
Mr. Cohen. It was a little different.
Mr. Cartwright. And, overall, would you agree, if we don't
have things like the Navigator Program, that would lead to
improper implementation of Obamacare?
Mr. Cohen. You know, I am sure that many people recall that
when Medicare Part D went into effect, there were problems in
the beginning, there were some significant problems in the
beginning; and I think that was a previous administration to
this one. And today millions of Americans rely on the benefits
that they get from that program.
So I think we ought to look at this like any other big
undertaking. Will it be perfect on day one? It may not be
perfect on day one. We are working day and night to make it as
good as it can be. We are going to be successful. We are going
to be ready on October 1st and millions of Americans will
benefit from the work that we are doing.
Mr. Cartwright. Thank you, Mr. Chairman. I yield back.
Mr. Jordan. I appreciate that. I just want to, again, for
the record, though, the senator used the term train wreck, he
didn't use that this was a big concern, this was going to have
some problems, this was going to take some time. He said train
wreck. And that was why I had the line of questioning I did.
With that, would yield to the gentlelady from Illinois, Ms.
Duckworth.
Ms. Duckworth. Thank you, Mr. Chairman.
Mr. Cohen, how are you this morning?
Mr. Cohen. Good. Thank you.
Ms. Duckworth. Great. Health insurance availability and
costs are a huge concern for small businesses, and in my
district I have a large percentage of small businesses. One of
the things that small businesses face is that they have less
bargaining power than large companies and they generally pay
higher prices for insurance, if they can afford it at all.
I was very disappointed when, earlier this year, CMS
decided to delay the requirements to make more poor health
plans available for small business workers in the Small
Business Health Option Program, the SHOP Program. I have heard
a lot of anxiety from small businesses in my district about how
the health care law will affect them. This provision has real
promise, when it gets implemented, to improving the status quo
for small businesses, since most of them are only currently
able to offer their employees access to a single health plan
that the employer themselves select.
Could you comment on the reason for this delay and how do
you expect the delay to effect the attractiveness of the
exchanges?
Mr. Cohen. Thank you. We are committed to providing
employee choice through the SHOP. We are mindful of the
significant undertaking we have ahead of us, and this really
was a strictly operational decision that we had to make in
terms of what we are able to accomplish for year one, and we
reached the conclusion that it was the more prudent thing just
to delay it for a year. We are committed to it, we believe it
is important, and we will put it into effect, but it was really
just a matter of the difficulty we had of getting it into place
in time for this October.
Ms. Duckworth. Thank you. We have been discussing the
importance of the Navigator Program and how we need to
certainly make sure it is implemented in the best way possible
for optimum results. With regard to the Navigator Program and
other outreach efforts, can you elaborate on the
Administration's plans to ensure that the information is
accessible and usable by people with disabilities?
Mr. Cohen. Yes. That is one of the factors that will be
scored in applying for grants under the Navigator Funding
Opportunity Announcement, is both a track record and a plan to
reach more difficult-to-reach, more vulnerable communities, in
particular the disabled. And then through the application
review process and the grant decisions we will definitely be
looking to provide grants to organizations that can fill that
need.
Ms. Duckworth. Thank you. You know, one of my highest
priorities is to ensure that my constituents have access to
affordable, quality health care. It is what my constituents
have told me over and over again that they want. I am
concerned, however, by reports that say that the majority of
Americans who are eligible for assistance to help them afford
health care are still unaware of how they can benefit from the
law. It seems to me that with the October 1st enrollment date
quickly approaching, you have a big communications problem on
your hand, and you alluded to that.
Could you speak a little bit on the Administration's
readiness to reach out to this huge number of people so that
they can enroll in time? Basically, you say that you are going
to be ready to go on October 1st, and you need to be. If not,
what do you need in order to get ready and have a successful
rollout of these provisions?
Mr. Cohen. So we have a plan in place that basically is
timed so that people are getting the information close to the
time in which there is something that they can do with it. So
right now we are in what we call the education phase, which
began in January and proceeds through June, where we are just
putting out information. We are in the process of re-purposing
the HealthCare.gov site to be really a consumer information
site. Our call center will be going live in June, where people
will be able to call and get information that way. And then
starting in the summer we will begin what we call the
anticipation, or get ready phase. And I am not an expert in
these things, but what I understand is that if you start too
early and then people say, well, what do I do, and then there
is nothing that they can do because it is too soon, then you
may end up having people who get a little bit kind of
frustrated or disappointed.
So we really are gearing towards making sure the people get
the information they need in time for October, when they
actually can take action and begin to get enrollment coverage.
Ms. Duckworth. Thank you, Mr. Cohen.
I yield back my time, Mr. Chairman.
Mr. Gosar. [Presiding.] I thank the gentlelady.
I will yield to the gentleman from Tennessee, Mr. Duncan.
Mr. Duncan. Thank you, Mr. Chairman.
Medicare ended up costing 12 times more than what was
predicted after its first 25 years of operation. The cost of
Medicaid exploded even more than that, as Chairman Jordan
mentioned in his opening statement. The estimated cost for
Obamacare, now the un-Affordable Care Act, are now double or
triple what was originally estimated. All other Federal medical
programs have gone far beyond what was originally predicted
with the low-ball front end estimates. And, of course, Speaker
Pelosi was famously quoted as saying we would have to pass
Obamacare before we could find out what was in it. But the more
we find out, the more complicated, confusing, and convoluted it
becomes. And we are told we have to hire 16,500 more agents for
the Internal Revenue Service to enforce the law, and possibly
thousands of navigators and assisters.
But I want to go in a little different direction, and that
is the solicitation of the contributions by the Secretary. The
Washington Post story on this says, but the industry official
who had knowledge of the cause, but did not participate
directly in them, said there was a clear insinuation by the
Administration that the insurers should give financially to the
nonprofits. Meredith McGehee, policy director for the
nonpartisan Campaign Legal Center, which researches government
ethics issues, said she was troubled by Sebelius' activities
because the Secretary seemed to be ``using the power of
government to compel giving or insinuate that giving is going
to be looked at favorably by the government.''
The New York Times story said, but several executives said
they were uncomfortable with the discussions because the
Federal Government has the power to approve or reject the
health plans they want to sell in insurance markets that will
be run by Federal officials in more than 30 States. Health care
executives said they were reluctant to make big contributions
for several reasons, including the fact that insurers are
required to pay more than $100 billion in new taxes over the
next 10 years to help defray the cost of expanded coverage.
Direct companies must pay new fees totaling $34 billion over
the same period.
As you can see, my main concern, Mr. Cohen, are the costs.
But do you know did the Secretary request a legal opinion about
the propriety of soliciting donations?
Mr. Cohen. I can't speak to the specifics of what the
Secretary, any conversations she had or what she did because I
don't know. It sounds like the person quoted in the story
doesn't know either, because they say they weren't on the
phone, but they just heard about it from somebody else.
What I can tell you, though, is that during Medicare Part
D, which was put into place by a previous administration, the
Department worked with a wide array of groups, including AARP,
PhRMA, the National Alliance for Hispanic Health, the National
Association of Area Agencies on Aging to do outreach and to
help people get enrolled in coverage in Medicare Part D. That
is what they did with Medicare Part D. It is called a public-
private partnership, and it can be a very effective way of
reaching out into the community and helping people learn about
a program and what it can benefit for them. That particular
partnership, which was called La Promesa, operated to do one-
on-one outreach in 17 different States. So that is what they
did with Medicare Part D.
Mr. Duncan. All right. Let me ask you something else that
Chairman Jordan mentioned. He mentioned the loss of jobs and
the fact that many companies are cutting people's hours back so
they don't go over the 30 hour limit, and once again The
Washington Post had this, said because of this Cook Medical-
Boston Scientific extractor corporation, Medtronic, Covidien,
and Zimmer Companies have all cited the medical device tax is
the reason for building plants in China, Mexico, Ireland, and
Costa Rica, and for laying off hundreds of U.S. workers, 1,000
in the case of Stryker. Several of these companies, possibly
all, have already planned charges against earnings ranging from
$50 million to $175 million.
Have you looked into this part of the law?
Mr. Cohen. I am not familiar with what those companies have
done or the decisions that they have made, no.
Mr. Duncan. All right, before my time runs out, how many
different companies and unions and businesses and governments
have requested waivers from the law and how many have been
granted?
Mr. Cohen. I would have to get you that information; I
don't know it off the top of my head. The only waiver program
that we had was a waiver from the annual limits provision to
allow companies that offered coverage to their employees, to
keep that coverage until January 1 of 2014. But I couldn't give
you the number. But it is on our website, I know that.
Mr. Duncan. Okay, thank you very much. My time is up.
Mr. Jordan. [Presiding.] I thank the gentleman from
Tennessee and now recognize the gentleman from Nevada, Mr.
Horsford.
Mr. Horsford. Thank you, Mr. Chairman.
Thank you for being here, Mr. Cohen. I am from Nevada and
we actually have a governor, who happens to be a Republican,
who is working to implement this bill, so I am going to focus
on what we can do and what we can't in my questioning.
As you know, Nevada has been working hard to set up our
exchange and to develop training and certification requirements
for the Navigator Program. We are already in the process of
training navigators; however, it is my understanding that
States are still waiting for CMS to finalize its proposed rule
on standards for navigators and the non-navigator assistance
personnel.
Can you give us an idea of when we can expect a final rule
on that so that the States who are working to implement this
bill can continue to do so on time and on track?
Mr. Cohen. I know that we are working through the comments
that we received to the proposed rule, and while I can't give
you a specific date, I expect that the final rule will come out
very soon.
Mr. Horsford. Also, my particular district in Nevada is
sparse, it represents both rural and urban interests, and it
takes over six hours to drive from one corner of my district to
the other, so one of my concerns is the implementation in
ensuring that all constituents are able to access information,
even the struggle that we have around online. I have
communities that literally have very little broadband
connectivity. So what is being done to ensure that ACA
implementation information is being disseminated to rural
communities in particular?
Mr. Cohen. I think it is a really good question, and
obviously there are parts of the Country where broadband access
is an issue and where it is not going to be practical for
someone to come door-to-door, given the distances involved and
the population density. I think for those people it is probably
going to have to end up being a paper application, and they
will probably have to get the help that they need through the
call center, which will be operational beginning in June, 24
hours a day, 7 days a week, and will be there to provide people
with assistance over the phone who don't have access to online
help.
Mr. Horsford. And is that an 800 number?
Mr. Cohen. You know, I actually don't know what their phone
number is. It is being launched in June and the information
will be out.
Mr. Horsford. And what type of personnel will be trained to
deal with different languages?
Mr. Cohen. There will be access to translation services,
and don't hold me to the exact number, but it is going to be a
large number of languages through a translation service that
will be available.
Mr. Horsford. I want to follow up on something my
colleague, the gentlelady from New Mexico, talked about, the
fact that health insurance is complicated to begin with, it
doesn't matter what type of program, if you are a private payer
or not. But one of the areas that the navigators are supposed
to respond to is specifically the uninsured individuals who may
have never been in an insurance program and are unfamiliar with
coverage options. How will navigators respond to this
population of uninsured specifically?
Mr. Cohen. So that is a great question, and part of the
training and then what the navigators will be doing is to
provide very basic information on how health insurance works;
what benefits are, what is covered, what is not covered; what
deductibles are; what cost-sharing is, co-insurance, co-pays.
And then, as you know, once you get to the point where you are
choosing what plan to buy, the Affordable Care Act requires a
couple things that do make it a little bit easier: one, all
plans have to have essential health benefits so that there is a
continuity across plans as far as what is covered; and then,
secondly, we have these medal levels, so you have the bronze,
silver, gold, platinum, and the navigator can help walk through
with the person what are your medical costs typically in a
year? If you have high medical costs, you might want to pay a
little bit more in premium, but get less of a deductible. If
you have not a lot of medical costs in a typical year for your
family, you might want to go with the bronze plan, which will
be less expensive, but the deductible will be higher before
coverage actually kicks in.
And that is the kind of information the navigators will be
trained in to be able to help their neighbors in understanding
this transaction.
Mr. Horsford. I am out of time. I do have some additional
questions I would submit for additional responsible. I just
hope that we will work in this Oversight Committee to figure
out ways to implement this bill and to help States like Nevada,
who actually want to do it right. Thank you.
Mr. Gosar. [Presiding.] I thank the gentleman from Nevada.
I now yield the floor to the gentleman from Tennessee, Dr.
DesJarlais.
Mr. DesJarlais. Thank you, Dr. Gosar.
Thank you, Mr. Cohen, for being here today. I was listening
to your conversation a bit earlier with Mr. Cartwright about
how the more people you get into a health care pool, the
cheaper it makes it for everyone. Is that your understanding or
your belief?
Mr. Cohen. Well, it is the mix as well as the number,
right? So generally we expect that folks who have a lot of
health care costs will find their way to us and will get
enrolled in coverage.
Mr. DesJarlais. Okay, that is a good point.
Mr. Cohen. We really want to reach out to the young and the
healthy folks who may not appreciate the need for health
insurance, and yet if, unfortunately, something were to happen
to them and they were to get sick or be in an accident, they
would need it.
Mr. DesJarlais. Okay, so people who have preexisting
conditions or health problems, they have a hard time getting
insurance now why?
Mr. Cohen. Because, if they are covered by their employer,
they are okay; but if they are not covered by their employer
and they are out in the individual market----
Mr. DesJarlais. It is very expensive, right?
Mr. Cohen.--a health insurer may decline to write them at
all or it will be very expensive.
Mr. DesJarlais. So the insurance companies cherry-pick in
order to be profitable; they keep these people out. And what is
frightening to me is who decides what a preexisting condition
is. It is really the people who are trying to make the money,
the insurance companies. We think of preexisting conditions as
cancer, maybe previous heart disease, but it actually can be
defined as anything from acne to hemorrhoids. And anyone in
here either has or is going to have a preexisting condition, so
it is going to get more expensive. And the whole problem with
our health care system is that it is too expensive right now
and it is unaffordable for too many people. So to have this
discussion that bringing a bunch of people in, especially the
most expensive people, is going to somehow make it cheaper for
everyone is just simply false. I have been in health care for
over 20 years and I can tell you that is not going to be the
case.
But there are a couple things I want to talk about. Do you
think that the statutory authority that you described here to
create the navigator/assisters is ambiguous or is it pretty
clear, the statutory authority?
Mr. Cohen. You know, I am not the lawyer, but we are
confident and believe that we have the statutory authority to
do the program that we propose.
Mr. DesJarlais. Okay, the Health and Human Services created
the Assisters Program solely through the rule-making process,
and HHS officials admitted to the committee staff that there is
no statutory authority for the Assisters Program. Are you
discounting what HHS said to the committee?
Mr. Cohen. Well, I wasn't there, so I can't tell you what
they said or they didn't say. What I am telling you in my
testimony is that we have authority for that.
Mr. DesJarlais. So you don't know whether they misled the
committee or not.
Mr. Cohen. Well, I am sure that they didn't mean to mislead
the committee.
Mr. DesJarlais. Well, they said they didn't have statutory
authority and you are saying you do, and I am asking you if it
is clear or ambiguous. Can you answer whether it is clear or
ambiguous?
Mr. Cohen. No. I just don't feel comfortable characterizing
it one way or the other.
Mr. DesJarlais. So basically, every time we run into a
hitch, rather than go through Congress, we just circumvent
Congress and we just make the rules to make it fit, we try to
put a round peg in a square hole. And that is what has been
going on with this bill because it was poorly written. We heard
the other side testify that this is the law of the land. Well,
sometimes bad laws are written, and this is a case of a bad
law. And to think that it is going to be ready to implement by
October is just ridiculous, considering the involvement of the
IRS, and the fact that we are having to create assisters to be
funded in a different fashion than what navigators are shows
that there is a real flaw here, too, as well.
I wanted to get to one more point. The proposed rule
requires navigators to recruit, support, and promote a staff
that is representative of the demographic characteristics of
communities in their service area. However, HHS has yet to
reveal how they plan to enforce this provision.
Okay, so my question is the proposed rule requires
navigators and assisters staff to be representative of the
demographic characteristic of communities in their service
area. What are the specific demographic characteristics that
HHS is referring to?
Mr. Cohen. I don't know what we have defined then any more
specifically than that, but I think the goal is--navigators are
going to help whoever comes to them, regardless of what their
demographic characteristics are. But we want the navigators to
reflect the community in which they will be working. That is
the purpose.
Mr. DesJarlais. Okay.
I have no further questions.
Mr. Gosar. I thank the gentleman from Tennessee.
The gentlelady from Illinois is recognized.
Ms. Kelly. Thank you, Mr. Speaker.
Thank you, Mr. Cohen, for being here. The majority has
suggested that the Navigator Program is somehow unprecedented
and has suggested a parade of horribles that will result from
community organizations and nonprofits providing consumers with
information so they can get enrolled in affordable, high-
quality health insurance plans. I wanted to ask you what types
of organizations can apply for Navigator grants under the
Funding Opportunity Announcement that CMS has released?
Mr. Cohen. A broad variety of different types of
organizations can apply: faith-based organizations, Native
American tribes, chambers of commerce, community nonprofits.
Ms. Kelly. So really the whole gamut?
Mr. Cohen. Really, the whole gamut that reflects the great
diversity and public activity of America.
Ms. Kelly. Does the Navigator Funding Opportunity
Announcement look at the organization's ties to the community
and history in the community in which it operates as important
factors in the review criteria?
Mr. Cohen. It absolutely does, yes.
Ms. Kelly. And doesn't CMS have prior experience with
exactly this type of program?
Mr. Cohen. We do. We have been involved with similar
programs for Medicare for Part D, for Medicaid, and for CHIP.
Ms. Kelly. Okay. Because I was going to say isn't it true
that the community-based application assisters under the State
Children Health Insurance Program back in the late 1990s.
Mr. Cohen. Exactly so.
Ms. Kelly. How successful would you say these organizations
are in getting children enrolled in the State Children Health
Insurance Program?
Mr. Cohen. I think they have been very successful.
Ms. Kelly. Thank you. It seems like CMS is on sound footing
and relying on its experience in establishing this grant
program. We need to do everything we can to ensure that
consumers are made aware of all their health insurance options
and that they choose a plan that is right for their family. The
Navigator Program is an important component, in my opinion, of
this process. Thank you.
Mr. Cohen. Thank you.
Mr. Connolly. Would the gentlelady yield?
Mr. Gosar. Yes. She yields.
Mr. Connolly. I thank my colleague.
Mr. Cohen, is there a confirmed head of CMS? You are the
deputy administrator and director.
Mr. Cohen. I believe Ms. Tavenner was confirmed last week
to be the administrator of CMS, yes.
Mr. Connolly. And have you been showered with
appropriations to implement the Affordable Care Act?
Mr. Cohen. We have not.
Mr. Connolly. In fact, is it not true that the majority has
refused to provide your department with any funds for
implementation?
Mr. Cohen. Yes. I mean, we have the funds that were
provided under the bill when it was enacted.
Mr. Connolly. Originally.
Mr. Cohen. Originally. But that has been the extent.
Mr. Connolly. We have a new majority in this Congress.
Mr. Cohen. Yes.
Mr. Connolly. And is it not also true that the majority
here in the House has voted, just last week, for the 37th time,
to try to repeal, in whole or in part, the Affordable Care Act?
Mr. Cohen. That is my understanding, yes.
Mr. Connolly. Well, so you have $54 million left over in
grants for the Navigator Program to try to implement the
exchanges, is that correct?
Mr. Cohen. That is what we have put out in this grant
application, yes.
Mr. Connolly. Do you know what the Yiddish word chutzpah
means, Mr. Cohen?
Mr. Cohen. I do.
Mr. Connolly. Might one just observing not want to apply
that word to the alleged concern being expressed here today by
some who have made it their lifelong effort to repeal Obamacare
and to make sure that you don't have a dime to implement it, to
suddenly show great concern as to whether it will be
implemented well? Might that fit the Yiddish definition of
chutzpah, Mr. Cohen?
Mr. Cohen. I think I will leave that to you, congressman.
Mr. Connolly. Well, growing up, I was known as the Little
Rabbi; I worked in a restaurant called The Pumpernickel, so I
take credit for understanding what chutzpah means. And if it
means anything, it certainly has application to this hearing.
It is a bit much to have people lecture you about how well or
poorly it is going to be implemented who have spent every
waking hour trying to make sure you can't implement a law that
they could not defeat fair and square on the floor of the House
in 2009.
Mr. Cohen. I will say we can use all the help we can get
from anyone who is interested in seeing us do the job well.
Mr. Connolly. Thank you.
And I thank my colleague for yielding.
Mr. Gosar. The gentlelady yields back.
Just to make a comment here, we are comparing apples and
oranges. When we are talking about CMS and S-CHIP, it is the
same plan that you are providing across the board. This is not
the same plan. These will have different deductibles. It is
much more authoritative and interpretive in regards to those
benefits. So it isn't the same program.
I yield to the gentleman from North Carolina, Mr. McHenry.
Mr. McHenry. Well, thank you. And I certainly would point
out to my colleague that we did succeed in passing a repeal of
Obamacare out of the House. The gentleman says in 2009 we lost
the vote, but we have won multiple--he referenced 37, so we
have won those 37 votes. It would be great if we had some folks
on the other side of the Senate comply with that and actually
do what is reasonable and right, and address these concerns.
The reason why we are trying to address concerns with you,
sir, is that we have deep concerns about this program and what
is happening. My colleague, Mr. Duncan, referenced a press
report about Secretary Sebelius making multiple phone calls to
solicit fund-raising from--and you can flip to your notes on
this, and I would certainly appreciate your answer on it--but
soliciting funds from health insurance folks, pharmaceutical
executives, hospitals, to donate large sums to Enroll America
to fund the implementation of Obamacare, the outreach effort.
Are you aware of this?
Mr. Cohen. No, I don't know what the Secretary did or
didn't do, so I can't comment on it.
Mr. McHenry. Are you aware that the Secretary made these
calls?
Mr. Cohen. No.
Mr. McHenry. Is this the first time you have heard this
being brought up?
Mr. Cohen. I have seen it in the media.
Mr. Mchenry. Oh. Let me give you an opportunity to restate
this. Have you heard or read about Secretary Sebelius making
fund-raising calls for Enroll America?
Mr. Cohen. I have read some stories about Secretary
Sebelius and Enroll America, yes.
Mr. McHenry. Okay.
Mr. Cohen. But I don't know what she did or didn't know
because I am not privy to what she did or didn't do, so I can't
comment on it.
Mr. McHenry. Okay. I just wanted to make sure we had it
correct on the record, and you can correct the record that you
have heard about it, because we certainly have and my
constituents have. I have gotten a lot of questions about it.
But are you aware if the Secretary or any HHS staff has
official legal opinion on the propriety of this, soliciting
donations?
Mr. Cohen. I don't know.
Mr. McHenry. You don't know? Okay.
So are you going to take specific steps to ensure that
there is not one favoring of a business that gave to this
effort or this organization, Enroll America, that that group
isn't favored over one that said no to the Secretary?
Mr. Cohen. Well, I am not aware that anyone was asked,
gave, said yes, said no. I don't know any of those things, so I
am not in a position to favor anybody or not favor anybody
because I am not aware that any of that happened. What I can
tell you, as I mentioned before, is that public-private
partnerships to help promote a new program, such as was done in
Medicare Part D, where AARP and PhRMA were involved with CMS in
efforts to help get information out about a prescription drug
program that presumably the members of PhRMA stood to gain by,
that is something that has been done in the past. I think
public-private partnerships can be a very effective way.
Mr. McHenry. Have you done any of that?
Mr. Cohen. I have not.
Mr. McHenry. You have not undertaken that. Okay. So there
is legal authority to do that?
Mr. Cohen. I haven't asked for any legal authority. I
haven't done it, so I don't know the answer to your question.
Mr. McHenry. Okay. And you are not aware of any persons or
individuals who are participating in this effort?
Mr. Cohen. I am not.
Mr. McHenry. You are not. Okay. So you don't know how
closely HHS is working with Enroll America on this advertising
effort?
Mr. Cohen. I don't.
Mr. McHenry. Okay. So you had no input on this Enroll
America process?
Mr. Cohen. I have no input with respect to Enroll America
at all.
Mr. McHenry. Okay. Okay. Now, this is interesting. In The
New York Times it said a number of executives felt a bit
uncomfortable with these calls. And the reason why we ask, Mr.
Cohen, is because many of us did not ask questions of the IRS,
and we found disclosures now about what happened in that whole
process with IRS undertaking targeting of certain political
groups. So we just want to confirm that that is in fact the
case, and that is why I ask these series of questions.
Mr. Cohen. Understood.
Mr. McHenry. And if you want to correct the record for
anything, I have 20 additional seconds, if I have not given you
ample time.
Mr. Cohen. Nope.
Mr. McHenry. Okay. Well, I certainly appreciate that, and I
just call the folks attention. The press reports say the
Secretary was making these fund-raising calls. We hope that, at
the end of the day, the groups that said no will not be
targeted for retribution by either Secretary Sebelius or the
Health and Human Services Department or the folks that are
implementing Obamacare. This is a deep concern Americans have
about their privacy and what their government can do to them if
they say no or try to act counter to the wishes of those in
powerful positions.
With that, I yield back.
Mr. Gosar. I thank the gentleman for yielding and I
acknowledge the gentlewoman from California, Ms. Speier.
Ms. Speier. Thank you, Mr. Chairman.
Mr. Cohen, it is great to see you.
Mr. Cohen. It is great to see you too.
Ms. Speier. Unlike most of the members here on the panel, I
have worked with you before. I know what a great talent you
are, how you served California very well in the Department of
Insurance, so we are very lucky that you are with us. Thank
you.
Mr. Cohen. Thank you.
Ms. Speier. Is it true that the Affordable Care Act passed
the Congress?
Mr. Cohen. Yes.
Ms. Speier. Is it also true that President Obama was re-
elected?
Mr. Cohen. He was.
Ms. Speier. So isn't it our obligation to then implement
that law?
Mr. Cohen. It is, and we are doing that every single day.
Ms. Speier. All right. So what keeps you up at night in
terms of your ability to implement that law?
Mr. Cohen. We would like to have more funding. That would
be helpful. And we would like to have less distraction.
Ms. Speier. All right, let's talk about one of the concerns
that my Republican colleagues have about the grantees that
serve as navigators or non-navigator assisters. My
understanding is, and based on your written testimony, that
qualified, unbiased, expert contractors will review all
applications using an evaluation rubric developed by HHS which
will be scored and statistically ranked. Will you explain that
process and some of the factors that have gone into that
consideration?
Mr. Cohen. I would be happy to. So this is a process that
we undertake in connection with our Office of Acquisitions and
Grant Management at CMS; it is a longstanding process, it is
not new to this particular grant. And they work with us to make
sure that we put out a Funding Opportunity Announcing that is
clear and complies with the law, and that people can submit
applications for. Then they help us, through a contractor,
select review panels that are people who know about the area
that we are involved with, who don't work for HHS or CMS, and
then they score the applications based on very specific
criteria that are set forth in the announcement that include
what type of organization it is, its ties to the community, its
previous accomplishments, the expertise of its personnel, just
how good an application and budget they have submitted, all
those things; and they score it on a 1 to 100 scale so we get
this objective view of the strength of each applicant. And then
they do a summary for us that basically says here are the
strengths, here are the weaknesses, as we move forward to make
the selections.
Ms. Speier. So this is very similar to the selection
process used for other grantees in HHS.
Mr. Cohen. Exactly.
Ms. Speier. All right. So nothing different, nothing that
is going to show bias; very objective, correct?
Mr. Cohen. Correct.
Ms. Speier. All right, let's go on and talk about training.
As I understand it, there are some training standards that will
require up to 30 hours of training in 15 different categories
of health care topics. Furthermore, as you explained in your
written statements, navigator grant awardees would have to pass
an exam prior to beginning to help consumers.
Based on all of this, I get the impression that the
training requirements in this actually exceed the training
requirements that States require for licensing of health
insurance agents and brokers, is that true?
Mr. Cohen. I think they are at least as much as what most
States require. They are more than some States require. In some
States there isn't any pre-licensing education that is
required; you have to pass a test, but you don't actually have
to take a course. So, yes, I think that this training compares
very favorably to what States require for agents licensing.
Ms. Speier. And the funding to provide this training you
have?
Mr. Cohen. Yes.
Ms. Speier. All right. Would you tell us a little bit more
about the program that has been developed in HHS that will
ensure that we will have skilled individuals who will be
assisting consumers? Give us some idea of what the training
components will include.
Mr. Cohen. So the training components will range from just
sort of very basic health insurance knowledge and knowledge of
the health insurance market; to benefits and what is covered by
health insurance policies, and specifically the essential
health benefits that are required to be covered by the
Affordable Care Act; to cost-sharing, deductible, co-insurance,
co-pay, and how that relates to the premiums that people will
have to pay and the different medal tiers that plans have under
the Affordable Care Act. It is also going to require training
in public programs, because some of the people who come to
navigators will be eligible for Medicaid or CHIP, and they will
have to have an understanding of how that works as well based
on adjusted gross income. And then it will also include
training in the entire process of helping someone through an
application through to the shopping experience and choosing a
plan.
But it is very important to note that they will not be
making recommendations, they will not be telling people this is
the plan I think is best for you; it is purely objective
information that they will be providing.
Ms. Speier. Thank you.
Mr. Gosar. I thank the gentlelady for yielding back.
Mr. Cohen, can you make those training modules accessible
to the committee?
Mr. Cohen. You know, we are working on them right now.
Mr. Gosar. So they don't exist. So this is theory right
now.
Mr. Cohen. We are working on them right now, and we would
be happy to get them to you.
Mr. Gosar. And do you have a date in mind? You know, we
talk about that we are going to be on time here. Can you tell
me when you expect to have them done and when we can actually
have them in possession by the committee?
Mr. Cohen. Well, as was noted earlier, the grants go out in
August, and that is when the training will begin. So the
training will be complete and ready prior to that. I can't give
you a specific date, but we are happy to work with you to get
you whatever information.
Mr. Gosar. We would like to have a constant dialogue, so we
would like to have those modules.
Mr. Cohen. Absolutely.
I would like to recognize the gentleman from Michigan, Mr.
Bentivolio.
Mr. Bentivolio. Thank you, Mr. Chairman.
Boy, have I got a lot of questions. Thank you, Mr. Cohen,
for coming in today and testifying.
Mr. Cohen. Sure.
Mr. Bentivolio. You had talked earlier, and I am a bit
confused. Maybe you can straighten me out here. You said that
the assisters don't obtain confidential privacy information
from those who are applying, correct?
Mr. Cohen. They don't retain any. The information is put by
the person who is filling out the application, either on paper
or online, but the person who is helping them doesn't keep that
information, because it just goes directly from the person who
is applying through the system and the navigators will be
instructed they are not to retain any personal information
belonging to the people they are helping.
Mr. Bentivolio. With that said, even though California has
a law that says that assisters have to have a background check?
Mr. Cohen. Yes.
Mr. Bentivolio. And you also said that if somebody does
misuse that privacy information, there is a $25,000 fine?
Mr. Cohen. Correct.
Mr. Bentivolio. And who investigates and enforces the
assisters, the IRS?
Mr. Cohen. No. It is our grant, so CMS will be doing the
oversight with respect to the federally-facilitated
marketplaces, and then the States will be doing it with respect
to the State marketplaces.
Mr. Bentivolio. So even though it goes on a computer or on
paper, the assisters aren't supposed to retain it.
Mr. Cohen. That is right.
Mr. Bentivolio. But I am a little concerned when you--maybe
I misunderstood, and you could clarify to me the qualifications
to be an assister. When he asked you have to have a high school
education, you didn't really answer that question. I mean, what
are the requirements for being an assister; social worker,
prior experience selling insurance?
Mr. Cohen. Well, in the navigator grant process, you have
to demonstrate both a track record and expertise of the people
who are going to be performing this function. So whether
someone could qualify who wasn't a high school graduate, I
can't say. I don't believe that that is going to be the norm,
no.
Mr. Bentivolio. Okay. And you said how many hours of
training in modules?
Mr. Cohen. Twenty to 30 hours.
Mr. Bentivolio. Twenty to 30 hours. I think that is the
amount of time you need to study HIPPA, if I remember what my
wife told me. She has been a nurse for 33 years.
Mr. Cohen. Okay.
Mr. Bentivolio. So 20 to 30 hours?
Mr. Cohen. Yes.
Mr. Bentivolio. How tall are you?
Mr. Cohen. How tall am I? I am about 5'6.
Mr. Bentivolio. Five foot six. Okay. I am 5'11, just short
of 6'. Do you know how many pages are in the new regulations
for the un-Affordable Health Care Act?
Mr. Cohen. I don't.
Mr. Bentivolio. Okay. It is 20,000. Can we get that up?
Mr. Cohen. There it is.
Mr. Bentivolio. There it is. Seven foot tall. And you
expect an assister who is going to assist people on this un-
Affordable Health Care Act to understand 20,000 pages of new
regulations?
Mr. Cohen. No, I don't. They are not going to have to read
all those regulations, and neither does an insurance agent have
to read every----
Mr. Bentivolio. Somebody does. And they have to digest that
information to put it in these modules. Twenty thousand pages.
Mr. Cohen. They will have the information that they need to
help people understand the benefits of the law and get enrolled
in coverage. That is what they need to do. They don't need to
understand every aspect of what it takes to implement the
Affordable Care Act. They will have the information that they
need.
Mr. Bentivolio. In reference to Congressman Connolly's
definition of chutzpah, if I remember right, I wasn't a member
of Congress at the time, but I remember my definition of
chutzpah is saying something like you have to pass the bill
before you can read it. In fact, truth in labeling, we would
have said you have to pass it before you even write it, or
something along those lines. Now, that takes a lot of chutzpah.
And calling it a constitutional right, when in fact the Supreme
Court said it was a tax, right? Didn't the Supreme Court the
un-Affordable Health Care Act is a tax?
Mr. Cohen. I believe the Supreme Court upheld the
individual responsibility penalty as a tax.
Mr. Bentivolio. Yes. It kind of reminds me of walking into
a department store, not buying anything, and meeting the IRS
agent outside and he says, hey, you have to pay a tax for not
buying anything. You are taxed on failing to engage in commerce
or buying any type of insurance under this program, correct?
Mr. Cohen. People who are required to have health insurance
under the law may be penalized if they don't have insurance
under the law.
Mr. Bentivolio. So they are going to be taxed for failing
to engage in commerce, correct? Yes or no? I am running out of
time.
Mr. Cohen. I can't argue with you what Chief Justice
Roberts decided in the case; he decided what he did.
Mr. Bentivolio. It takes a lot of chutzpah to do that to
the American people.
I could use more time, but I yield back.
Mr. Gosar. I thank the gentleman.
I would like to recognize the gentleman from Georgia, Mr.
Woodall.
Mr. Woodall. Thank you, Mr. Chairman.
Thank you, Mr. Cohen, for being here today. I am relatively
new in Congress and I was not here when we voted on the bill
and I did not read it. Your testimony titled Navigators and
Assisters Programs, the copy that I have talks a lot about the
Navigators Program but does not talk a lot about the Assisters
Program. We have talked about the requirements for
participating in the Navigator Program, how those grants go out
the door. Where will I look to find the answers to what those
regulations and requirements are for participating in the
Assisters Program?
Mr. Cohen. So we will be coming out with a final rule.
Right now the Assisters Program is in a proposed rule, and we
are reviewing comments and will be coming out with a final rule
soon.
Mr. Woodall. I may have asked the wrong question, Mr.
Cohen, and, again, forgive me if I have. I was looking at the
stack that Mr. Bentivolio put up there on the wall. I know
there is a lot of reg that has to come out and, after I vote
yes or no, I sometimes lose control over that and it goes down
to the agency. I am actually thinking about the bill itself.
Even the legislative language of the bill is explicit about how
to participate. It is in this whole consumer choice section, it
is all about protection, all about making sure we get the best
people involved and making sure consumers have the best
information they can. I see the Navigator side.
Mr. Cohen. Right.
Mr. Woodall. I just don't see the Assister side.
Mr. Cohen. Well, what we propose in the rule that we put
out was that States have come to us that are running their own
exchanges, and what they have said is that----
Mr. Woodall. Again, I might not be asking the right
question. I am not interested in what you all are doing in your
regulatory work.
Mr. Cohen. Okay.
Mr. Woodall. Because I think all of your regulatory work is
simply responding to what we passed in the Affordable Care Act.
Mr. Cohen. Right.
Mr. Woodall. So in the Affordable Care Act I see all about
how to participate in the Navigators Program; it defines it,
tells me about it, tries to make it very robust.
Mr. Cohen. Right.
Mr. Woodall. I don't see anything about the Assisters
Program.
Mr. Cohen. It says that exchanges have to provide outreach,
education, and consumer assistance, and that is what the
Assisters Program is going to implement, that provision.
Mr. Woodall. It says that States have to provide that?
Mr. Cohen. If they are operating their own marketplace,
yes.
Mr. Woodall. And that the Feds will fund the provision of
those services?
Mr. Cohen. That funds are available under Section 1311
while States are establishing their exchanges, yes.
Mr. Woodall. So what do you make of the funds under 1311?
Because, again, language is very explicit here: navigators will
do this, navigators will do that, States will provide these
services. And it says very clearly grants under this subsection
shall be made from the operational funds of the exchange, and
not Federal funds received by the State to establish the
exchange. I read that as an explicit we don't want Federal
funds used for this purpose. If you choose to participate in an
exchange, you will be responsible for these costs. But you are
going through an entire rule-making process, great machinations
in order to make sure folks do receive Federal funds for this.
Do you read this provision differently than I do?
Mr. Cohen. I agree with you that the statute says that
Federal funds under 1311 are not available to States to do
their Navigator Programs, and what we said is but States still
have this obligation to provide consumer assistance, and during
the first year, before they are financially self-sustaining,
they may use 1311 money to perform that function.
Mr. Woodall. Let me make sure I----
Mr. Cohen. But not to run their Navigator Program. They
still have to have a Navigator Program, but they may use that
funding to perform their statutory obligation under the law to
do consumer assistance, to do consumer outreach as part of
establishing the exchange before it is financially self-
sustaining.
Mr. Woodall. That doesn't pass the smell test for me. You
know, when is a cut not a cut? Only in Washington, right? You
increase it by $2 and we call that a cut. Folks don't
understand the Washington math. I don't think they understand
the Washington rhetoric. I wish we were all in this together to
try to make provisions better.
Can I ask how many times have you gone to the committee of
jurisdiction to say, you know what, you explicitly say we can't
do this, but we think we need to do this, and can you change
the law to give us that authority?
Mr. Cohen. And I actually don't know the answer to that
question.
Mr. Woodall. Do you believe that it has happened, though?
Mr. Cohen. I don't know.
Mr. Woodall. You don't have any idea?
Mr. Cohen. I don't.
Mr. Woodall. Mr. Chairman, that is the crisis of confidence
I think we perpetuate on the American people. Here is something
that explicitly says thou shalt not. I wasn't here to vote on
it, but my colleagues did, the Senate did; the President signed
it. For whatever reason, we said thou shalt not. And when you
decided you didn't like it, you just decided you would go a
different way to do the exact same thing, the exact same way,
but call it something different, and get another pot of money.
Not even knowing if you ever came to Congress to say we think
this could be done better, will you give us that authority.
Folks say that the Administration and Congress can't work
together; hard to work together when we don't even get the
invitation and the first thing we see is the rule-making that
seems to be directly contradictory to statutory authority, and
I deeply regret that both for us and for the American people.
I yield back, Mr. Chairman.
Mr. Gosar. I thank the gentleman of Georgia.
The gentleman from Georgia, Mr. Collins, is now recognized.
Mr. Collins. Thank you, Mr. Chairman. We will just continue
the Georgia pattern here for just a moment. I want to have a
dialogue and I have a lot of questions here that I think can be
answered sort of yes, no, or just say you will provide. I am
leaving it open at this point.
One of the questions that always comes up here, especially
in these oversight hearings, is the issue of oversight, and it
is one of those things that, after something happens, well, if
we had had better oversight, we would have caught it. I
understand explicitly the States are supposed to provide for
their own oversight in dealing with their program; however,
States such as our own, Congressman Woodall and myself, have
chosen not to participate in this. So the Federal program will
have to do. Do you have a program set up for oversight and
management that would oversee this if it falls back on you to
instruct this?
Mr. Cohen. And you are speaking about the Navigator
Program?
Mr. Collins. Yes.
Mr. Cohen. Yes, we absolutely do. It is consistent with the
way we manage grants.
Mr. Collins. I apologize, sir. Do you have these written
down? Are these policies written down? Is this oversight plan
written down?
Mr. Cohen. I am hesitating because I am not certain whether
there is a specific oversight plan for this program written
down. There are rules that we follow in terms of how we do
oversight when we do grants administration that are not unique
to this program.
Mr. Collins. But as far as this program, especially in
light of what this program is going to entail, it seems to me
that there should be, because you are requiring the States to
have a written oversight program for this, and an oversight
plan.
Mr. Cohen. I will have to look.
Mr. Collins. Okay, so at this point we don't have one.
Mr. Cohen. I will have to look; I am not certain.
Mr. Collins. If you do, will you provide it to this
committee?
Mr. Cohen. I will look and we will certainly work with you,
yes.
Mr. Collins. Also, you said on awarding--and I am going
simply by your statement that you provided for this committee.
It said you were using an evaluation rubric developed by HHS
for the qualified unbiased expert contractors who will review
all the applications. Do you have that rubric?
Mr. Cohen. I am sure we do.
Mr. Collins. Okay, I am trying to be calm here. You are
sure we do?
Mr. Cohen. I am sure we do, yes. Yes.
Mr. Collins. And can you provide it?
Mr. Cohen. We will work with you to get that for you, sure.
Mr. Collins. Okay.
Mr. Cohen. And let me, as long as you are on that subject,
if I might, because I made a statement earlier that I am
informed is not correct, so I want to make sure I correct it. I
was talking about the grant review panels and I said that
people from HHS and CMS won't be on them, and that is not
right; there could be people from HHS and CMS who could be on
them. There won't be anyone on them who is involved in the
program that is running the Navigator Program.
Mr. Collins. Okay. All right.
Mr. Cohen. So I just wanted to correct that.
Mr. Collins. Same page you discuss that these folks will
all comply with different standards. In your statement you said
comply with privacy and security standards, among other
activities. Do you have written down what these privacy and
security standards are? Are they written down anywhere?
Mr. Cohen. The privacy and security standards are in our
proposed rule, I think, yes.
Mr. Collins. Okay. Can you provide those for the committee?
Mr. Cohen. Yes.
Mr. Collins. Thank you. Can you ensure us that the
navigators and assisters who will have access to extremely
personal and sensitive information will be held to the same
hiring standards of U.S. Census employees?
Mr. Cohen. I hesitate there because I am not responsible
for the census, so I don't know what they are required to do. I
know that they will be subject to the standards that CMS
employs with respect to all the grants that it does, there is
nothing different here.
Mr. Collins. Thank you. Will you commit to requiring
background checks equivalent to those that the U.S. Census uses
before the rule is finalized?
Mr. Cohen. In the proposed rule we have not required
background checks, and I can't say what is going to happen in
the final rule, but we have given flexibility to States, and
some States have decided that they are going to require them,
yes.
Mr. Collins. And not to be argumentative here, I am not
trying to be. This is so important for people right now because
this is absolutely changing what we do, and I believe in a very
bad way. But in a security situation here I would encourage
you, if that is not being given a lot of thought, as far as
security background checks, you are dealing with people's lives
here, and I would believe that that would be an important
aspect.
Moving on. Are you aware of the secrecy law passed by the
State of California to conceal spending on government
contractors setting up the California exchanges?
Mr. Cohen. I am not, actually.
Mr. Collins. From April 2012 to July 2012, did you serve as
chief counsel to the California Health Exchange Board?
Mr. Cohen. I did.
Mr. Collins. Okay. Two weeks ago it was revealed that the
State of California passed a law allowing State exchanges to
conceal spending on the contractors that will perform most of
its functions, potentially shielding the public from seeing how
hundreds of millions of dollars are spent. These contracts will
be funded largely by taxpayer dollars. Do you believe taxpayers
have the right to know how Federal taxpayer dollars are being
spent to implement State-based exchanges?
Mr. Cohen. Well, I know that we review the budgets and the
expenditures of all the State-based exchanges, including
California's, so whatever law California passes is not going to
affect our ability to do oversight over their activities.
Mr. Collins. Okay, but at this point I think the question
here is should taxpayers have the right to know which companies
receive these contracts and how much, and how are you going to
balance that if you have set the State exchange up to do it
their own way, then you are going to say now that you are going
to override California law?
Mr. Cohen. No. Under the terms of the grant, we have the
right to look at what they are spending, and we are looking
at----
Mr. Collins. Which will be public record?
Mr. Cohen. I don't know the answer to that.
Mr. Collins. Okay. So the concern comes here is it secret.
And my time has expired, but these are the kinds of questions,
just providing transparency if we are heading down this road.
But that is a concern, because if we are going into this and we
don't have those answers, that was just the reason for these
questions. I appreciate your time.
Mr. Chairman, I yield back.
Mr. Gosar. I thank the gentleman.
What we are going to do, Mr. Cohen, is I am going to
acknowledge the gentlelady from California, then myself to
close off the meeting. Thank you.
The gentlelady from California, Ms. Speier.
Ms. Speier. Thank you, Mr. Cohen.
And, Mr. Chairman, thank you.
Do you feel like you are being sabotaged?
Mr. Cohen. Well, I prefer not to use that word.
Ms. Speier. I think you are being sabotaged. And I think it
is un-American at this point in time, when this law has passed,
we are in the process of implementing it, that you don't have
the resources to do the job. You are going to be doomed if you
don't get the resources you need.
We just spent over $1 billion in the Air Force on a
computer system that didn't work and we had to trash. A billion
dollars. And you have $54 million to do your outreach? How much
do you need to do your outreach?
Mr. Cohen. I don't have a number in my head, but we
certainly could use additional funding to be able to do
additional outreach and to perform all of the things that we
need to do under the law, definitely.
Ms. Speier. All right, so I think what the committee should
benefit from is having an estimate from you of what you really
need in order to do the job and do it well. I mean, there is a
lot of stirring up the pot today about how this is going to
fail. Well, we can guarantee that it will fail if we don't give
you the resources to actually roll it out properly. So tell us
what you need. If we can spend $1 billion on a failed system
for the Air Force computers, we can certainly spend enough
money so that every American has the information they need to
access the health care and the health insurance that they are
now qualified to receive.
Mr. Cohen. I do know that in the President's budget he has
requested about $1.5 billion for implementation of the
exchanges.
Ms. Speier. And that includes the outreach?
Mr. Cohen. Yes.
Ms. Speier. $1.5 billion.
Mr. Cohen. That is in the 2014 budget.
Ms. Speier. So maybe that money we spent on that failed
computer system could have been better spent here.
I yield back.
Mr. Gosar. I thank the gentlelady.
Mr. Cohen, how closely is HHS working with IRS on Obamacare
implementation?
Mr. Cohen. We are working closely with IRS on those aspects
of implementation where we have to work together, so, for
example, as you know, in determining whether a person is
eligible for Medicaid or CHIP on the one hand, or tax credits
in the marketplaces on the other, income is a test, and we are
working with IRS on verifying people's income when they apply.
Mr. Gosar. So the IRS is going to be gathering and sending
this enormous amount of taxpayer information to all the 50
exchanges. All 50 exchanges are to be ready by October 1st,
right?
Mr. Cohen. Yes.
Mr. Gosar. So will there be any problems with this massive
amount of data sharing?
Mr. Cohen. No. And data sharing may not be exactly the
right way to look at it. Basically what will happen is people
will put information about their income in an application; that
information will be verified by data that comes from the IRS,
but there is no exchange of information from the IRS to the
exchange; the information goes out, it is verified, and it
comes back.
Mr. Gosar. But it is still from the exchange going to the
IRS, and that is where I am going.
Mr. Cohen. It is going to the data hub. Information is
coming from the IRS to the data hub and from the exchange to
the data hub, and there is a comparison and then there is an
answer back. But the tax information isn't actually going to
the exchange.
Mr. Gosar. Gotcha. Okay, so what will the navigators and
assisters tell individuals about the subsidy reconciliation
process?
Mr. Cohen. They will give them accurate information and
they will encourage them, certainly, to make sure that if their
income situation changes over the course of the year, that they
should update their account to make sure that that is
reflected.
Mr. Gosar. Okay, so will navigators and assisters tell
individuals that a change in income, marital status, household
size, or workplace insurance may make them ineligible for tax
credits and, if not, almost certainly will impact the size of
their tax credit?
Mr. Cohen. They will certainly let them know that if they
have a change in circumstance, they need to provide that
information, yes. It is important that they do so.
Mr. Gosar. Okay. So will navigators and assisters tell
individuals that the Government will be sending the tax credit
to the insurance companies, but if an overpayment occurs, the
IRS will come after the individual, not the insured, to collect
that overpayment?
Mr. Cohen. They will certainly let them know that if their
situation changes, they need to put that information in there
so that they can avoid getting a tax credit to which it turns
out they are not entitled to at the end of the year.
Mr. Gosar. So will navigators and assisters tell
individuals that the failure to report a change in income,
marital status, household size, workplace insurance, and some
other criteria may cause them to owe hundreds of thousands of
dollars to the IRS when they file their taxes?
Mr. Cohen. Hundreds of thousands of dollars? I am not aware
of that number.
Mr. Gosar. Hundreds or thousands.
Mr. Cohen. Oh, hundreds or thousands. I see. You scared me
there for a second.
Mr. Gosar. The IRS and hundreds of thousands always scares
a taxpayer.
Mr. Cohen. I think that it will be very important for
people to understand that they need to update their information
if their situation changes, and that information will certainly
be provided by navigators, yes.
Mr. Gosar. Okay. So what will a navigator or assister do if
an individual applying for health insurance doesn't have a W-2
or an income tax return?
Mr. Cohen. I don't think it is a requirement that a person
have a W-2 or an income tax return. If I understand the way the
application works correctly, you can enter in the amount of
income that you had, and if you have filed taxes, that is the
data that will be accessible through the data hub from the IRS,
what your tax return was last year, and that is what we will be
checking against.
Mr. Gosar. Okay, so what will the navigator or assister do
if an individual reports that they are paid under the table?
Mr. Cohen. That is a good question. I will have to think
about that and talk to folks.
Mr. Gosar. We will expect an answer.
Couple last questions. Will you commit to the committee to
getting us a list of all phone calls placed to whom they were
made and the other solicitations that the Secretary made to
fund Enroll America and for all other purposes?
Mr. Cohen. I think you are asking the wrong guy for that.
Mr. Gosar. Well, you can carry the message back. I mean,
you are the messenger from HHS, so you can be the messenger
back.
Mr. Cohen. I am happy to be a messenger back.
Mr. Gosar. Will you also commit to getting the committee a
list of all the amounts that were promised or received?
Mr. Cohen. Same answer. I will take the message back. I
can't commit anything to you because that is not my job.
Mr. Gosar. Well, one thing I want to end with here is I
have done working with patients with insurances, with privacy
compliance for 25 years being a dentist. It is not a simple
task at all. And, to me, when we see that we are still
developing modules and that we don't have them in place, and we
are coming up on June, and then we say that we already have
some type of oversight made, I find it interesting that it is
either the chicken or the egg. I think you have to have the
modules first, before you outline a protocol of oversight.
Wouldn't you agree?
Mr. Cohen. I think we are developing all those things and
we will have them all in place in time for open enrollment in
October.
Mr. Gosar. Well, I think some of your comments I applaud,
that you are looking at building these modules, but I also
think that how you develop those modules develops your
oversight plan, so something off the shelf isn't going to be
applicable 100 percent of the time. So it seems to me you are
going to build these modules and then behind it is going to be
coming oversight. So we would also like not only the modules,
but the oversight plan to the committee as well.
Mr. Cohen. That is a fair point and we will work with you
to get you that.
Mr. Gosar. I thank you very, very much.
Seeing there are no other questions, I adjourn this
meeting. Thank you.
[Whereupon, at 12:13 p.m., the subcommittee was adjourned.]
APPENDIX
----------
Material Submitted for the Hearing Record
[GRAPHIC] [TIFF OMITTED] 82107.012
[GRAPHIC] [TIFF OMITTED] 82107.013
[GRAPHIC] [TIFF OMITTED] 82107.014
[GRAPHIC] [TIFF OMITTED] 82107.015
[GRAPHIC] [TIFF OMITTED] 82107.016
[GRAPHIC] [TIFF OMITTED] 82107.017
[GRAPHIC] [TIFF OMITTED] 82107.018
[GRAPHIC] [TIFF OMITTED] 82107.019