By Melissa Attias, CQ Roll Call
November 5, 2013 -- A top Obama administration official in charge of overseeing the health care law rollout recently said that officials are looking at a target projection of 800,000 Americans newly enrolled in health insurance coverage by the end of November.
However, Department of Health and Human Services aides would not clarify the comments made by Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner at a Senate hearing, so it was unclear whether that number applies to both the state and federal insurance exchanges or just the federally run exchange. Administration officials have said they will not release enrollment figures for the troubled federal exchange until mid-November but have cautioned the numbers will be low.
"Our projections are constantly changing based on the experience on the ground," said Joanne Peters, a spokeswoman for HHS. "We have always anticipated that the pace of enrollment will increase throughout the enrollment period."
Peters added, "As Secretary Sebelius said before Congress last week, even prior to Oct 1, we expected the first month's numbers to be low and we have since faced challenges with the website not working the way it should. We are focused on reaching as many people as possible to make sure that they know about the benefits they are entitled to under the Affordable Care Act."
The number emerged at a hearing of the Senate Health, Education, Labor and Pensions Committee when Tavenner was asked about "the target enrollment number for the end of November for the exchange" by Sen. Richard M. Burr, R-N.C.
"For the end of November?" asked Tavenner. "I think we are looking at, between October and November, I think that number was, I want to say around 800,000." Last week, internal exchange "war room" documents released by the House Oversight and Government Reform Committee indicated that there were just six enrollments on the first day of operation of the problem-plagued federal health insurance exchange. There were 248 by the second day.
Meanwhile, the top Democrat and Republican on the Senate panel agreed on at least one thing: the troubled website for the new federal exchange will get fixed. But they had fundamentally different opinions about whether the overhaul is taking the country in the right direction.
Senators from both parties peppered Tavenner with questions at the hearing, demanding specific answers about how the administration plans to move forward with the rollout of the law (PL 111-148, PL 111-152).
Although the questioning was generally less heated than when administration officials testified before House panels controlled by Republicans last week, Senate Democrats did not mince words. Barbara A. Mikulski of Maryland, for one, expressed concern about a "crisis of confidence" that could prevent the new system from succeeding.
In response to questions from ranking Republican Lamar Alexander, Tavenner also said CMS is in the process of putting together information on enrollment and that it will be available next week. Members of Congress have been pressing for enrollment numbers, which officials repeatedly have said they would release in mid-November.
Also, House Ways and Means Chairman Dave Camp subpoenaed CMS for enrollment data after Tavenner responded to his request from last week without turning over the figures.
Tavenner wrote in her Nov. 4 letter that the agency "is focused on providing reliable and accurate enrollment-related information" through a process it expects to continue over the next two weeks, with the data released in mid-November.
She said the documents about enrollment cited by Camp "appear to be notes and do not reflect official enrollment-related statistics." And she closed by expressing appreciation for Camp's patience and said that the agency would provide the information as soon it's available.
But Camp said in a letter that accompanied the subpoena that administration officials including Tavenner have received status reports on enrollment and refuse to turn them over to policymakers.
"Congress needs to know what you know so Congress, the American people's representatives, can also take corrective action," the Michigan Republican wrote. "Both Republicans and Democrats need to understand the full extent of the crisis if we are going to find a fair and workable solution for the American people."
According to the committee, Camp demanded the documents by close of last week.
Opening the Senate hearing, Chairman Tom Harkin, D-Iowa, said he wanted the website working so the overhaul will succeed, not be torn down like many have been working to make happen. He called it "a machine that will be fixed" and listed some of the benefits of the new law.
"That's the big picture and we shouldn't forget it," Harkin said at the hearing, at which Tavenner was the sole witness.
Alexander, R-Tenn., also said he was sure the administration would be able to fix the website and that he's not very worried about the penalties that take effect next year. But he said he's more concerned about the individuals who are getting cancellation notices for their current coverage.
Alexander voiced support for a measure (S 1617) from Wisconsin Republican Ron Johnson that he said would put into law President Barack Obama's promise that individuals could keep their health plans if they like them. When Alexander asked whether the administration would support it, Tavenner said she had not looked at Johnson's bill. She also encouraged those individuals receiving cancellation notices to go on the exchange website and look at their options, noting that some of them may qualify for subsidies.
Harkin said he's heard a lot of concern from Republicans about cancellations, but that he didn't hear much in the past when insurance companies would cancel policies if someone got sick.
"What we're saying is, that's over with. That old value system was no good for this country," Harkin said.
Outreach and Education
Mikulski told Tavenner she is worried that there is such a "crisis of confidence" in the new system that the young and healthy people needed to make the law a success will not enroll. She asked if the administration has a plan to restore young people's interest, which Tavenner said was the case.
"I believe that there's been a crisis of confidence created in the dysfunctional nature of the website, the cancelling of policies and sticker shock from some people," said Mikulski, who also serves as chairwoman of the Senate Appropriations Committee.
While the goal this month is to stabilize the website, Tavenner said CMS has a targeted plan that includes young people and large populations of the uninsured that draws on a combination of media, including television, radio and some print. And she said she thought the administration would be able to restore confidence in the program, maintaining that the website has already been improved.
In addition, Washington Democrat Patty Murray asked about the administration's plan to get information to people whose plans are being cancelled. Tavenner said they are going to be discussing the issue soon and that she would get back to her with information.
"I think that's really important because a lot of them are just seeing 'Your policy's been cancelled by Obamacare' and not being told 'Here is what your options are,'" said Murray, the chairwoman of the Budget Committee.
North Carolina Democrat Kay Hagan also asked about education and outreach and questioned what steps the administration would take if the site is not working, such as delaying the penalties on individuals who do not purchase insurance. Hagan has called for an extension of open enrollment and waiving the penalties for two months. But Tavenner said there are no plans to delay the individual mandate and maintained that the website is working now and performance improvements being made.
Security Concerns
Senators from both parties also asked Tavenner several questions related to the security of the website—an issue that Tavenner said she thinks there has been a lot of confusion about. Tavenner said the security of the hub, which serves the federal and state exchanges, went through end-to-end testing and was signed off on. It's the exchange itself that went through security testing by component and got a short-term authorization to operate, she said, since CMS officials knew they would be making software upgrades.
"I think there's confusion about what was tested and what was not tested," Tavenner said.
Harkin noted that he's found that security is a "paramount concern" from talking to other senators. Consumers have to be completely sure that their information is secure when they fill out an application, he said.
"I just think this is an issue that really has to really be focused on thoroughly so there's absolute assurance that that is secure," Harkin said.
Georgia Republican Johnny Isakson also asked whether Tavenner was aware of a separate June report from the Health and Human Services Department inspector general that found that contractor Quality Software Services, Inc. had not sufficiently implemented required security controls for USB ports and devices, putting the personal information of more than 6 million Medicare beneficiaries at greater risk. Tavenner said she was not aware of it.
Obama Remarks
At an Organizing for Action political event last week, Obama tried to reassure supporters of the health care law that their work on the overhaul is already making a difference and will continue to do so. While he reiterated his frustration with the federal exchange website, he also emphasized that open enrollment only began one month ago and that everyone will have the opportunity to sign up for coverage.
"I know you're not happy about it because as long as the website is not working the way it should, it makes it harder for you to help them get covered," Obama said. "And that's unacceptable and I'm taking responsibility to make sure that it gets fixed. And it will be fixed."
Like in his speech in Boston in October, Obama also tried to ease concerns about individuals receiving cancellation notices for their current health coverage and explain his promise that if people liked their plans, they could keep them. And he urged supporters to continue their outreach and education efforts for the law.
"I have run my last political campaign, but I'll tell you what, I've got one more campaign in me—the campaign to make sure that this law works for every single person in America," Obama said. "And I'm asking for your help."
Obama will also meet with volunteers in Dallas, Texas, who are helping educate and enroll people in health coverage through the insurance exchanges.