Advocacy / Politics

House Hearing to Address ObamaCare’s Eligibility and Verification System

By – Kathleen Spillane

On Wednesday, July 16th, the House Energy and Commerce Health Subcommittee held a hearing on the reliability of ObamaCare’s eligibility and verification system entitled, “Failure to Verify: Concerns Regarding PPACA’s Eligibility System.”  Two Assistant Inspectors General testified to two separate reports filed by their office demonstrating the failure of both federal and state ObamaCare marketplaces to properly verify the eligibility of citizens who have signed up to receive subsidies.  These failed eligibility systems experienced the most trouble in verifying income and citizenship status specifically.  To further compound the issue, a second report by the Office of Inspector General cited that both federal and state marketplaces were having trouble resolving these inconsistencies, which means that not only are the proper controls not operating, but nothing has been instituted to fix these inoperable controls.  In a Subcommittee document released on May 27th, there had been 4 million inconsistencies reported.  These failures to verify subsidy qualifications will result in skewed tax returns for people across the country, as some states are seeing payments double what they owe while others are paying far less than what they actually owe.  These large marketplace failures at both the federal and state levels, as the Subcommittee noted, need to be fixed before the next enrollment period -before hard earned tax payer dollars are going to be squandered once more.

Kay Daly, the Assistant Inspector General for the Office of Audit Services, offered testimony on behalf of herself and the second witness, Joyce Greenleaf, the Regional Inspector General for the Office of Evaluation and Inspections.   In their testimony, Daly described the purpose and findings of both reports published by the OIG.  The first report looked into the federal, Connecticut, and California marketplaces.  The findings indicated that these marketplaces “had certain procedures in place but not all internal controls were effective in determining eligibility and maintaining and updating data.”  Furthermore, through the period of October 2013 to December 2013, the report found that in 2.6 of 2.9 million cases, the eligibility systems were not fully operational, which means there was nothing to prevent the use of fraudulent information such as Social Security Numbers and other identifiers.  Daly assured the Subcommittee that “inconsistencies don’t necessarily indicate inaccurate information.”  In the second report, the OIG found that the federal and state marketplaces were mostly unable to resolve these system failures on their own.

During the question and answer session that followed, Rep. Joe Pitt (R-PA), the Subcommittee Chairman, expressed concern over why the former Secretary of Health and Human Services (HHS), Kathleen Sebelius, certified on January 1st, 2014, that the marketplaces were verifying eligibilities and that subsidies would be made as a result of this verification.  Although the witness said she could not speak to that statement, Chairman Pitt further questioned if their report offered a timetable for when inconsistencies would be resolved.  Daly responded that there is no official timetable though the OIG has “a tracking system in place to monitor the implementation of [their] recommendations.”  Greenleaf reiterated this, stating that the OIG has called on Centers for Medicare and Medicaid Services (CMS) to make public their plan to fix their eligibility systems; however, in the meantime, CMS has an interim system in place that allows fraudulent data to be manually changed or updated.  Still, it remains largely unclear if a long-term plan has been either finalized or implemented.  The Subcommittee members were rather concerned about this uncertainty, stressing that the next enrollment period is in a matter of months and that coverage and pricing are one again at risk.

Representative Renee Ellmers (R-NC) asked the witnesses about the inconsistency periods that are included in the ObamaCare mandate.  This 90-day period, according to Daly, “gives an opportunity to clarify… during that people are additionally enrolled.  The rules state that if there is a case where someone got a subsidy they weren’t entitled to, plans are in place for obtaining resolutions.  With the tax credit, when they file their tax return all will be reconciled.”

This line of questioning was echoed by Rep. Cathy McMorris Rogers (R-WA), who inquired as to whether the witnesses have any knowledge of who has been paying these premiums.  The witnesses were unable to answer this question definitively and said that these issues were not a part of the work they did in their report.  Rep. McMorris Rogers voiced much concern over the impact on tax payer money, citing that her constituents who were enrolled in the Washington Health Plan Founder were “receiving an invoice for twice what they owed, others with no invoice, and some with a zero balance.”  The witnesses stated that the IRS is scheduled to oversee the resolution of these premium issues by spring of 2015.

Rep. Phil Gingrey (R-GA) again reiterated the sentiments of many of the Subcommittee members as the hearing came to a close, which was that the OIG is not doing enough to oversee that these problems with the eligibility verification and resolution systems are actually being resolved.  “When I talk to people in 11th Congressional District of Georgia, I have no way to give confidence that people who are undeserving to receive part of trillion dollars of subsidies are not receiving them, and thus these subsidies are not getting to the right people.”

AMAC is staying on top of this continued pattern of misinformation and inconsistency that are representative of ObamaCare as a deeply flawed and overreaching law.  AMAC intends to hold the federal government accountable for how it uses – or misuses – taxpayer dollars, while not providing the quality and access to care that it promised.


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8 years ago

Those hearings were yet another example of how NOT to run an investigative line of inquiry. I get that various members of the Republican party to demonstrate to the public how poorly run Obamacare really is and that the supposed “safeguards” are either badly broken or completely inoperative. However, the line of questioning asked should have been directed towards leadership members of HHS, who would have been in a position to answer those questions or, more likely, since they wouldn’t be able to answer them to Congress’ satisfaction, at least been shown to incompetent in their duties to run the program properly.

Almost all the questions posed to GAO were outside the scope of what the agency is responsible for or has the power to do anything about. The GAO’s responsibility to audit various agencies and programs to ensure they are in complaince with the stated rules and objectives associated with their operational mandates. They can not tell HHS to do their job better or differently. They can only report that they are either in or out of compliance with the standards defined for their operation of various programs. Period. If Congress wanted to ask this line of questioning, then they should have subpoenaed leadership from HHS. That would have been the correct approach to take.

It like asking the auditor of a business why the owners and operators of the business aren’t spending money to upgrade their stores, instead of on inventory for their stores and then expecting the auditor to be able to tell you when those upgrades, that are not even being planned by the way by the owners or operators, will be completed. Now do you see why the line of questioning of GAO personnel was inappropriate and a colossal waste of time?

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