[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
FAILURE TO VERIFY: CONCERNS REGARDING PPACA'S ELIGIBILITY SYSTEM
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HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON ENERGY AND COMMERCE
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
SECOND SESSION
__________
JULY 16, 2014
__________
Serial No. 113-161
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Printed for the use of the Committee on Energy and Commerce
energycommerce.house.gov
______
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COMMITTEE ON ENERGY AND COMMERCE
FRED UPTON, Michigan
Chairman
RALPH M. HALL, Texas HENRY A. WAXMAN, California
JOE BARTON, Texas Ranking Member
Chairman Emeritus JOHN D. DINGELL, Michigan
ED WHITFIELD, Kentucky Chairman Emeritus
JOHN SHIMKUS, Illinois FRANK PALLONE, Jr., New Jersey
JOSEPH R. PITTS, Pennsylvania BOBBY L. RUSH, Illinois
GREG WALDEN, Oregon ANNA G. ESHOO, California
LEE TERRY, Nebraska ELIOT L. ENGEL, New York
MIKE ROGERS, Michigan GENE GREEN, Texas
TIM MURPHY, Pennsylvania DIANA DeGETTE, Colorado
MICHAEL C. BURGESS, Texas LOIS CAPPS, California
MARSHA BLACKBURN, Tennessee MICHAEL F. DOYLE, Pennsylvania
Vice Chairman JANICE D. SCHAKOWSKY, Illinois
PHIL GINGREY, Georgia JIM MATHESON, Utah
STEVE SCALISE, Louisiana G.K. BUTTERFIELD, North Carolina
ROBERT E. LATTA, Ohio JOHN BARROW, Georgia
CATHY McMORRIS RODGERS, Washington DORIS O. MATSUI, California
GREGG HARPER, Mississippi DONNA M. CHRISTENSEN, Virgin
LEONARD LANCE, New Jersey Islands
BILL CASSIDY, Louisiana KATHY CASTOR, Florida
BRETT GUTHRIE, Kentucky JOHN P. SARBANES, Maryland
PETE OLSON, Texas JERRY McNERNEY, California
DAVID B. McKINLEY, West Virginia BRUCE L. BRALEY, Iowa
CORY GARDNER, Colorado PETER WELCH, Vermont
MIKE POMPEO, Kansas BEN RAY LUJAN, New Mexico
ADAM KINZINGER, Illinois PAUL TONKO, New York
H. MORGAN GRIFFITH, Virginia JOHN A. YARMUTH, Kentucky
GUS M. BILIRAKIS, Florida
BILL JOHNSON, Missouri
BILLY LONG, Missouri
RENEE L. ELLMERS, North Carolina
Subcommittee on Health
JOSEPH R. PITTS, Pennsylvania
Chairman
MICHAEL C. BURGESS, Texas FRANK PALLONE, Jr., New Jersey
Vice Chairman Ranking Member
ED WHITFIELD, Kentucky JOHN D. DINGELL, Michigan
JOHN SHIMKUS, Illinois ELIOT L. ENGEL, New York
MIKE ROGERS, Michigan LOIS CAPPS, California
TIM MURPHY, Pennsylvania JANICE D. SCHAKOWSKY, Illinois
MARSHA BLACKBURN, Tennessee JIM MATHESON, Utah
PHIL GINGREY, Georgia GENE GREEN, Texas
CATHY McMORRIS RODGERS, Washington G.K. BUTTERFIELD, North Carolina
LEONARD LANCE, New Jersey JOHN BARROW, Georgia
BILL CASSIDY, Louisiana DONNA M. CHRISTENSEN, Virgin
BRETT GUTHRIE, Kentucky Islands
H. MORGAN GRIFFITH, Virginia KATHY CASTOR, Florida
GUS M. BILIRAKIS, Florida JOHN P. SARBANES, Maryland
RENEE L. ELLMERS, North Carolina HENRY A. WAXMAN, California (ex
JOE BARTON, Texas officio)
FRED UPTON, Michigan (ex officio)
C O N T E N T S
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Page
Hon. Joseph R. Pitts, a Representative in Congress from the
Commonwealth of Pennsylvania, opening statement................ 1
Prepared statement........................................... 2
Hon. Frank Pallone, Jr., a Representative in Congress from the
State of New Jersey, opening statement......................... 3
Hon. Fred Upton, a Representative in Congress from the State of
Michigan, prepared statement................................... 5
Witnesses
Kay Daly, Assistant Inspector General, Office of Audit Services,
Office of Inspector General, U.S. Department of Health and
Human Services; and Joyce Greenleaf, Regional Inspector
General, Office of Evaluation and Inspections, Office of
Inspector General, U.S. Department of Health and Human Services 6
Prepared statement........................................... 8
Answers to submitted questions............................... 66
Submitted Material
Article entitled, ``Obamacare Fails to Fail,'' The New York
Times, July 13, 2014, submitted by Ms. Schakowsky.............. 39
Article entitled, ``7 predicted Obamacare disasters that never
happened,'' Vox, July 15, 2014, submitted by Ms. Schakowsky.... 42
Article entitled, ``Sebelius Stands Firm Despite Calls to
Resign,'' The New York Times, October 16, 2013, submitted by
Mr. Pitts...................................................... 53
Letter of June 4, 2014, from Mr. Upton to Mr. Waxman, submitted
by Mr. Pitts................................................... 56
Report entitled ``Marketplace Inconsistencies,'' by CMS, Center
for Consumer Information and Insurance Oversight (CCIIO)....... 59
FAILURE TO VERIFY: CONCERNS REGARDING PPACA'S ELIGIBILITY SYSTEM
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WEDNESDAY, JULY 16, 2014
House of Representatives,
Subcommittee on Health,
Committee on Energy and Commerce,
Washington, DC.
The subcommittee met, pursuant to call, at 10:15 a.m., in
room 2322, Rayburn House Office Building, Hon. Joseph R. Pitts
(chairman of the subcommittee) presiding.
Present: Representatives Pitts, Shimkus, Blackburn,
Gingrey, McMorris Rodgers, Lance, Cassidy, Guthrie, Griffith,
Bilirakis, Ellmers, Pallone, Schakowsky, Green, Barrow, Castor,
and Waxman (ex officio).
Staff Present: Clay Alspach, Chief Counsel, Health; Matt
Bravo, Professional Staff Member; Leighton Brown, Press
Assistant; Paul Edattel, Professional Staff Member, Health;
Sydne Harwick, Legislative Clerk; Katie Novaria, Professional
Staff Member, Health; Chris Pope, Fellow, Health; Chris Sarley,
Policy Coordinator, Environment & Economy; Macey Sevcik, Press
Assistant; Heidi Stirrup, Health Policy Coordinator; Ziky
Ababiya, Minority Staff Assistant; Karen Lightfoot, Minority
Communications Director and Senior Policy Advisor; and Matt
Siegler, Minority Counsel.
OPENING STATEMENT OF HON. JOSEPH R. PITTS, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA
Mr. Pitts. The subcommittee will come to order. The chair
will recognize himself for an opening statement.
On July 1st, 2014, the Department of Health and Human
Services Office of the Inspector General released two
disturbing reports regarding eligibility verification for
individuals purchasing coverage in the exchanges. According to
the reports, between October 1st and December 31st, 2013, OIG
identified 2.9 million inconsistencies between applicants'
information and data received through the Data Hub or from
other data sources. One-third of these is related to income.
Resolving these inconsistencies is often critical in
determining eligibility for the nearly $1 trillion in exchange
subsidies that are being spent over the course of the next
decade, and this is why Congress passed a law requiring the
Secretary of HHS to certify that processes were in place to
verify eligibility before subsidies were made available.
Secretary Sebelius made such a certification to Congress on
January 1st, 2014. Yet one OIG report states, ``As of the first
quarter of 2014, the Federal marketplace was unable to resolve
about 2.6 million of the 2.9 million inconsistencies because
the CMS eligibility system was not fully operational. It was
unable to resolve inconsistencies, even if applicants submitted
appropriate documentation.''
It is clear that the eligibility system is far from
operational. CMS reports that it now has in place an interim
manual process to resolve inconsistencies, and it hopes to have
a fully automated process later this summer.
It is absolutely stunning that this administration, nearly
a year after the launch of the exchanges and with $1 trillion
on the line, has yet to build a functioning eligibility system.
Given the administration's false promises when it comes to
Affordable Care Act implementation, CMS' hope to have a fully
automated process up and running later this summer deserves to
be treated with skepticism.
From telling Americans falsely that they could keep their
health plan and doctors, to Secretary Sebelius' commitment that
the exchanges would be ready to launch on October 1st,
implementation of this law has been a series of broken
promises. Additionally, this problem appears to be getting
worse, not better. According to documents released by this
committee, as of May 27, at least 4 million inconsistencies
have been identified.
These facts make it clear that the administration is taking
a, ``shovel the money out the door first, verify later,''
approach when it comes to exchange subsidies. It is simply
unacceptable that CMS does not yet have the internal controls
necessary to validate Social Security numbers, citizenship,
national status, income, and employer-sponsored coverage.
Americans sending taxes to Washington don't deserve to have
their money so blatantly disregarded by a Federal Government
that is supposed to serve them.
OIG has recommended that CMS, ``should develop and make
public a plan on how and by what date the Federal marketplace
will resolve inconsistencies.'' One has to wonder how long it
will take to clear this backlog and whether proper internal
controls will be in place to prevent this from happening again
during the next open enrollment period this fall.
One also has to wonder how the administration intends to
claw back any improper subsidies that were given as a result of
inaccurate information. Middle-class families could be left on
the hook for thousands of dollars in payments back to the IRS
as a result of this failure.
My time has expired. I yield back. And now recognize the
ranking member of the subcommittee, Mr. Pallone, 5 minutes for
an opening statement.
[The prepared statement of Mr. Pitts follows:]
Prepared statement of Hon. Joseph R. Pitts
The Subcommittee will come to order.
The Chair will recognize himself for an opening statement.
On July 1, 2014, the Department of Health and Human
Services Office of the Inspector General released two
disturbing reports regarding eligibility verification for
individuals purchasing coverage in the Exchanges.
According to the reports, between October 1 and December
31, 2013, OIG identified 2.9 million inconsistencies between
applicants' information and data received through the Data Hub
or from other data sources.
One third of these related to income.
Resolving these inconsistencies is often critical in
determining eligibility for the nearly $1 trillion in exchange
subsidies that are being spent over the course of the next
decade.
This is why Congress passed a law requiring the Secretary
of HHS to certify that processes were in place to verify
eligibility before subsides were made available.
Secretary Sebelius made such a certification to Congress on
January 1, 2014.
Yet, one OIG report states, ``As of the first quarter of
2014, the Federal marketplace was unable to resolve about 2.6
million of 2.9 million inconsistencies because the CMS
eligibility system was not fully operational. It was unable to
resolve inconsistencies even if applicants submitted
appropriate documentation.''
It is clear that the eligibility system is far from
operational. CMS reports that it now has in place an interim
manual process to resolve inconsistencies, and it hopes to have
a fully automated process later this summer.
It is absolutely stunning that this Administration, nearly
a year after launch of the exchanges and with $1 trillion on
the line, has yet to build a functioning eligibility system.
Given the Administration's false promises when it comes to
Affordable Care Act implementation, CMS' hope to have a fully
automated process up and running later this summer deserves to
be treated with skepticism.
From telling Americans falsely that they could keep their
health plan and doctors to Secretary Sebelius' commitment that
the exchanges would be ready to launch on October 1st,
implementation of this law has been a series of broken
promises.
Additionally, this problem appears to be getting worse, not
better. According to documents released by this Committee, as
of May 27, at least four million inconsistencies had been
identified.
These facts make it clear that the Administration is taking
a ``shovel the money out the door first, verify later''
approach when it comes to exchange subsidies.
It is simply unacceptable that CMS does not yet have the
internal controls necessary to validate Social Security
numbers, citizenship, national status, income, and employer-
sponsored coverage. Americans sending taxes to Washington don't
deserve to have their money so blatantly disregarded by a
federal government that is supposed to serve them.
OIG has recommended that CMS ``should develop and make
public a plan on how and by what date the Federal marketplace
will resolve inconsistencies.''
But one has to wonder how long it will take to clear this
backlog, and whether proper internal controls will be in place
to prevent this from happening again during the next open
enrollment period this fall.
One also has to wonder how the Administration intends to
``claw back'' any improper subsidies that were given as a
result of inaccurate information. Middle class families could
be left on the hook for thousands of dollars in payments back
to the IRS as a result of this failure.
I appreciate the Office of the Inspector General's work and
would like to thank you for being here today to discuss the
findings of these reports in more detail, and I yield back.
OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF NEW JERSEY
Mr. Pallone. Thank you, Mr. Chairman.
Let me welcome the Office of the Inspector General's
representatives here today. The work you do is invaluable to
our committee and Congress, and there is always a role for us
to strive to do better so we can ensure that taxpayer dollars
are well spent.
But I think there are some important lessons I hope we can
learn from today's hearing. The first and most important is the
fact that a data inconsistency on a consumer's application does
not equate to errors. In fact, nearly all of the cases of
inconsistencies can be easily resolved. The second lesson is
that we should use OIG to learn how we can strengthen our
Federal programs, not as a political blunt object to mislead
the American public.
We get it. Republicans don't like Obamacare. In fact, they
won't recognize one single benefit from the law, and they
predicted one disaster after another, and none of them have
come true. I respect my chairman a lot, but, I mean, all I kept
hearing in his comments about how we are so worried about this
subsidy. Well, this subsidy goes to middle-class people, not to
poor people, not to rich people. I think it is, what, something
between $25,000, $30,000 and up to maybe $80,000 or $90,000 for
a family of four in order to get the subsidy. That is the
middle class. That is the middle class that we are trying to
preserve. These are the average Americans.
Why are they so worried about a subsidy for middle-class
people instead of worrying about the big corporations or the
oil companies? I could have 10 hearings on all the subsidies
for the oil companies, and God knows what they are getting away
with. These are not the fat cat contributors. This is the
average person.
And the ACA is working. The results are in. Three
independent surveys support this claim. During the law's first
open enrollment period, 9.5 million previously uninsured
Americans got health coverage, reducing the uninsured rate
amongst working adults from 20 percent to 15 percent in less
than a year. According to a Commonwealth Fund survey, the
overwhelming majority of the newly ensured, including 74
percent of Republicans, are satisfied with their coverage.
Now, that doesn't mean the law is perfect. No one on my
side of the aisle is arguing that. But we have had some
technical hiccups with enrollment. The reports that OIG will
discuss today, I believe, are a reflection of those challenges.
We have learned how to improve the process. And this fall, the
hope is to strengthen the system even further and capture
millions more Americans who need healthcare coverage.
But if Republicans really want to talk about taxpayer
dollars being spent wisely, let's have that conversation. We
can talk about Speaker Boehner's frivolous lawsuit against the
President or the wasteful $3 billion being spent on this
repetitive, unnecessary Benghazi fishing expedition. And then
there is the $2.3 million they spent defending discrimination
in the courts during the Defense of Marriage, or DOMA case.
The House GOP is interested in wasting taxpayer dollars to
score political points. The ACA, on the other hand, is helping
people get access to health care, and it is saving lives. So I
would just ask my colleagues to stop the political stunts, stop
trying to dismantle the ACA's success, and come together with
Democrats to strengthen and improve its historic benefits and
protections. We are trying to help the middle class. That is
what this is all about. And without that subsidy, they are not
going to be able to get health insurance.
So I would like to yield now 1 minute to Congressman Green
from Texas.
Mr. Green. Thank you, Chairman.
I thank the ranking member for yielding.
According to the recent report from the Commonwealth Fund,
9.5 million additional adults ages 19 to 64 are now covered by
insurance. Seventy-three percent of the people who bought
health plans and 87 percent of those signed up for Medicaid
said they were pleased with the new insurance. Even 74 percent
of the newly insured Republicans like their plans.
Mr. Chairman, there are certainly shortcomings in the
Affordable Care Act both in policy and implementation, but as I
always say, if you want something perfect, don't come to
Congress or a legislative body. Yes, the 9.5 million newly
insured and millions more are benefiting from reforms included
in the law.
It is long past time to move beyond political posturing and
misinformation campaigns to get back to business, time we start
working to improve the law in ways where there is broad
agreement. The American people deserve better, and I hope to
work with my colleagues to build on this success and make
changes that best serve the public.
And I yield back my time.
Mr. Pallone. I yield now to the gentlewoman from Florida,
Ms. Castor, the remainder.
Ms. Castor. Well, thank you, Mr. Pallone.
And thank you, Mr. Chairman, for calling this hearing on
how we improve the Affordable Care Act for America's families.
I appreciate the Inspector General's Office, all of the
work you have done to help us identify where we need to
improve.
Why is this important? Millions and millions of Americans
are depending on us. And I look at my home State of Florida.
We, surprisingly, had 1 million Floridians sign up through the
Federal marketplace. It is remarkable. But now we are going to
face a different open enrollment period starting November 15th
to February 15th. We have got to ensure that this is working
for our families. So help us prioritize where we have to pay
additional attention, help us make this better for America's
families.
Thank you, and I yield back.
Mr. Pitts. The chair thanks the gentlelady.
All members' written opening statements will be made a part
of the record.
[The information follows:]
Prepared statement of Hon. Fred Upton
For months and even years, the alarms were sounding over
the president's health care law that it was not ready for prime
time and that it would not work for the American people. For
the past nine months, since the start of the first open
enrollment period, we have seen this play out in a broken and
still-incomplete Web site, cancelled plans, rising costs, and
false promises from the administration.
The Office of Inspector General is before the subcommittee
today to discuss important work that underscores some of the
major problems that continue to plague this broken law. Two
recent reports from the administration's own nonpartisan
watchdog provide a preview of what the future of this law
holds. These reports indicate that, despite assurances from the
Secretary of Health and Human Services, the backend and
verification systems for the health care exchanges is still not
built. OIG has found that HHS failed to resolve nearly 2.6
million of 2.9 million data inconsistencies as of February of
this past year. This committee has uncovered that this number
grew to more than 4 million by the end of May. What's worse,
HHS still does not have a fully operational eligibility
verification system in place although the systems should be the
highest priority.
The administration should never have gone live last fall in
the first place without the Web site being structurally
complete, and yet everyday Americans are left to endure the
administration's incompetence. And, according to media reports,
it seems the administration has made it a higher priority to
fight bad publicity, than to actually fix the problems.
Taxpayers could be on the hook for improper payments in a
program that is estimated to spend $1 trillion over the next
decade. Middle class families filing their taxes in 2015 could
come to find out they owe the IRS thousands of dollars based on
an inaccurate eligibility determination.
Sadly, it is clear this administration has taken a ``spend
first, verify later'' approach to this law, and it's taxpayer
dollars that are on the line. Once again, ordinary Americans
stand to suffer because of the administration's reckless
rollout of this health care law and its disregard for taxpayer
dollars.
Mr. Pitts. On our panel today we have two witnesses, Ms.
Kay Daly, Assistant Inspector General, Office of Audit
Services, Office of Inspector General, U.S. Department of
Health and Human Services, and Ms. Joyce Greenleaf, Regional
Inspector General, Office of Evaluation and Inspections, Office
of Inspector General, U.S. Department of Health and Human
Services.
Thank you for coming.
While we have two witnesses on our panel, I understand
their statements are one and the same, so I will ask Ms. Daly
to present the joint statement, and then both witnesses will be
available for questions from members.
Ms. Daly, you will have 5 minutes to summarize your
testimony. Your written testimony will be placed in the record.
You are recognized for 5 minutes.
STATEMENT OF KAY DALY, ASSISTANT INSPECTOR GENERAL, OFFICE OF
AUDIT SERVICES, OFFICE OF INSPECTOR GENERAL, U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES; AND MS. JOYCE GREENLEAF, REGIONAL
INSPECTOR GENERAL, OFFICE OF EVALUATION AND INSPECTIONS, OFFICE
OF INSPECTOR GENERAL, U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES
Ms. Daly. Thank you and good morning Chairman Pitts,
Ranking Member Pallone, and other distinguished members of the
committee. Thank you for the opportunity to testify today about
two new reports from the Department of Health and Human
Services Office of Inspector General. These reports provide a
first look at a critical component of the health insurance
marketplaces that were established under the Affordable Care
Act: their verification of enrollee eligibility.
Accompanying me today is Joyce Greenleaf, our Regional
Inspector General For Evaluation and Inspections. First, I will
highlight our report, which responded to a congressional
mandate to examine the effectiveness of enrollment procedures
and safeguards. Then I will talk about our companion report,
which addressed a specific risk area: the inconsistency
resolution process.
Our mandated work examined and directly tested internal
controls at the Federal, California, and Connecticut
marketplaces. These controls related to verifying the identity
of applicants and application information, determining
eligibility of applicants for enrollment in qualified health
plans, and maintaining and updating enrollment data. Our period
of review for that report was October through December of 2013.
We concluded that the Federal, Connecticut, and California
marketplaces had certain procedures in place to verify an
applicant's information. However, not all internal controls
were effective. The presence of an internal control deficiency
does not necessarily mean that applicants were improperly
enrolled in health plans or in insurance affordability
programs. Other mechanisms exist that may remedy the internal
control deficiency. These deficiencies in internal controls may
have limited the marketplace's ability to prevent the use of
inaccurate or fraudulent eligibility information.
We recommended in this report that CMS and the Connecticut
and California marketplaces take actions to improve internal
control deficiencies. These include verifying the applicant's
identity, determining the applicant's eligibility, and
maintaining enrollment data.
For the companion report, we analyzed from a national
perspective how marketplaces resolved inconsistencies between
applicant self-attested information and other data sources. We
obtained data from the State marketplaces from October through
December of 2013, and for the Federal marketplace we analyzed
data through February of 2014.
During those time periods, many marketplaces were unable to
resolve most inconsistencies. The most common were related to
citizenship and income. The Federal marketplace wasn't able to
resolve 2.6 million of 2.9 million inconsistencies because the
CMS eligibility system was not fully operational.
The ability to resolve inconsistencies varied across the
marketplaces. Seven state-based marketplaces reported that they
were able to resolve those inconsistencies without delay.
Now, inconsistencies do not necessarily indicate that an
applicant provided inaccurate information, nor do
inconsistencies equate to errors in enrollment in health plans
or insurance affordability programs. However, marketplaces must
resolve these inconsistencies to ensure eligibility is
accurate.
So, accordingly, we recommended that CMS develop a plan for
resolving the inconsistencies in the Federal marketplace. We
also recommended that CMS ensure that inconsistencies in State-
based marketplaces were resolved according to the Federal
requirements.
These are the first two reports in a series related to
operations of the marketplaces. We have a substantial body of
work underway and planned to ensure that taxpayer dollars are
spent for their intended purposes in a system that operates
effectively and is secure. This work will examine additional
critical issues related to eligibility systems, payment
accuracy, contract oversight, data security, and consumer
protection.
I want to thank you all for your interest and support for
the OIG's mission and for the opportunity to discuss our work
today. We are happy to answer any questions you may have.
Mr. Pitts. The chair thanks the gentlelady for her
testimony.
[The prepared joint statement of Ms. Daly and Ms. Greenleaf
follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Pitts. We will now begin questions and answers, and I
will recognize myself 5 minutes for that purpose.
Ms. Daly, on January 1st, 2014, Secretary Sebelius
certified to Congress that the exchanges are verifying
eligibility. Federal law required this certification before
exchange subsidies could be made available. OIG's report
states, ``As of the first quarter of 2014, the Federal
marketplace was unable to resolve about 2.6 million of 2.9
million inconsistencies because the CMS eligibility system was
not fully operational.''
Based on these facts, isn't it true that HHS made the
certification to Congress before the eligibility system was
fully operational?
Ms. Daly. Chairman Pitts, we of course looked at the
Secretary's report purely for informational purposes and didn't
really analyze it to understand more about what was behind
that, what the Secretary had available for making that
certification, so I really can't speak directly to your
question. I am sorry.
Mr. Pitts. Although your statement says ``because the CMS
eligibility system was not fully operational.'' Do you stand by
that statement?
Ms. Daly. Oh, absolutely, sir.
Mr. Pitts. All right. Has CMS provided the OIG a firm
timetable when their eligibility verification system will be
fully operational?
Ms. Daly. No, sir, not to my knowledge.
Mr. Pitts. Is it possible that these inconsistencies will
not be resolved by the next open enrollment period, which
starts in November of 2014?
Ms. Daly. Well, we have work ongoing in that area right
now, but I really don't know about any definite timetable, nor
when they may be fully operational at that time.
Mr. Pitts. Ms. Greenleaf, did you want to add to that?
Ms. Greenleaf. I would add that in CMS' comments to our
report they indicated that they had implemented an interim
manual system to address the inconsistencies that they were
unable to address during the period of our report, and CMS
reported to us that it would have an automated system by the
end of the summer. We have not followed up as yet, but we do
have a tracking system in place to monitor the implementation
of the recommendations.
Mr. Pitts. Thank you. The OIG is focusing on several areas
of work to conduct oversight over spending under the Affordable
Care Act. Understanding that much of the scope of the work is
fluid, can you highlight some of the specific areas of work
your office intends to focus on?
Ms. Daly. I would be glad to do so, sir. Our office has
embarked on a strategic approach to looking at the
marketplaces, and we have developed a strategy we refer to as
PECS, and that stands for payment accuracy, eligibility,
contracting, and security. And with that, we have some works
planned and already underway looking at payment accuracy, how
accurate are the payments that are going out to insurers, and
also we are starting work looking at payments within the
context of providing subsidies and things of that nature.
Further, with our eligibility work, this is just the first
and other jobs that we have planned and underway to look at
eligibility. We started work at other State-based marketplaces
to understand what their systems were and then doing additional
work at the Federal marketplace also.
For contracting, we are looking at several aspects of the
contracting that were involved in the development of
HealthCare.gov. And then finally with security, we are looking
at the information security that is designed to protect the
information in these marketplaces.
Mr. Pitts. All right. The OIG report states that the
administration did not have effective controls in place to
perform basic tasks. Can you elaborate on this and tell us what
HHS has done to date to alleviate this problem, either one of
you?
Ms. Daly. Well, I would be glad to talk about some of the
issues that were in our mandated report. For the Federal
marketplace, we found that some Social Security numbers were
not always validated through the Social Security
Administration, and CMS has advised that they are following up
on these issues and trying to identify any particular issues
that were causing that from the systemic approach.
With that, also there were the inconsistencies in
eligibility data that we had talked about, and we have already
identified that they said they had put in an interim system and
were continuing to address those inconsistencies and that a
more formal process will be in place later.
Last, we saw that there was not the system functionality to
allow enrollees to update their information that was in the
system. CMS advised us in agency comments that they had taken
steps to allow the functionality so that that information could
be updated. So we have not had a chance to go back and look at
how well that is functioning at this time.
Mr. Pitts. Ms. Greenleaf, can you elaborate a little?
Ms. Greenleaf. I would just reiterate what I said
previously regarding the inconsistencies. That was the priority
concern in the report that dealt with the inconsistencies, and
we called on CMS to fix that and make public a plan, and we
will be monitoring their response to that through our formal
tracking system.
Mr. Pitts. My time has expired.
The chair recognizes the ranking member, Mr. Pallone, 5
minutes for questions.
Mr. Pallone. Thank you, Mr. Chairman.
It is not a surprise anymore that my Republican colleagues
never want to talk about the good news with the Affordable Care
Act. Eight million signed up for private plans, 6.7 million
newly enrolled in Medicaid, 3 million young adults on their
parents' plans. The list goes on.
For years now, the GOP have ignored the financial
assistance available through the marketplaces. They put out
misleading analyses claiming massive premium increases, and
they have never once admitted that the vast majority of
enrollees will qualify for assistance and that coverage will
become extremely affordable.
But here are some facts. This year, tax credits cut the
average enrollee premium by 76 percent. The average premium
consumers are actually paying for dependable comprehensive
coverage is $82 per month. Seventy percent of people getting
financial assistance pay less than $100 a month. Fifty percent
pay less than $50 per month.
And this is incredible news, and that is why the
Republicans of course don't want to talk about it. Instead,
they claim there is widespread fraud in who is getting the
financial assistance. And the reports our witnesses are
discussing today address the eligibility checks on the front
end. And as we have heard, an inconsistency does not
necessarily mean an individual is getting an incorrect subsidy.
So I will say, Ms. Greenleaf, but whoever can answer, isn't
it correct that your report states, ``Inconsistencies do not
necessarily indicate that an applicant provided inaccurate
information or is enrolled in a qualified health plan or is
receiving financial assistance inappropriately?''
Ms. Greenleaf. That is correct. Inconsistencies can occur
for both eligible and ineligible applicants.
Mr. Pallone. Thank you.
An inconsistency on an application should not be a
surprise. Automatically checking dozens of pieces of
application data against a variety of Federal databases is not
a simple thing. In fact, a family of 4 could generate 21
different inconsistencies on their application. And that is why
the lead contractor responsible for resolving these
inconsistencies said he was not surprised by the number of
inconsistencies.
If the consumer includes a hyphen in their name on their
application which does not appear in Federal databases, that
could generate an inconsistency. If the consumer had recently
moved, that might generate an inconsistency. But those are
clearly not examples of fraud or misrepresentation. They are
harmless. Similarly, with regard to income, the marketplace
checks individual income off of 2012 tax data, so it would not
be a surprise if their 2014 income data was different than
2012.
Again, Ms. Greenleaf, isn't it true that an income
inconsistency does not necessarily mean an individual is
getting too much or too little financial assistance?
Ms. Greenleaf. It doesn't necessarily mean that, no. As I
mentioned previously, both eligible and ineligible applicants
can have inconsistencies, and the law anticipated the existence
of inconsistencies. What is concerning is the number of
unresolved inconsistencies.
Mr. Pallone. OK. Now, again, CMS has resolved more than
460,000 inconsistencies and has a process in place to resolve
the remaining inconsistencies this summer. So, Ms. Greenleaf,
CMS concurred with your recommendation to make public their
plan to resolve inconsistencies. Isn't that correct?
Ms. Greenleaf. We have not received CMS' official response
outside of what is in the actual report yet, so they have a
certain amount of time to respond to the recommendations
officially. In its comments to our report, they did indicate
that the interim manual system will fully automate later this
summer, so we will be monitoring that closely through our
formal tracking system.
Mr. Pallone. And isn't it correct that in their response to
your recommendations they wrote, and I quote, ``The FFM now has
in place an interim manual process that allows it to reconcile
inconsistencies and plans to implement the automated
functionality this summer''?
Ms. Greenleaf. CMS did say that in its response to our
report.
Mr. Pallone. I am just pleased that the IG is monitoring
the agency's work, but the progress CMS has made to address
these issues is important.
And I guess, look, I am just so frustrated by the fact that
the Republicans are ignoring all this in order to score
political points. I mean, again, we are talking about middle-
class people here. We are talking about someone who is trying
to fill out a form. We are talking about people whose income
is, what, $25,000, $30,000 to $80,000 or $90,000 for a family
of four. This is the middle class that supposedly all of us
want to build and provide a decent healthcare benefit package
for.
I am not saying we shouldn't have the hearing, obviously,
but I just think that there is so much emphasis on the GOP side
on the fact that some average person is going to commit fraud,
and that is not the case here. This is not a huge problem that
is being presented.
Thank you, Mr. Chairman.
Mr. Pitts. The chair thanks the gentleman.
Now recognize the gentlelady from North Carolina, Mrs.
Ellmers, 5 minutes for questions.
Mrs. Ellmers. Thank you, Mr. Chairman.
And thank you, Ms. Daly and Ms. Greenleaf, for being with
us today.
Your study shows that 85 percent have not been resolved,
and that is an incredibly large number of applicants'
application process that is in question. And that certainly
doesn't mean that there was fraud perpetrated. It just means
that there are inconsistencies and those inconsistencies need
to be addressed. And it goes to the larger problem of
eligibility and how are we ensuring the American taxpayers
their hard-earned dollars are being utilized to the best
possible. And we want to see everyone have affordable health
care. We need to make sure that it is done right. And starting
at this point is a good place.
So I guess what I need to know is, what happens now? I
mean, what happens? I know that you said, Ms. Daly, you talked
about a formal tracking system going into place, which that is
very, very good, making sure that payments that are going out
are accurate and being accounted for. But then in relation to
those who might be in a situation of getting subsidies that
might not have qualified, how can we address that issue? I am
glad that there is a tracking system in place for the payments,
but how is that going to help us get to the bottom of the
issue?
And, Ms. Greenleaf, I would like for you to weigh in as
well, if you would like.
Ms. Daly. Well, thank you very much for that question.
I think the inconsistency periods, that was set up as part
of the law and the regulations surrounding ACA because, indeed,
there can be some variations in some of the information. So it
gives an opportunity to try to clarify all that.
During that period, people are conditionally enrolled in
the program until that is cleared up. I think the rules state
that if there does turn out to be a case where perhaps someone
may have gotten a subsidy that they were not entitled to of
whatever nature, financial assistance of whatever nature, there
are plans in place for obtaining resolution on that. So that,
for example, with the tax credit, that would be worked out when
the consumer files his tax return next year, and this is all
supposed to be reconciled at that point in time.
Mrs. Ellmers. How would it be reconciled, though, because
basically aren't they paying a certain premium amount or
getting a certain tax credit at that level? Because would they
or would they not be paying more for their healthcare coverage
if there is an inconsistency that is found to be accurate,
essentially meaning that they did find the inconsistency? How
do you make up that difference?
Ms. Greenleaf.
Ms. Greenleaf. I think that happens, it is my
understanding, through the reconciliation process with the IRS.
So it could be that some applicants would be owed money and
others would in fact owe money. So it could be determined
either way. They come fully enrolled during the 90-day
inconsistency period, after which a redetermination is supposed
to be made.
Mrs. Ellmers. OK. And then I guess there again, from what
you are saying, the IRS then becomes the enforcing body that
will make sure that this happens.
Ms. Daly. That is my understanding, yes.
Mrs. Ellmers. OK.
Well, thank you.
And I really, Mr. Chairman, I don't have any more
questions, so I yield back the remainder of my time.
Mr. Pitts. The chair thanks the gentlelady.
Now recognize the gentleman from Texas, Mr. Green, 5
minutes for questions.
Mr. Green. Thank you, Mr. Chairman and Ranking Member
Pallone and our witnesses for their testimony today.
I am going to start by echoing my colleagues:
Inconsistencies are not the same as errors or fraud. It is
incorrect and deliberately misleading to refer to them that
way. According to John Lau, vice president of Serco, the
contractor responsible for obtaining the necessary information
to address enrollment inconsistencies, 99 percent of the
inconsistencies in marketplace applications are innocuous.
And it is also disingenuous to suggest such inconsistencies
are specific to the Affordable Care Act. Federal and State
programs where eligibility must be verified, such as Medicaid,
all face the challenges of reconciling inconsistent data in
applications. However, in Medicaid eligible applicants are put
on a waiting list while the discrepancy is sorted out, forced
to go without health coverage for however long it takes. Under
the ACA, Americans can enroll and get coverage immediately.
The inconsistencies, which I repeat are 99 percent
innocuous in ACA applications, are going to be resolved at some
point, but we feel it is better for people to get coverage
after applying instead of going on a waiting list indefinitely.
Ms. Daly and Ms. Greenleaf, other Federal programs have to
verify individuals' eligibility through an application process.
Isn't this correct?
Ms. Daly. Yes, sir.
Mr. Green. OK. So inconsistencies in applications are not
unique to exchanges created under the Affordable Care Act?
Ms. Daly. Yes, sir.
Mr. Green. Thank you.
In the Medicaid program, eligible applicants are put on a
waiting list until their inconsistency is fixed and an
applicant can access coverage. That is partly why we have a
massive backlog in Medicaid applications in States around the
country. That is not a solution at all. Given the unknown
nature of health care, you never know when you will need it. It
is long overdue that we move beyond efforts to undermine,
repeal, or create unwarranted alarm for political gain about
the ACA and get back to the business of serving the American
people.
I have some time left. Can you give me examples of other
programs that maybe the GAO has investigated that you go back
in and have inconsistencies?
Ms. Daly. I am sorry, but just nothing is coming to mind at
this point in time. But I would be glad to get back with you on
that.
Mr. Green. OK. If you would and share it.
Ms. Greenleaf. Nothing comes to my mind either. Thank you.
We can get back to you if we identify anything.
Mr. Green. Were there any specific recommendations that
either of your agencies made to Health and Human Services to
correct some of the problems?
Ms. Daly. In our report, sir, we had identified a number of
weaknesses at both the Federal, Connecticut, and California
marketplaces, and we made specific recommendations to fix the
underlying systems, of course, that were prompting such errors,
and then we also asked them to fix the specific cases that we
had found. And they were generally amenable to doing so, so
that was very helpful.
Mr. Green. Have you followed up with that to see both on
the national exchange and the Connecticut and California if
that is what they are doing if they agreed to correct those
inconsistencies?
Ms. Daly. Well, we do have work that we are getting
underway right now to do additional work at the Federal
exchange to look at some other issues there and plan, as part
of that, to do additional follow-up on the status of the
recommendations we had made in this report.
Mr. Green. OK. So this is not something that we are going
to sweep under the rug, we want to deal with it, because,
again, the ACA is a valuable tool for people in our country to
get health care, and we want to make sure it is done right. And
I appreciate your agencies for doing that, and hopefully
Congress will get back to what we want to do, which is make
sure it gets done right.
Mr. Chairman, I will yield back my time.
Mr. Pitts. The chair thanks the gentleman.
I now recognize the gentleman from New Jersey, Mr. Lance, 5
minutes for questions.
Mr. Lance. Thank you very much, Mr. Chairman.
This committee has spent a great deal of time and effort
discussing the inadequacies of the healthcare law's rollout.
Some people believe that the worse is behind us and many of the
most important serious problems have been resolved. However, I
believe, as your report has pointed out, many of our
constituents may be in for a rude awakening when their tax bill
comes due.
I am also greatly concerned, and this is not an area for
you to address, but I wish to place on the record the fact that
there is the significant constitutional and statutory issue
regarding subsidies for the Federal exchange as opposed to
subsidies for the State exchanges. That issue will be resolved
in the courts. I did ask Secretary Sebelius about that very
significant matter at a previous hearing, and let me predict
that that case is likely to go to the Supreme Court, although
it is now in the various circuits.
Regarding the issue this morning, it is my understanding
that you did not review certain eligibility issues because you
did not have access to Federal taxpayer information at the time
of your audit. Would you please update the committee on your
access to that information now? Ms. Daly.
Ms. Daly. Yes, sir. Yes, as we were performing our work, we
learned that you could not have the access to the Federal
taxpayer data. So we immediately began to discuss the issue
with IRS and have worked very closely with them. They have been
very agreeable in helping us sort through the issues.
At this time we have been advised that we can access the
Federal taxpayer information that is provided to the Federal
marketplace, and so that is going to be one of the key areas we
are following up on to do the similar work that we had done
looking at other aspects of determining eligibility to also
look at verifying the income. And with that, we are also
continuing to discuss with IRS obtaining access to the state
marketplaces, too.
Mr. Lance. And do either of those matters require statutory
change or can you do that administratively?
Ms. Daly. Well, to date, we have had success in doing that
administratively, but if it looks like we may need to have a
statutory change, we would be glad to get back and work with
you and your staff to try to bring about such a change.
Mr. Lance. Do you have a timeframe, Ms. Daly, when you will
receive that information regarding both the Federal exchange
and the state exchanges with the IRS?
Ms. Daly. Well, for the Federal exchange we have received
the authorization to go in and review that. We are just going
through some more logistic issues of ensuring that we have
appropriate safeguards in place to protect that taxpayer data
while it is in our possession.
And for the timeframe, for completing the work on the
Federal exchange, I believe it is in the spring of 2015 we
should have the results out on that assessment there. And with
the States, we are continuing to work with them, so I can't
provide you with an assessment right now of when that may be
available.
Mr. Lance. Thank you. I hope you are able to provide us
with that when you do get that information.
Regarding the fact that the Federal exchange information
with the IRS may be available in the spring of 2015, next
spring, I wish to make sure that my constituents understand the
implications of these problems that were highlighted in your
report. If the eligibility verification system produces a
determination for an applicant with an inaccurate exchange
subsidy, am I accurate that the IRS is required by law to claw
back that money from the individual?
Ms. Daly. Sir, if you are referring to the tax credits and
so forth, yes, sir, that would be part of the IRS'
responsibility.
And I would also like, if I could, to take a second to
clarify that our work that we plan to be doing at the Federal
exchange, that is when we would have completed the work, would
be in the spring of 2015, so we can provide the results at that
time to the august members of this body.
Mr. Lance. Thank you. I am not suggesting necessarily that
there is fraud on the part of those who may have provided
inaccurate information. I would imagine in most cases it is not
a matter of fraud, it simply may be a matter of inaccurate
information. And all of us as human, we all make mistakes.
I do believe that there is a potential that there are going
to be many unhappy surprises come tax time next spring, in the
spring of 2015. Only time will tell. But certainly that
impresses me as being a possibility.
Thank you, Mr. Chairman.
Mr. Pitts. The chair thanks the gentleman.
Now recognize the gentlelady from Illinois, Ms. Schakowsky,
5 minutes for questions.
Ms. Schakowsky. Thank you. Mr. Chairman, I have a statement
and a request to make. I hope I will still have time for some
questions.
But we have had a lot of good news about the Affordable
Care Act in recent weeks: 8 million enrolled in private
coverage, 6.7 million enrolled in Medicaid, the number of
uninsured dropping by 10 million people, and the rate of
uninsured in states around the country dropping by 30, 40, even
50 percent in just 1 year. Actually that is pretty amazing. And
I want to put two articles in the record that discuss some of
this good news and what I believe is the warped Republican
reaction to it.
The first is a column in the New York Times. The columnist
writes, ``What you get whenever you suggest that things are
going OK with the ACA, there is an outpouring not so much of
disagreement as of fury. People get red in the face, angry,
practically to the point of incoherence over the suggestion
that it is not a disaster.'' He goes on to say, ``I suspect
there is now an element of shame if this thing is actually
working. Everyone who yelled about how it would be a disaster
ends up looking fairly stupid.''
The next piece I want to highlight is from health reporter
Sarah Kliff, who listed out, ``7 Predicted Obamacare Disasters
That Never Happened.'' Here is the list. One, the Web site will
never work. Two, nobody wants to buy coverage. Three, the ACA
would not meet enrollment goals. Four, only people who already
had coverage are signing up. Five, there would be a net loss of
insurance. Six, premiums will skyrocket. And finally, seven,
that the law just won't work. People won't get doctors' visits,
insurers will drop out, et cetera.
And, Mr. Chairman, each and every one of these predictions
has proven flat wrong. Ten million people have gained coverage
this year because of the ACA. Surveys indicate that they like
their coverage. There are none of the increased wait times or
skyrocketing premiums Republicans claimed, especially when you
factor in the financial assistance that is available. More and
more insurers are participating in the marketplaces next year,
increasing choice and competition.
So, Mr. Chairman, I would like to put these two articles in
the record.
Mr. Pitts. Without objection, so ordered.
[The information appears at the conclusion of the hearing.]
Ms. Schakowsky. Thank you.
And I just want to say about this hearing, if this were a
good faith effort to really find and fix some of the problems
that are in the Affordable Care Act, I would be more than happy
to fully participate in every way in those kinds of efforts.
Anybody knows that such an ambitious piece of legislation is
going to have to be tweaked. I don't think anybody would
disagree that there aren't ways that we can make this better.
But time after time in this committee what we do is look for
ways to simply attack the law, suggesting that it is just
horrendous, it is unworkable, when we know that it is helping
millions and millions of people. Seventy-four percent of
Republicans who have signed up said they like that.
I would say that is pretty good. I mean, there is still a
quarter of the people who say that they are not happy. Let's
figure out why and try and make that better. But I don't feel
like this is the spirit of these hearings. We are talking now
about lawsuits that are going to go to the Supreme Court. We
could as a Congress, as a committee, address some of these
problems and actually suggest changes that we could vote out
and then present to the full House of Representatives and make
those things better and work.
Our ranking member expressed frustration, and I feel that,
too. The reason that I am in public service is because my hope
was that at the end of my career I could say that I helped
provide health care to all Americans. What could be more basic
than wanting to do that? Is that really what my colleagues
across the aisle are looking for or is it to nitpick and
ultimately sue?
I mean, think about this lawsuit that is being considered
today. We are talking about the President being sued for not
enforcing the Affordable Care Act, that hated law by the
Republicans, for not enforcing it fully, and for not enforcing,
they are saying, a provision that perhaps was the most hated,
the employer mandate. So I am just really, really confused.
I am sorry. I appreciate the witnesses. I appreciate that
you are looking into these problems and trying to help us solve
them. That, to me, ought to be the goal of all of us here.
And I yield back.
Mr. Pitts. The chair thanks the gentlelady.
And now recognize the gentleman from Kentucky, Mr. Guthrie,
5 minutes for questions.
Mr. Guthrie. Thank you, Mr. Chairman. I thank the ranking
member. And I thank the witnesses for being here today.
It is not just providing the information that has to be
checked as well. I have heard from multiple groups that
represent employers that haven't been notified a single time by
CMS, as required by law, that an employee has received an
advanceable premium tax credit. And I understand how the
process is supposed to work is that CMS should be verifying up
front whether the employee has access to affordable coverage
prior to authorizing a subsidy, and to me, this step is
critical. As we know, certain coverage offered by an employer
would make individuals ineligible for tax credits.
Do you see how this process was working? Or was it working?
My understanding, employers are not being contacted to see if
they offer affordable coverage.
Ms. Daly. Well, yes, sir, that was part of the audit work
that we did in performing our tests, and as part of that, of
course, it varied across the marketplaces how that worked. For
the Federal marketplace, they were checking other Federal
organizations such as to determine whether there was coverage
offered for, like with OPM, with the Department of Defense, and
other places that offer health insurance. For other cases,
there would be attestation, bringing in information from the
employer to do that check itself.
Mr. Guthrie. Is that happening the way it should be
happening? I know what is supposed to happen. How is it
happening? Yes, I am sorry.
Ms. Daly. No, perfectly fine. No, that is actually how it
is happening now because the issue is that there is no national
database in which you could quickly go check, so that was the
approach that was taken.
Mr. Guthrie. Well, the problem is, if it is done
inaccurately, then employers, as a couple of my colleagues have
said, then employees will be receiving thousands of dollars of
inaccurate tax credits, and they will be required, as we
established earlier, to pay it back.
I read the report, too, I went to the report, and I
understand what you are saying, they were trying to make this
provision work, but it doesn't seem to have a good way to do
it, and therefore we are going to have people being ineligible
to receive credits they are receiving, and they are going to
have to pay it back. Like I said, not in any malice are they
doing it. They are just following, hey, I can sign up for
health care. I have heard it in on the TV, radio, if you are in
Kentucky, see it on billboards, and they go sign up, and if it
is not verified, then later on they will have to pay back.
And I said, they are not doing it on purpose, but that can
happen to them, and it is a lot of money to have to pay back at
one time when they find that.
So as we move forward, you are doing further tests, I think
that is an area you really need to look at. Do you have, Ms.
Greenleaf, any comments on that process?
Ms. Greenleaf. I don't have anything to add to that.
Mr. Guthrie. OK. Well, thank you, and I yield back.
Mr. Pitts. The chair thanks the gentleman.
Now recognize the vice chair of the full committee, Mrs.
Blackburn, 5 minutes for questions.
Mrs. Blackburn. Thank you, Mr. Chairman.
I want to thank you all for being here. We have got an
interesting hearing going on downstairs also, as you all are
probably aware, with the problems with the HHS CDC labs, et
cetera. So I have been back and forth from that.
I think that as we talk about this verification system it
is important to remind everybody that Secretary Sebelius, on
January 1, 2014, certified, verified that the exchanges were
indeed verifying eligibility. And while the Secretary certified
a verification system, there is still no real system in place.
And even HHS, the watchdog, reports that the administration
does not have effective controls in place to perform basic
tasks, such as validating Social Security numbers, correctly
identifying applicants, and verifying citizenship. And, again,
this has not been corrected.
So for some of us who have lived through some of the
government-run healthcare programs, and for Mr. Pallone's
benefit I always have to bring up TennCare, because it thrills
him when I bring up TennCare and the failed experiment in
Tennessee with government-run health care. And if Congressman
Green wanted examples of inconsistencies and how they were or
were not dealt with, I can give him a laundry list. And so I am
sure Mr. Pallone will have him come talk to me about those.
But I find it so curious, and Ms. Daly, I will come to you,
how do you certify a verification system when there really
isn't a verification system in place, and what are the
detailed, step-by-step components of this verified, certified
verification system?
Ms. Daly. OK. Well, with that the Secretary was responsible
for providing such a certification on the report--I am sorry,
on the system that was in place--and she did indeed provide
one. Now, we haven't reviewed that report in detail. We did use
it for informational purposes to learn more about the
regulations and law and so forth that was in there. So I can't
really speak to what the Secretary relied on or used for making
such a certification.
Mrs. Blackburn. Well, let me ask you this. Ms. Greenleaf,
does it make sense that you would certify a verification system
when you didn't have a verification system?
Ms. Greenleaf. I am not familiar with the process that the
Secretary used to take a look at that system.
Mrs. Blackburn. So what you are telling me is there is no
standard operating procedure or there are no benchmarks, there
are no written expectations for what the system will be. Is
that correct, Ms. Greenleaf?
Ms. Greenleaf. I am not familiar with what the benchmarks
or systems for operation would be for that.
Mrs. Blackburn. Ms. Daly.
Ms. Daly. Yes, Congresswoman. Yes, there are regulations
that are in place that went through the full vetting process
that all Federal regulations go through for determining what is
appropriate to have in such a system. They help in designing
the system.
Mrs. Blackburn. OK. So you have got regulations.
Ms. Daly. Yes.
Mrs. Blackburn. Do you have a plan for a full end-to-end
system for verification processing?
Mrs. Blackburn. There was a plan that was put in place for
determining the system.
Mrs. Blackburn. Is it active and operational?
Ms. Daly. Well, there is a system that is operational at
this time.
Mrs. Blackburn. Is it functioning?
Ms. Daly. Our report identified that some of the controls
in that system were functioning as they were planned to do so
within the----
Mrs. Blackburn. Some were?
Ms. Daly. Some were, some were not.
Mrs. Blackburn. OK. So still, they don't have their
verifications processes in place end to end?
Ms. Daly. That would be fair, yes, because we identified
some that weren't operating as they should at that point in
time.
Mrs. Blackburn. So as long as we have that systemic
failure, we cannot certify that the subsidies are working
appropriately and people that are receiving taxpayer money--and
this is something, I think, everybody needs to remember. This
is not Federal Government money that is making the subsidies.
It is taxpayer money that is sent to the Federal Government by
hard-working taxpayers that is going into these subsidies, into
a system that does not have a verification process in place end
to end.
In Tennessee, when it didn't work, Democrat governor had to
come in and remove 300,000 people from the program--300,000.
Now, you say that times 50, and you see the problems we are
going to be up against because we don't know who is getting the
money.
I yield back.
Mr. Pitts. The chair thanks the gentlelady.
Now recognize the gentleman from Virginia, Mr. Griffith, 5
minutes for questions.
Mr. Griffith. Ms. Daly, I am going to pick up a little bit
where Mrs. Blackburn left off, and appreciate her questions.
The administration, when dealing with criticisms about the
implementation of the Web site, likes to come back and say,
well, it is better now, and in October they did not have a
fully operational back-end eligibility system. And yes or no,
based on your testimony here today, it sounds like to me they
do not currently have a fully operational back-end eligibility
system, isn't that correct, yes or no?
Ms. Daly. It depends on the time. The timeframe that we
looked at covered the period through December of 2013, so that
is what we focused on.
Mr. Griffith. OK. But you indicated that some were working
and some weren't, but it is not working right now completely,
isn't that correct?
Ms. Daly. I can't speak to what is working right now, sir.
I am sorry.
Mr. Griffith. All right. But if they did have a system, you
wouldn't have expected the document from CMS to have been
released last month indicating the number of individuals
enrolled in the exchange plan. And when the committee received
that document, if you could read the part, I believe it has
been given to you, or Ms. Greenleaf, on page 3 of that document
provided by CMS to the committee. And that last statement says,
if you would read that for us, please?
Ms. Daly. Yes, sir, I did receive that document, and I just
wanted to acknowledge that I have not had a chance to analyze
this, and these aren't the IG's data, by any means. But I would
be glad to read it for you.
Mr. Griffith. Yes, ma'am.
Ms. Daly. ``Current data indicates that 2.1 million people
who are enrolled in a qualified health plan, or QHP, as it
states on the document, are affected by one or more
inconsistency.''
Mr. Griffith. All right. Now, if there was in fact a fully
operational back-end eligibility system on January 1, we should
not have this problem, isn't that correct, yes or no? On
January 1.
Ms. Daly. I would say that that would be a fair statement,
that we would have a fully operational system on January 1, and
our work showed that that was not in place.
Mr. Griffith. That was not in place. And so then when
Secretary Sebelius certified to Congress that that system did
in fact work, she would have been mistaken, isn't that correct?
Ms. Daly. I really can't respond to that.
Mr. Griffith. I am not asking you whether she was doing
anything intentional or whether she was given bad information.
I am just saying she said it worked, it didn't work, you know
it doesn't work, therefore she had to be mistaken, isn't that
correct?
Ms. Daly. Well, I think the issue is that the----
Mr. Griffith. It is yes or no, either she was mistaken or
she was correct. If she was correct, it worked fine. You have
already told us it didn't work fine, so the answer should be
yes, shouldn't it?
Ms. Daly. Well, I think what----
Mr. Griffith. I know you don't want to say she was
mistaken. But wasn't she mistaken?
Ms. Daly. Well, I would have to read very carefully how
that certification was worded. Quite frankly, I have not done
so.
Mr. Griffith. All right. That being said, let me take a
minute, Mr. Chairman, if I might, to respond to some of the
things that were said earlier about Obamacare not being a
disaster.
My constituents feel it is a disaster. Let me go through a
few of the things that were raised in the point by the
gentlelady previously.
Talking about the suit for the President, she indicated
that we were suing the President for not going forward with
Obamacare in parts that we didn't care for. While that is true,
the real reason for the suit is that the President is not
faithfully executing the laws passed by Congress.
Whether I like the law or not, the President ought to
execute the laws passed by Congress and not suspend the law and
then re-insert his own legislation into that.
Further, I would say, Mr. Chairman, she said that, you
know, we could fix it. I would submit that Dr. Frankenstein
couldn't fix his monster. We are not capable of fixing
Obamacare.
For people who she said the premiums are not skyrocketing,
I don't know about her district, but in my district, people are
finding that their premiums are going up at a substantial rate.
They would tell me--and they do on a regular basis--that it is,
in fact, skyrocketing.
And then she said that it was working. Look, for my folks--
and I represent what I call the cornucopia of Virginia, that
part that comes out of the deep southwest and spills out into
the rest of the State.
We border the states of North Carolina, West Virginia,
Tennessee and Kentucky. We have split cities in two, Bluefield,
Virginia/West Virginia, and Bristol, Virginia/Tennessee, where
the main commerce street is State Street and the line is right
down the middle of the main street of commerce.
But you can't go to a hospital if you live on one side of
State Street that is more than one county out if you are in the
Obamacare plan. You can't go to a hospital in West Virginia.
If you live in Martinsville or in Galax, Virginia, you
can't go to Bowman Gray in North Carolina or Duke any longer.
You want to say a system is working when people have been able
to go to teaching hospitals in the past and now they have to
drive a lot farther to get to one because of Obamacare. It is
not working.
I submit that the gentlelady in that case was wrong as
well. And I yield back.
Mr. Pitts. The chair thanks the gentleman and now
recognizes the gentlelady from Washington, Cathy McMorris
Rodgers, for 5 minutes for questions.
Mrs. McMorris Rodgers. Thank you, Mr. Chairman. And I
appreciate you both being here today.
I wanted just to reinforce before I went to my question
that the administration didn't make a pledge to prevent
fraudulent payments.
The law states that only certain individuals are able to
qualify for subsidies and that they must be able to prove
citizenship. And it is just another example of the
administration ignoring the rule of law.
My questions. First, the secretary has refused to release
any more enrollment reports after the one they released in May.
Do you think continuing the issuing of these reports to
Congress and public would be helpful?
Ms. Daly. I am not certain that the secretary is compelled
to do so under any law or anything of that----
Mrs. McMorris Rodgers. Do you think it would be helpful?
Ms. Daly. I think it would be helpful.
Mrs. McMorris Rodgers. OK. Thank you.
After your analysis of the Federal marketplace and the two
state marketplaces, do you think these exchanges are able to
start reporting on who has actually been paying their premiums?
Ms. Daly. I am sorry. I am not in a position to answer that
at this time on the current status of what is going on at the
marketplaces.
Mrs. McMorris Rodgers. Do you know how soon we will have a
sense as to who is actually paying their premiums in these
exchanges?
Ms. Daly. Well, we do have a variety of work that is
planned and underway looking at further operations of the
marketplaces, but I think we are going to be looking at the
state marketplaces.
We have already got that work started on the ones we had
not already reviewed, and that work is going to be coming out
probably sometime in the winter and spring of next year. And it
could be--because there are quite a few, there is a number of
reports that will be coming on that.
Mrs. McMorris Rodgers. Is it the goal to better clarify
actually who has been paying premiums and not? Is that going to
be part of the goal?
Ms. Daly. Well, I think who is paying the premiums on the
insurance--we are looking at this time at how the premiums that
are being paid--if they are going to the right insurers.
But whether the insuree, the person that has gotten the
insurance, is making their premium payments is not an issue
that we had focused on at this time.
But we would be glad to work with your staff to understand
more about some of the implications surrounding that and see if
we can get the resources to work that into our work plan.
Mrs. McMorris Rodgers. Now, I know that your report focused
on the Federal marketplace and the State marketplaces in
Connecticut and California.
However, I represent Washington State. And I was curious as
to the extent of OIG's office and their monitoring of the State
exchanges beyond California and Connecticut.
Recently the Washington healthplanfinder--that is our
exchange--had to explain to customers why some of them received
an August invoice for twice the amount they owed.
Now, you think about the impact on the middle class and the
uncertainty that they face and the confusion that they continue
to face and whether or not they are paying double their
premiums or not. Others received no invoice. And some received
an invoice with a zero balance, even though they owed a monthly
premium.
So are there procedures in place in Washington and other
State marketplaces to quickly remedy these types of errors?
Ms. Daly. Unfortunately, our work hasn't looked at that
particular issue at this point in time. So I am sorry. I can't
respond directly to your question.
Mrs. McMorris Rodgers. Well, is the Office of Inspector
General ever going to look at this question as to who is
actually paying these premiums and whether or not it is
accurate?
These are hardworking middle-class families quite often
that are in need of health insurance, are trying to figure out
how to stretch their paychecks to pay for oftentimes increasing
premiums.
Are we ever going to assure them that they are actually
paying accurate premiums? Or how are we going to address when
there is a double bill and those kind of issues?
Ms. Daly. Well, those are important issues. And again, we
would be glad to work with you and your staff to help see if we
can design some work that would be able to address those areas
of concern.
Mrs. McMorris Rodgers. So my final question.
What is going to happen to someone when they are either
confused or they accidentally don't pay or if they pay double,
whatever the situation? Are they going to be cut from coverage
or will they receive a refund? How is this going to be
remedied?
Ms. Daly. I am sorry. If you could just help clarify for
me----
Mrs. McMorris Rodgers. OK. My question is: You are an
individual. You have either been charged double or maybe you
accidentally didn't pay. How is this going to be remedied?
Ms. Daly. Right. I am just not positioned to respond to
that today simply because our work hasn't focused in that
particular area as yet. So----
Mrs. McMorris Rodgers. Is there a plan to ever address
these questions?
Ms. Daly. I just don't have any information available for
you at this time, but we would be glad to try to get back with
you on that.
Mrs. McMorris Rodgers. And the weeks go by and individuals
are out there still looking for answers, too.
Thank you, Mr. Chairman.
Mr. Pitts. The chair thanks the gentlelady.
I now recognize the gentleman from Georgia, Dr. Gingrey, 5
minutes.
Mr. Gingrey. Mr. Chairman, thank you.
I haven't been here for the entire hearing because we have
one going on concurrently downstairs, very important as well,
but the little bit that I have heard since I have been here
really disturbs me.
My term in Congress--my 12th year, my 6th term--will come
to an end at the end of the 113th Congress. I am looking for
something else to do and I think I am going to apply for a job
as an Inspector General in the Federal Government because the
hours seem good and, obviously, there is no heavy lifting.
Your responses so far, both of you, have indicated to me
that you don't seem to really be on the ball in regard to
Inspector-Generaling in a non-biased, unbiased way, which is
what you are supposed to be doing.
And when I talk to the people in the 11th Congressional
District of Georgia, there is no way that I can give them any
confidence that you are doing your job so that people who are
undeserving, unqualified to receive part of the million--excuse
me--trillion dollars' worth of subsidies in this ultra-
expensive program are getting to the right people.
So let me specifically ask you--and you can comment on my
comments as well--but the OIG's work has revealed a number of
problems, as I have heard this morning, in CMS's process of
verifying whether an individual is eligible for part of the
estimated $1 trillion in exchange subsidies that will be spent
over the next 10 years.
And I would like to ask if OIG has found problems in
resolving inconsistencies in the following areas: An
applicant's Social Security number, an applicant's legal
status, an applicant's income and all these income set-asides
that exist by virtue of waivers in the Medicaid program and
everything across the various and sundry 50 States and
territories, other sources of coverage for an applicant, such
as employer-sponsored income.
Can you give us a little insight on any of that? And, for
goodness' sakes, isn't that what you are supposed to be looking
at?
Ms. Greenleaf. Thank you for the question.
In fact, when we looked at the marketplaces, we did find
problems with their abilities to resolve inconsistencies in all
those areas that you identified. The most common
inconsistencies that were not resolved did concern citizenship
and income.
You had also mentioned Social Security number. There was
some ability of the Federal marketplace to resolve those, but,
in the end, the marketplace resolved very few.
So these inconsistencies don't necessarily equate to an
improper enrollment or an improper subsidy, but they are
concerning, and we made recommendations that CMS resolve these
and make its plan public on how and when it will do so.
Mr. Gingrey. Well, have they made that public? You made the
recommendations that they do so. But as far as you know to this
point----
Ms. Greenleaf. We are tracking their response. In their
comments to our report, CMS indicated that it had implemented
an interim manual process to resolve inconsistencies and was
making progress, and we will be following up with them in a
formal way to track their responses over the next couple of
months.
Mr. Gingrey. Well, I don't have any other questions.
Ms. Daly, did you want to respond to that as well?
Ms. Daly. No, sir. But thank you for the opportunity. I
think Ms. Greenleaf did a fine job.
Mr. Gingrey. Well, yes. She did OK.
Honestly, Mr. Chairman, I think we would have done well
this morning to have somebody from GAO here as well to tell us
what kind of a job they think the Office of Inspector General
is doing in regard to this program.
Look, I am not picking on the witnesses. I mean, this is an
opportunity for us to get information. There are people out
there that need and deserve these subsidies.
After all, the PPACA was put in place for the supposedly 15
to 20 million people who through no fault of their own couldn't
afford health insurance because of low income.
And, yet, if we have got people gaming the system, other
people are suffering because of it. They are not on the
program, maybe.
And then those that are not eligible for a subsidy, it just
simply means that their premiums, their deductibles, their co-
pay, are going through the roof, and they are just going to
throw up their hands and say, ``I am not going to buy into the
system. I will pay the fine and go bare.''
And I, as a physician, know how bad that is. We don't want
that to happen. So that is why I am being a little hard on the
witnesses, but I don't think too hard.
And I thank them for being here this morning.
I yield back, Mr. Chairman.
Mr. Pitts. The chair thanks the gentleman and now recognize
the gentleman from Florida, Mr. Bilirakis 5 minutes for
questions.
Mr. Bilirakis. Thank you, Mr. Chairman.
This report that the IG issued is troubling to me. It is
further evidence that the administration wasn't ready----
Mr. Pitts. You want to pull your mic down a little bit.
Mr. Bilirakis. Thank you.
The 2.6 million unresolved inconsistencies exist because
CMS's eligibility system was not fully operational. This means
that people may have received a subsidy that they are not
legally entitled to, or people could be receiving too much.
When they file their taxes next year, people could receive a
shock when they have to repay parts of their subsidy to the
government.
I knew that this system was not going to work. I knew that
it was broken. Last year I introduced the No Taxation Without
Verification Act. My bill would have prevented any tax
provisions from being implemented until there was a working
verification system in place.
It wasn't enough that the administration had a process.
They should have to meet certain metrics, in my opinion.
Unfortunately and predictably, the administration made a mess
of verification, in my opinion, and the entire back end of the
Web site, just like they made a mess, in my opinion, of the
healthcare.gov.
Ultimately, this hurts the American taxpayer. That is the
bottom line. And I do have a couple questions.
In the OIG report, you recommend that CMS develop a public
plan and set a deadline to clear the current backlog of
inconsistencies and resolve the problems.
This is the question: When does CMS need to have the plan
and deadline release to address these pressing problems?
And do you think it is necessary to provide time to test
the verification changes in the system before the next open
enrollment period begins?
Ms. Greenleaf. We will be tracking--we have a formal
tracking system for monitoring CMS's response to our
recommendations.
So over the next couple of months--I believe within 6
months they have to have a formal plan back to us, though it
could well be sooner.
Mr. Bilirakis. Are you going to press them?
Ms. Greenleaf. Yes. We will be following up both formally
and informally. The Office of Inspector General leadership
meets regularly with the CMS leadership.
And this is a high-priority recommendation, and the bottom
line is inconsistencies need to be resolved so we can have
confidence that the determinations about eligibility are
accurate.
Mr. Bilirakis. Thank you.
Next question. The OIG reports that applicants are given a
90-day period to resolve inconsistencies after a notice is sent
to a consumer.
This 90-day period can be extended, generally, by the
Secretary, but cannot be extended in instances involving
citizenship and immigration status.
Do you know if HHS is holding applicants to this standard?
Can you answer that question first?
Ms. Greenleaf. That was a little bit outside the scope of
our review.
And you are correct. There is the 90-day inconsistency
period during which an applicant can lawfully enroll, and the
inconsistency is supposed to be resolved during that time.
But we did not collect information on how often it is being
extended or how that is being managed at the marketplaces.
Mr. Bilirakis. Ms. Daly, can you respond to that?
Ms. Daly. No, sir. I am sorry. I can't add anything to that
either.
Mr. Bilirakis. Well, I have another question. I would like
to get this information from you immediately, I mean, within
the next couple days, please.
Is HHS actually terminating coverage, if you can answer
that, or withdrawing subsidies if an applicant has failed to
provide documentation to address an inconsistency regarding
citizenship or legal status within the 90-day period? Can you
try to respond to that, please?
Ms. Greenleaf. I think we will have to get back to you on
that to try and answer that. I don't have that information.
Mr. Bilirakis. So you are not sure?
Ms. Greenleaf. That is correct.
Mr. Bilirakis. Is that correct, Ms. Daly? You are not sure?
Ms. Daly. Yes, sir. I am not certain at this time.
Mr. Bilirakis. Please get back to us. This is vital. I
really would appreciate it. Thank you very much.
I yield back, Mr. Chairman.
Mr. Pitts. The Chair thanks the gentleman.
Now recognize the gentleman from Louisiana, Dr. Cassidy, 5
minutes for questions.
Mr. Cassidy. Hello. I am sorry to have come in late. So
people may have asked my questions. I apologize.
Looking at your testimony on pages 3 and 4, I gather a
sample was done of California, Connecticut, the Federal
exchange, a sample of 45.
Now, as best as I can tell on Page 4, the second bullet
point refers specifically to California. Verifying citizenship,
7 out of 45, it was unclear that their citizenship was
verified.
I gather that is 15 percent of those in California who
signed up we cannot confirm that they are U.S. citizens. Is
that a correct reading of this?
Ms. Daly. Yes, sir. That finding indicates that, of the 45
applicants that we selected for sampling in California, 7 of
those 45 did not have their information run through the system
as it was supposed to occur.
Mr. Cassidy. Now, I am told that California had roughly 1.5
million people sign up through their Cover California exchange.
So potentially 15 percent of those, or 225,000, were not
citizens?
Ms. Daly. I would caution against----
Mr. Cassidy. Accept that.
Ms. Daly [continuing]. Trying to extrapolate those results.
The type of sampling that we did wasn't the type that you could
use for extrapolation purposes. It was simply to provide a
``yes'' or ``no'' answer. Was the action done? Yes or no.
Mr. Cassidy. But it was a random sample, I presume.
Ms. Daly. Yes, sir.
Mr. Cassidy. So as a random sample, theoretically,
representative of the whole--granted, maybe they just didn't
provide--but, nonetheless, potentially as many as 15 percent of
those who signed up through California were not citizens,
potentially. Fair statement?
Ms. Daly. Well, given the type of sampling that we have
done, I can't make that extrapolation.
Mr. Cassidy. There is a margin of error.
Ms. Daly. Yes.
Mr. Cassidy. There is a margin of error, but nonetheless--
so this being the case--wow--have you done a follow-up sample,
larger and more statistically significant?
Ms. Daly. At this time we have not had an opportunity to
follow up with California on this.
Mr. Cassidy. Now, Ms. Daly, that just seems to beg to be
done. I mean, if it is a potential--granted, a small sample
size with a large margin of error.
But if 15 percent of the people may not be citizens, that
actually seems like kind of moves up list of follow-up actions
taken on this sample size. Am I missing something?
Ms. Daly. Well, sir, I think it is really important to
recognize that this was a system design issue, and I think
California told us that they were following up to try to get
that addressed.
And I think that is an important point to make, that when
there is a systemic issue where it is a problem with the
programming----
Mr. Cassidy. California actually has a vested interest in,
frankly, not addressing this because the subsidy is coming from
the United States taxpayer, not in general, not just
Californians. So as I am also told, 90 percent of those who
signed up on California exchanges received subsidies.
Now, if that's the case, again, just back of envelope, that
means over 200,000 people on the California exchange
potentially are receiving generous subsidies and they are not
citizens.
Now, that seems more the purview of the Federal Government
as an overseer as opposed to the Californians, who may not
care. Again, am I missing something?
Ms. Daly. Well, the point is that our sampling approach was
more of a compliance sample in which you are either identified
as yes or no, you meet that or do not meet that.
Mr. Cassidy. I accept that. You have explained that
methodology.
But I am--we have got hardworking taxpayers who are barely
making it and we were told by those who promoted this that only
citizens would be allowed to sign up.
Now, in a random sample size in California--which, if it
was truly chosen randomly, statistically, that will probably
represent the whole with a given margin of error--as many as 15
percent of those aren't citizens.
If I am a taxpayer in Louisiana, I am thinking, ``What the
heck. We were told this would only be for citizens. Now my tax
dollars are going to subsidize someone here illegally,
potentially.''
I guess I am wondering, does the administration--your kind
of view of this--and I don't mean to overread--seems a little
nonplussed. ``Yes. Might be. But we will trust the Californians
to pull it together.'' And I say that not to indict, but only
to observe.
Again, am I wrong on this?
Ms. Daly. Well, I think we are concerned, and that is why
we have done the work that we have done to provide you, the
overseers for this program, among others, the information that
you need to provide that oversight.
Mr. Cassidy. Well, I thank you for that.
Ms. Daly. I think you know the challenges that the
marketplaces were facing.
Mr. Cassidy. I am almost out of time.
I recognize that. But, nonetheless, the challenges the
marketplaces were facing did not excuse them from executing the
law, which is only citizens shall sign up.
And it does seem as something that should require HHS to
follow aggressively, if only to keep at least this measure of
commitment to the American people, that only citizens would be
allowed to do so.
I am out of time. Thank you all for your testimony.
Mr. Pitts. The chair thanks the gentleman.
The Chair now recognize the gentleman from Illinois, Mr.
Shimkus, 5 minutes for questions.
Mr. Shimkus. Thank you.
And thanks for coming.
I am sorry I was absent for a lot of it. That is why I
waited in line to hear some of the exchange and the questions.
From the Inspector General's Office of Health and Human
Services. Right? So you are doing an internal review of the
signups, proper or improper, and you have proffered a report.
And I think that is where some of the frustration is, is
some of these things come out in the report. What would compel
the HHS or CMS to rapidly respond to fix these deficiencies? I
guess that is the concern.
You are the OIG. All you can do is report. Right? You can't
go to the new secretary or the former secretary and say, ``Act.
Here's a major problem.''
But I guess, from the tone of some of my colleagues, they
are not convinced that there was red flags flying that this was
a problem and that there may have been a delay.
So let me go to the question. I mean, I am just trying to
put my observation in the few minutes I have been here, trying
to think through the line of questioning.
So when CMS failed to put a fully operational eligibility
system in place, it had--we believe it had major consequences.
And I think your report highlights that, yes, there are
some major problems when you don't have a fully operational
system.
We have learned that the verification process to resolve
inconsistencies often did not start until May--right?--even
though, in fact, it could be very likely that these
inconsistencies contained in the applications submitted in
October--is it safe to say that they languished for months
without resolution?
Ms. Greenleaf. May is outside the period that we report on.
And during the period that we report where we say 2.6 million
inconsistencies were unresolved is through October--October
through mid-February for the Federal exchange.
Mr. Shimkus. So we could say it languished through that
period of time at least?
Ms. Greenleaf. For that period of time, yes, they were
unable to resolve inconsistencies, in particular regarding
citizenship.
Mr. Shimkus. Do you think that we can--you don't know for
sure. But, again, going on some of the lines of the questions,
is it safe to guess that some of these inconsistencies that you
identified are still unresolved?
Ms. Greenleaf. We don't have information to that effect. We
will be tracking CMS's response and ask CMS to report back to
us in our recommendations regarding----
Mr. Shimkus. I guess that is part of this whole debate and
a little bit of frustration.
So we got the answer that there is an interim pamphlet.
Right? But, I guess, isn't this compelling enough to say give
us more information now?
What kickstarts that additional review by you to see that
there is not--that the inconsistencies that you raised based
upon the February time frame--and maybe we assume May--that
they are still not inconsistencies and that they have been
resolved?
Ms. Greenleaf. Well, we will be monitoring their response
to our report and----
Mr. Shimkus. Wait. Wait. Wait. That is the frustration,
``We will be monitoring.''
Are you monitoring? I mean, that is the problem. I mean,
don't you understand? ``We will be.'' No. A lot of us think you
should be. This monitoring should have been done, especially
with these gross inconsistencies.
Ms. Daly.
Ms. Daly. Yes, sir. Thank you for the opportunity.
I think that, you know, we will do--as my colleague here
pointed out, we do follow up on our recommendations. And at the
same time we already are beginning extra work out at the
Federal marketplace.
And as part of that we can be assessing whether--the status
of addressing those inconsistencies that we currently are aware
of. I would be very interested in learning the new processes
that are in place. Of course that work is going to really----
Mr. Shimkus. OK. So we are--please. I guess we would like
you to try. Not wait. I mean, that is our frustration.
These inconsistencies are as large as they might be, and we
have had a long time. We want this present tense, not future
tense. Does that make sense? It should be going on now.
Aren't we coming right now to another signup? Right?
Enrollment is coming.
If we haven't fixed the original signup and the
inconsistencies--we have identified the problems. We don't have
follow-up. We don't know if they have been fixed.
Aren't we at risk of having the same problem in the next
enrollment? If they haven't addressed it, will we have the same
problem, Ms. Greenleaf?
Ms. Greenleaf. If CMS doesn't address our recommendations,
we would be concerned that additional inconsistencies would
remain unresolved, and that could lead to inaccurate
determinations.
Mr. Shimkus. OK. You have been very helpful, at least for
my part. Just remember--I will leave on this, Mr. Chairman--
present tense, not future tense, and we would all be a lot
happier.
Mr. Pitts. The chair thanks the gentleman.
That concludes the questions of the Members who are in
attendance. There will be a lot of other questions from other
members as well to follow up, and we will submit those to you
in writing. We ask that you please respond promptly.
I remind Members that they have ten business days to submit
questions for the record. Members should submit their questions
by the close of business on Wednesday, July 30.
I have a UC request. I would like to insert into the record
an article in the New York Times from October 16, 2013, where
Secretary Sebelius is quoted as saying, ``I think we are on
target. We are on track to flip the switch on October 1 and say
to people come on and sign up.''
Without objection, so ordered.
[The information appears at the conclusion of the hearing.]
Mr. Pitts. And the Ranking Member has a UC request.
Mr. Pallone. Mr. Chairman, I would ask unanimous consent to
enter into the record a letter from June 4 from Ranking Member
Waxman to Chairman Upton.
Mr. Pitts. Without objection, so ordered.
[The information appears at the conclusion of the hearing.]
Mr. Pitts. Very interesting hearing. Thank you. We look
forward to working with you to get more information.
Without objection, the subcommittee is adjourned.
[Whereupon, at 11:44 a.m., the subcommittee was adjourned.]
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