Health and Human Services Secretary Kathleen Sebelius (D) testified before the House Energy and Commerce Committee Wednesday about the rocky rollout of the Affordable Care Act’s insurance exchanges.
Twice, Republican representatives asked her a stock question: If Obamacare is so great, why don’t you enroll in a plan through the exchanges?
This is an inane question. Sebelius is both a federal employee and old enough to qualify for Medicare. Asking Sebelius why she doesn’t decline the Federal Employee Health Benefits Plan and Medicare so she can enroll though the exchange is kind of like asking the Secretary of Agriculture why he doesn’t decline his salary so he can qualify for food stamps, if food stamps are so great.
But just because a question is inane doesn’t mean you’re allowed to give a wrong answer to it. Sebelius did that twice, saying it would be illegal for her to shop in the exchange because she is offered health insurance through work.
That’s wrong. As made clear on Healthcare.gov, you may enroll in coverage through the exchanges even if you are offered coverage through work. Your offer of work-based coverage may make you ineligible for a subsidy, but that doesn’t stop you from enrolling. And while Sebelius is eligible for Medicare, she’d only be locked out of the exchanges if she actually chose to enroll in Medicare. She is legally permitted to drop her employer based coverage, decline Medicare, and enroll through the exchange. It would be silly, but it would be legal.
This is a kind of shocking oversight from the top official overseeing implementation of Obamacare. It’s not a minor technical point; one of the key issues in the law’s design is how to deal with workers who might choose exchange coverage over their offers of work-based coverage.
In Sebelius’ case, opting for the exchange would be obviously a bad financial choice, but other workers (for example, those whose work coverage is very expensive and mostly paid by the employee) might well choose to buy in the exchange. The law is quite deliberately designed to allow them to do so, and Sebelius should know that.
Instead of answering incorrectly, Sebelius should have given the perfectly good correct answer that was available to her. I’ll offer a template that she can copy next time she’s asked (and she will be asked again):
“The purpose of the exchanges is to offer quality, affordable health insurance options to people who don’t get insurance through work. More than 80% of Americans are in situations like mine: They get health insurance coverage through work, Medicare or Medicaid and their best option next year will be to stay on the same coverage. If I weren’t insured through work, I would gladly shop in the exchanges. But what I’m doing isn’t an ‘opt-out’: This law doesn’t change source of insurance for the vast majority of Americans, including me.”
Lying (or at least being wrong) about her options under Obamacare wasn’t Sebelius’ only bad moment in today’s hearing. Faced with a line of tendentious questioning about whether President Obama is “responsible” for the website problems, Sebelius eventually answered “whatever.” Yes, Congressional hearings are stupid, and they typically feature members of Congress asking stupid questions. When you are a Cabinet official, part of your job is to conceal your contempt for them when they do so.
And Sebelius fumbled a question from Rep. John Barrow (D-Ga.) about how HHS will address concerns that enrollment problems could change the composition of the insurance participant pool. If signing up for insurance is hard, the sickest people with the most expensive health needs will be the most motivated to sign up, which could push insurers to raise premiums. He wanted to know how HHS will evaluate this problem and how long signup problems can persist before components of the program (like the individual mandate) will need to be delayed.
Sebelius responded, basically, that HHS will try to get as many people to sign up as possible. There are other things she should have said, particularly that the law includes risk adjustment provisions to compensate insurers in the event that they end up with especially sick participant pools. This doesn’t prevent a “death spiral,” but it significantly diminishes the risk and gives insurers reason not to freak out too much.
Much like with her Daily Show interview, Sebelius seemed incapable today of making an accurate and forthright case for the law she is implementing. I’m not sure whether that derives from a lack of talent as a spokesperson or a lack of familiarity with the policy architecture of the law. Either way, she is a terrible spokesperson for the Affordable Care Act.
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