HHS makes quick moves to keep PPACA on track


As Republication leadership strives to dismantle the law, administration officials are taking steps to protect it

Even though there was no chance that legislation repealing PPACA could succeed due to firm White House opposition, Republicans still hope to enact bills that end specific programs and block funding for certain activities.

New Republican committee chairmen in the House also are planning to conduct extensive oversight hearings on administration health policy and regulatory initiatives. In addition to promising to repeal the "job-killing health law," House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) is targeting burdensome mandates and penalties on small businesses.

In addition to girding for the oversight onslaught, Department of Health and Human Services (HHS) leaders moved to defuse some of the opposition by revising contentious policies and shifting policy operations out of the limelight. Most notable was a quick switch in early January to drop a Medicare regulation that would allow reimbursement of health professionals for providing end-of-life counseling to seniors.

Don Berwick, administrator of the Centers for Medicare and Medicaid Services (CMS), included that provision in a Medicare regulation issued in late November to set provider rates. When word of the counseling proposal came out, HHS quickly reversed course and dropped the item.


Of particular importance to insurers, HHS also moved the fairly new Office of Consumer Information and Insurance Oversight (OCIIO) out of the office of HHS Secretary Kathleen Sebelius and into CMS to make it less of a target for health reform critics. It will fall under the direction of CMS Deputy Administrator Marilyn Tavenner. Most OCIIO managers and staffers are expected to stay with the new entity, but OCIIO chief Jay Angoff, who has appeared all too eager to challenge insurance companies, will become a special assistant to Sebelius.

Over the last eight months, OCIIO crafted policies affecting the insurance market, including rules governing medical loss ratios and premium rate review, the early retiree reinsurance program, and the federal high-risk pool program. One of its main tasks is to craft policies and infrastructure supporting state-based insurance exchanges. In addition, the new Center will continue to build an online information system for consumers to compare coverage policies, quality and pricing.

Most of these policies do not relate directly to Medicare or Medicaid, supporting speculation that the shift of this insurance oversight operations aims to shield it from Republican attack.

Jill Wechsler, a veteran reporter, has been covering Capitol Hill since 1994.

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