What’s Next for Obamacare’s Exchanges?

Concerns continue to rise as states examine navigator approaches.

Now Congress is asking some questions of its own, including how Navigators and the organizations they work for will be spending $67 million in federal grants they received last month.

The groups are outraged that they are being questioned. “It is shocking. It is absolutely shocking,” says Lisa Hamler-Fugitt, executive director of the Ohio Association of Foodbanks, that received a $1.9 million grant.

Letters signed by 15 Republican members of the House Energy and Commerce Committee request information from 51 organizations – including hospitals, universities, Indian tribes, patient advocacy groups and community organizers – about how they intend to use the money. A total of 104 organizations shared the $67 million in grants.

“It is Congress’ responsibility to conduct careful oversight and to be good stewards of taxpayer dollars,” said Energy and Commerce Committee Vice Chairman Marsha Blackburn, R-TN. “Americans have every right to know how their hard-earned dollars are being spent to implement the president’s health care law.”

The ranking member on the committee, Rep. Henry Waxman, D-CA, who is a master at congressional oversight, blasted back with a letter of his own: “You have opened investigations of every group that received Navigator grants in 11 states,” he wrote. “And you are requesting that they provide briefings and answer a long list of questions on organization budgets and employee training, education, monitoring, review, and supervision.”

Exactly.

The questions Upton and 14 other members of his committee are asking are sensible questions designed to make sure that taxpayer money is being spent appropriately.

Sen. Tom Coburn (R-OK) and others are asking why the administration is getting a pass on implementing Obamacare correctly:

On September 9, 2013, Dr. Coburn, with Senators Burr, Enzi, Grassley, Ayotte, and Thune, sent a letter to Acting Office of Personnel Management Director Elaine Kaplan regarding OPM’s 2010 decision to grant the U.S. Department of Health and Human Services (HHS) “direct hire authority” after the passage of the Patient Protection and Affordable Care Act.

In the letter, they outline nine issue areas with specific questions for OPM including why special authority was granted to fill 1,800 “mission critical positions” over 6 months that were “necessary for implementing the health care law,” meaning HHS would have had to hire roughly 10 candidates per day in order to fill all positions.

The letter follows OPM’s release of documents after Judicial Watch filed a Freedom of Information Act (FOIA) request …

Background

• Direct-hire authority is a legal authority that the OPM can give to Federal agencies for filling vacancies when a critical hiring need or severe shortage of candidates exists. This authority effectively allows Federal agencies to hire, after public notice is given, any qualified applicant without regard to other provisions of law which would otherwise place certain restrictions on the hiring process.

• On the date of the passage of the Patient Protection and Affordable Care Act – which became law on March 23, 2010– former OPM director John Berry’s sent a letter to Denise Wells, Deputy Assistant Secretary for Human Resources at HHS. The letter states that HHS has the authority “to fill 1,814 mission critical positions at the GS-9 through GS-15 grade levels(or equivalent) as depicted above [in the letter] nationwide. This authority is based on a critical hiring in support of the Health Care Education Affordability Reconciliation Act of 2010.” The letter is says that “this authority will provide HHS with the means to meet hiring needs in support of the Act.”

North Carolina hospitals must post prices for 140 procedures.

North Carolina Gov. Pat McCrory has signed into law House Bill 834, which requires hospitals to post their prices on 140 of their most common procedures.

Under the new law, all hospitals and ambulatory surgery centers will submit pricing on the 100 most common inpatient diagnosis-related groups, effective April 1, 2014, and every quarter thereafter, to North Carolina’s Department of Health and Human Services.

Beginning July 1, 2014, hospitals and ASCs will also provide prices for the 20 most common surgical procedures and 20 most common imaging procedures, bringing the total number of required priced procedures to 140. The original bill only called for the 50 most common procedures.

In addition, all hospitals will have to submit their charity care policy. DHHS will publish the pricing and charity care information on its website.

The law, which made its way through North Carolina’s legislature over the course of this year, came in response to several local newspaper reports that found significant variation in hospital prices for certain procedures, with some hospitals’ prices three times more than those of their peers.

Investor’s Business Daily finds 258 employers cut work hours, jobs so far.

IBD is introducing ObamaCare Employer Mandate: A List Of Cuts To Work Hours, Jobs – a compilation of employers who have opted to restrict work hours to limit new liability for employee health coverage.

As of Sept. 3, this list has reached 258 – including more than 200 public-sector employers.

Almost all of those employers have cut the hours of part-time workers to below 30 per week – the point at which ObamaCare’s insurance mandate kicks in.

A few have cut payrolls to steer clear of ObamaCare’s 50 full-time-equivalent-worker definition of a large employer subject to employer fines. A few others have reduced staff while contracting with employment services firms to limit their ObamaCare exposure.

The scorecard reflects an extensive, though less than exhaustive, search. It only includes employers when there is convincing documentation (generally news accounts or public records) that job actions are specifically tied to ObamaCare.

For example, when Forever 21 said it was cutting hours for 192 workers to 29.5 per week or Lowe’s (LOW) said it would hire 9,000 permanent workers – all part-time – the ObamaCare connection wasn’t quite the slam dunk needed to land them on this list.

Because private firms may fear bad publicity or litigation if they admit to cutting hours to avoid ObamaCare’s coverage mandate, it’s not surprising that few would be willing to come right out and say it. It’s only logical to take their denials with a grain of salt.

Public employers, on the other hand, tend to make decisions in a much more transparent way. Even here, limiting hours for part-timers is often an administrative, rather than legislative, action, so documentation may be hard to come by.

All this is to say that the list in no way represents an accounting of ObamaCare’s actual impact on work hours.