WASHINGTON - President Barack Obama sought to turn the tables on critics of his health-care law, saying opposition will shrink as the benefits improve the lives of millions of Americans.
Kicking off a three-week campaign to regain support for a program marred by a troubled implementation, Obama said the Republicans who oppose the law will never be satisfied and haven’t offered an alternative.
“This law is working and will work into the future,” Obama said Tuesday at a White House-organized event in Washington. To the law’s opponents, he said, “If you’ve got good ideas, bring them to me.”
The president is seeking to counter Republican lawmakers’ criticism of the Patient Protection and Affordable Care Act regarding healthcare.gov stumbles and cancellation notices sent to hundreds of thousands of current policyholders as a result of the law.
The botched start meant the government achieved only a fraction of the 800,000-enrollee target it set through November. The administration’s prediction is 7 million sign-ups for the first year. Open enrollment ends March 31.
Rep. Fred Upton, a Michigan Republican and chairman of the House Energy and Commerce Committee, said Monday that his panel will be monitoring the law’s rollout for potential fraud and scams.
“The still-struggling website speaks to the administration’s incompetence in implementing this law and raises serious concerns moving forward,” Upton said in a statement.
Obama said the benefits of the law, including requiring coverage of preventive health care and letting young people stay on their parents’ policies until age 26, have “gotten lost a little bit over the last few months” because of the difficulties in getting the website running.
The president’s campaign to build public confidence in the law is set to run through Dec. 23, according to an administration official who asked not to be identified discussing internal planning.
The White House also plans an effort to encourage people to sign up for insurance before Dec. 23, the last day that people who enroll are guaranteed to have medical insurance by Jan. 1.
“Do not let the initial problems with the site discourage you,” Obama said.
Republicans, who were unanimous in their opposition to the law when it passed in 2010 through a Congress controlled by Democrats, have sought to turn the troubled rollout into a political advantage. In addition to hearings, they have released documents showing administration officials knew of flaws in the main insurance exchange website before it opened.
The federal website serves 36 states, including Texas, Florida and Pennsylvania, while 14 states, including New York and California, run their own.
The state sites for the most part haven’t encountered the technical problems of healthcare.gov.
Obama has apologized to the thousands of Americans who lost their medical insurance plans as a result of his health-care law despite his repeated pledge that people who like their coverage would be able to keep it when the law took effect. On Nov. 14, he promised a one-year reprieve to people facing the loss of coverage, a move that prompted objections from insurers saying that doing so would boost costs.
The administration is weighing whether to increase payments to insurers to offset the added cost of letting people keep medical coverage that otherwise would have been canceled next year, according to a notice posted on the Federal Register on Monday.
1.46 MILLION ELIGIBLE
Also on Tuesday, the Obama administration said 1.46 million people had applied and been found eligible for Medicaid or the Children’s Health Insurance Program in October, far more than had selected a private health plan in the new insurance marketplaces.
Of those found eligible for Medicaid or the children’s program, slightly more than half were in states that have decided to expand Medicaid, as permitted under the Affordable Care Act.
But 48 percent of the people found eligible for the programs - 697,000 people - were in states that have not expanded Medicaid.
The health law has produced many changes in the way states assess eligibility for Medicaid, and it provided money to states to upgrade antiquated computer systems. These changes, combined with publicity around the rollout of the federal law this fall, apparently contributed to increases in the number of applications for Medicaid and in the number approved.
The report confirms expectations that many people who were eligible for Medicaid but not enrolled would come forward and seek coverage, even in states not expanding Medicaid.
For example, about 370,000 people were found eligible for Medicaid or the children’s program last month in four states that have not expanded Medicaid: Florida (165,000), North Carolina (59,000), Pennsylvania (72,500) and South Carolina (73,300).
By contrast, in October, just 26,800 people selected private health plans in the new federal exchange, and 79,400chose private plans through exchanges run by states.
SUBSIDIES VULNERABLE
Meanwhile, an audit released by the tax agency’s inspector general on Tuesday says the Internal Revenue Service needs to make changes to prevent fraud and improve security in systems it is building to deliver health-insurance subsidies.
The audit, released Tuesday by the Treasury Inspector General for Tax Administration, finds that the IRS successfully completed development and testing for the systems that compute the subsidies under the Affordable Care Act. The audit found that “critical” pieces in security controls failed during testing and anti-fraud programs are still being developed.
“The IRS’s existing fraud detection system may not be capable of identifying ACA refund fraud or schemes prior to the issuance of tax return refunds,” the auditors wrote.
In the IRS’ response, Chief Technology Officer Terence Milholland said the agency has improved security since the auditors completed their review and that work continues on combating tax-refund fraud.
“The IRS has a strong, effective system in place for administering the premium tax credit,” Danny Werfel, the acting IRS commissioner, said in a statement. “We have a proven track record of safely and securely transmitting federal tax information and we have a robust and secure process in place to deliver this important credit for taxpayers.”
The Affordable Care Act authorizes subsidies on a sliding scale tied to income, with the smallest amounts available for people at four times the poverty level, or $94,200 for a family of four.
Consumers typically qualify for the subsidies for 2014 on the basis of their incomes in2012, the most recent complete year available.
The IRS and the Treasury Department, which already collect income data for tax purposes, are responsible for sending the subsidies directly to health insurers during 2014.
Then, when taxpayers file their income tax returns in early 2015, the subsidies will be reconciled to actual 2014 income. In some cases where income exceeds the projections, taxpayers will have to pay back the government. In cases where income dropped, taxpayers will receive additional subsidies delivered through their tax return.
That process requires the IRS to have accurate, up-to date information about taxpayers’ incomes, family size and insurance coverage.
That system of payment followed by reconciliation is a “fraudster’s dream come true,” said Orrin Hatch of Utah, the top Republican on the Senate Finance Committee.
“While the IRS needs to do more to ensure more safeguards are put in place, the fact is that the problems with these tax credits are deeply rooted in the law itself,” he said in a statement. “I fear the IRS will never be fully capable of ensuring that these refundable tax credits got to those who are truly eligible.”
According to the Congressional Budget Office, the U.S. government will spend $51 billion in fiscal 2015 and $1.1 trillion over the next decade on subsidies and other spending related to the health law.
NOTRE DAME SUES
The University of Notre Dame on Tuesday filed another lawsuit opposing parts of the health law that forces it to provide insurance for students and employees that includes birth control, saying it contravenes the teachings of the Roman Catholic Church.
The lawsuit filed in U.S. District Court in South Bend,Ind., claims that the law violates Notre Dame’s freedom to practice religion without government interference. Under the law, employers must provide insurance that covers a range of preventive care, free of charge, including contraception. The Catholic Church prohibits the use of contraceptives.
The lawsuit challenges accommodations offered by the Obama administration that attempted to create a buffer for religiously affiliated hospitals, universities and social service groups that oppose birth control. The law requires insurers or the health plan’s outside administrator to pay for birth control coverage and creates a way to reimburse them.
The Rev. John Jenkins, Notre Dame’s president, said that wasn’t enough.
“The government’s accommodations would require us to forfeit our rights, to facilitate and become entangled in a program inconsistent with Catholic teaching and to create the impression that the university cooperates with and condones activities incompatible with its mission,” he said in a statement.
Notre Dame says in the lawsuit that its employee health plans are self-insured, covering about 4,600 employees and a total of about 11,000 people. Its student health plans cover about 2,600 students. The lawsuit says the health plans do not cover abortion-inducing products, contraceptives or sterilization.
“The U.S. government mandate, therefore, requires Notre Dame to do precisely what its sincerely held religious beliefs prohibit - pay for, facilitate access to, and/ or become entangled in the provision of objectionable products and services or else incur crippling sanctions,” the lawsuit says.
Daniel Conkle, an Indiana University professor of law and adjunct professor of religious studies, said Notre Dame’s arguments are similar to those in a case last month where a federal judge in Pennsylvania granted the Pittsburgh and Erie Catholic dioceses a delay in complying with the federal mandates.
The Obama administration argues that the burden on the Catholic entities is minimal,Conkle said. Notre Dame and other Catholic groups say it’s substantial.
Information for this article was contributed by Roger Runningen, Mike Dorning, Alex Wayne and Richard Rubin of Bloomberg News; by Robert Pear of The New York Times; and by Tom Coyne of The Associated Press.
Front Section, Pages 1 on 12/04/2013