Top Democrats in the House and Senate stepped up their oversight into the Trump administration's healthcare regulatory agenda this week in letters seeking answers from administration officials about their handling of the Center for Medicare and Medicaid Innovation and the Affordable Care Act.
The newly minted House Democratic chairman of the House Ways and Means Committee, along with his Republican counterpart, wrote to CMS Administrator Seema Verma on Wednesday to urge CMS to increase transparency at its model testing and innovation arm CMMI, asking her to "reform its processes to incorporate greater opportunity for public input."
Also Wednesday, Democrats on the House committees on Energy and Commerce, Ways and Means and Education and Labor, along with the Senate committees on Health, Education, Labor, and Pensions and Finance, wrote HHS Secretary Alex Azar and Verma to request "detailed information" on how HHS and CMS are spending state user fees intended to support the ACA exchanges.
The two letters are the opening sally in a newly emboldened and more Democratic Congress. Notably, on the House side, the top Republican joined his colleague in the gambit for increased oversight.
"Significant policy changes made unilaterally by the executive branch without sufficient transparency could yield unintended negative consequences for beneficiaries and the health care community," read the Ways and Means letter signed by Chairman Richard Neal, D-Mass., and Republican ranking member Kevin Brady of Texas.
The lawmakers took issue with CMMI's opacity in recent years, especially in its rulemaking focused heavily on mandatory models. They asked Verma to supply the committee with information on what models CMMI is considering, with the estimated timeline for each, the public comment period that will be provided before model finalization, the financial repercussions of the models and what experts CMMI consulted when crafting it.
Ways and Means also asked for a description of additional activities the government will take to "promote transparency and engage Congress, stakeholders, Medicare beneficiaries and the public" by the deadline of Jan. 23.
Top Democrats in House and Senate committees looped in Azar to inquire how the Trump administration is spending money when it comes to the federal ACA marketplace.
"The Administration's record of undermining enrollment in the Marketplaces, including by cutting funding for vital functions such as marketing and outreach, as well as spending agency funds on 'repeal and replace' propaganda, raises questions about whether the dedicated funding is being spent effectively, legally, and appropriately," reads the letter, signed by Chairmen Frank Pallone, D-N.J., of Energy and Commerce, Neal of Ways and Means and Bobby Scott, D-Va., of Education and Labor; along with Senate ranking members Patty Murray, D-Wash., of Health, Education, Labor, and Pensions and Ron Wyden, D-Ore., of Finance.
The joint letter cited CMS cutting funding for ACA marketing and consumer assistance by 90% and navigator funding by 40% in 2017, cuts the Government Accountability Office described as "problematic" and supported by "unreliable" data.
The top Congressional Democrats also took issue with other the administration's 2018 actions around the ACA, noting that (among other efforts) further slashed funding and the promotion of association and short-term health plans undermined the law ahead of the 2019 enrollment period.
The 2019 exchanges saw lower interest than any year since 2014 so far. Eleven states and D.C. have yet to be tallied.
"Given the agency's clear intent to undermine enrollment in the Marketplaces by reducing funding for vitally important Marketplace functions, it is unclear why CMS continues to charge states that use the federal platform a 3.5 percent user fee," the report notes — or why CMS recently raised the fee on state-based marketplaces that use the federal platform from 2% to 3%.
The five Democrats requested a breakdown of how user fees were spent in 2017 and 2018, along with outreach and marketing expenditures. They're also interested in details on how the Trump administration invested funds to improve the marketplace and what contracts currently exist with outside companies around the ACA's functioning.
Azar and Verma have until Jan. 24 to provide the information.