New DOJ Push to Kill ACA Stirs Questions in Congress

House Dems grill top HHS official on department's budget, attitudes toward Obamacare

  • by Washington Correspondent, MedPage Today

WASHINGTON -- House Democrats at a Tuesday hearing interrogated Deputy HHS Secretary Eric Hargan about proposed cuts to the department's FY 2020 budget they say would threaten access to care for HIV patients and people with opioid addiction.

Hargan also faced questions about the Trump administration's recent letter telling a federal appeals court it should strike down the entire Affordable Care Act.

Rock and a Hard Place

On Monday, the Department of Justice (DOJ) sent a two-sentence letter saying the 5th U.S. Circuit Court of Appeals should affirm a December decision by a federal judge stating that the ACA was unconstitutional and therefore should be invalidated.

At Tuesday's House Budget Committee hearing, Rep. Sheila Jackson Lee (D-Texas) said the administration's actions in the pending lawsuit, Texas v. United States, will "implode" the ACA and asked whether he agreed with its strategy.

Hargan started by repeating the president's long-stated promise to protect people with pre-existing conditions, but Jackson Lee cut him off. "That will be impossible if he blows up the Affordable Care Act," she said. "What is his substitute right now? Does he have a bill that's going through the House and Senate that he's going to pass and sign?"

"We have spelled out in the budget a -- ," Hargan began, but Jackson Lee interrupted again, "You have no legislation."

Questions from Rep. Brendan Boyle (D-Penn.) highlighted the tightrope the deputy secretary is walking between his duties at HHS and the administration's recent actions.

"We are supportive of the ACA exchanges, we've been implementing them all along," said Hargan in response to a question about whether poor people were being forced to pay more for health insurance.

Boyle asked if this meant the president actually did support the ACA.

Hargan quickly walked back his comments saying instead that "the administration has carried out the ACA exchanges ... we obey the law within the administration" which is different from claiming "support."

When committee chair John Yarmuth (D-Ky.) asked Hargan whether he or HHS officials were consulted about the DOJ's actions and the decision's potential impact.

Hargan didn't answer directly, saying only that the DOJ "sets litigation strategy."

As for the impact of the DOJ's actions, at present, "the judge has not issued a stay or enjoined the Affordable Care Act," Hargan said. "It will have no impact, as it stands, on our administration of the Affordable Care Act."

Then, eyeing a prepared statement on the table, he added that the administration "stands ready to work with the Congress on policy solutions, like those in our budget, that empower consumers and state to gain control over their healthcare and increase affordability and continue to protect individuals with pre-existing conditions."

In addition to the DOJ's efforts to have the ACA overturned, HHS's FY 2020 budget proposal -- the primary focus of the hearing -- would eliminate the ACA and the associated Medicaid expansion. The proposal also aims to transform the Medicaid program into a system of per-capita-cap block grants, and mandate national work requirements, as Yarmuth noted in his opening statement.

Yarmuth pointed out that 16,000 people in Arkansas lost their health insurance after work requirements were implemented there, "with no evidence that they found new employment."

He argued that expanding such a policy nationwide would cause hundreds of thousands, possibly millions of Americans to lose their healthcare coverage.

"It is hard for me and my Democratic colleagues to understand how that meets HHS' mission to 'enhance the health and well-being of all Americans,'" Yarmuth said.

Throughout the hearing, Democrats battered Hargan with questions about funding cuts. At one point, he responded that while the budget may cut Medicaid spending in one place, it adds it elsewhere with increased flexibility on how it's spent. He noted that the budget proposal includes new monies for states to address the "vulnerable, fragile" population that the program was intended to serve: women, children, the disabled, and the elderly.

"We don't believe a state would choose to disadvantage a particular population ... simply because they're given more flexibility," Hargan said.

House Republicans, for their part, found the budget proposal reasonable, given a national debt of $22 trillion and certain budgetary caps.

Rep. Chris Stewart (R-Utah) said that the cuts to Medicaid and Medicare were "defensible."

"The money is still going to be spent. It's just going to be spent more efficiently," he said.

Republicans applauded the budget proposal's Medicare reforms. Hargan said it aims to keep the Medicare Trust Fund solvent through 2034, or 8 years beyond current projections.

"I just turned 35 and I have really little hope that I will see Medicare in my lifetime," said Rep. Dan Crenshaw (R-Texas). "It frustrates me that on the Republican side, we often have to be the adults in the room and say 'Hold on, we can't promise all of these things.'"