The shingles attack that brainwrap has been suffering from has apparently gotten into one eye. He is pulling back on reporting the numbers again, so we only have one number so far today.
Update: No he isn't. He felt well enough to make several more postings, which I will cover tomorrow. The hearing coverage below is plenty for today.
C-SPAN3 coverage of the Sylvia Burwell confirmation hearing as HHS Secretary starts at 9:30 AM ET/6:30 PT. I will watch and report.
Update: It was tame. Full coverage below.
And yes, again, they paid, at 83-90% according to insurance executives. The calculations at ACA Signups are still based on brainwrap's estimate that it will reach 93%.
Update: Republican unskewers blindsided themselves by calling a hearing on how bad the payment numbers are without reading any of the numbers from the invited witnesses in advance.
Last week, the House Energy & Commerce Committee put out a mendacious report claiming that insurance company executives had submitted data to them showing that just two thirds of ACA private plan enrollees had paid their first month's premium. ACA signups tracker Charles Gaba shot that rotten fish in a barrel within an hour of the report's release.Shooting a rotten fish in a barrel is the best mixed metaphor I have ever seen.
…they're VERY clear about what they're claiming: that as of 4/15/14, only 67% of all QHP enrollments via Healthcare.Gov had paid their first month's premium, right?Gaba was the first of many; the claim was widely debunked.
Well, there's a serious problem right there, because out of the 8 million or so enrollments as of 4/15, only 5 million of the first month's premiums were even due.
Yes, Republicans, they are paying
Sylvia Burwell Confirmation Hearing
In the updates.
6:30 AM PT: Sens. Tom Harkin and Lamar Alexander greet Sylvia Burwell. She takes her seat.
6:40 AM PT: Sen. Harkin introduces the nominee. Sen. Alexander tells a story about turning steam engines, and turning the ACA in a different direction. Freedom, choice, cut costs, step by step, standard list of Republican lies about premiums, losing insurance, jobs, yadda, yadda, yadda.
6:44 AM PT: Sen. McCain brags about resisting cuts in unnecessary Medicare expenses.
6:47 AM PT: McCain, as witness, not committee member, says that Burwell is well qualified to be Secretary of HHS, and will work better with Congress than Sebelius. He advised her not to take the position, comparing it to the Captain of the Titanic.
6:50 AM PT: Sen. Manchin apologizes for Sen. Rockefeller not being able to attend. Sylvia Burwell is from Hinton, West Virginia, so they have to be proprietary about her and her family history.
6:58 AM PT: Burwell opening statement: Focus on three things: relationships, teams, results. At OMB, worked on returning the budget process to regular order. Review of various HHS programs. ACA strengthens health care, economy, society.
7:03 AM PT: Harkin gets first five-minute question period. Will Burwell emphasize prevention and community health? (Yes) Question on salt in food causing hypertension. Can we get it reduced, and possibly save a hundred thousand lives? (package labeling, yes; access to lower-sodium food, yes)
7:08 AM PT: Sen. Alexander: Will you allow people to keep junk insurance? Fake case of "Emily" in Tennessee forced to buy real insurance, in spite of the existence of catastrophic care as an ACA option. Burwell talks about flexibility in HHS implementation.
7:09 AM PT: Alexander: Where are the numbers? Answer our questions! (Maybe he hasn't heard of ACA Signups, or read the HHS and CMS reports)
7:12 AM PT: Sen. Warren (Yay!) Wait, actual numbers in a Senate hearing? Democrats have cut spending, Republicans object. ACA saves lots of money. Burwell: Health care costs $900 billion less over some years than they would be without ACA. We can do more to extend Medicare solvency.
7:14 AM PT: Warren: ACA mandates new payment methods to save money, based on success in Massachusetts. Could save $47 billion over some years. What would Burwell do about this at HHS? Burwell: We need data-based decision-making to get maximum impact. Warren thanks her.
7:18 AM PT: Sen. Johnny Isakson, R-GA: Complains about OMB action on Savannah Harbor expansion project. Does not want her to leave OMB until the project is approved. Burwell: We want to move forward as quickly as possible. Hopes the relevant bill passes. We agree it is a good project. She had to deal with the need for the Army Corps of Engineers budget extension, which is required for the port expansion, as required by Congress. This is happening.
7:24 AM PT: Sen. Mikulski D-MD: Appreciates her integrity, responsiveness, competence, confidence of President. We need a CEO at HHS. We see three issues: money, management, and morale (because of budget battering and opposition trivializing of their work). Can you do that? Burwell gives brief tutorial on management.
7:30 AM PT: Sen. Pat Roberts, R-KS: President intends to move to single payer. Do you agree with that? Burwell: The law provides private insurance. She will work within that. Roberts: IPAB (Independent Payment Advisory Board) will decide what treatments will be allowed. He wants it repealed. Burwell: It has not been activated, and probably won't ever be triggered. Roberts: 22 delays within Obamacare. Is it fair to delay the mandate for business but not individuals? Burwell: This was because of reporting problems for business. Roberts: Will submit other questions on abortions and other objections.
7:34 AM PT: Sen. Michael Bennet, D-CO: A budget can be a tool for management, or just a compliance document. Can we get to a continuous improvement model? Can the Federal Government be efficient and effective? Burwell: Another management tutorial.
7:38 AM PT: Sen. Enzi, R-WY: Complains about Healthcare.gov. Blames Burwell. What role did she play in the development and rollout? None, of course. It was up to the agency. Burwell has looked into IT procurement and could say much more. Enzi: Backend problems not yet fixed. Burwell: Will get right on that. OMB had nothing to say about current contractors.
7:40 AM PT: Enzi: BUT HAVE THEY PAID? Quotes bogus House report. When will Burwell put out the actual report? Burwell: OMB has nothing to do with this. Insurance companies have not provided the data to HHS, but they testified in Congress that the House was wrong.
7:43 AM PT: Sen. Murphy D-CT: Debunks Enzi's point and many other Republican talking points. "Avalanche of good news" but "a tale of two countries" with states seeking to undermine the law. What do you plan to do about that? Burwell: Willing to have the conversations and listen to the ideas, as with the waivers for Arkansas Medicaid expansion. Medicaid expansion saves states money and improves health.
7:45 AM PT: Murphy: How do we balance building big systems for needed coordination with competition? Burwell: Another very brief management tutorial.
7:51 AM PT: Sen. Murkowski R-AK: ACA has more than doubled premiums in Alaska [from junk insurance to real insurance]. How do we increase enrollment and decrease cost? (Does not wait for answer, and so doesn't get one.) Also, firefighters are concerned about how the ACA applies to them. She claims that some stations are reducing employment to 29 hours per week to avoid the employer mandate. Burwell asks for the data. Notes that 9.1 million jobs have been created since passage of the ACA. Murkowski has questions about e-cigarettes that she did not ask.
7:57 AM PT: Sen. Baldwin D-WI: Transparency problem in health care on costs and effectiveness. Wisconsin Health Information organization helping. Can they get better access to Medicare data? She has a bill to do that. Asks about transparency and quality improvements. Burwell: We have been having those conversations. Information in markets is an important thing. [Information is an absolute requirement for market efficiency.] Emphasizes providing the correct context for information. Baldwin: 140,000 in Wisconsin signed up, despite fierce ideological attacks. Gov. Walker turned down Medicaid expansion, and in fact cut BadgerCare (the state's version of Medicaid), tossing 77,000 onto the exchanges.
7:58 AM PT: Sen. Baldwin D-WI: Transparency problem in health care on costs and effectiveness. Wisconsin Health Information organization helping. Can they get better access to Medicare data? She has a bill to do that. Asks about transparency and quality improvements. Burwell: We have been having those conversations. Information in markets is an important thing. [Information is an absolute requirement for market efficiency.] Emphasizes providing the correct context for information. Baldwin: 140,000 in Wisconsin signed up, despite fierce ideological attacks. Gov. Walker turned down Medicaid expansion, and in fact cut BadgerCare (the state's version of Medicaid), tossing 77,000 onto the exchanges.
8:04 AM PT: Sen. Burr R-NC: Do you consider medical and public health preparedness programs to be a matter of national security? (Yes. Worked on that at the Gates Foundation.)
Regulatory certainty at FDA? (Sure.)
How do we find the cause of ALS? What if the FDA stood in the way of a cure?
Will Burwell advance the cancer study at Camp Lejeune? Already happening.
Burr supports Burwell as a tremendous asset with a portfolio of relevant experience.
8:08 AM PT: Sen. Casey D-PA: We still lack a real strategy for children's health care, early learning, protection of children, food and nutrition. Starting with CHIP, a substantial bipartisan achievement, covering some 8 million children, based on a Pennsylvania program. Funding will expire in September, and there have been efforts to undermine CHIP. What would be the impact on children's health if we fail to fund CHIP. Burwell: She worked on that program from the beginning. Burwell: She would look forward to working with Congress to extend the program.
8:11 AM PT: Casey: Secondly, CHGME Children's Hospitals Graduate Medical Education, has been reauthorized for five years in a bipartisan manner. Tremendously successful in training doctors to work in children's hospitals. Burwell: Committed to working on it.
8:12 AM PT: Oops. Some of my updates have disappeared.
8:13 AM PT: Oh, there they are. Some sort of refresh problem.
8:16 AM PT: Sen. Hagan D-NC: North Carolina refused Medicaid expansion, so that 500,000 people are left getting care in ERs, and not managing chronic conditions, at considerable expense to them and the economy. Asks Burwell to compare states with and without expansion. Burwell: We need more data. We are seeing fewer people uninsured. She expects better health outcomes at lower cost.
8:19 AM PT: Hagan: What happens when somebody earning $11,000 seeks coverage under the ACA in a state like NC without Medicaid expansion? Burwell: She would get a hardship exemption from the mandate, but no coverage. Hagan: What is the cost to a state for expanding Medicaid? Burwell: That would be 0 for the first few years.
8:23 AM PT: Hagan: Looking forward to Inspector-General reports on Web site failure. Burwell: At OMB, looked into IT procurement. It is an error to tell the IT team to connect to a business without involving the business in the design. The waterfall methodology (each stage must be completed before the next can begin, making it extremely difficult and expensive to go back and fix errors from a previous stage) is an error. We need an iterative approach (also known as Agile Development), building and testing in small pieces. The third thing that is important is ownership of the process. It is a much more general issue it government procurement that GSA is working on.
8:23 AM PT: Oops. In government procurement.
8:25 AM PT: Sen. Whitehouse D-RI: Has it been your experience...that having solid, clear, performance metrics is an advantage? Burwell: It is an advantage to know where you're headed.
8:30 AM PT: Whitehouse: We've made pretty significant progress in cleaning up some of the mess in the insurance market. Access, 8 million signed up. That leaves cost. How do we reduce the growth in health care costs? We should be able to do that by increasing the quality of care. He believes that we are trying to do that without adequate performance metrics. Would she be willing to do that? Burwell: Looking forward to it. The question is what are the right metrics. Whitehouse: There should be specific cost-saving metrics with dates. [Nope. Advances come when you find them, not according to a pre-defined schedule.]
8:38 AM PT: Sen. Murray D-WA: How has your professional experience prepared you for the challenges at HHS? Yet another brief management tutorial on team-building and clarity in roles and responsibility, and how your organization can best impact an issue and its solution space. Murray: How will Burwell strengthen children's early learning programs? Burwell: We have proposals in the budget to build on existing programs, and to implement quality measures. Burwell looks forward to working with Congress on this. She has two children, 6 and a half, and 4 and a half.
Murray: Notes Gallup's numbers on decrease in the numbers of the uninsured, and hopes to advance further.
8:41 AM PT: Sen. Sanders I-VT: Unlike Sen. Roberts, I believe in a Medicare-for-all Single-Payer system. I think there is something wrong when in our great country we are the only nation in the industrialized world that does not guarantee health care to all of its people, and yet we end up spending far more than most other countries.
8:42 AM PT: Sanders: Put in language, along with Sen. Harkin, allowing states to move to Single Payer. Will Burwell work with Vermont on this? Burwell: Looking forward to it.
8:44 AM PT: Sanders: We need to expand community health centers in rural areas. They are under threat in the budget. Will Burwell fight for this funding? Burwell: Having grown up in a rural area, and understanding the importance of these centers, yes. Sanders asks again a little differently, and gets the same answer.
8:46 AM PT: Sanders: Crisis in rural primary care. Will Burwell work for National Health Service Corps funding for training medical personnel to work in rural Community Health Care Centers. Burwell: Yes.
8:55 AM PT: Sen. Scott R-SC: I'll be brief. Fuzzy math seems to be part of Obamacare; promises made, promises not kept; will Burwell be the ambassador of Obamacare or the Secretary of HHS? (Enjoyed meeting her, she is well qualified.) Having spent 1.5 Trillion and still having millions uninsured, siphoning hundreds of billions from Medicare, 8 million have signed up but haven't paid their premium, but we count that number. Acknowledges that we have 28% young people but claims that that is not enough for actuarial soundness.
8:59 AM PT: Scott: And finally, now I will ask a question. As HHS Secretary, will you be clear and honest with the American people, the Congress, and this committee about the implementation of Obamacare, regardless of what the Administration's policy is? You mentioned during our time that you have a lot of experience, served on Met Life board and others. It would be helpful for the American people to have a clear picture of what is in fact happening with Obamacare since we are now relegated to getting our information from the New York Times and the Washington Post, and not from HHS. Burwell: Senator, you have my commitment that if I am confirmed the two principles that will guide me with regard to information are transparency and accuracy. Those are the two things, and I will work to do that in due course, in terms of speed as well.
9:07 AM PT: Scott: On the issue of promises made, promises not kept, people were promised that they could keep their insurance but millions had policies cancelled, and have had to change doctors, and costs have gone up with higher deductibles and higher out-of-pocket expenses. Also limitations on insurance networks restricting what doctors you can see in what hospitals, which he says will raise costs. And he blames that, too, on Obamacare. Then not having a functioning Web site, dismissing all of the successes since. He says insurance companies are complaining that the backdoor (he means backend; backdoors are security vulnerabilities) processes are not set up yet. But that isn't in any way the fault of the insurers. Will you in fact be the HHS Secretary for the American people, or will you be as your predecessor has been the ambassador of Obamacare? Burwell: I'm here to serve the American people.
9:10 AM PT: Now that questioning time is over, Harkin steps in to defend Sec. Sebelius as a responsible and attentive Secretary of HHS who carried out the law as Congress wrote it.
He also had a statement of support from SEIU, and a letter from the American Public Health Association to include in the record.
End of hearing.
9:11 AM PT: So in sum, not so much of an attack on Obamacare as many had predicted, except for the champion bloviator of the day, Sen. Tim Scott of South Carolina.
Sylvia Mathews Burwell's Senate confirmation hearing was not the tense, partisan fight over Obamacare some Republicans promised. It was actually pretty lame.There is more of this sort of thing.