Nine questions for HHS nominee Sylvia Burwell

Kathleen Sebelius — in somewhat sudden and appropriately inept form — is out at HHS. Pending Senate confirmation, current White House budget chief Sylvia Mathews Burwell is in.  As Republicans prepare to cross-examine the president’s nominee, they are reportedly intent on using the opportunity to once again shine the spotlight on Democrats’ unpopular healthcare overhaul.  This strategy makes sense, if carried out adroitly.  GOP questioners should avoid the appearance of bullying, which could come in the form of obnoxiously spiking the football on Sebelius’ tarnished legacy, or unfairly holding the failures of Burwell’s predecessor against her.  Questions ought to be methodical and forward-looking; designed to shine the light on how Obamacare will continue to impact the American people, rather than to settle old scores.  A few modest suggestions:

(1) Now that [X weeks] have elapsed since the administration announced that 7.5 million Americans selected plans through the Affordable Care Act’s marketplaces, can you tell us how many of those people have paid their premiums, and are therefore covered?  Was Sec. Sebelius’ comment that up to one-fifth of those “enrollments” may have been unpaid an accurate estimate?  Can you tell us what percentage of the “newly” enrolled lacked coverage prior to the law’s implementation?*  Even if you don’t have official, finalized data, three separate independent studies have pegged that number between 25 and 33 percent.  Is that in the right ballpark, at least?  Finally, how many of the (paid) enrollees were so-called “young invincibles“?  How many were older and sicker than expected?

(2) Sec. Sebelius acknowledged that healthcare premiums will rise in 2015, but downplayed the increases as “far less significant” than they’ve been in the past.  Has this administration abandoned the promise that “everybody” will see their health costs reduced by $2,500 “per family, per year” on average as a result of the Affordable Care Act?  Also, The Hill and Reuters have reported that Sebelius’ characterizations were hotly disputed by insurance industry sources, who will be setting premium rates for next year.  Whom should Americans believe?  Has the Affordable Care Act bent the overall US healthcare cost curve down — yes or no?  (If Burwell goes down this predictable route to evade the question, Republicans should query her on this).

(3) An estimated 5.1 to 6.2 million Americans received cancellation notices from their existing coverage providers last year.  Will any more Americans receive similar letters in the future?  If so, can you estimate how many?  Mid-range internal White House estimates projected that up to 93 million Americans would ultimately lose “grandfathered” status under the law.  Does that number strike you as realistic?

(4) Sec. Sebelius stated earlier this year that “there is absolutely no evidence” that the Affordable Care Act is having a negative impact on America’s employment picture.  Do you accept the findings of a recent Congressional Budget Office report, which found that the new law is slowing growth and hiring, while substantially shrinking the US workforce?  How much will the Affordable Care Act cost taxpayers between 2014 and 2023?

(5) We understand that you played no role in the failed roll-out of the Affordable Care Act.  Sec. Sebelius admitted in mid-April that the implementation timeline was “flat out wrong,” so time management was clearly an issue.  In your role as OMB director, President Obama’s FY 2015 budget proposal was delivered more than one month past its statutory deadline — as were three of his previous four offerings (over which you did not preside).  How did the process you oversaw fall so far behind schedule?  Do deadlines matter?

(6) A former Obama administration spokesman recently stated that the Affordable Care Act’s twice-delayed employer mandate will “be one of the first things to go.”  Does the executive branch have the legal authority to unilaterally delay, or even jettison, elements of a law that has been duly passed by Congress and signed by the president?  What is the legal justification for the previous two postponements of the employer mandate, for instance?

(7) Our colleagues on the Democratic side of the aisle are talking a lot about “fixing” the Affordable Care Act.  What are three significant fixes to the law you’d recommend to Congress?

(8) Is Medicare facing a solvency crisis?  If so, what specific solutions does the budget you helped produce recommend to protect the program for future seniors?

(9) Via Marc Thiessen:

The agency Burwell heads, the Office of Management and Budget, is responsible for the president’s budget. But OMB also has another, lesser-known responsibility: fact-checking presidential speeches. Every proposed presidential utterance is scrubbed for accuracy by OMB…Thanks to Burwell’s nomination, Americans may finally get to the bottom of how the biggest presidential lie in recent memory made it though OMB’s fact-checking process — not once but dozens of times. The first time the lie surfaced — when Obama told the American Medical Association on June 15, 2009, “If you like your doctor, you will be able to keep your doctor, period. If you like your health-care plan, you’ll be able to keep your health-care plan, period. No one will take it away, no matter what” — it wasn’t on Burwell’s watch. But Burwell was OMB director when Obama declared on Sept. 26, 2013: “Now, let’s start with the fact that even before the Affordable Care Act fully takes effect, about 85 percent of Americans already have health insurance — either through their job, or through Medicare, or through the individual market. So if you’re one of these folks, it’s reasonable that you might worry whether health-care reform is going to create changes that are a problem for you — especially when you’re bombarded with all sorts of fear-mongering. So the first thing you need to know is this: If you already have health care, you don’t have to do anything.” Burwell should explain to Congress and the American people how her office allowed blatant falsehoods to get into presidential speeches, including whether political aides overruled career policy advisers who warned that the president’s claims were untrue.

We’ll see if Burwell answers any of these questions directly.  Based on her exchange with Sen. Jeff Sessions in March, don’t hold your breath:

*I changed the wording of this question for clarity.