Conservatives Want a Bigger Obamacare Fight Around HHS Nominee

The senators behind the government shutdown say Sylvia Mathews Burwell shouldn’t get confirmed until she answers more questions about Obamacare.

Republican Senator Ted Cruz of Texas(R) and Republican Senator Mike Lee of Utah attend a hearing on sequestration effects on military budget and spending before the Senate Armed Services Committee on Capitol Hill in Washington, DC, November 7, 2013.
National Journal
Sam Baker
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Sam Baker
May 16, 2014, 8:29 a.m.

Con­ser­vat­ives are angling for a big­ger fight over Sylvia Math­ews Bur­well’s nom­in­a­tion for Health and Hu­man Ser­vices sec­ret­ary.

Bur­well has at­trac­ted some bi­par­tis­an sup­port already and has breezed through two con­firm­a­tion hear­ings. But Sens. Mike Lee and Ted Cruz — who spear­headed the anti-Obama­care cam­paign that led to a gov­ern­ment shut­down last year — said Fri­day that the Sen­ate should delay a con­firm­a­tion vote un­til Bur­well an­swers more ques­tions about the Af­ford­able Care Act.

In a let­ter to Bur­well, Lee and Cruz sought more in­form­a­tion about Obama­care en­roll­ment fig­ures and the ad­min­is­tra­tion’s ap­proach to im­ple­ment­ing the law. They said Bur­well has been “less than forth­com­ing” in her con­firm­a­tion hear­ings and ques­tioned wheth­er she would co­oper­ate with con­gres­sion­al over­sight if con­firmed.

“The ques­tions we pro­pose in the let­ter have not only been asked re­peatedly, but deal with is­sues she should have been pre­pared to an­swer at her hear­ings but did not,” Lee said in a state­ment. “We are there­fore go­ing to at­tempt one more time to get an­swers to these simple ques­tions and the Sen­ate should not move for­ward on her nom­in­a­tion un­til we get them.”

Some con­ser­vat­ives have grown frus­trated with Bur­well’s con­firm­a­tion pro­cess. At least three Re­pub­lic­an sen­at­ors have en­dorsed Bur­well, and her nom­in­a­tion has not be­come a broad­er ref­er­en­dum on Obama­care.

But con­ser­vat­ive act­iv­ists want to force the is­sue.

“I cer­tainly think you will hear more about what her role will be once she gets to the floor,” said Dan Holler, com­mu­nic­a­tions dir­ect­or for Her­it­age Ac­tion, the ad­vocacy arm of the Her­it­age Found­a­tion.

Still, there are lim­its to what con­ser­vat­ives can truly ac­com­plish. Thanks to a re­cent change in the Sen­ate’s rules, Bur­well’s nom­in­a­tion needs only 50 votes to ad­vance — mean­ing Re­pub­lic­ans have little lever­age to ex­tract con­ces­sions. Demo­crats could ad­vance to the nom­in­a­tion even without any Re­pub­lic­an sup­port.

Lee’s and Cruz’s let­ter to Bur­well re­flects con­ser­vat­ives’ skep­ti­cism about Obama­care en­roll­ment. They asked her how many of the law’s 8 mil­lion sign-ups have paid their first month’s premi­um, how many were pre­vi­ously un­in­sured, and wheth­er that total in­cludes du­plic­ate ap­plic­a­tions.

In­surers have said 80 per­cent to 90 per­cent of their new cus­tom­ers are mak­ing their first premi­um pay­ment — the fi­nal step to ac­tu­ally get­ting covered. An of­fi­cial break­down of newly in­sured con­sumers is not avail­able. Some out­side es­tim­ates sug­gest the num­ber is as low as one-third, al­though sur­veys also show the share of un­in­sured Amer­ic­ans fall­ing.

Lee and Cruz also asked for more in­form­a­tion about im­ple­ment­a­tion de­cisions, in­clud­ing delays in the law’s em­ploy­er man­date and the ad­min­is­tra­tion’s ap­proach to safety-net pro­grams that com­pensate in­sur­ance com­pan­ies whose en­roll­ment ex­per­i­ence is worse than ex­pec­ted.

And they pressed Bur­well to ex­plain how she would im­ple­ment the In­de­pend­ent Pay­ment Ad­vis­ory Board, an ex­pert pan­el tasked with cut­ting Medi­care pay­ments to doc­tors if the pro­gram’s spend­ing grows too quickly. Pres­id­ent Obama hasn’t nom­in­ated any­one to the board yet, and if he nev­er does, the HHS sec­ret­ary can step in as an “IPAB of one.”

When asked about that pos­sib­il­ity in her con­firm­a­tion hear­ings, Bur­well has punted, not­ing that Medi­care spend­ing is not cur­rently grow­ing quickly enough to trig­ger the IPAB.

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