By Tom Howell Jr.
Health and Human Services Secretary Kathleen Sebelius told skeptical House Republicans on Friday that President Obama's health care law will roll out on time and improve health outcomes, despite limited resources and fears about the overhaul's impact on small businesses.
For more than two hours, Ms. Sebelius faced a battery of questions from GOP members of the Committee on Ways and Means on her agency's budget, its timeline for implementing the Affordable Care Act and plans to keep Medicare solvent.
Democrats, meanwhile, praised Mrs. Sebelius for taking on the "herculean task" of health care reform and needled their counterparts across the aisle for condemning Mr. Obama's law instead of taking steps to buttress its implementation.
The health care law drove the conversation before the tax committee, interrupted briefly by topics such as Mr. Obama's plan to study the human brain, the potential link between violent media and real-life aggression and Mrs. Sebelius" opposition to a House GOP plan to turn Medicare into a voucher system.
"Both Republicans and Democrats can agree that Americans need the right kind of health care reform -- reform that lowers costs, improves health and protects the vulnerable, said Rep. Kevin Brady, the Texas Republican who chairs the panel's subcommittee on health issues. "But many Americans are concerned the Affordable Care Act may not be able to deliver."
Mr. Obama requested $1.5 billion through HHS to fund the health care law's federally-run health "exchanges," where qualified consumers without employer-based insurance can buy coverage from competing providers with the help of tax credits.
Roughly half of the states have defaulted to federally-run exchanges instead of running the markets themselves. The exchanges are scheduled to begin enrollment on Oct. 1 for insurance coverage that takes effect on Jan. 1.
The federal tab for grants that help states run exchanges on their own is also mounting, raising Republicans' concerns. Yet Mrs. Sebelius said the agency is working with much less funding than the Congressional Budget Office projected when the reforms passed in 2010.
In one terse exchange, Mr. Brady repeatedly challenged Mrs. Sebelius on her agency's ability to have exchanges operating by this fall, citing a series of missed deadlines in recent months.
"I can only tell you what I'm telling you," Mrs. Sebelius said. "We are on track to meet the Oct. 1 deadline."
The Republican majority also sounded the alarm over an employer mandate in the law that requires firms with 50 or more full-time employees to provide adequate health plans or face penalties.
GOP members said employers in their districts are switching full-time employees to part-time status or declining to hire so they can stay below the 50-employee threshold.
Mrs. Sebelius said the law will give small employers more leverage than ever in seeking adequate health plans through a large pool of choices on "Small Business Health Options Programs" (SHOP) exchanges. She said criticism of the mandate is premature, noting similar fears about a clause in Massachusetts' high-profile health reforms proved unfounded.
"I hope you're right," Rep. Jim Renacci, Ohio Republican, said.
Republican members also pressed the secretary on a facet of the small business exchanges that will be delayed for one year.
Mrs. Sebelius said small business owners will be able to choose from a variety of plans in 2014, but a second-phase option that allows employers -- if they choose -- to offer an array of health plans to their employees will be delayed for one year among the exchanges that will be run by the federal government.
Mrs. Sebelius said the delay was based on feedback from insurers, who faced implementation hurdles in getting their plan options ready by next year.