President Obama's top health official tried Thursday to stanch Republican lawmakers' complaints about the federal health care law amid growing concerns from both sides of the aisle that the administration is facing a "train wreck" as it prepares to go live with key parts of the system next year.
One congressman demanded that Health and Human Services Secretary Kathleen Sebelius explore when oral contraceptives cross the line into chemical abortions — an issue that could complicate the administration's contraceptive mandate. Other lawmakers pointed to a Maryland insurance company's decision to seek a 25 percent boost in premiums, saying that undercuts the health care law's promise of lower costs.
Concerns over the law have been brewing since it was enacted three years ago, but were inflamed last week when Sen. Max Baucus, Montana Democrat and one of the architects of the act, said he sees "a huge train wreck coming" if officials can't get a handle on the parts slated to go into effect next year.
The Obama administration will meet its deadlines and is doing the best it can with what it has, Mrs. Sebelius told the House Appropriations health and human services subcommittee Thursday.
She said she does not expect delays in the state exchanges, where people who don't have health care plans through their companies can buy insurance with the aid of government subsidies.
She acknowledged that money is tight, though she blamed Congress for not giving her the additional funding she requested this year to carry out the law.
"Having failed in both of those efforts, through the work of the United States Congress, we are then using the resources available within the department to make sure we implement the law of the land," she said.
The health care law remains so toxic politically that when Politico reported that lawmakers were considering exempting themselves and their staffs, all sides rushed to dismiss that as an option.
"There are not now, have never been, nor will there ever be any discussions about exempting members of Congress or congressional staff from Affordable Care Act provisions that apply to any employees of any other public or private employer offering health care," said Adam Jentleson, a spokesman for Senate Majority Leader Harry Reid, Nevada Democrat.
At issue is whether the federal government would be allowed to pay part of staffers' health care premiums — a move that could affect low-paid aides in particular.
Among Republicans, the health care law is such an anathema that when House Republican leaders tried to pass a bill cutting a section on preventive health care funding in order to support another program to help those with pre-existing conditions acquire coverage, their own troops rebelled, saying they didn't want any part of rescuing the law.
Republican leaders had to pull their bill from the calendar.
In her two-hour appearance Thursday, when Mrs. Sebelius explained why her department has had to shuffle money and why the pre-existing condition fund was running low on funds, Republicans accused her of using the disease prevention money as a "slush fund."
"I have concerns about where this money comes from," said subcommittee Chairman Jack Kingston, Georgia Republican.
Mrs. Sebelius reiterated that lawmakers had only themselves to blame for the agency's fiscal maneuvering.
"As you know, we did not have a 2013 budget and we made a request in the debate over the continuing resolution for additional funding — for particularly outreach and education — that also was not granted by the United States Congress," Mrs. Sebelius said.
She also said lawmakers should not jump to conclusions after Maryland's largest insurer, CareFirst BlueCross BlueShield, on Wednesday proposed raising premiums by an average of 25 percent among the plans that it wants to offer on the state's health care exchange. She noted that state regulators will continue to scrutinize the rates, that other insurers did not seek steep rate hikes and that customers will be assisted by tax credits when the exchanges are in place next year.
The hearing turned dramatic when Rep. Andy Harris, a Maryland Republican, raised one of the law's most contentious features — a mandate that forces most employers to insure contraception.
Mr. Harris, a doctor, asked the secretary to declare whether ella, a form of emergency contraception, is an abortion-causing drug.
"I am not a scientist and don't pretend to be one," Mrs. Sebelius said, noting that scientists at the Food and Drug Administration designate drugs.
Conservative lawmakers have backed corporations such as Hobby Lobby that object to the mandatory coverage, especially for drugs that are taken after sex. Opponents of the mandate have equated morning-after pills such as Plan B and ella as abortifacients.
"It's not an abortifacient," ranking member Rosa L. DeLauro, Connecticut Democrat, said abruptly, prompting Mr. Harris to object.
"I was going to get some coffee," Mr. Kingston said, when things calmed down. "Don't need it anymore."
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