House Republicans suspect the White House has more Obamacare data than it is letting on, sparking a tug of war that is playing out amid fears that Medicaid enrollment could far outpace requests for private insurance under President Obama's program.
House Ways and Means Committee Chairman Dave Camp, Michigan Republican, sent a stern letter Friday to Marilyn Tavenner, the federal official closest to the health care law's implementation, threatening to subpoena the records from the Centers for Medicare and Medicaid Services.
"The committee is not prepared to wait until 'around mid-November' for the administration's scrubbed and spun numbers," Mr. Camp wrote.
The White House has said it will release the figures on a monthly basis, beginning in mid-November, and that it takes time to gather reliable data from the federal exchange system and state-run markets.
But Rep. Darrell E. Issa, California Republican and chairman of the House Oversight and Government Reform Committee, last week released "war room meeting notes" that suggest Obamacare contractors discussed enrollment numbers with officials within CMS on Oct. 1 and 2.
The documents said only six people enrolled through HealthCare.gov — the federal website that processes applications from 36 states — on the first day. That number rose to 248 after the second day of activity.
The federal website has been plagued by problems that inhibit enrollment — picking a plan and paying for it — so the Obama administration has said only that at least 700,000 people have applied for coverage.
"These appear to be notes. They do not include official enrollment statistics," HHS spokeswoman Joanne Peters said of Mr. Issa's figures. "We will release enrollment statistics on a monthly basis after coordinating information from different sources such as paper, online and call centers, verifying with insurers, and collecting data from states."
But Republicans are eager to highlight the myriad problems Obamacare is experiencing after their party took a dive in public opinion polls for trying to dismantle the law in the run-up to the government shutdown last month.
Rep. Cathy McMorris Rodgers, Washington Republican, told Health and Human Services Secretary Kathleen Sebelius last week that the lion's share of enrollees on the Washington State exchange were heading into Medicaid, and not private insurance with the help of subsidies, presenting a new avenue of attack after Web glitches spoiled HealthCare.gov's debut. Mr. Obama already had to backtrack on his pledge that all Americans could keep their existing health care plans.
"Not only will this threaten state budgets with new and unexpected costs, but two out of three doctors do not accept new Medicaid patients," she said in a statement after Mrs. Sebelius' testimony before the Energy and Commerce Committee.
A spokeswoman for Minnesota's state-run exchange, MNSure said the exchange was processing 3,769 enrollments as of Oct. 16. Of those enrollees, 2,496 were for the state's Medicaid program, 406 were in the process of paying for private insurance and 867 were waiting for invoices.
Sen. Rand Paul, Kentucky Republican, said Sunday that "nearly 90 percent" of enrollees are "signing up for Medicaid, free health insurance from the government."
"My fear is that these hospitals may be bankrupt by overwhelming them with Medicaid patients," he told ABC's "This Week." "Same with doctors. Some may leave the community. Some may discontinue seeing Medicaid patients if they're overwhelmed. So I see the positive, but I also see the negative."
More than half of the states agreed to expand Medicaid enrollment under Obamacare to those making up to 138 percent of the federal poverty level. That's because the federal government agreed to pay for 100 percent of the expanded population from 2014 to 2016 before scaling back its contribution to 90 percent by 2020 and beyond.
Analysts said the Obamacare publicity would have a "woodwork" effect, and people eligible for Medicaid would take notice of the exchanges and sign up for federal-state entitlements. But only the newly eligible population is covered by the federal government's new contribution rate, meaning states would feel financial pain if the population that is currently eligible, even without Obamacare, enrolls at a higher-than-expected rate.
"The hardest reality about this trend is that the states haven't budgeted enough for the new enrollees," said Abigail Moncrieff, an associate professor at the Boston University School of Law.
Early Obamacare figures — to the extent they are available — might overstate the problem because people who already are eligible for Medicaid can get it now instead of waiting for Jan. 1, and trends could even out by the time open enrollment ends March 31 and HealthCare.gov improves.
Because Medicaid existed long before Obamacare, states were equipped to enroll the woodwork population faster than the expansion population or those seeking private plans on the exchanges, said Jenna Stento, a senior manager at Avalere Health, a Washington-based advisory firm.
"You are able to market and reach out to people under an existing program," she said.
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