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Implementation of Ppaca's Exchanges and Medicaid Expansion Hearing Committee on Energy and Commerce Hous STATE OF UNCERTAINTY: IMPLEMENTATION OF PPACA’S EXCHANGES AND MEDICAID EXPANSION HEARING BEFORE THE SUBCOMMITTEE ON HEALTH OF THE COMMITTEE ON ENERGY AND COMMERCE HOUSE OF REPRESENTATIVES ONE HUNDRED TWELFTH CONGRESS SECOND SESSION DECEMBER 13, 2012 Serial No. 112–185 ( Printed for the use of the Committee on Energy and Commerce energycommerce.house.gov U.S. GOVERNMENT PRINTING OFFICE 86–248 PDF WASHINGTON : 2014 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001 VerDate Aug 31 2005 15:01 Jan 16, 2014 Jkt 037690 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 F:\112-00~1\112-18~2\86248K.TXT WAYNE COMMITTEE ON ENERGY AND COMMERCE FRED UPTON, Michigan Chairman JOE BARTON, Texas HENRY A. WAXMAN, California Chairman Emeritus Ranking Member CLIFF STEARNS, Florida JOHN D. DINGELL, Michigan ED WHITFIELD, Kentucky Chairman Emeritus JOHN SHIMKUS, Illinois EDWARD J. MARKEY, Massachusetts JOSEPH R. PITTS, Pennsylvania EDOLPHUS TOWNS, New York MARY BONO MACK, California FRANK PALLONE, JR., New Jersey GREG WALDEN, Oregon BOBBY L. RUSH, Illinois LEE TERRY, Nebraska ANNA G. ESHOO, California MIKE ROGERS, Michigan ELIOT L. ENGEL, New York SUE WILKINS MYRICK, North Carolina GENE GREEN, Texas Vice Chairman DIANA DEGETTE, Colorado JOHN SULLIVAN, Oklahoma LOIS CAPPS, California TIM MURPHY, Pennsylvania MICHAEL F. DOYLE, Pennsylvania MICHAEL C. BURGESS, Texas JANICE D. SCHAKOWSKY, Illinois MARSHA BLACKBURN, Tennessee CHARLES A. GONZALEZ, Texas BRIAN P. BILBRAY, California TAMMY BALDWIN, Wisconsin CHARLES F. BASS, New Hampshire MIKE ROSS, Arkansas PHIL GINGREY, Georgia JIM MATHESON, Utah STEVE SCALISE, Louisiana G.K. BUTTERFIELD, North Carolina ROBERT E. LATTA, Ohio JOHN BARROW, Georgia CATHY MCMORRIS RODGERS, Washington DORIS O. MATSUI, California GREGG HARPER, Mississippi DONNA M. CHRISTENSEN, Virgin Islands LEONARD LANCE, New Jersey KATHY CASTOR, Florida BILL CASSIDY, Louisiana JOHN P. SARBANES, Maryland BRETT GUTHRIE, Kentucky PETE OLSON, Texas DAVID B. MCKINLEY, West Virginia CORY GARDNER, Colorado MIKE POMPEO, Kansas ADAM KINZINGER, Illinois H. MORGAN GRIFFITH, Virginia SUBCOMMITTEE ON HEALTH JOSEPH R. PITTS, Pennsylvania Chairman MICHAEL C. BURGESS, Texas FRANK PALLONE, JR., New Jersey Vice Chairman Ranking Member ED WHITFIELD, Kentucky JOHN D. DINGELL, Michigan JOHN SHIMKUS, Illinois EDOLPHUS TOWNS, New York MIKE ROGERS, Michigan ELIOT L. ENGEL, New York SUE WILKINS MYRICK, North Carolina LOIS CAPPS, California TIM MURPHY, Pennsylvania JANICE D. SCHAKOWSKY, Illinois MARSHA BLACKBURN, Tennessee CHARLES A. GONZALEZ, Texas PHIL GINGREY, Georgia TAMMY BALDWIN, Wisconsin ROBERT E. LATTA, Ohio MIKE ROSS, Arkansas CATHY MCMORRIS RODGERS, Washington ANTHONY D. WEINER, New York LEONARD LANCE, New Jersey JIM MATHESON, Utah BILL CASSIDY, Louisiana HENRY A. WAXMAN, California (ex officio) BRETT GUTHRIE, Kentucky JOE BARTON, Texas FRED UPTON, Michigan (ex officio) (II) VerDate Aug 31 2005 15:01 Jan 16, 2014 Jkt 037690 PO 00000 Frm 00002 Fmt 0486 Sfmt 5904 F:\112-00~1\112-18~2\86248K.TXT WAYNE CONTENTS Page Hon. Michael C. Burgess, a Representative in Congress from the State of Texas, opening statement .................................................................................... 1 Prepared statement .......................................................................................... 3 Hon. Bill Cassidy, a Representative in Congress from the State of Louisiana, opening statement ................................................................................................ 4 Hon. Frank Pallone, Jr., a Representative in Congress from the State of New Jersey, opening statement .......................................................................... 4 Hon. John D. Dingell, a Representative in Congress from the State of Michi- gan, opening statement ....................................................................................... 5 Hon. Phil Gingrey, a Representative in Congress from the State of Georgia, opening statement ................................................................................................ 6 Hon. Henry A. Waxman, a Representative in Congress from the State of California, opening statement ............................................................................. 6 Hon. Tammy Baldwin, a Representative in Congress from the State of Wis- consin, opening statement ................................................................................... 7 Hon. Fred Upton, a Representative in Congress from the State of Michigan, prepared statement .............................................................................................. 187 Hon. Joseph R. Pitts, a Representative in Congress from the Commonwealth of Pennsylvania, prepared statement ................................................................. 188 WITNESSES Gary Cohen, Deputy Administrator and Director, Center for Consumer Infor- mation and Insurance Oversight, Centers for Medicare and Medicaid Serv- ices, Department of Health and Human Services ............................................. 9 Prepared statement 1 Answers to submitted questions ...................................................................... 190 Cynthia Mann, Deputy Administrator and Director, Center for Medicaid and CHIP Services, Centers for Medicare and Medicaid Services, Department of Health and Human Services ........................................................................... 11 Prepared statement .......................................................................................... 14 Answers to submitted questions ...................................................................... 205 Dennis G. Smith, Secretary, Department of Health Services, State of Wis- consin .................................................................................................................... 30 Prepared statement .......................................................................................... 32 Answers to submitted questions ...................................................................... 215 Bruce D. Greenstein, Secretary, Department of Health and Hospitals, State of Louisiana .......................................................................................................... 50 Prepared statement .......................................................................................... 52 Answers to submitted questions ...................................................................... 223 Gary D. Alexander, Secretary, Department of Public Welfare, Commonwealth of Pennsylvania .................................................................................................... 75 Prepared statement .......................................................................................... 77 Answers to submitted questions ...................................................................... 229 Joshua M. Sharfstein, Secretary, Department of Health and Mental Hygiene, State of Maryland ................................................................................................ 104 Prepared statement .......................................................................................... 107 Andrew Allison, Director, Division of Medical Services, Department of Health and Human Services, State of Arkansas ............................................................ 119 Prepared statement .......................................................................................... 121 Answers to submitted questions ...................................................................... 235 1 Mr. Cohen submitted a joint statement with Ms. Mann. (III) VerDate Aug 31 2005 15:01 Jan 16, 2014 Jkt 037690 PO 00000 Frm 00003 Fmt 5904 Sfmt 5904 F:\112-00~1\112-18~2\86248K.TXT WAYNE IV Page SUBMITTED MATERIAL Letter, dated December 12, 2012, from American Academy of Family Physi- cians, et al., to Senators and Members of Congress, submitted by Mrs. Capps ..................................................................................................................... 146 Letter, dated December 5, 2012, from Academic Pediatric Association, et al., to House and Senate leadership, submitted by Mrs. Capps ...................... 148 Letter, dated December 12, 2012, from Lucinda Ehnes, President and Chief Executive Officer, California Children’s Hospital Association, submitted by Mrs. Capps ............................................................................................................ 156 Letter, dated July 9, 2012, from Rick Perry, Governor of Texas, to Kathleen Sebelius, Secretary, Department of Health and Human Services, submitted by Mr. Burgess ..................................................................................................... 158 Article, dated June 29, 2012, ‘‘This Week in Poverty: 89,000 Children in Pennsylvania Lose Medicaid,’’ by Greg Kaufmann for The Nation, sub- mitted by Ms. Schakowsky .................................................................................. 177 VerDate Aug 31 2005 15:01 Jan 16, 2014 Jkt 037690 PO 00000 Frm 00004 Fmt 5904 Sfmt 5904 F:\112-00~1\112-18~2\86248K.TXT WAYNE STATE OF UNCERTAINTY: IMPLEMENTATION OF PPACA’S EXCHANGES AND MEDICAID EXPANSION THURSDAY, DECEMBER 13, 2012 HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON HEALTH, COMMITTEE ON ENERGY AND COMMERCE, Washington, DC. The subcommittee met, pursuant to call, at
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