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Barack Obama

Health care income verification a symbolic gesture

Kelly Kennedy
USA TODAY
Douglas Holtz-Eakin is the former director of the Congressional Budget Office.
  • Provision was part of the deal to end the government shutdown
  • HHS will have to provide Congress two reports
  • Republican analyst said the hope is that the provision will keep HHS honest

WASHINGTON — As part of the deal that ended the government shutdown, House Republicans gained one Affordable Care Act concession.

But even Republicans acknowledge it's not much of a coup.

"Its symbolic importance is clear, I don't think there's any question about that," said Douglas Holtz-Eakin, former director of the Congressional Budget Office and former chief economic policy adviser to the 2008 presidential campaign of Sen. John McCain, R-Ariz. But the rule itself "leaves a lot of latitude" for Health and Human Services Secretary Kathleen Sebelius.

"That means we're effectively where we are now," Holtz-Eakin said.

The agreement signed Thursday by President Obama says HHS will give Congress two reports:

•A report showing how the government plans to ensure that people who sign up for the health insurance exchanges do not lie about their income levels to get higher subsidies for insurance. People who make less than 400% of the federal poverty level, about $94,000 for a family of four, may be eligible for subsidies to pay for insurance.

•An HHS inspector general's review of the law's safeguards for reporting fraud.

Republicans had asked HHS to verify incomes as people enrolled, but most don't know how much they will make in the coming year and their incomes may differ substantially from the previous year.

Also, trying to add another system to verify incomes could slow down the already-slow health exchange sign-up process even more.

Discrepancies in claimed income compared with actual income will be clear when people file their tax returns.

The delay until 2015 of the requirement for employers with more than 50 employees to provide insurance means that employers won't verify incomes, Holtz-Eakin said. "Given the quality of the computer system they're working with for the exchanges," immediate verification seems unlikely, Holtz-Eakin said.

Paul Ginsburg, president of the Center for Studying Health System Change, agreed verification could be near impossible.

"Of course we want to verify people's income," Ginsburg said. "But what's feasible to do? What's cost effective?"

In this case, he said "good sound bites" competed with "good policy" in trying to create something meaningful.

"I think it's instructive that that's the one thing they could agree on," Ginsburg said. "I hope it's worthwhile."

Holtz-Eakin said the agreement is symbolic because it plays to Republicans' stated frustration that administration officials are not playing by the rules. This year, HHS officials said they would audit a sample of people who buy insurance through the exchanges, rather than everyone.

"This is the Republicans saying, 'Pay attention to the laws that we passed,' " Holtz-Eakin said. "Don't do whatever you want."

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