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Camp, Brady: Facts Show HHS Has Data on How Many People Have Paid Their First Premium

March 25, 2014

Washington, DC – Today, Ways and Means Chairman Dave Camp (R-MI) and Health Subcommittee Chairman Kevin Brady (R-TX) wrote to Health and Human Services Secretary Kathleen Sebelius calling into question the Administration’s claims that they do not know how many individuals have paid their first month’s premium in the new health care Exchanges.

New evidence obtained by the Committee strongly suggests that the Administration knows who has enrolled and paid their first month’s premium.  In fact, there is specific information about who has paid their premium that Centers for Medicare and Medicaid Services (CMS) is collecting and using to make payments to insurers.  On January 16, 2014, CMS posted a series of FAQs on the portal.  The portal is used by insurers to receive basic information about how to receive payments, what information is required of them and in what format, etc.  The Committee has obtained FAQ 671, which states,

“[S]ubmitters will include the full enrollment and payment profile for January (i.e. all active enrollments for January effectuated through January 15th) … The January restatement template should contain all enrollments effective during the month of January. It will capture what was already submitted to CMS in December (effectuated enrollments through 12/15) but will also capture enrollments effectuated after 12/15) … submitters will include the full enrollment and payment profile for February (i.e. all active enrollments for February effectuated through January 15th). It will include enrollments that were previously effectuated for January and that are still in place in February.”

In the letter, Camp and Brady wrote, “We have recently obtained information that suggests your most recent testimony before the Ways and Means Committee was at best evasive and perhaps misleading….Insurers are submitting information to CMS about who has effectuated their enrollment, i.e., who has paid their premium.  Please provide this information in its most updated form immediately.  It will give the Committee and the American people real time information about the number of individuals who have paid their first month’s premium and are eligible for a tax credit or cost-sharing subsidy.  That in and of itself is relevant and important data.  Equally important, it provides an accurate, if not precise, estimate of the number of individuals in total who have paid their first month’s premium”

The full letter can be read here.