Commentary Health Systems

In the GOP’s Oz, Congressmen Paint Sebelius as Wicked Witch

Adele M. Stan

The glitchy rollout of Obamacare offered plenty of fodder for Republicans who oppose the bill. But what most will remember from Wednesday's House hearing is a bunch of angry men yelling at a woman.

It should have been a slam dunk for Republican members of Congress, eager to make their case against Obamacare, as the health-care reform mandated under the Affordable Care Act is popularly known, when Health and Human Services Secretary Kathleen Sebelius appeared as the sole witness before the House Energy and Commerce Committee on Wednesday, for a hearing about the “implementation failures” of the health-care program.

But instead of using the moment to simply point out the administration’s missteps in the bumpy rollout of the new health insurance exchanges, Republicans instead yelled at and mansplained to the lone woman at the witness table, addressing her as the dog in the classic film The Wizard of Oz, demanding that she purchase her own coverage through the health insurance exchanges, and badgering her to hang blame on President Barack Obama for problems with the website for the federal health insurance exchange and the cancellation, by insurers, of some insurance policies held by individuals.

On the day before Halloween, it seemed, Republicans were seeking a witch to burn, and some came off looking like bullies, while others were merely condescending jerks.

Democrats, on the other hand, focused mostly on all the nice things the law does for people: mandating coverage for preexisting conditions, for maternity care, for prescription birth control with no co-pay or deductible. Nice is nice, but not the greatest defense.

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Through it all, Sebelius remained calm and polite, though occasionally showing signs of exasperation.

When Rep. Gregg Harper (R-MS) told her it was great that she was a team player, apologizing as she did at the opening of the hearing for the glitches, but pushed her to lay the blame at the feet of the president, the cabinet secretary replied, “Whatever.” (TIME’s Zeke Miller has the video, here and also to the right here.)

Not long after the hearing began, a ridiculous note was sounded when Rep. Joe Barton (R-TX), referring to Sebelius’ former position as governor of the Sunflower State, said: “Madam Secretary, you’re not in Kansas anymore.” He went on to say that one might say that the HHS secretary and Congress might well be in “Wizard-of-Oz-land,” citing “the parallel universes we appear to be habituating.”

Rep. John Shimkus (R-IL) raised a favorite trope of anti-choice forces that it is impossible to tell when purchasing health insurance through the exchanges whether or not the policy one is buying covers abortion—coverage anti-choicers oppose.

“If someone, a constituent of mine, or someone in this country has strongly held pro-life views,” Shimkus began.

“Here we go,” said an unidentified woman who was apparently near a microphone.

“Can you provide for the committee the list of insurers in the federal exchange who do not offer as part of their package abortion coverage?” Shimkus asked.

“I think we can do that, sir,” Sebelius said.

But that wasn’t good enough for Shimkus.

“Well, you should be able to do it,” he admonished.

Sebelius replied, with an outstretched hand, “I just said—”

“—No, you just said ‘if we can do it,’” Shimkus interjected.

“No, ‘I think we can do that’ is what I said,” Sebelius replied.

“You think, or you know we can do it?” Shimkus continued.

“Sir—I can’t tell you what I don’t know firmly right now,” Sebelius said. “I know that is the plan; I will get that information to you.”

And that’s pretty much the way it went throughout the morning, and into the afternoon.

In an apparent attempt to be helpful, Rep. Bruce Braley (D-IA) tried to spin the Wizard of Oz theme, noting that Oz people were digging the wizard “because of the wonderful things he did” and that Obamacare does good things too. This led the lords of the Twitterverse to remind Braley that the wizard was a fraud, and likely led others to pin the Scarecrow’s theme song on Braley.

More useful to Sebelius was her interaction with Rep. Kathy Castor (D-FL), who urged Sebelius to get the website for the federal exchange running smoothly as soon as possible (Sebelius said it would be by December 1), and then teed up a question about the Medicaid expansion, which a number of Republican-controlled states have rejected, despite the fact that the federal government picks up nearly the whole tab for the program, which is the mechanism by which the ACA was designed to cover the lowest-income Americans. (In the same decision that declared the ACA constitutional, the Supreme Court allowed states to opt out of the Medicare expansion.)

“I understand the frustration with the website,” Castor said. “But what I don’t understand is why people are not similarly outraged by the lack of Medicaid coverage in our states. Do you find that hypocritical?”

“Well I think it’s very troubling that millions of low-income working Americans will still have no affordable options if states don’t take advantage of the expansion program,” Sebelius replied, “leaving the state bearing the cost of uncompensated cost, the family bearing the cost that can’t take care of their kids, and workers not able to work, and people still accessing care through the emergency room, where it’s the most expensive and least effective.”

The hearing reached its most sublimely ridiculous in the questioning of Sebelius by Rep. Cory Gardner (R-CO), who waved at Sebelius a letter he said came from his insurance company, canceling his health insurance policy, he said, because of Obamacare. Gardner went on to explain that he had rejected the federal health coverage available to members of Congress in order to be a man of the people. He then demanded that Sebelius reject her own federal employee-earned health insurance and purchase her care on the exchange.

Sebelius said that she wasn’t eligible to do so, because she had affordable health care through her employer, but Gardner would have none of it. Actually, Sebelius is over age 65 and is enrolled in Medicare Part A, leaving her legally ineligible to participate on the exchanges because she is … covered by Medicare. As Igor Volsky at ThinkProgress notes, “Exchange plans ‘duplicate many benefits provided by Medicare, and it is illegal for insurance companies, agents and brokers to sell such polices to people known to have Medicare,'” federal officials told the New York Times in October.

Then he had aids trot out a poster of a print ad commissioned by a Colorado nonprofit that urged college-age men to buy health insurance with an image of one “bro” doing a keg stand, supported by two others. “Keg stands are crazy,” reads the copy. “Not having health insurance is crazier. Don’t tap into your beer money to cover those medical bills.” (The Washington Post’s Sarah Kliff has the ad, here.)

Gardner asked Sebelius if she approved of the ad. She said she had never seen it before, had nothing to do with it, and couldn’t even read it from across the room, where she sat.

“That’s a pretty big font,” Gardner sneered.

His question time ended with him demanding a waiver from participating in Obamacare for his congressional district.

Rep. Billy Long (R-MS) took a similar line, asking if, in the case that she was mistaken in her assumption that she was ineligible to participate in the exchange, would she do so? Each time that Sebelius tried to explain why she would not, Long interrupted, raising his voice louder each time.

“I don’t want to give misinformation to the American public,” Sebelius said.

“If you can, will you?” Long shouted, momentarily giving the hearing the feeling of domestic violence about to happen.

As Sebelius started to answer, he talked over her. “That’s a yes or no; that’s not an answer.”

Calling a point of order, ranking member Rep. Henry Waxman (D-CA) asked whether, if the secretary chose to go into the exchange, would she be able to find a plan that protected her “from cheap shots.”

Perhaps the most jaw-dropping comments, though, came from Rep. Renee Ellmers (R-NC), who was incredulous that the plans sold to single men would include maternity coverage, since they will never need it. Ellmers is apparently ignorant of the way in which insurance works, factoring into premiums coverage for all manner of conditions individuals will never have.

No, the mandated maternity care benefit, as Ellmers saw it, was all about the oppression of young men.

“You’re forcing them to buy things that they will never need,” Ellmers said to Sebelius.

“Men often do need maternity coverage, for their spouses and their families,” Sebelius replied.

“A single male, age 32, does not need maternity coverage,” Ellmers replied. “To my knowledge, a man has never had a baby.” Her fellow Republicans erupted in laughter, not long before the committee closed up shop for a congressional recess.

They’ll return to the Emerald City on November 12.

CORRECTION: A version of this article incorrectly noted that the congressional recess had been “hastily called.” The recess was, in fact, on the schedule. We regret this error.

News Abortion

GOP’s Latest ‘Fetal Tissue Subpoenas’ Provoke Widespread Concern in the Medical Community

Christine Grimaldi

As the GOP's subpoenas continue, inflammatory language and repetition of false allegations of profit-making around fetal tissue procurement have alarmed abortion providers who may find themselves the subject of investigation.

Abortion providers, medical college officials, and other institutions with ties to fetal tissue research are worried about their privacy and safety after a U.S. House of Representatives panel issued another round of subpoenas last week.

Republicans on the Select Investigative Panel on Infant Lives issued the subpoenas—for depositions and documents from four people whose names were redacted, as well as four additional demands for records from organizations—as part of an ongoing investigation that began after an anti-choice group, the Center for Medical Progress (CMP), alleged that Planned Parenthood was selling fetal tissue for profit.

No proof was ever offered for these claims. An independent research company found last year that CMP’s smear videos had been manipulated; United States District Court Judge William Orrick has placed many of them under a restraining order. David Daleiden, the head of CMP, was indicted in January by a Texas grand jury.

Meanwhile, incidents of targeted clinic violence have steadily climbed since the release of the discredited videos.

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There has been one congressional hearing on fetal tissue research, with testimony comparing it to Nazi experimentation. Twelve states with GOP-majority legislatures have investigated practices surrounding fetal tissue donations and research, which is legal in the United States and governed by strict ethical guidelines, and found no evidence of provider wrongdoing.

House Republicans nonetheless insist other hearings are necessary.

Patients who donate fetal tissue for medical research expect confidentiality, a Southwestern abortion provider said in an interview with Rewire. Though the Health Insurance Portability and Accountability Act (HIPAA) covers patient privacy, the same protections do not extend to providers, researchers, or their support staff. As a result, these groups fear further harassment and violence with the release of identifying information.

As the GOP’s subpoenas continue, inflammatory language and repetition of false allegations of profit-making around fetal tissue procurement have alarmed providers who may find themselves the subject of investigation.

“It does paint a really negative view, and people that are unstable are going to see that as the go-ahead” to act violently toward providers, the provider said.

Mike Reynard, the spokesman for the panel’s Republicans, told Rewire that not only do the subpoenas refrain from asking for patient information, but that investigators have proposed using pseudonyms to prevent the names of lower-level staff witnesses from appearing in public or in committee publications going forward.

Such names were redacted in the panel’s first hearing last month and again in last week’s subpoenas, Reynard said.

The panel needs names of people involved in fetal tissue transactions and research in order to have a full understanding of what they involve, Reynard said. Democrats on the panel, however, have repeatedly called on Chairwoman Marsha Blackburn (R-TN) to throw out the subpoenas and otherwise institute measures to protect privacy.

The medical community’s trepidation extends beyond the latest round of subpoenas. David Moore, senior director of government relations for the Association of American Medical Colleges (AAMC), told Rewire that various federal and state legislative proposals could have a chilling effect on fetal tissue research, deterring people worried about privacy and security from entering the field.

“We believe that this is a viable and necessary line of scientific inquiry,” Moore said. Research using fetal tissue has led to vaccines for polio, hepatitis A, chickenpox, rubella, and rabies. Scientists told the Associated Press in August that fetal tissue is essential for medical research on Parkinson’s, AIDS, and Ebola.

In a joint letter, the AAMC, the Association of American Universities, and the Association of Public and Land-grant Universities voiced safety concerns that subpoenaed institutions would have to release identifying information about researchers, graduate students and trainees, health-care providers, and administrative and support staff, regardless of their level of involvement in fetal tissue research.

The groups urged the panel to either outline security measures to protect the personal information of people working in this field or drop the subpoenas, allowing individuals and their institutions to voluntarily comply with the panel’s inquiries.

“I think we’re going to have to see, as this goes forward, how the information is being used, whether or not it’s being disseminated either publicly or privately,” Moore said.

News Health Systems

New GOP Kentucky Governor Wants to Undo the State’s Health-Care Gains

Teddy Wilson

Bevin's victory leaves in doubt the future of the program that provides health care to more than 400,000 low-income residents.

Newly elected Kentucky governor, Republican Matt Bevin, may be poised to eliminate health care for thousands of the state’s low-income residents after he defeated Attorney General Jack Conway on Tuesday.  

The gubernatorial campaign focused heavily on the Affordable Care Act (ACA) and the state’s expansion of Medicaid. Bevin promised to dramatically scale back the state’s kynect program, which expanded health-care access. Bevin’s victory leaves in doubt the future of the program that provides health care to more than 400,000 low-income residents.

“I’m proud of the fact that this is a great night for Republicans in Kentucky and, more importantly, a great night for conservatives in Kentucky,” Bevin said in front of a crowd of supporters, reported the New York Times. Bevin added, “We have a lot of work to do.”

Bevin won decisively, defeating Conway, 52.5 percent to 43.8 percent, after narrowly winning the Republican primary in May by 83 votes.

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The victory comes less than two years after Bevin waged an unsuccessful primary campaign against U.S. Senate Leader Mitch McConnell.

Bevin’s wealth and campaign style earned him comparisons to Republican presidential candidate billionaire Donald Trump. However, the policies he has promised to implement as governor are comparable to Republican governors such Kansas’ Sam Brownback and Wisconsin’s Scott Walker, who have focused efforts on eliminating health-care access to low-income families.

The central issue of the campaign was the expansion of Medicaid under the ACA through the kynect program, which Bevin called “a disaster.”

The program has been widely praised as a success, and it has been credited with reducing the uninsured rate in the state from 20.4 percent in 2013 to 11.9 percent in mid-year 2014. Kentucky’s 8.5 percent drop in the uninsured rate over the past two years is more than any other state with the exception of Arkansas.

Bevin said that if elected he would repeal Gov. Steve Beshear’s executive order expanding Medicaid eligibility to 138 percent of the federal poverty level. “Absolutely,” Bevin said. “No question about it. I would reverse that immediately.”

Bevin’s proposed plan is to transition residents on Medicaid through kynect to the federal health insurance exchange by 2017, when the federal subsidies are reduced.

The federal government pays 100 percent of the cost of expanding Medicaid in the state, and beginning in 2017, federal funding will decrease to 90 percent. Kentucky’s expansion of Medicaid created a $15.6 billion economic impact as well as nearly 17,000 new jobs across the state, according an analysis by the state health department.

Bevin has expressed an ideological opposition to Medicaid expansion. During a debate in May, Bevin said that there are too many “able bodied, working age people” who are “taking advantage” of the government benefits.

“We’ve got to stop subsidizing poor decisions,” Bevin said, reported the Lexington Herald-Leader. “Stop subsidizing those who are able to take advantage of a situation and of a system that we literally cannot afford to continue.”

The elimination of the kynect program is just one of an assortment of conservative policies Bevin will seek to impose as governor. He has also pushed implementation of so-called right-to-work laws designed to crush labor unions, and has promised to “lead the charge” decreasing taxes and regulations on businesses.

Bevin, who became Kentucky’s first Republican governor since 2003 and just the second Republican to hold the office since 1971, may soon have the GOP majorities he needs in the state legislature to implement his agenda.

The Republican gains in Kentucky are just the latest in two decades worth of defeats for Democrats throughout the South, and leaves only Virginia with a Democrat in the governor’s mansion.

Kentucky is the only Southern state in which Republicans and Democrats each control one chamber of the state legislature. Republicans hold a massive 27-11 majority in the state senate, while Democrats maintain a slim 54-46 majority in the state house.

However, the control of the state house may now be in doubt.

“This changes the dynamics,” state Senate President Robert Stivers told the New York Times. “Instead of having one leg of the stool, we now have two legs of the stool—and the third leg is very weak.”