WASHINGTON -- Newly confirmed Secretary of Health and Human Services Alex Azar, JD, tiptoed around the issue of states openly flouting Obamacare's rules during a hearing of the Senate Finance Committee on Thursday.
Democrats pressed Azar to defend the Affordable Care Act, while Republicans argued that no laws were being broken.
In his opening statement, at the Senate Finance Committee hearing, Ranking Member Ron Wyden (D-Ore.) said the Trump budget had given the green-light to "junk insurance" plans -- those that charge more for people with preexisting conditions while limiting the amount of care they receive.
He pointed to Idaho as an example of a state that is defying the ACA.
On Tuesday, that appear to be a direct response to the state's controversial executive order, issued by Republican Gov. Butch Otter. The order allows insurers to charge people more based on their health status and age.
Asked by Wyden how he would respond to Idaho's actions, Azar said he had not yet seen a waiver request or other plan from the state.
"I can assure you that if we do receive that ... we'll be looking at that very carefully and measuring it up against the standards of the law, as is our duty," he said.
Wyden then clarified that Idaho does not appear to be asking for a waiver. "Idaho's just saying, 'We're going to do this,'" said Wyden.
He then pressed Azar to outline HHS planned response to Idaho actions within the next 10 days. And seeing Azar's reluctance, proposed a 30-day deadline.
Azar said he did not want to "prematurely" intervene, but agreed about "the need of the department to be engaged."
Sen. Mike Crapo (R-Idaho) argued that the Blue Cross Idaho plans don't exclude individuals with preexisting conditions and did not violate the law -- although the Idaho Statesman's analysis indicated that Blue Cross can "charge them more if they're deemed likely to need medical care," which is not allowed under the ACA.
"The reality is the efforts being undertaken by the people in Idaho is one to protect and expand the opportunities and access people have to insurance of their choice," Crapo said.
He noted that his state would still be offering ACA-compliant plans for those who wanted them.
Azar then said the matter required "deliberation" and called Idaho's actions "a cry for help."
"Too many citizens simply cannot afford the insurance packages that we have in our program because of the way the statute is designed and the way it's been implemented," he said.
Azar also fielded criticism of Trump's budget proposal.
The proposal would increase HHS's overall budget by 11% to $95.4 billion, which included an increase of more than $700 million for the National Institutes of Health, and a nearly $500-million increase for the FDA.
The budget proposal also included $10 billion to address the opioid epidemic and serious mental illness.
Several Democrats, including Sen. Debbie Stabenow (D-Mich.) complained that the new budget would cut the Medicaid budget by $1.4 trillion, noting the program's vital role in helping respond to the opioid crisis.
However, Sen. Pat Toomey (R-Pa.) said capping the Medicaid program was a "sensible" idea. He noted that without any changes, the Medicaid program will continue to grow at 6% per year, according to a report released on Wednesday.
Moreover, shifting Medicaid to a per-capita cap system is an idea suggested by former President Bill Clinton, said Toomey, which had the support "at one point, of every Democrat in the United State Senate."
The newly proposed budget also supports such a redesign and would tie caps to the official consumer price index for urban consumers.
As a result, "Medicaid spending every year would grow. Medicaid spending per beneficiary would grow, but it might just grow at a rate that we could afford," Toomey argued.
Democrats also criticized proposed reductions to certain programs such as the Office of Minority Health, and the elimination of others including the program and the
Said Azar, "If it's not a direct care service delivery program or was viewed as being less effective than other expenditures of money in a scarce fiscal environment, tough choices have to be made."
Sen. Johnny Isakson (R-Ga.) also critiqued the budget proposal for reducing the budget for the CDC, based in his home state.
"They are the world's health center ... they're our safety blanket ... to cut it by almost 10%, to me, is unconscionable," he said.
Azar clarified that two separate programs were moved out from under the CDC's purview and because of those changes, on net, the actual reduction to the agency's budget would be about $100 million.