On Wednesday, June 10, the House Ways and Means Committee held what was to be the Committee’s annual review of the Administration’s proposed changes for HHS (including proposals addressing child welfare) but instead the event may be a precursor for a coming fight over health care reform.  With the Supreme Court in the last weeks of its session, a decision on the Affordable Care Act could come as early as today or Thursday.

The hearing focused on the ACA and at times the opening comments, questions and back and forth between members was a replay of the contentious debate over the ACA that has played out for more than half a decade.  In his opening remarks to HHS Secretary Burwell, Chairman Paul Ryan (R-WS), said:

“And I hope he [the President] gives you a medal after this—because defending Obamacare is no easy task. I think any objective observer would say this law is on the fritz . . . by the law’s own standards…

“So, whatever the Supreme Court decides this month, I think the lesson is clear: Obamacare is busted. It just doesn’t work. And no quick fix can change this fact. We’re not talking about a fender bender or a flat tire. The whole law’s a lemon. It’s very linchpin—its central principle—is government control. That means higher prices, fewer choices, and lower quality. So the answer isn’t just tighten a few screws and everything will be fine. The answer is to repeal and replace this law with real, patient-centered reforms.”

From that point on the comments and questions were directed in terms of the positives and negatives of the law with no real indication on how the Committee might act or react to a Court ruling that could potentially prohibit federal tax credits to those health insurance buyers in states that decided not to run their own health care exchanges.

It is estimated that over 6.5 million people would lose their federal tax credits which substantially reduce the cost of health insurance premiums. People who purchase health insurance in states that run their own exchanges such as California and New York would be fine but insurance customers in states like Florida and Texas would lose their tax credits.

Congressman Ryan was on a Sunday talk show to discuss the issue but it is really in the Courts hand at this point. The Supreme Court could come up with an unusual decision as they did in 2012 when they decided that the expanded Medicaid coverage through the ACA was a state option despite the fact that all other Medicaid state mandates require a state to either agree to the mandated coverage or drop the entire Medicaid program.

There were some questions aside from the ACA including questions on Social Security number security, the increasing spread of heroin addiction and the Secretary did include in her official committee statement:

“Improving Child Welfare.–The Department’s Budget also proposes several improvements to child welfare programs that serve children who have been abused and neglected or are at risk of maltreatment. The Budget includes a proposal that has generated bipartisan interest that would provide $750 million over five years for an innovative collaboration between the Administration for Children and Families (ACF) and CMS that would assist states to provide evidence-based interventions to youth in the foster care system to reduce the over-prescription of psychotropic medications. There is an urgent need for action: ACF data show that 18 percent of the approximately 400,000 children in foster care were taking one or more psychotropic medications at the time they were surveyed. It also requests $587 million over ten years in additional funding for prevention and post-permanency services for children in foster care, most of which must be evidence-based or evidence-informed. It includes savings of $69 million over ten years to promote family-based foster care for children with behavioral and mental health needs, as an alternative to congregate care, and provides increased oversight of congregate care when such placements are determined to be necessary.”

There were no questions asked on the child welfare topic.