Community groups feel heat of D.C. health-care battle

The letter from Washington arrived on Laura Line's desk Wednesday, three weeks after her nonprofit won a federal grant to help consumers make sense of the health-insurance marketplaces created by the Affordable Care Act and four weeks before they were to open for business.

It gave her nine days to provide Republicans on the House Committee on Energy and Commerce with all details and documents, electronic and paper, in her possession and not, involving the $953,716 her organization is getting to assist with health-insurance enrollment in 10 Pennsylvania counties.

"The letter doesn't concern us; it just adds to our workload," said Line, corporate assistant director for health care at Resources for Human Development, a national social services organization based in Philadelphia. "We are working at an incredible pace to try to be ready for Oct. 1," she said. "It will definitely distract us from what we are trying to do, which is to get health-insurance coverage for uninsured and underinsured residents who qualify in the marketplace."

Republicans said the letter was an attempt to protect tax dollars and personal medical information. Democrats said it was intended to sow confusion and undermine health reform.

The vitriol and hyperpartisanship that accompanied President Obama's health overhaul at first seemed to be largely rooted in Washington, where it was passed on party-line votes in 2010 and largely upheld by the Supreme Court in 2012. When that decision made optional the law's main provision for insuring low-income people - an expansion of Medicaid - much of the battle shifted to state capitals.

Now, with the six-month open-enrollment period approaching for the insurance-exchange marketplaces, opponents are aiming at community organizations that will be working with consumers.

"One of the ways that the ACA could fail is just a complete train wreck of enrolling people," said Scott Burris, a professor of law and public health at Temple University. "This is part of a pattern in which people involved in the political world are treating community people out trying to do good as combatants. It is demoralizing and it's cruel and it really throws sand in the gears of communities that are trying to make the policy work."

The letter from Republicans on the House Energy and Commerce Committee - two pages, another two for 15 signatures, and four pages of instructions and definitions - was sent Aug. 29 to 51 organizations that received a total of $67 million to do outreach and direct "navigators." These groups will help explain the insurance marketplaces and guide people in determining eligibility and enrollment.

The grants are in states that decided to let the federal government run their marketplaces, and they represent far less funding than is being spent by states that decided to run their own. Maryland, for example, which is running its own exchange, announced $24 million

in outreach grants in April, while Pennsylvania and New Jersey are getting $4.73 million combined. Five groups each in Pennsylvania and New Jersey, including the Center for Family Services in Camden, will share the awards, often subcontracted to smaller organizations across the state.

The letter says the committee "is examining the role Navigators will play in efforts to enroll individuals in health-insurance exchanges."

Asked what that means, a spokesman for Rep. Joseph R. Pitts, a Republican who represents Chester County and is chairman of the committee's subcommittee on health, declined comment.

A spokeswoman for the main committee said in an e-mail that the letter represented "a thoughtful exercise to protect taxpayer dollars and Americans' sensitive personal medical information. Even after three years of preparation, implementation has been plagued by delays, missed deadlines, broken promises, and special waivers," she said, adding that this program "is now $13 million over budget" and that "there is no reason basic questions cannot or should not be answered."

Rep. Frank Pallone, a Democrat on the committee from New Brunswick, described it via e-mail as "another attempt to undermine the Affordable Care Act," saying his GOP colleagues "are using harassment and intimidation tactics, and what amounts to modern McCarthyism, with no justification for their actions."

At Resources for Human Development's headquarters on Wissahickon Avenue, Line said that about half of the 20 or so new hires to help with enrollment were on board. She said the letter, the first of its kind she has received in 10 years of working with federal grants, sent a message of a "lack of trust" from the same government that had approved her organization's proposal.

"I'm guessing it will take many hours to respond to the questions," she said, although nothing compared with the amount of time the navigators will spend answering questions about insurance from the public. "People are just so interested in learning more."