The Center for Medicare and Medicaid Services, the federal agency that administers the programs,  has put a critical component of expanding Medicaid on the backburner until 2015, and Sen. Maria Cantwell (D-WA) is none too happy about it. So much so, that Cantwell said in Senate Finance Committee  hearing today that she won't support President Obama’s renomination for Acting Administrator of CMS, Marilyn Tavenner.

Cantwell, who has a history of getting in Obama allies' faces,  recently championed the a component of the Affordable Care Act known as the federal Basic Health Plan Option, which provides medical coverage for those between the cut offs for Medicaid (138 percent of the federal poverty level or $26,000 for a family of three), but are still too poor to participate in the state exchange established by Obamacare.

A version of the BHPO has been a working reality in Washington State for 20 years, covering those who haven't qualified for Medicaid. With Cantwell’s prodding, the federal government added this provision as an essential component of ACA when they passed it in 2010. The Basic Health Plan Option was intended to be available as part of the ACA by 2014 when Medicaid expansion kicked in.

However, low income consumers are evidently supposed to shoulder the burden of higher premium rates for  year-long gap until the CMS makes good on their inclusion of the HBFO in 2015. That could cost low-income health care consumers about $1,500 more per plan.

“Somehow the agency seems to be very anxious – instead of implementing the law in 2014 as called by in the Affordable Care Act – seems to be anxious that somehow giving this population just above the Medicaid rate a more affordable benefit plan[…] is somehow against the interest of the overall Act,” Cantwell said at today’s hearing.

ACA is supposed to give states 95 percent of what the federal government would have spent on tax credits and subsidies for out-of-pocket costs for adults with income between the Medicaid cutoff  and 200 percent of the Federal Poverty Level. This specific niche of coverage does not require the state to subsidize insurance in the exchange. Instead, the state will use its buying power to bargain for cheaper plans that must provide at least the minimum benefits under the ACA, for a lower cost that what consumers would have paid in the exchange.

In response to Cantwell's criticism of the agency's hesitancy in implementing Basic Health, Jonathan Blum, Acting Principal Deputy Administrator and Director of CMS responded, “I haven’t personally worked on this issue so I can’t speak to the decision-making behind it. I do believe – I do understand that Marilyn Tavenner has promised to provide you a schedule of how we plan to implement this provision. But we are happy to work with you and to help.”

“Well, Ms. Tavenner definitely will not have my support and I’m not interested in how she’s going to implement the Act. I’m interested in the commitment to the administration to live up to the way the Affordable Care Act’s provisions say it should be implemented,” Cantwell said. “Right now I can’t get anybody at CMS to own up to the fact that states under the law could receive 95 percent of the tax credits to provide cheaper care to the beneficiaries, instead of making them out-of-pocket expenses.”

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