The Truth about Obamacare Keeps Coming Forward

From the Manchester Union Leader last week came word of an interesting development.  In a debate, former Congresswoman Carol Shea-Porter, who looks to regain her seat this fall, admitted that Obamacare – which she voted for two years ago – WON’T reduce health costs:

Shea-Porter said the Obama health care plan will slow the increase in health care costs, but no one should expect them to drop. “Everyone knows that costs go up. For him [Rep. Frank Guinta] to say health care costs should drop when nothing else ever drops, it’s just not accurate,” Shea-Porter said.

But Guinta said Congress should try to reduce health care costs. “I’ve yet to hear anyone say ‘Thank goodness for the Affordable Care Act because it slowed my (premium) increase,’” he said.

And the reason Rep. Guinta has yet to hear anyone say Obamacare has cut their premium increases is because the law hasn’t fulfilled its promise.  Even fact-checkers have admitted this reality, when Politifact last month officially declared candidate Obama’s promise to “cut the cost of a typical family’s health insurance premium by $2,500 a year” a broken promise.

In assessing this promise, we consider the following: An author of the $2,500 figure has disavowed its use as it relates to premiums alone.  An independent health care analyst projects that premiums will go up for the typical family.  The federal agency implementing the Affordable Care Act did not provide evidence that premiums will go down for the typical family.  We rate this a Promise Broken.

The fact that Democrats – and even President Obama’s own Administration – acknowledge that the law won’t meet the President’s stated promise is yet another way that the promise of “hope and change” has evaporated for families struggling to pay their insurance bills.

Obamacare’s Taxes Hitting the Middle Class

Even as President Obama claims he doesn’t want tax increases to hit struggling middle class families, evidence has piled up in recent weeks about the effects Obamacare’s massive “temporary refund adjustments” have had on the economy.  Earlier this month medical device manufacturer Welch Allyn announced it was laying off ten percent of its workforce – amounting to several hundred jobs – due to the “new onerous U.S. Medical Device Tax scheduled to begin in 2013 as mandated in” Obamacare.  To these workers, the idea that Obamacare’s tax increases will not affect the middle class is a broken promise.

Separately, many federal workers received an e-mail noting that Flexible Spending Account limits will decline in 2013 from $5,000 to $2,500, thanks also to Obamacare. (It’s also interesting that, unlike the rebate checks issued under the law, the e-mail contains absolutely zero references to “the Affordable Care Act” or “Obamacare” in explaining the reason for this tax increase.  Coincidence?  I think not.)  Candidate Obama promised families their costs would decline by $2,500 – but instead, middle class families will lose $2,500 in tax-free savings.  It’s yet another example among many about how President Obama has broken his promises – and those broken promises are breaking the back of the middle class.

Is Obamacare Accelerating Health Cost Growth?

The Health Care Cost Institute yesterday released its annual report on the rate of health expenditure inflation, and the news was not good – not only are costs rising, they are rising at a faster rate than in prior years.  As the Washington Post reports:

Spending for private health insurance surged by 4.6 percent in 2011…That growth rate is faster than the rest of the economy and higher than the previous year, which had 3.8 percent growth.  Average spending on a private insurance patient rose to $4,547 in 2011, compared with $4,349 in 2010.  That statistic suggests that a recent downturn in health-care spending may have been a temporary product of the recession rather than a more permanent change, as some health-care economists have hoped.

As a reminder, candidate Obama said repeatedly his health plan would CUT premiums by an average of $2,500 per family – meaning premiums would go DOWN, not merely just “go up by less than projected.”  The campaign also promised that that those reductions would occur within Obama’s first term.  But as the below graph shows, while candidate Obama promised premiums would fall by $2,500 on average, premiums have risen by $3,065 since Barack Obama was elected President.

Regardless of whether or not Obamacare was the cause of the acceleration in health costs in 2011, the news once again illustrates how the 2700-page law has failed to live up to Barack Obama’s promise to lower costs for struggling American families.

Obama Administration, Asleep at the Switch…

Yesterday various press outlets reported that the Administration warned hospitals and other medical providers about questionable Medicare billing tactics that could range from abusive to fraudulent.  But that’s not the real story – the real story is how the Administration was asleep at the switch for years, allowing these abusive practices to continue, even accelerate.  A study by the Center for Public Integrity published in the Washington Post more than a week ago, and highlighted in this space, noted that “thousands of doctors and other medical professionals have billed Medicare for increasingly complicated and costly treatments over the past decade, adding $11 billion or more to their fees – and signaling a possible rise in medical billing abuse.”

So what did the Administration do when this major Washington Post expose appeared, questioning $11 billion in Medicare spending as questionable, abusive, or even downright fraudulent?  Exactly nothing.  Only when a second, similar story appeared in the New York Times this weekend did Secretary Sebelius finally send a letter questioning provider billing practices, and promising vigilance on this issue – with “vigilance” hopefully meaning something, after her Department’s years of neglect.

The Administration has asked questions of Medicare providers about their billing practices, but the real questions belong to the Administration:

  1. Why did the Administration wait so long to take action – and how many billions of dollars in questionable transactions were completed because this Administration decided not to examine billing practices for potential abuse and fraud?
  2. How can the Administration implement the 2700 pages of Obamacare if they can’t even ensure that existing laws and practices within Medicare are being followed?  Conversely, was the Administration asleep at the switch when it comes to questionable billing practices because HHS is spending all its time, personnel, and resources implementing Obamacare, rather than watching over Medicare?
  3. How can President Obama and Secretary Sebelius claim Obamacare helps crack down on fraud, when they allowed $11 billion in questionable transactions to go unchallenged?  Given this record, perhaps the Administration would be better off outsourcing oversight of Medicare to the Center for Public Integrity and the New York Times.

One final note:  Three liberal advocates, including former OMB advisor Zeke Emanuel and former CMS Administrator Donald Berwick, penned an op-ed in this morning’s Wall Street Journal denouncing comprehensive Medicare reform, and claiming that government-run Medicare can do a better job containing costs because “the key to sustainable cost control lies in encouraging physicians and hospitals to focus on quality rather than quantity, and value rather than volume.”  These claims would have somewhat more credibility if they weren’t co-authored by someone who, in nearly two years at CMS, allowed transactions potentially bilking Medicare for billions to pass through undetected right under his nose.  Given that track record, Dr. Berwick is in absolutely no position to give lessons on how to “save” Medicare.  Instead the old proverb rings true:  Physician, heal thyself.

David Axelrod, Pots, and Kettles

Obama campaign adviser David Axelrod appeared on MSNBC’s Morning Joe this morning, and repeated the old tropes that Obamacare “plowed [money] back into Medicare,” and that “Medicare’s length of life has been extended” due to Obamacare.  We’ve previously fact-checked all of these statements here.  But what caught us as interesting was this comment:

There’s an awful lot of demagoguery out there.  And in that environment, it’s very hard to have a serious discussion about issues like that.

It is entirely true that there is an awful lot of demagoguery about Medicare and entitlements out there.  The problem for Mr. Axelrod is that most of it comes from Democrats:

  • As one House Member put it, if the President had proposed a true restructuring of our unsustainable entitlements, that would “cancel out any bludgeoning that Democrats might give the Republicans over Medicare and Medicaid.”
  • The Washington Post’s liberal Plum Line reported last year that Senate Democrats don’t want to pass Medicare reform because it would be “giving away the biggest [political] advantage” Democrats have had “in some time.”
  • Last November, Rep. Steve Israel, Chair of the Democratic Congressional Campaign Committee, in an interview with the Postdeclined to say whether a [deficit] agreement to cut entitlements might have hindered his political strategy.”  In other words, Democrats WANTED the supercommittee to fail – so that they could resume their “Mediscare” political attack ads against Republicans.

If Mr. Axelrod wants to criticize the members of his own party for using Medicare as a political cudgel, we’re all ears.  But unless and until that happens, if the Obama campaign wants to complain about Medicare demagoguery, they might be wise to first look in the mirror.

Fact Check: Access to Physician Services

In reviewing the transcript of the President’s speech before AARP, there was one dubious statement we overlooked, and it’s this: “A new study says that under their [premium support] plan, if just 5 percent of seniors switch to private plans, 40 percent of doctors who currently take Medicare would stop accepting it.  So think about that.  Millions of seniors would be forced to change doctors.”  As one might expect, there are several problems with this statement:

  • First, it wasn’t a “study” in any sense of the term – and it certainly wasn’t independent.  The President was referring to a back-of-the-envelope calculation by his former budget director in a Bloomberg column this weekOne might argue that the author of the study, Peter Orszag, might be slightly biased towards the President this November, seeing as how he used to work for him.
  • Second, Obama himself mis-characterized the Orszag column.  Here’s what Orszag actually wrote: “About 10 percent of the U.S. population is now enrolled in traditional Medicare, and an additional 5 percent has private Medicare plans.  Let’s assume, for the sake of argument, that the Ryan plan would cause another 5 percent of the population to shift…”  Orszag based his conclusions on 5 percentage of the entire American public switching away from Medicare, whereas the President said Orszag’s conclusions were based on 5 percent of seniors switching away from Medicare – a much lower bar.  So the President over-stated the impact of Orszag’s “study” and its effects on physician access.
  • Most importantly, Orszag’s conclusions – which were over-estimated by the President – aren’t borne out by recent evidence.  Medicare Advantage enrollment HAS gone up by leaps and bounds in recent years – since 2003, it has more than doubled in both absolute terms and as a percentage of Medicare beneficiaries.  In other words, seniors have switched plans, as the chart below shows.  Yet the Medicare Payment Advisory Commission said this year that “overall, beneficiary access to [Medicare physician] fee schedule services is good.”  If Orszag believes that beneficiaries switching to private plans would cause doctors to stop seeing Medicare patients, then why did a 100 percent increase in Medicare Advantage enrollment not have a significant effect on access to physician services in traditional Medicare?

Peter Orszag has made ludicrous claims before.  He previously said that Obamacare’s CLASS act would be “on a firm financial footing of its own,” only to watch as the program collapsed even before it began.  Given the evidence above, his claims about physician access appear as logical as his claims about the CLASS Act, and should be taken just as seriously.

Fact Check: “At the Mercy of Insurance Companies”

The Hill reports that, during his remarks to AARP this morning, the President attacked Republicans for leaving seniors “at the mercy of insurance companies.”  Well, in case you missed it, here are five ways the President and his Administration have left seniors at the mercy of one organization with insurance interests – AARP – by granting them special exemptions and ignoring their questionable insurance practices:

  1. AARP’s lucrative Medigap insurance was exempted in Obamacare from the ban on pre-existing conditions; medical loss ratio requirements; caps on insurance industry executive compensation; and the tax on all other health insurance plans.
  2. The Department of Health and Human Services didn’t think all these Obamacare exemptions were enough; last year they also exempted Medigap insurance from premium rate review – even though AARP, which carries the plan with the largest market share, earns greater profits the more seniors pay in premiums.
  3. At a conference hosted by America’s Health Insurance Plans in March 2010, HHS Secretary Sebelius encouraged the insurance industry to give up some of its profits, at a time when health insurance profit margins were about 2 percentYet neither Secretary Sebelius nor anyone else in the Administration ever criticized AARP for making a profit margin of nearly 5 percent on its Medigap insurance.
  4. In April 2010, the Administration engaged in very public efforts to “encourage” insurance companies to ban rescissions and extend coverage to young adults earlier than is required by the law.  But no one from the Administration has taken similar steps to encourage AARP to stop discriminating against sick seniors applying for Medigap coverage.
  5. In a speech at an AARP conference in October 2010, Secretary Sebelius praised AARP as the “gold standard in cutting through spin and complexity to give people the accurate information they need.”  Yet the National Association of Insurance Commissioners (NAIC) has previously expressed concern about the potential for conflicts-of-interest associated with percentage-based compensation arrangements.  So Secretary Sebelius praised as the “gold standard” for “accurate information” an organization that has the types of financial conflicts her insurance commissioner colleagues have criticized as ripe for abuse.

If the President is so worried about leaving seniors at the mercy of insurance companies, perhaps he should tell the people within his own Administration to stop granting political favors to Democrats’ cronies at the AARP.

Fact Check: Paying in to Entitlements

The President just told the AARP that seniors pay in to Social Security and Medicare.  The problem is, that claim is half true.  While individuals obviously do pay in to the Social Security and Medicare programs, most beneficiaries receive more in benefits than they paid in in taxes.  An Urban Institute study about the entitlement benefits and taxes recipients will receive (and pay) over their lifetimes found that a senior with average wages retiring this year will have paid $58,000 in Medicare taxes – but will receive over $167,000 in Medicare benefits.  The Associated Press ran a story on this issue in December 2010, and its headline was clear: “What You Pay for Medicare Won’t Cover Your Costs.”

Our nation’s entitlement programs are in dire need of reform, to become more sustainable.  Perpetuating myths about their long-term viability, which the President’s comments imply by saying individuals fully-fund their benefits when paying into the system, only makes generating the political consensus necessary for true entitlement reform more difficult.

Fact Check on Medicare and Obamacare

The President just told the AARP that the claim that Obamacare took $716 billion from Medicare was “not true.”  The problem is that the facts say otherwise:

  • Last November, Nancy Pelosi admitted that Democrats “took a half a trillion dollars out of Medicare in [Obamacare], the health care bill” to pay for more federal spending.
  • The Congressional Budget Office agrees; that’s why the CBO said that the Medicare reductions in Obamacare “will not enhance the ability of the government to pay for future Medicare benefits” – because those savings will be used to fund other unsustainable entitlements.  If Democrats want to use the Medicare savings provisions to extend the life of the Medicare trust fund – and not to fund the new entitlements created by the law – the Congressional Budget Office previously estimated what the fiscal impact would be:  “A net increase in federal deficits of $260 billion” through 2019.
  • The non-partisan Medicare actuary also previously confirmed that the Medicare reductions in Obamacare “cannot be simultaneously used to finance other federal outlays and to extend the [Medicare] trust fund” solvency date – rendering dubious any potential claims that Obamacare will extend Medicare’s solvency.

President Obama himself admitted the problems with Obamacare’s supposed logic in a 2010 interview, when he stated that “You can’t say that you are saving on Medicare and then spending the money twice.”  Yet that’s EXACTLY what the law did – and no amount of spin can change that fact.

The Obama Administration’s Protection Racket

Shortly, President Obama will be addressing the AARP convention via satellite.  He will undoubtedly say nice things about AARP’s role as a “senior advocate.”  But what he won’t discuss are the ways in which his own Administration has allowed AARP to continue making billions in profits on its insurance business:

  1. AARP’s lucrative Medigap insurance was exempted in Obamacare from the ban on pre-existing conditions; medical loss ratio requirements; caps on insurance industry executive compensation; and the tax on all other health insurance plans.
  2. The Department of Health and Human Services didn’t think all these Obamacare exemptions were enough; last year they also exempted Medigap insurance from premium rate review – even though AARP, which carries the plan with the largest market share, earns greater profits the more seniors pay in premiums.
  3. At a conference hosted by America’s Health Insurance Plans in March 2010, HHS Secretary Sebelius encouraged the insurance industry to give up some of its profits, at a time when health insurance profit margins were about 2 percentYet neither Secretary Sebelius nor anyone else in the Administration ever criticized AARP for making a profit margin of nearly 5 percent on its Medigap insurance.
  4. In April 2010, the Administration engaged in very public efforts to “encourage” insurance companies to ban rescissions and extend coverage to young adults earlier than is required by the law.  But no one from the Administration has taken similar steps to encourage AARP to stop discriminating against sick seniors applying for Medigap coverage.
  5. In a speech at an AARP conference in October 2010, Secretary Sebelius praised AARP as the “gold standard in cutting through spin and complexity to give people the accurate information they need.”  Yet the National Association of Insurance Commissioners (NAIC) has previously expressed concern about the potential for conflicts-of-interest associated with percentage-based compensation arrangements.  So Secretary Sebelius praised as the “gold standard” for “accurate information” an organization that has the types of financial conflicts her insurance commissioner colleagues have criticized as ripe for abuse.

Why might the Administration look the other way despite these abuses?  Documents released by the Energy and Commerce Committee yesterday provide myriad reasons, showing all the political favors senior Administration officials asked of AARP as they rammed Obamacare through Congress:

  • Jim Messina, White House Deputy Chief of Staff: “We need [AARP CEO] Barry Rand to go meet with Ben Nelson personally and just lay it on the line.  ‘We will be with you, we will protect you.  But if you kill this bill, seniors will not forget.’  We are at 59 [votes in the Senate], we have to have him.” (page 7)
  • Jim Messina: “Can we get immediate robo calls into Nebraska urging [Ben] Nelson to vote for cloture?” (page 9)
  • Nancy-Ann DeParle, Director, White House Office of Health Reform: “Can AARP support accountable care orgs [sic] and some other delivery system reforms?” (page 26)
  • Jim Messina: “Latest top 25 targets list from House leadership” (page 35)
  • Ann Widger, Office of Public Engagement: “We would really like AARP to participate in this roundtable.” (page 37)
  • Ann Widger: “Did you guys put out any paper today on the McCain [Medicare] amendment?” (page 39)
  • Jim Messina: “[Rep. Larry] Kissel a problem…Help.” (pages 42-43)
  • Nancy-Ann DeParle: “Can you get me a copy of the [AARP] bulletin we discussed yesterday?” (page 64)

Secretary Sebelius has already admitted she has acted improperly in using her office to conduct political activities; the Office of Special Counsel last week concluded she violated the law to do so.  Given all of the above, it is not unreasonable to question whether the Secretary, and others within the Administration, made a calculated political decision to grant special favors to AARP – and ignore its questionable business practices – because AARP endorsed Obamacare.

Yesterday President Obama claimed that he changed Washington “from the outside” by enacting Obamacare.  The pattern of conduct described above suggests just the opposite: That the President rammed Obamacare through only by establishing what amounts to an inside-the-Beltway protection racket between the Administration and AARP – the former will allow the latter to continue overcharging seniors for insurance, so long as AARP uses its advocacy megaphone to endorse the President’s liberal causes.

 

The Honorable Kathleen Sebelius

Secretary

Department of Health and Human Services

200 Independence Avenue, S.W.

Washington, DC 20201

Dear Secretary Sebelius:

Today my office is releasing a report, “Profits Before Principles,” regarding the insurance practices of AARP. The report finds that AARP has a strong financial interest in keeping Medigap supplemental insurance premiums high – because the organization receives greater profits the more seniors pay in premiums. In addition, AARP’s financial interests have been aided by the Patient Protection and Affordable Care Act (PPACA), which AARP not coincidentally endorsed. Experts agree that PPACA’s provisions will have the effect of driving seniors out of Medicare Advantage health plans and into Medigap supplemental insurance – a market where AARP enjoys the largest market share.

I am greatly concerned by AARP’s questionable business practices, and by the numerous exemptions granted to Medigap insurance – both legislatively and through your Department’s regulatory process – as a result of PPACA. Therefore, I ask you to respond to the following questions:

  1. The text of PPACA exempts Medigap supplemental insurance plans from several new requirements: Section 1103 exempts plans from medical-loss ratio requirements; Section 1202(2)(A) exempts plans from the prohibition on pre-existing condition exclusions; Section 9014 exempts plans from caps on industry executive compensation; and Section 10905(d) exempts plans from the tax applied to all other health insurers. Does the Administration support all these special exemptions for Medigap plans? Why or why not?
  2. My staff attended a PPACA implementation briefing for Senate Republican staff in April 2010. At that time, Jeanne Lambrew of your Department’s Office of Health Reform admitted that PPACA exempted Medigap insurance from the law’s new regulatory regime. If in fact the Administration does NOT support PPACA’s numerous exemptions for Medigap plans, why has your Department done nothing to publicize that fact in the intervening two-plus years since that briefing?
  3. Your Department continues to claim that PPACA “ended many of the insurance industry’s worst abuses” – even though you are fully aware that these changes do not apply to Medigap plans. For instance, HHS previously released a publicity brochure that says “starting in 2014, discrimination based on a pre-existing condition by an insurer will be prohibited in every state.” Why has your Department continued to repeat these misleading slogans, even though your staff admitted that seniors applying for Medigap insurance remain subject to pre-existing condition discrimination due to the special carve-outs included in PPACA?
  4. In your speech to the Democratic National Convention on September 4, 2012, you criticized Republicans for “let[ting] insurance companies continue to cherry-pick who gets coverage and who gets left out, priced out, or locked out of the market.” Likewise, during his speech at the Democratic National Convention, President Obama said that “no American should have to spend their golden years at the mercy of insurance companies.” Please detail the specific provisions included in PPACA that place new limits on Medigap insurers’ ability to “cherry-pick who gets coverage and who gets left out, priced out, or locked out of the market,” and ensure that no applicant for Medigap coverage with a pre-existing condition will be left “at the mercy of insurance companies.”
  5. In a speech on September 8, 2012, President Obama claimed that Medicare premium support proposals would lead to billions of dollars in greater profits for insurance companies. But a 2011 House Ways and Means Committee member report found that PPACA itself could lead to billions in profits for AARP, because the law’s cuts to Medicare Advantage will reduce enrollment in that program, and encourage seniors to purchase supplemental Medigap insurance instead. Do you agree with the Ways and Means Committee report’s premise that PPACA will lead seniors to migrate from Medicare Advantage coverage to Medigap plans – thereby increasing profits to AARP? If not, on what basis do you disagree with the non-partisan experts at the Congressional Budget Office and the Medicare Office of the Actuary, who have concluded the law will reduce Medicare Advantage enrollment by millions?
  6. In addition to the above exemptions, your Department added yet another Medigap carve-out to the ones included in the statute, by exempting Medigap insurance from PPACA’s rate review process. Why do seniors not deserve this supposed protection? If PPACA’s benefits are so good, why didn’t your Department extend them to seniors as well?
  7. Did AARP, or anyone associated with or paid by it, influence or attempt to influence the Administration regarding the numerous exemptions given to Medigap insurance in PPACA, or the regulatory interpretations of PPACA? If so, please provide details as to the dates, persons, positions, and circumstances of said efforts.
  8. The 2011 House Ways and Means Committee member report noted that for its Medigap plans, AARP receives 4.95% of every premium dollar paid by seniors. As a former insurance commissioner, do you think it’s appropriate that AARP has a perverse financial incentive to keep Medigap insurance premiums high?
  9. In a speech at an AARP conference in October 2010, you praised that organization as the “gold standard in cutting through spin and complexity to give people the accurate information they need.” As a former insurance commissioner, how exactly do you believe AARP can serve as a “gold standard” giving seniors “accurate information” about Medigap insurance plans, when the organization has a financial incentive to sell seniors more insurance than they may need or want?
  10. As a former insurance commissioner, you are no doubt aware that the National Association of Insurance Commissioners (NAIC) has previously expressed concern about the potential for conflicts-of-interest associated with percentage-based compensation arrangements. In fact, Section 18 of NAIC’s Producer Model Licensing Act recommends that states require explicit disclosure by insurer affiliates, and clear written acknowledgement by consumers, of any percentage-based compensation arrangement, due to the potential for financial abuses. Did you undertake any due diligence to ensure that AARP’s Medigap percentage-based compensation model was in full compliance with both the letter and spirit of Section 18 of the Producer Model Licensing Act prior to making your assertion that AARP constitutes the “gold standard” for giving seniors “accurate information?” If not, why not?
  11. Given that AARP holds the largest share of the Medigap market, why did your Department grant a special exemption for Medigap insurance from PPACA rate review? Why do you believe that AARP can act in a proper manner to control premium increases – even though the organization gains profits for every additional dollar Medigap premiums rise?
  12. At a conference hosted by America’s Health Insurance Plans in March 2010, you encouraged the insurance industry to give up some of its profits, at a time when health insurers were earning between 2 and 3 cents of profit for every dollar of revenue, according to Fortune 500 estimates. If you criticized other insurers for earning between 2 and 3 cents of every premium dollar in profits, why haven’t you criticized AARP for taking 4.95 cents of every Medigap premium dollar as pure profit?
  13. In April 2010, the Administration and you personally engaged in very public efforts to “encourage” insurance companies to ban rescissions and extend coverage to young adults earlier than was required by PPACA. Why haven’t you taken similar steps to encourage AARP to stop discriminating against sick seniors applying for Medigap coverage?
  14. At the April 2010 Senate Republican briefing, staff asked whether your Department would write a letter to AARP asking them to stop denying Medigap applications for individuals with pre-existing conditions. Jeanne Lambrew of the Office of Health Reform promised to look into the matter, but the letter was never sent. Why has your Department waited more than two and a half years to ask AARP to stop discriminating against sick and disabled individuals applying for Medigap insurance?
  15. Finally, please forward copies of any and all Administration documents – including those originating from outside your Department – from January 20, 2009 through today inclusive regarding: 1) the Medigap exemptions included in PPACA, and the Administration’s viewpoints and/or technical assistance provided regarding same during the drafting process; 2) the Administration’s administrative interpretations of the Medigap exemptions during the rulemaking process; 3) AARP’s positions on Medigap insurance plans, including but not limited to the exemptions included in PPACA; and 4) AARP’s position on PPACA, including but not limited to any policy changes AARP said it required to be included in the legislation for the bill to receive the organization’s endorsement.

I look forward to receiving your response on these issues within two weeks. If you have any questions, feel free to contact Alec Aramanda or Chris Jacobs of my staff. Thank you for your time, and I look forward to your reply.