HHS would become federal giant under Senate plan

By: Susan Ferrechio
Chief Congressional Correspondent
November 26, 2009

A quick search of the Senate health bill will bring up "secretary" 2,500 times.

That's because Health and Human Services Secretary Kathleen Sebelius would be awarded unprecedented new powers under the proposal, including the authority to decide what medical care should be covered by insurers as well as the terms and conditions of coverage and who should receive it.

"The legislation lists 1,697 times where the secretary of health and humans services is given the authority to create, determine or define things in the bill," said Devon Herrick, a health care expert at the National Center for Policy Analysis.

For instance, on Page 122 of the 2,079-page bill, the secretary is given the power to establish "the basic per enrollee, per month cost, determined on average actuarial basis, for including coverage under a qualified health care plan."

The HHS secretary would also have the power to decide where abortion is allowed under a government-run plan, which has drawn opposition from Republicans and some moderate Democrats.

And the bill even empowers the department to establish a Center for Medicare and Medicaid Innovation that would have the authority to make cost-saving cuts without having to get the approval of Congress first.

"It's a huge amount of power being shifted to HHS, and much of it is highly discretionary," said Edmund Haislmaier, an expert in health care policy and insurance markets at the Heritage Foundation, a conservative think tank.

Haislmaier said one the greatest powers HHS would gain from the bill is the authority to regulate insurance. States currently hold this power, and under the Senate bill, the federal government would usurp it from them. This could lead to the federal government putting restrictions and changes in place that destabilize the private insurance market by forcing companies to lower premiums and other charges, he said.

"Health and Human Services ... doesn't have any experience with this," Haislmaier said. "I'm looking at the potential for this whole thing to just blow up on people because they have no idea what they are doing. Who in the federal government regulates insurance today? Nobody."

The health care reform legislation would rely on the U.S. Preventive Services Task Force for recommendations as to what kind of screening and preventive care should be covered. Last week, the group, which operates under HHS, drew sharp criticism for advising that mammograms should begin at age 50, a decade later than the current standard.

Critics of the bill said this was an example of how the new bill could empower HHS to alter health care delivery, but Democrats argue they would rather have the government making these decisions.

"There's an insurance company bureaucrat in between the patient and her doctor right now," Rep. Debbie Wasserman Schultz, D-Fla., said on ABC's "This Week."

sferrechio@washingtonexaminer.com