By David Morgan
WASHINGTON (Reuters) - A Democratic senator who helped craft President Barack Obama's signature healthcare law gave the administration "a failing grade" on Wednesday for its efforts to educate the public and small employers about sweeping changes due to take effect in eight months.
"I just see a huge train wreck," Senator Max Baucus of Montana told Health and Human Services Secretary Kathleen Sebelius at a hearing of the Senate Finance Committee, an oversight panel that he chairs.
"I'm very concerned that not enough is being done so far. Very concerned," said Baucus, citing examples of perplexed small business owners and polling data showing that most Americans either do not know much about the coming changes or have false information about what to expect.
"The administration's public information campaign on the benefits of the Affordable Care Act, I think, deserve a failing grade. You need to fix it," he said.
Baucus' comments came a week after the release of Obama's $3.77 trillion budget for fiscal 2014, which included a request for extra funding to implement the Patient Protection and Affordable Care Act, often nicknamed Obamacare, one of the biggest pieces of U.S. social legislation since the 1960s.
Sebelius told the committee that the administration takes outreach and education "very, very seriously." She said efforts are under way to address the concerns of small business owners and to organize a public outreach campaign for the summer.
"We also understand that people have a lot of questions and are deploying as many resources as we can to answer those questions and get folks ready," she said.
A main concern is the creation of state online marketplaces where consumers will be able to buy private health insurance at subsidized rates intended to make the coverage affordable for those with family incomes of up to $90,000 a year.
Those exchanges, are due to start enrolling beneficiaries on October 1 and are open to individuals and businesses with fewer than 100 employees. Full operations are scheduled for January 1.
The federal government is required by law to operate exchanges in 33 of 50 states - those that have not set up their own marketplaces.
The exchanges are expected to provide health coverage for an estimated 26 million Americans by the end of the decade, with 7 million expected to sign up for 2014, according to the nonpartisan Congressional Budget Office. Another 12 million people are expected to gain coverage through a huge expansion of the Medicaid program for the poor.
But Republican opposition this year scuttled a nearly $1 billion funding request to help pay for an outreach campaign that had been due to start over the summer.
"We were incredibly disappointed that our request for additional outreach and education resources were not made available," Sebelius said.
A fresh $1.5 billion request contained in Obama's latest budget is also not expected to succeed.
Analysts warn that a weak outreach campaign could compromise the success of the exchanges, particularly in Republican-led states where political opposition is greatest. That could leading to higher healthcare costs for consumers and threaten the 2014 congressional midterm re-election prospects of Democrats who voted for the law, which remains unpopular with large numbers of voters.
The Department of Health and Human Services has responded by shifting funds from other areas. But Republicans, who have voted dozens of times to repeal or defund the law, are pressuring the administration over its so-called reprogramming of resources.
Senator Orrin Hatch of Utah, the finance committee's top Republican, suggested that as much as $500 million may have been moved to pay for exchange implementation and called on Sebelius to outline her legal authority to shift funds within the $970 billion HHS budget.
"(We) were not given additional resources by the United States Congress, although we have the duty to implement the law," Sebelius said.
The administration has shifted at least $450 million to health exchange implementation from a $5 billion prevention fund created to support public health and other initiatives.
A Republican-led panel in the House of Representatives on Wednesday approved legislation that would use the fund's remaining resources to provide private health insurance to people with preexisting medical conditions under a program due to expire at year-end.
Meanwhile, Baucus recommended that the public outreach campaign have the ability to measure its own success at improving public understanding of the law.
"You need data," he told Sebelius. "You've never given me any data. You just give me concepts, frankly."
(Editing by Ros Krasny, Mohammad Zargham and Cynthia Osterman)