WASHINGTON ‚ÄĒ Democratic senators, at a caucus meeting with White House officials, expressed concerns on Thursday about how the Obama administration was carrying out the health care law they adopted three years ago.
Doug Mills/The New York Times
Democrats in both houses of Congress said some members of their party were getting nervous that they could pay a political price if the rollout of the law was messy or if premiums went up significantly.
President Obama‚Äôs new chief of staff, Denis R. McDonough, fielded questions on the issue for more than an hour at a lunch with Democratic senators.
Senator Jeanne Shaheen, Democrat of New Hampshire, who is up for re-election next year, said, ‚ÄúWe are hearing from a lot of small businesses in New Hampshire that do not know how to comply with the law.‚ÄĚ
In addition, Mrs. Shaheen said, ‚Äúrestaurants that employ people for about 30 hours a week are trying to figure out whether it would be in their interest to reduce the hours‚ÄĚ of those workers, so the restaurants could avoid the law‚Äôs requirement to offer health coverage to full-time employees.
The White House officials ‚Äúacknowledged that these are real concerns, and that we‚Äôve got to do more to address them,‚ÄĚ Mrs. Shaheen said.
Senator Tom Harkin, Democrat of Iowa and chairman of the appropriations subcommittee on health care, said he was extremely upset with Mr. Obama‚Äôs decision to take money from public health prevention programs and use it to publicize the new law, which creates insurance marketplaces in every state.
‚ÄúI am greatly disappointed ‚ÄĒ beyond upset ‚ÄĒ that the administration chose to help pay for the Affordable Care Act in fiscal year 2013 by raiding the Public Health and Prevention Fund,‚ÄĚ Mr. Harkin said.
The administration said it had transferred $332 million from the prevention fund to pay for ‚Äúeducation and outreach‚ÄĚ activities publicizing the new insurance markets, or exchanges.
To express his displeasure, Mr. Harkin has blocked Senate action on Mr. Obama‚Äôs nominee to be administrator of the Centers for Medicare and Medicaid Services, Marilyn B. Tavenner. By putting a ‚Äúhold‚ÄĚ on the nomination, aides said, Mr. Harkin hopes to draw the White House into negotiations on the future of the prevention fund, which he has championed.
At Congressional hearings this week, Kathleen Sebelius, the secretary of health and human services, said it was necessary to tap the prevention fund because Congress had refused to provide money requested by the president for outreach and education activities.
Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee, said last week that the administration deserved ‚Äúa failing grade‚ÄĚ for its efforts to explain the law to the public.
‚ÄúI just see a huge train wreck coming down,‚ÄĚ Mr. Baucus said then.
But after hearing White House officials on Thursday, Mr. Baucus said he was encouraged, and he praised the administration‚Äôs efforts to get healthy young people to sign up for insurance coverage.
Senator Benjamin L. Cardin, Democrat of Maryland, said he told White House officials on Thursday that he was concerned about big rate increases being sought by the largest health insurer in his state. The company, CareFirst BlueCross BlueShield, has sought increases averaging 25 percent for individual insurance policies that will be sold in the state insurance exchange, and it is seeking increases of about 15 percent for small businesses. The company said the higher premiums reflected costs of complying with the new law.
Senator Cardin said he was also distressed by the administration‚Äôs failure to require health insurers to provide affordable coverage of dental services for children. The law lists pediatric dental care as one of 10 categories of ‚Äúessential health benefits‚ÄĚ to be provided by all health plans.
Under a rule issued by the administration, Mr. Cardin said, ‚Äúthere is no guarantee or requirement that families have pediatric dental coverage, and the coverage could be provided in a stand-alone plan with a separate deductible, so that a family with two children might have to pay as much as $1,400 in out-of-pocket costs for dental coverage.‚ÄĚ
In that case, he said, many families would go without dental coverage.
Congressional leaders wrestled at the same time with a more parochial concern, health insurance for members of Congress and their aides.
A provision of the 2010 law, sought by a Republican senator, says members of Congress and many of their aides must get their health benefits through the new insurance exchanges. Some lawmakers and their aides are worried that the government may not continue to pay its share of the premiums.
Michael Steel, a spokesman for Speaker John A. Boehner, said this was the ‚ÄúDemocrats‚Äô problem to solve.‚ÄĚ
But Adam Jentleson, a spokesman for Senator Harry Reid of Nevada, the Senate Democratic leader, said, ‚ÄúNo legislative fix is necessary.‚ÄĚ