Department of Health and Human Services: Solicitations of Support for Enroll America

What GAO Found

GAO’s review of written responses and documentation from the Department of Health and Human Services (HHS) found that, since enactment of the Patient Protection and Affordable Care Act (PPACA), the Secretary of HHS (the Secretary) contacted the Chief Executive Officers of five organizations to solicit support for one outside entity, Enroll America, involved in activities related to PPACA. Specifically, the Secretary requested financial support for Enroll America from the Robert Wood Johnson Foundation (RWJF) and H&R Block; and nonfinancial support, such as technical assistance, from Ascension Health, Johnson & Johnson, and Kaiser (which consists of the Kaiser Foundation Health Plans and Kaiser Foundation Hospitals). GAO’s review of the documentation also found that the Secretary received oral guidance from HHS’s Office of General Counsel in early February 2013 and written guidance on soliciting support for outside entities later in the month, after the contact with RWJF but prior to the four remaining contacts. Among other things, this guidance stated that HHS officials may encourage members of the public to support certain organizations assisting Americans to enroll in coverage under PPACA, pursuant to authority provided under sections 1703 and 1704 of the Public Health Service Act. GAO provided a draft of this report to HHS and the White House for review. HHS provided technical comments, which were incorporated as appropriate. The White House informed GAO it had no comments on the draft report.

PPACA includes provisions intended to increase the number of Americans who have health care insurance, including requiring the establishment of health insurance exchanges in all states. HHS plays a key role in implementing PPACA. Many nongovernmental entities are also involved in activities related to PPACA, including educating consumers about the health coverage options newly available under PPACA and assisting with enrollment. In June 2013, the Secretary of HHS testified that she solicited support on behalf of Enroll America, a nonprofit organization whose mission is to maximize the number of uninsured Americans who enroll in health coverage made available by PPACA. However, certain facts about HHS’s activities to solicit support for outside entities engaged in PPACA-related activities were unclear. GAO was asked to develop information on HHS’s activities to solicit support for such outside entities. This report provides information on the facts surrounding any solicitations of support made by HHS officials for outside entities engaged in activities related to PPACAand the actions taken by HHS officials to inform their decisions to make such solicitations.

GAO reviewed written responses from HHS to questions GAO asked about its solicitations of support since the enactment of PPACA in March 2010 and the actions taken to inform the decision to make such solicitations. GAO also reviewed HHS documentation related to those activities. To supplement these reviews, GAO interviewed or reviewed written statements from HHS officials, representatives from Enroll America, and representatives from the five organizations from which HHS reported soliciting support for Enroll America.