Welcome to Health Reform Watch, Jason Millman's regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Jason with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, or sign up here to receive it straight from your inbox. Read previous columns here.
Shortly after Obamacare's disastrous Oct. 1 roll out, there was one major question that emerged: Who was actually in charge of this thing? The answer wasn't entirely clear.
A number of federal offices were involved in the development of the exchanges, mainly within the Centers for Medicare and Medicaid Services. But pointing to a single person responsible for ensuring a successful rollout was difficult.
With the law's first enrollment period now over and a leadership transition taking place at the Department of Health and Human Services, the liberal Center for American Progress, which has close ties to the White House, is calling on the Obama administration to name a chief executive to oversee the health insurance marketplaces.
Some advocates called for an Obamacare CEO shortly after the failed HealthCare.gov launch in October. The administration instead tapped former Microsoft executive Kurt DelBene to improve HealthCare.gov, and the talk of an Obamacare CEO subsided as the enrollment process quickly improved.
However, there were fresh reminders over the weekend about how much work the federal enrollment Web site still needs. More than 1 million Americans may be getting incorrect subsidy information, and the Obama administration opened the door to new delays for the health-care law's somewhat-neglected small business exchanges.
The timeline before the next enrollment period is tight, with now less than seven months until open enrollment starts again Nov. 15. The CAP report identifies more than a dozen IT challenges still facing the exchanges, and that's just based on what's been reported publicly.
"We don’t really know what steps still remain," said Topher Spiro, CAP vice president of health policy.
Now may be the best possible timing for a shakeup of the management structure. Budget director Sylvia Mathews Burwell, who's been praised as a competent manager, may be confirmed as the next HHS secretary as soon as this week. The federal office overseeing the marketplaces, the Center for Consumer Information and Insurance Oversight, has been without a permanent leader for almost two months, and the White House last week named a new aide to oversee the Affordable Care Act.
So, what would an Obamacare CEO deal with? There's the technical side, where the remaining challenges are numerous. Then there are the policy questions about what rules the health-care industry has to follow as the law's new coverage scheme takes fuller effect. Here's how CAP describes the responsibility of an Obamacare CEO:
The federal marketplace — and implementation generally — involves more than a website or IT project. The marketplaces are a business that market health insurance, which requires management of the following functions: call centers, eligibility determinations, premium payments, setting rules for plans, soliciting and processing plan bids, appeals, marketing, and communications.
Ultimately, though, the real issue is the ongoing need for transparency about how the exchanges are working. Leading up to the HealthCare.gov launch, the Obama administration and the troubled state exchanges never indicated how far behind they were setting up the vital IT infrastructure. Before the Oct. 1 launch, administration and state exchange officials tried to brace the public for "glitches," but they never really conveyed how problematic the rollout would be. They said they didn't even anticipate the depth of the technical problems that emerged Oct. 1.
"Greater transparency might have identified some of these issues early and certainly maybe the president would have been aware of them earlier," Spiro said. CAP recommended setting up advisory boards that would work with the new Obamacare CEO to develop a work plan that would be made public.
Spiro pointed to the transparency efforts that the administration made during October and November, when HealthCare.gov was in its worst shape. CMS officials hosted daily calls with the press about their progress repairing the Web site, but they were also very careful about what information they released. For example, CMS said at the time there was a "punch list" that identified more than 200 fixes to the system.
"They never really disclosed the punch list," Spiro said. "But at least there were regular updates on the metrics and improvements to the metrics. I think we just worry that since that phase is over, it might go back to normal, and it would instead to be great to continue at least that level of transparency."
CAP points to the 15 state-run exchanges, which have clearly visible leaders accountable to oversight boards. CAP also notes that some of the state exchanges are having major problems, so just having a clearly defined governance structure isn't enough.
There's a good argument to be made for having a single person responsible for making the insurance marketplaces work correctly. That leader can only be effective, though, if the administration is more transparent about the remaining challenges.
Top health policy reads from around the Web:
Lying about Obamacare comes with a price. "The Obama administration Friday spelled out civil fines of up to $250,000 for knowingly and willfully providing false information to get taxpayer-subsidized coverage under the new health care law. New regulations say the fines also apply for lying to escape the law’s requirement that most Americans carry health insurance." The Associated Press.
Pfizer's bid rejected again. "AstraZeneca rejected another takeover offer from Pfizer Inc. as too low, leaving the companies in a stalemate over a deal that would create the world’s biggest drugmaker. AstraZeneca shares plunged the most in more than 16 years in London trading, while Pfizer gained in New York. Now, any progress on an agreement is up to AstraZeneca, Pfizer said today. Yesterday, Pfizer offered to pay 69.4 billion pounds ($117 billion) to buy the London-based drugmaker." Drew Armstrong and Oliver Staley in Bloomberg.
Obamacare repeal still possible? "According to those in the elite salons of Washington, ObamaCare cannot be repealed. ... The country that won two world wars and put a man on the moon cannot, it is believed, repeal a disastrous public policy. Says who? Why not?" Louisiana Gov. Bobby Jindal for Fox News.